Deck 21: Flail Chest

Question 1

MATCHING
The clinical scenarios associated with respiratory diseases result from the pathophysiologic mechanisms caused (or activated) by the anatomic alterations of the lungs associated with the disorder. Using the "Yes" or "No" items, match the major anatomic alterations of the lungs that cause the clinical scenario associated with Flail Chest.
Bronchospasm Clinical Scenario

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Answer 1

NO-This is not associated with flail chest.

Question 2

Identify the major anatomic alterations of the lungs associated with flail chest.
Lung contusion

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Answer 2

YES-This is associated with flail chest.

Question 3

Identify the major anatomic alterations of the lungs associated with flail chest.
Alveolar hyperinflation (air-trapping)

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Answer 3

NO-This is not associated with flail chest.

Question 4

Identify the major anatomic alterations of the lungs associated with flail chest.
Lung collapse

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 5

Identify the major anatomic alterations of the lungs associated with flail chest.
Alveolar inflammation

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 6

Identify the major anatomic alterations of the lungs associated with flail chest.
Distal airway and alveolar weakening

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 7

MATCHING
The clinical scenarios associated with respiratory diseases result from the pathophysiologic mechanisms caused (or activated) by the anatomic alterations of the lungs associated with the disorder. Using the "Yes" or "No" items, match the major anatomic alterations of the lungs that cause the clinical scenario associated with Flail Chest.
Excessive Bronchial Secretions Clinical Scenario

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 8

Identify the major anatomic alterations of the lungs associated with flail chest.
Secondary pneumonia

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 9

Identify the major anatomic alterations of the lungs associated with flail chest.
Interstitial edema

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 10

Identify the major anatomic alterations of the lungs associated with flail chest.
Compression of great vessels and decreased cardiac return

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 11

Identify the major anatomic alterations of the lungs associated with flail chest.
Alveolar-capillary destruction

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 12

Identify the major anatomic alterations of the lungs associated with flail chest.
Fibrosis and calcification of lung parenchyma

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 13

Identify the major anatomic alterations of the lungs associated with flail chest.
Bronchospasm (smooth muscle constriction of bronchial airways)

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 14

Identify the major anatomic alterations of the lungs associated with flail chest.
Pulmonary capillary congestion

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 15

Identify the major anatomic alterations of the lungs associated with flail chest.
Atelectasis

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 16

MATCHING
The clinical scenarios associated with respiratory diseases result from the pathophysiologic mechanisms caused (or activated) by the anatomic alterations of the lungs associated with the disorder. Using the "Yes" or "No" items, match the major anatomic alterations of the lungs that cause the clinical scenario associated with Flail Chest.
Atelectasis Clinical Scenario

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 17

MATCHING
The clinical scenarios associated with respiratory diseases result from the pathophysiologic mechanisms caused (or activated) by the anatomic alterations of the lungs associated with the disorder. Using the "Yes" or "No" items, match the major anatomic alterations of the lungs that cause the clinical scenario associated with Flail Chest.
Alveolar Consolidation Clinical Scenario

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 18

Identify the major anatomic alterations of the lungs associated with flail chest.
Distortion and dilation of the bronchi

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 19

MATCHING
The clinical scenarios associated with respiratory diseases result from the pathophysiologic mechanisms caused (or activated) by the anatomic alterations of the lungs associated with the disorder. Using the "Yes" or "No" items, match the major anatomic alterations of the lungs that cause the clinical scenario associated with Flail Chest.
Distal Airway and Alveolar Weakening Clinical Scenario

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 20

MATCHING
The clinical scenarios associated with respiratory diseases result from the pathophysiologic mechanisms caused (or activated) by the anatomic alterations of the lungs associated with the disorder. Using the "Yes" or "No" items, match the major anatomic alterations of the lungs that cause the clinical scenario associated with Flail Chest.
Increased Alveolar-Capillary Membrane Thickness Clinical Scenario

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 21

Match the arterial blood gas changes that occur in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
HCO₃^-

A)Increases
B)Decreases
C)Normal

Question 22

Identify the major anatomic alterations of the lungs associated with flail chest.
Lung restriction

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 23

Identify the major anatomic alterations of the lungs associated with flail chest.
Double fracture of numerous adjacent ribs

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 24

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
TLC

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 25

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
FRC

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 26

Match the arterial blood gas changes that occur in a mild to moderate flail chest to the items listed below. Items may be used once, more than once, or not at all.
pH

A)Increases
B)Decreases
C)Normal

Question 27

Match the arterial blood gas changes that occur in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
PaCO₂

