A 43-year-old man from Chile comes to the physician because of a 1-day history of upper back pain and difficulty swallowing. He has had pain in his shoulder and knee joints over the past 10 years. He is 190 cm (6 ft 3 in) tall and weighs 70.3 kg (155 lb); BMI is 19.4 kg/m2. His blood pressure is 142/86 mm Hg in the right arm and 130/70 mm Hg in the left arm. Physical examination shows a depression in the sternum and a grade 3/6 diastolic murmur at the right upper sternal border. A CT scan of the chest with contrast is shown. Which of the following is the most likely underlying cause of this patient's condition?
AAutoimmune valve damage
BAtheroma formation
CProtozoal infection
DCystic medial degeneration
ECongenital aortic narrowing
A 24-year-old man is brought to the emergency department after being involved in a motor vehicle accident as an unrestrained driver. He was initially found unconscious at the scene but, after a few minutes, he regained consciousness. He says he is having difficulty breathing and has right-sided pleuritic chest pain. A primary trauma survey reveals multiple bruises and lacerations on the anterior chest wall. His temperature is 36.8°C (98.2°F), blood pressure is 100/60 mm Hg, pulse is 110/min, and respiratory rate is 28/min. Physical examination reveals a penetrating injury just below the right nipple. Cardiac examination is significant for jugular venous distention. There is also an absence of breath sounds on the right with hyperresonance to percussion. A bedside chest radiograph reveals evidence of a collapsed right lung with depression of the right hemidiaphragm and tracheal deviation to the left. Which of the following is the most appropriate next step in the management of this patient?
ATube thoracostomy at the 2nd intercostal space, midclavicular line
BTube thoracostomy at the 5th intercostal space, midclavicular line
CTube thoracostomy at the 5th intercostal space, anterior axillary line
DNeedle thoracostomy at the 5th intercostal space, midclavicular line
ENeedle thoracostomy at the 2nd intercostal space, midclavicular line
An 18-year-old man is brought to the emergency department 30 minutes after being stabbed in the chest during a fight. He has no other injuries. His pulse is 120/min, blood pressure is 90/60 mm Hg, and respirations are 22/min. Examination shows a 4-cm deep, straight stab wound in the 4th intercostal space 2 cm medial to the right midclavicular line. The knife most likely passed through which of the following structures?
ASerratus anterior muscle, pleura, inferior vena cava
BExternal oblique muscle, superior epigastric artery, azygos vein
CPectoralis minor muscle, dome of the diaphragm, right lobe of the liver
DIntercostal muscles, internal thoracic artery, right heart
EPectoral fascia, transversus thoracis muscle, right lung
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