diagnosis of diaphragmatic rupture is difficult and generally mostindividuals present later. Delayed presentation carries a highmorbidity. Barium swallow will be diagnostic. All diaphragmaticruptures require treatment. Surgery is best done via theabdomen in acute conditions and via the chest in chronicconditions. VATS would be diagnostic of diaphragmaticperforation on intial admission.Option A: The patient has a collection/mass in the L. chest and itmay look similar to pleural effusion. Placing a chest tuve in a ptw/ diaphragmatic perforation with bowel herniation can be adisaster, when in doubt, get a CT scan.4.B.Major veins at the base of the neck have negative pressureduring inspiration and, if injured at that moment, will suck airrather than bleed. The air embolism then leads to sudden death.Arterial injury (choice A) would have led to massive bleeding butnot to sudden death.Pneumothorax (choice C) can indeed happen when surgery isbeing done in the supraclavicula area, and a sucking soundmight even be heard. However, sudden lung collapse in a young,healthy person leads to dyspnea, not to sudden death.Sympathetic discharge (choice D) would be hard to producewhile pulling and dissection a node. If it were done, however,there would be vasoconstriction, tachycardia, perspiration andhypertension.Essentially nothing would have happened at the time had thetrachea (choice E) been injured.5.C The patient most likely has an injury to a major bronchus. Inaddition to the wretching effect of a sudden deceleration, thesecan happen when a major blow to the chest occurs at a timewhen the glottis is closed. If not recognized right away by thepresence of subcutaneous emphysema, they become evidentonce the air leak persists and the lung does not re-expand.Air embolism (choice A) is manifested by sudden death shortlyafter a patient with unrecognized injuries to the tracheobronchialtree in proximity to major intrathoracic vessels is placed on arespirator.Injured lung parenchyma (choice B) can indeed leak air andproduce a pneumothorax, but typically heals rapidly.Suction applied to a chest tube (choice D) is used to acceleratethe rate of resolution of a pneumothorax, but the large amountof air draining in this case indicates that the pleural space fills asquickly as it can be drained out.