Question 1

When a patient has a flail chest, what happens during the ventilatory cycle?&#10;A) The I:E ratio becomes inverse.&#10;B) Air leaks out through the flail area.&#10;C) Air leaks in through the flail area.&#10;D) Air is shunted from one lung to the other.

Accepted Answer

Because of the instability of the flail area, the ribs and lung tissue will move in the opposite direction than normal during a breath. This can cause air to be shunted from one lung to the other during the ventilatory cycle.

Question 2

What is the most common finding at the site of the flail portion of a flail chest?&#10;A) Pulmonary contusion&#10;B) Pulmonary abscess&#10;C) Pulmonary edema&#10;D) Pulmonary fibrosis

Accepted Answer

The force of the injury that fractures multiple ribs most likely will injure the underlying lung resulting in a pulmonary contusion.

Question 3

All of the following are causes of a flail chest EXCEPT:&#10;A) blast injury.&#10;B) motor vehicle accident.&#10;C) split sternum for open heart surgery.&#10;D) fall from heights.

Accepted Answer

A flail chest can be caused by blunt injury, trauma incurred in an MVA, and falls from heights.

Question 4

Which of the following are pathologic changes associated with a flail chest?
1) Pneumothorax
2) Secondary pneumonia
3) Pleural effusion
4) Elevated diaphragms

A) 1, 2
B) 3, 4
C) 1, 3, 4
D) 1, 2, 3, 4

Accepted Answer

Among the conditions that may result with a flail chest are the development of a pneumothorax and the development of a secondary pneumonia.

Question 5

Which of the following would be recommended for the management of an adult with a severe flail chest?
1) Continuous positive airway pressure (CPAP)
2) Pain management
3) Mechanical ventilation
4) Positive end-expiratory pressure (PEEP)

A) 1, 2
B) 2, 3
C) 2, 3, 4
D) 1, 2, 3, 4

Accepted Answer

Appropriate pain management is needed with a flail chest injury. Mechanical ventilation with PEEP will stabilize the chest and provide ventilatory support.

Question 6

Which of the following accurately describes a flail chest?&#10;A) Double fractures of 2 adjacent ribs&#10;B) Double fractures of 3 adjacent ribs&#10;C) Single fracture of 3 adjacent ribs&#10;D) Triple fractures of 2 adjacent ribs

Accepted Answer

A flail chest is defined as double fractures of three or more adjacent ribs.

Question 7

While assessing a patient who was involved in a serious car crash and hit his steering wheel, the respiratory therapist observes that a section of his left anterior chest wall sinks inward during inspiration. What is the most likely cause?

A) Pulmonary fibrosis
B) Flail chest
C) Pneumothorax
D) Cardiac tamponade

Accepted Answer

A flail segment of a flail chest would move inward during inspiration, opposite of normal chest wall movement.

Question 8

What is the term for abnormal gas movement from one lung to the other?&#10;A) Paradoxical movement&#10;B) Pendelluft&#10;C) Palindromic breathing&#10;D) Pneumatic shift

Accepted Answer

The abnormal movement of gas from one lung to the other is termed pendelluft and may occur with a flail chest.

Question 9

A patient with a flail chest is experiencing pendelluft. Which of the following would be expected in a patient with a flail chest with pendelluft?
1) Hypoventilation
2) Hypertension
3) Cyclical deeper and then more shallow breathing
4) Rebreathing dead-space gas

A) 1, 4
B) 1, 3
C) 2, 3, 4
D) 1, 2, 3, 4

Accepted Answer

Pendelluft is the movement of air from one lung to the other and results in hypoventilation and the rebreathing of dead-space gas.

Question 10

Which of the following statements is TRUE regarding paradoxical chest movement?&#10;A) With inspiration, the flail section moves outward.&#10;B) The trachea deviates away from the flail side of the chest.&#10;C) During inspiration, the flail section moves inward.&#10;D) During exhalation, the flail area moves inward.

Accepted Answer

Paradoxical chest movement means that the flail area moves in the opposite direction from which it normally would. So, with inspiration, the flail area moves inward, and with exhalation, the flail area moves outward. The tracheal position is not affected by broken ribs.

Question 11

How many days of ventilatory support are anticipated for a patient with a flail chest to allow sufficient time for bone healing?&#10;A) 3 to 5 days&#10;B) 5 to 10 days&#10;C) 12 to 15 days&#10;D) 18 to 21 days

Accepted Answer

The answer of How many days of ventilatory support are...

Question 12

Which of the following initial blood gas results would a respiratory therapist expect to find in a patient with a mild flail chest? A) Elevated pH and elevated SaO₂ B) Decreased pH and decreased SaO₂ C) Increased pH and decreased SaO₂ D) Decreased pH and increased SaO₂

Accepted Answer

The answer of Which of the following initial blood gas...

Question 13

Which of the following chest radiograph findings would be expected for a patient with a flail chest?
1) Increased opacity
2) Rib fractures
3) Decreased opacity
4) Tracheal deviation

A) 1, 2
B) 1, 4
C) 2, 3
D) 2, 4

Accepted Answer

The answer of Which of the following chest radiograph findings...

Question 14

What is the primary cause of hypoxemia in a patient with a severe flail chest?&#10;A) Myocardial contusion&#10;B) Hemorrhage&#10;C) Pulmonary edema&#10;D) Alveolar atelectasis

Accepted Answer

The answer of What is the primary cause of hypoxemia...

Question 15

Which breath sounds would be expected to be heard when auscultating the chest of a patient with a flail chest?&#10;A) Diminished over the flail chest section only&#10;B) Diminished over both lungs&#10;C) Crackles over the flail chest section&#10;D) Bilateral wheezing

Accepted Answer

The answer of Which breath sounds would be expected to...

Question 16

Which of the following can stimulate an increased respiratory rate when a flail chest is present?
1) Activation of deflation receptors
2) Activation of irritant receptors
3) Stimulation of J receptors
4) Pain and anxiety

A) 1, 3
B) 1, 4
C) 1, 2, 3
D) 1, 2, 3, 4

Accepted Answer

The answer of Which of the following can stimulate an...

Deck 22: Flail Chest