🫁 Pneumothorax: The Lung Collapse You Can’t Miss on Step Exams
Pneumothorax is a board-favorite emergency that combines anatomy, radiology, and quick intervention. It often appears in Step 1 or Step 2 vignettes involving sudden shortness of breath + chest trauma or tall thin patients.
USMLE Clue: Absent breath sounds + tracheal deviation = Think pneumothorax
🧬 Types of Pneumothorax
| Type | Description | Cause |
|---|---|---|
| Spontaneous | Air enters pleural space without trauma | Tall thin men, ruptured blebs |
| Tension | One-way air leak increases pressure | Trauma, mechanical ventilation |
| Traumatic | Direct chest wall or lung injury | Stab wound, rib fracture |
| Iatrogenic | Medical procedure-related | Central line, thoracentesis |
🩺 Signs and Symptoms
| Feature | Spontaneous | Tension |
|---|---|---|
| Chest pain | Sudden, sharp | Severe, worsening |
| Dyspnea | Mild to moderate | Severe, hypoxia |
| Tracheal deviation | Absent | Present (away from affected side) |
| JVD | Absent | Present |
| Hypotension | Uncommon | Common |
| Breath sounds | Decreased | Absent |
🩻 Classic CXR Findings
| Finding | Description |
|---|---|
| Visible pleural line | Lung edge seen separated from chest wall |
| Absent lung markings | No vascular markings beyond pleural line |
| Tracheal shift | To opposite side in tension pneumothorax |
| Deep sulcus sign | Visible on supine X-ray (common in ICU patients) |
⚠️ Do not delay treatment for imaging in tension pneumothorax.
💊 Management
| Condition | Treatment |
|---|---|
| Small spontaneous | Observe + oxygen |
| Large spontaneous | Needle aspiration or chest tube |
| Tension pneumothorax | Needle decompression → chest tube |
| Traumatic/iatrogenic | Chest tube and treat cause |
📚 Sample USMLE Vignette
A 21-year-old tall, thin male develops sudden chest pain and dyspnea while playing basketball. Physical exam shows decreased breath sounds on the right, normal vitals. Chest X-ray shows a collapsed right lung. Diagnosis?
✅ Answer: Spontaneous pneumothorax
📲 Call to Action
💨 Don’t let a missed lung collapse your score.
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Frequently Asked Questions (FAQs)
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Aim for 4-6 focused hours, ensuring you incorporate breaks to avoid burnout.
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Practice mindfulness techniques, take practice exams under realistic conditions, and maintain a balanced lifestyle.
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