What is pectus excavatum deformity of chest?

DSSSB - 28 August 2019 (Shift-1)

Medical & Surgical Nursing

Easy

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Pectus excavatum is a structural deformity where the sternum (breastbone) is pushed inward, or depressed.
This inward depression causes a reduction or narrowing of the anterior-posterior (front-to-back) diameter of the chest.
The condition is often referred to as "funnel chest" due to its characteristic appearance.
As seen in the provided image, the sternum sinks towards the vertebral column, which is the hallmark of this condition.

Option A: While the sternum is depressed in pectus excavatum, the primary change is a narrowing of the anterior-posterior diameter, not the transverse (side-to-side) diameter.
Option B: A 1:1 ratio of the anterior-posterior to transverse diameter describes a 'barrel chest,' which is a different type of chest deformity.
Option D: This describes the opposite condition, pectus carinatum, or 'pigeon chest,' where the sternum protrudes outward.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of Thorax and Lungs: Chest Wall Deformities as background academic context rather than a clinical decision trigger.
During a physical assessment, a nurse should inspect the chest for symmetry and deformities. Identifying pectus excavatum is crucial as it can be associated with connective tissue disorders like Marfan syndrome.
In severe cases, the deformity can displace the heart and limit lung expansion, leading to cardiac murmurs, palpitations, or dyspnea on exertion. The nurse must assess for these associated signs and symptoms.
What if? If a patient with pectus excavatum reports new-onset chest pain and shortness of breath, the nurse should not assume it's just due to the deformity. It requires immediate investigation to rule out acute cardiac or pulmonary events, as the underlying anatomical variation can complicate diagnoses.

How to Approach the Question

First, identify the key term in the question: 'pectus excavatum'.
Recall the definition of pectus excavatum or analyze the provided image. The term 'excavatum' suggests a cavity or hollow, and the image confirms a sunken-in sternum.
Understand the anatomical diameters of the chest: anterior-posterior (front-to-back) and transverse (side-to-side).
Evaluate how a sunken sternum affects these diameters. An inward depression will decrease the front-to-back (anterior-posterior) distance.
Assess each option: Option A is incorrect about the transverse diameter. Option B describes a barrel chest. Option D describes the opposite condition, pectus carinatum. Option C correctly identifies both the depressed sternum and the resulting narrowed anterior-posterior diameter.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 501-503