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Old 07-28-2011
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Question Cause of Dyspnea and chest pain in a young man

A 20-year-old man falls to the ground while jogging along a city street early one morning. He suffers a minor abrasion to his left hand. However, within minutes he is very dyspneic and has right-sided chest pain. He walks into a nearby store, and the manager calls for an ambulance. On arrival at the hospital, he has tachypnea and tachycardia. On physical examination breath sounds are absent over the right lung fields. A chest radiograph shows that the mediastinum is shifted to the left, and there are no fractures. A thoracentesis on the right yields a rush of air. Which of the following conditions is most likely to have given rise to these events?

A Bronchopleural fistula

B Paraseptal emphysema

C Foreign body aspiration

D Intrinsic asthma

E Pulmonary atherosclerosis
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Old 07-28-2011
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[QUOTE=usmle2011;56723]A 20-year-old man falls to the ground while jogging along a city street early one morning. He suffers a minor abrasion to his left hand. However, within minutes he is very dyspneic and has right-sided chest pain. He walks into a nearby store, and the manager calls for an ambulance. On arrival at the hospital, he has tachypnea and tachycardia. On physical examination breath sounds are absent over the right lung fields. A chest radiograph shows that the mediastinum is shifted to the left, and there are no fractures. A thoracentesis on the right yields a rush of air. Which of the following conditions is most likely to have given rise to these events?

A Bronchopleural fistula

B Paraseptal emphysema

C Foreign body aspiration

D Intrinsic asthma

E Pulmonary atherosclerosis[/QU

answer is PARASEPTAL EMPHYSEMA....given vignette is classic case of spontaneous pneumothorax...most common cause of spontaneus pneumothorax is rupture of subpleural bleb...
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Old 07-28-2011
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Quote:
Originally Posted by usmle2011 View Post
A 20-year-old man falls to the ground while jogging along a city street early one morning. He suffers a minor abrasion to his left hand. However, within minutes he is very dyspneic and has right-sided chest pain. He walks into a nearby store, and the manager calls for an ambulance. On arrival at the hospital, he has tachypnea and tachycardia. On physical examination breath sounds are absent over the right lung fields. A chest radiograph shows that the mediastinum is shifted to the left, and there are no fractures. A thoracentesis on the right yields a rush of air. Which of the following conditions is most likely to have given rise to these events?

A Bronchopleural fistula

B Paraseptal emphysema

C Foreign body aspiration

D Intrinsic asthma

E Pulmonary atherosclerosis
bbbbbbbbbbbbbbbbbb
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Old 07-28-2011
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I'll go with b also.
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Old 07-28-2011
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B) Paraseptal emphysema
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i agree with b
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Old 07-29-2011
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Default Explanation

(A) Incorrect. A bronchopleural fistula typically occurs in the setting of a severe lung infection, not in a healthy person.

(B) CORRECT. Paraseptal emphysema is not common, but does account for a significant number of cases of spontaneous pneumothorax in young persons. It is not related to smoking. There are subpleural bullae that can burst, even with minimal trauma.

(C) Incorrect. Aspiration of a foreign body can lead to localized air trapping, but a pneumothorax is not common.

(D) Incorrect. Intrinsic asthma, usually seen in middle aged adults, can be set off by a variety of stimuli, including infections and exposure to cold. Pneumothorax does not typically result.

(E) Incorrect. Both chronic restrictive and obstructive lung diseases can reduce the pulmonary vascular bed to increase pulmonary arterial pressures that promote pulmonary atherosclerosis. The vessels do not rupture.
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