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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=William J Gibson
|QuestionAuthor=William J Gibson (Reviewed by {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Physiology
|MainCategory=Physiology
Line 21: Line 21:
|MainCategory=Physiology
|MainCategory=Physiology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|Prompt=A 19-year-old male presents to the urgent care clinic with the sudden onset of dyspnea and pleuritic chest pain.  The patient cannot recall any recent trauma or illness.  An upright chest X-ray of the patient is shown below.
|Prompt=A 19-year-old man presents to the urgent care clinic with sudden onset of dyspnea and pleuritic chest pain.  The patient cannot recall any recent trauma or illness.  An upright chest X-ray of the patient is shown below.


[[File:WBR0948.jpg | 400px]]
[[File:WBR0948.jpg | 400px]]


Which of the following processes most likely explains this patient’s condition?
Which of the following processes most likely explains this patient’s condition?
|Explanation=The patient in this vignette has suffered a spontanoues pneumothorax.  Spontaneous pneumothorax tends to occur in tall, thin young males (M:F ratio is 8:1).  It is thought to arise due to the rupture of apical “blebs “(small air-filled lesions just under the pleural surface), which are presumed to be more common in those classically at risk of pneumothorax (tall males) due to mechanical factors. In spontaneous pneumothorax, blebs can be found in 77% of cases, compared to 6% in the general population without a history of spontaneous pneuomothorax.
|Explanation=The patient in this vignette has suffered a spontanoues pneumothorax.  Spontaneous pneumothorax tends to occur among tall, thin young males (M:F ratio is 8:1).  It is thought to arise from the rupture of apical "blebs" (small air-filled lesions under the pleural surface), which are presumed to be more common in those classically at risk of pneumothorax (tall males) due to mechanical factors. In spontaneous pneumothorax, blebs can be found in approximately 77% of cases, compared with only 6% in the general population without a history of spontaneous pneuomothorax.
 
|AnswerA=Coxsackie B infection
|AnswerA=Coxsackie B infection
|AnswerAExp=While Coxsackie B virus infection is the most common cause of pleurisy and pericarditis, the chest x-ray in this patient clearly shows a large left sided pneumothorax.
|AnswerAExp=While Coxsackie B virus infection is the most common cause of pleurisy and pericarditis, the chest x-ray in this patient clearly demonstrates a large left-sided pneumothorax.
|AnswerB=Rupture of apical blebs
|AnswerB=Rupture of apical blebs
|AnswerBExp=The patient in this vignette most likely has a spontaneous pneumothorax.
|AnswerBExp=The patient in this vignette most likely has a spontaneous pneumothorax, which are thought to arise from the rupture of apical blebs (small air-filled lesions under the pleural surface).
|AnswerC=Fat embolism
|AnswerC=Fat embolism
|AnswerCExp=While fat embolism can cause dyspnea, it is rare and usually associated with sever physical trauma such as the fracture of long bones.
|AnswerCExp=While fat embolism can cause dyspnea, it is rare and usually associated with sever physical trauma such as the fracture of long bones.
|AnswerD=Deep vein thrombosis
|AnswerD=Deep vein thrombosis
|AnswerDExp=The chest x-ray in this patient clearly shows a large left sided pneumothorax.  The vignette gives us no other alarming tip-offs for deep vein thrombosis such as prolonged immobility, smoking, or oral contraceptives.
|AnswerDExp=The chest x-ray in this patient clearly demonstrates a large left sided pneumothorax.  The patient is young and does not seem to have acquired or hereditary risk factors of deep vein thrombosis.
|AnswerE=Fibrillin defect
|AnswerE=Fibrillin defect
|AnswerEExp=While Marfan syndrome can cause pneumothorax, it is far more likely that this patient does not have Marfan syndrome and simply has suffered a spontaneous pneumothorax.
|AnswerEExp=While Marfan syndrome can cause pneumothorax, it is far more likely that this patient does not have Marfan syndrome and simply has suffered a spontaneous pneumothorax.
|EducationalObjectives=Spontaneous pneumothorax is due to the rupture of apical “blebs”.
|EducationalObjectives=Spontaneous pneumothorax typically occurs among tall, thin young males. It is thought to arise from the rupture of apical "blebs" (small air-filled lesions under the pleural surface).
|References=Light, Richard W. "Management of spontaneous pneumothorax." American Review of Respiratory Disease 148 (1993): 245-245.<br>
|References=Light, Richard W. "Management of spontaneous pneumothorax." Am Rev Resp Dis. 1993;148: 245-245.<br>
First Aid 2015 page 615
First Aid 2015 page 615
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=Pneumothorax, Lung, Pleura, Dyspnea, Chest, Chest pain
|WBRKeyword=Pneumothorax, Lung, Pleura, Dyspnea, Chest pain
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 22:50, 15 August 2015
Author [[PageAuthor::William J Gibson (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Physiology
Sub Category SubCategory::Pulmonology
Prompt [[Prompt::A 19-year-old man presents to the urgent care clinic with sudden onset of dyspnea and pleuritic chest pain. The patient cannot recall any recent trauma or illness. An upright chest X-ray of the patient is shown below.

Which of the following processes most likely explains this patient’s condition?]]

Answer A AnswerA::Coxsackie B infection
Answer A Explanation AnswerAExp::While Coxsackie B virus infection is the most common cause of pleurisy and pericarditis, the chest x-ray in this patient clearly demonstrates a large left-sided pneumothorax.
Answer B AnswerB::Rupture of apical blebs
Answer B Explanation AnswerBExp::The patient in this vignette most likely has a spontaneous pneumothorax, which are thought to arise from the rupture of apical blebs (small air-filled lesions under the pleural surface).
Answer C AnswerC::Fat embolism
Answer C Explanation AnswerCExp::While fat embolism can cause dyspnea, it is rare and usually associated with sever physical trauma such as the fracture of long bones.
Answer D AnswerD::Deep vein thrombosis
Answer D Explanation AnswerDExp::The chest x-ray in this patient clearly demonstrates a large left sided pneumothorax. The patient is young and does not seem to have acquired or hereditary risk factors of deep vein thrombosis.
Answer E AnswerE::Fibrillin defect
Answer E Explanation AnswerEExp::While Marfan syndrome can cause pneumothorax, it is far more likely that this patient does not have Marfan syndrome and simply has suffered a spontaneous pneumothorax.
Right Answer RightAnswer::B
Explanation [[Explanation::The patient in this vignette has suffered a spontanoues pneumothorax. Spontaneous pneumothorax tends to occur among tall, thin young males (M:F ratio is 8:1). It is thought to arise from the rupture of apical "blebs" (small air-filled lesions under the pleural surface), which are presumed to be more common in those classically at risk of pneumothorax (tall males) due to mechanical factors. In spontaneous pneumothorax, blebs can be found in approximately 77% of cases, compared with only 6% in the general population without a history of spontaneous pneuomothorax.

Educational Objective: Spontaneous pneumothorax typically occurs among tall, thin young males. It is thought to arise from the rupture of apical "blebs" (small air-filled lesions under the pleural surface).
References: Light, Richard W. "Management of spontaneous pneumothorax." Am Rev Resp Dis. 1993;148: 245-245.
First Aid 2015 page 615]]

Approved Approved::Yes
Keyword WBRKeyword::Pneumothorax, WBRKeyword::Lung, WBRKeyword::Pleura, WBRKeyword::Dyspnea, WBRKeyword::Chest pain
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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