The chest radiograph showed the presence of a meniscus in the ...

[tsand2]

The chest radiograph showed the presence of a meniscus in the right chest together with a blunt-ed right costophrenic angle. Which of the following procedures would you recommend at this point to treat Ms. Paul?
 
  a. Anterior chest tube thoracostomy
  b. Chest needle decompression
  c. Video-assisted thoracoscopy (VAT)
  d. Posterior chest tube thoracostomy

Question 2

At what point is intrapleural pressure most negative?
 
  a. End-exhalation
  b. FRC
  c. Inspiration
  d. Maximal expiration

[guyanai]

Answer to Question 1

ANS: D
The presence of a meniscus in the chest radiograph is indicative of a large pleural effusion. Large pleural effusions need to be drained either by needle aspiration during a thoracentesis for spon-taneously breathing patients or by the insertion of a posterior chest tube. Anterior chest tubes are used for a pneumothorax.

Answer to Question 2

ANS: C
The pleural space is under negative pressure except during forced expiration. The intact thoracic rib cage provides elastic recoil pressure outward, whereas the intrinsic recoil pressure of the lung is inward toward the lung hilum. The diaphragm further decreases the intrapleural pressure below the atmospheric pressure to allow inspiration to occur.