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Question 1

What is the most common cause of a primary spontaneous pneumothorax (PSP)?
A. Chronic obstructive pulmonary disease (COPD)
B. Rupture of subpleural blebs or bullae
C. Necrotizing pneumonia
D. Connective tissue disease

Correct Answer: B. Rupture of subpleural blebs or bullae
Explanation: Primary spontaneous pneumothorax (PSP) typically occurs in individuals without underlying lung disease and is caused by the rupture of subpleural blebs or bullae, usually in the apices.
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Question 2

Which underlying condition is most commonly associated with secondary spontaneous pneumothorax (SSP)?
A. Pulmonary Langerhans cell histiocytosis (PLCH)
B. Cystic fibrosis
C. Chronic obstructive pulmonary disease (COPD)
D. Pneumocystis jirovecii pneumonia (PJP)

Correct Answer: C. Chronic obstructive pulmonary disease (COPD)
Explanation: COPD, particularly bullous emphysema, is the most common cause of secondary spontaneous pneumothorax due to the rupture of abnormal airspaces.
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Question 3

What is the hallmark radiographic finding of a pneumothorax on a chest X-ray?
A. Increased vascular markings in the periphery
B. Thin visceral pleural line with no lung markings beyond it
C. Mediastinal shift toward the affected side
D. Bilateral pleural effusions

Correct Answer: B. Thin visceral pleural line with no lung markings beyond it
Explanation: A pneumothorax is identified by the presence of a thin visceral pleural line with the absence of lung markings peripheral to this line, representing air in the pleural space.
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Question 4

Which imaging modality is most sensitive for detecting a small pneumothorax?
A. Chest X-ray (CXR)
B. High-resolution computed tomography (HRCT)
C. Magnetic resonance imaging (MRI)
D. Ultrasound

Correct Answer: B. High-resolution computed tomography (HRCT)
Explanation: HRCT is the gold standard for detecting small pneumothoraces and for identifying underlying lung abnormalities, such as bullae or blebs.
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Question 5

Which factor is considered a predisposition for primary spontaneous pneumothorax?
A. Older age
B. Obesity
C. Narrow anteroposterior (AP) chest diameter
D. High levels of physical activity

Correct Answer: C. Narrow anteroposterior (AP) chest diameter
Explanation: Young, thin men with narrow AP chest dimensions are predisposed to PSP due to increased transpulmonary pressure and mechanical forces in the lung apices.
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Question 6

What is the most common complication of a tension pneumothorax?
A. Pulmonary embolism
B. Hemothorax
C. Mediastinal shift causing cardiovascular compromise
D. Pleural effusion

Correct Answer: C. Mediastinal shift causing cardiovascular compromise
Explanation: Tension pneumothorax occurs when air accumulates in the pleural space without exit, leading to mediastinal shift, compression of great vessels, and potentially fatal hemodynamic compromise.
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Question 7

What is the initial management for a small, asymptomatic primary spontaneous pneumothorax?
A. Immediate chest tube placement
B. Needle decompression
C. Observation and supplemental oxygen
D. Pleurodesis

Correct Answer: C. Observation and supplemental oxygen
Explanation: Small, asymptomatic PSPs are often managed conservatively with observation and supplemental oxygen to accelerate reabsorption of air.
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Question 8

What is a key indication for surgical intervention in recurrent spontaneous pneumothorax?
A. First-time PSP with no symptoms
B. Recurrent pneumothorax or persistent air leak
C. Tension pneumothorax managed with a chest tube
D. Small pneumothorax resolving spontaneously

Correct Answer: B. Recurrent pneumothorax or persistent air leak
Explanation: Surgical intervention, such as pleurodesis or bullectomy, is indicated in recurrent pneumothorax or when there is a persistent air leak after chest tube placement.
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Question 9

What distinguishes secondary spontaneous pneumothorax from primary?
A. SSP always occurs in smokers.
B. SSP involves underlying lung disease.
C. SSP occurs in younger individuals without risk factors.
D. SSP cannot lead to tension pneumothorax.

Correct Answer: B. SSP involves underlying lung disease.
Explanation: Secondary spontaneous pneumothorax occurs in individuals with pre-existing lung diseases, such as COPD, ILD, or infections, unlike primary pneumothorax, which occurs without apparent lung pathology.
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Question 10

How does supplemental oxygen help in the management of spontaneous pneumothorax?
A. It prevents lung infection.
B. It accelerates the absorption of air from the pleural space.
C. It reduces pain and inflammation in the pleural cavity.
D. It prevents tension pneumothorax.

Correct Answer: B. It accelerates the absorption of air from the pleural space.
Explanation: Supplemental oxygen creates a greater gradient for nitrogen resorption, thereby accelerating the reabsorption of air from the pleural space.
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