A)Increases
B)Decreases
C)Normal

Question 28

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
VC

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 29

Identify the major anatomic alterations of the lungs associated with flail chest.
Excessive bronchial secretions (severe)

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 30

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
RV/TLC %

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 31

Match the arterial blood gas changes that occur in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
pH

A)Increases
B)Decreases
C)Normal

Question 32

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
V_T

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 33

Match the arterial blood gas changes that occur in a mild to moderate flail chest to the items listed below. Items may be used once, more than once, or not at all.
PaCO₂

A)Increases
B)Decreases
C)Normal

Question 34

Identify the major anatomic alterations of the lungs associated with flail chest.
Rib instability

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 35

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
FRC

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 36

Match the arterial blood gas changes that occur in a mild to moderate flail chest to the items listed below. Items may be used once, more than once, or not at all.
HCO₃^-

A)Increases
B)Decreases
C)Normal

Question 37

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
IC

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 38

Identify the major anatomic alterations of the lungs associated with flail chest.
Frothy white (or pink) bronchial secretions

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 39

Next to the pulmonary function studies listed below, match the findings that typically develop in the patient with a flail chest. Items may be used once, more than once, or not at all.
RV%

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 40

Identify the major anatomic alterations of the lungs associated with flail chest.
Permanent enlargement and deteriorations of alveoli

A)YES-This is associated with flail chest.
B)NO-This is not associated with flail chest.

Question 41

Match what develops in the oxygen indices of a patient with flail chest to the items listed below. Items may be used once, more than once, or not at all.
O₂

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 42

A flail chest is the result of double fractures of at least two adjacent ribs, which causes the thoracic cage to become unstable.

Question 43

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
SV

A)Normal
B)Decreases
C)Increases

Question 44

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
RVSWI

A)Normal
B)Decreases
C)Increases

Question 45

Match what develops in the oxygen indices of a patient with flail chest to the items listed below. Items may be used once, more than once, or not at all.
SvO₂

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 46

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
PCWP

A)Normal
B)Decreases
C)Increases

Question 47

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
LVSWI

A)Normal
B)Decreases
C)Increases

Question 48

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
SVI

A)Normal
B)Decreases
C)Increases

Question 49

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
RAP

A)Normal
B)Decreases
C)Increases

Question 50

Match what develops in the oxygen indices of a patient with flail chest to the items listed below. Items may be used once, more than once, or not at all.
_S/ _T

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 51

Match what develops in the oxygen indices of a patient with flail chest to the items listed below. Items may be used once, more than once, or not at all.
DO₂

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 52

When a paradoxical movement is seen in a patient with a flail chest, the fractured ribs are pushed outward during inspiration.

Question 53

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
CO

A)Normal
B)Decreases
C)Increases

Question 54

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
PVR

A)Normal
B)Decreases
C)Increases

Question 55

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
SVR

A)Normal
B)Decreases
C)Increases

Question 56

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
CVP

A)Normal
B)Decreases
C)Increases

Question 57

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
CI

A)Normal
B)Decreases
C)Increases

Question 58

Match what develops in the oxygen indices of a patient with flail chest to the items listed below. Items may be used once, more than once, or not at all.
C(a-v)

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 59

Match what develops in the oxygen indices of a patient with flail chest to the items listed below. Items may be used once, more than once, or not at all.
O₂ER

A)Normal
B)Decreases
C)Increases
D)Normal or decreased
E)Normal or increased

Question 60

Match what hemodynamic indices develop in a severe flail chest to the items listed below. Items may be used once, more than once, or not at all.
PA

A)Normal
B)Decreases
C)Increases

Question 61

The DO₂ increases in response to a severe flail chest.

Question 62

As a result of a severe flail chest, the patient's CO decreases.

Question 63

"Paradoxical movement of the chest wall" means that the ribs move outward during inspiration and inward during expiration.

Question 64

As a result of a severe flail chest, the patient's RVSWI increases.

Question 65

Which of the following pathophysiologic mechanisms may be activated as a result of a flail chest and increase the patient's respiratory rate?

A) IV only
B) III only
C) I and II only
D) II and IV only
E) I, II, III, and IV

Question 66

The shunting of air from one lung to another as the result of a flail chest is known as paradoxical movement of the chest.

Question 67

As a result of a severe flail chest, the patient's PA decreases.

Question 68

When the lung on the affected side is compressed as a result of a flail chest, gas moves into the unaffected lung during inspiration.

Question 69

It is generally preferred to place a patient with a severe flail chest on an assist/controlled volume cycled ventilator.