We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Image of the Month FREE

Cynthia L. Leslie, MD
[+] Author Affiliations

From the Critical Care Unit, Yale[[ndash]]New Haven Hospital, New Haven, Conn.

Section Editor: Grace S. Rozycki, MD

Arch Surg. 2001;136(10):1211-1212. doi:.
Text Size: A A A
Published online

A 70-YEAR-OLD unrestrained female driver was involved in a head-on motor vehicle collision. On arrival at the trauma room, she was only experiencing pain in her right knee. There was no shortness of breath. Her medical history was remarkable for asthma and hypertension. On examination, her respiratory rate was 18 breaths per minute. Breath sounds were decreased over the left hemithorax. Bowel sounds were not heard. Her room-air arterial blood gas pH was 7.38, with PO2and PCO2levels of 145 mm Hg and 44 mm Hg, respectively, and a bicarbonate level of 28 mEq/L. Radiograph images (Figure 1and Figure 2) showed marked elevation of the left hemidiaphragm.


A. Ruptured diaphragm

B. Bochdalek hernia

C. Phrenic nerve paralysis

D. Eventration




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Hemorrhagic Stroke?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference