Tension Pneumothorax, ARDS & Pulmonary Hypertension: Step 1 review notes and self-test
Notes for the Tension Pneumothorax, ARDS & Pulmonary Hypertension rapid review: the clue that separates each of its 4 confusion pairs, with timestamps and a self-test.
October 21, 2026
This video covers tension pneumothorax, ARDS, and pulmonary hypertension through four confusion pairs. Watch the video, then use these notes to test yourself on the single clue that separates each pair.
Simple / open pneumothorax vs Tension pneumothorax
You separate them by deciding whether pleural air is simply present, communicates through a chest wall wound, or is pressurized enough to cause obstructive shock. Tension pneumothorax causes severe respiratory distress, absent unilateral breath sounds, hyperresonance, hypotension, JVD, and mediastinal shift. Tracheal deviation is late, so do not wait for it when shock physiology and absent unilateral breath sounds are present.
Simple / open pneumothorax vs Tension pneumothorax Tension is pneumothorax plus obstructive shock physiology; open is defined by chest wall communication. Open the comparison and video →Cardiac tamponade vs Tension pneumothorax
You separate tamponade from tension pneumothorax with the heart and lung exam. Muffled heart sounds with bilateral breath sounds and an enlarged globular cardiac silhouette point to tamponade, while absent unilateral breath sounds with hyperresonance and tracheal deviation away from the affected side point to tension pneumothorax. Both can cause obstructive shock with hypotension, JVD, and pulsus paradoxus, so do not rely on the hemodynamic profile alone.
Cardiac tamponade vs Tension pneumothorax Tamponade is muffled heart sounds and effusion; tension pneumothorax is absent unilateral breath sounds with hyperresonance. Open the comparison and video →Neonatal respiratory distress syndrome vs Acute respiratory distress syndrome
You separate them by age and trigger. Neonatal RDS is a premature newborn surfactant deficiency problem, while ARDS is acute diffuse inflammatory lung injury after a lung or systemic insult. Both can show diffuse alveolar injury with hyaline membranes, so that pathology finding is not specific.
Neonatal respiratory distress syndrome vs Acute respiratory distress syndrome Neonatal RDS is prematurity surfactant deficiency; ARDS is acute diffuse alveolar damage after a lung/systemic insult. Open the comparison and video →Pulmonary arterial hypertension vs Secondary pulmonary hypertension groups
You separate them by naming the cause before naming the group. Group 1 PAH is pulmonary arterial vascular disease without a left-heart, lung or hypoxia, or thromboembolic cause, while Groups 2 through 5 reflect those upstream causes or unclear and multifactorial mechanisms. Do not call every pulmonary hypertension PAH because PAH refers specifically to Group 1.
Pulmonary arterial hypertension vs Secondary pulmonary hypertension groups Group 1 is pulmonary arterial vascular disease; Groups 2-5 are classified by the upstream cause. Open the comparison and video →Quick self-test
Name the diagnosis from the clue, then tap to check.
Acute diffuse inflammatory lung injury after sepsis, aspiration, trauma, pneumonia, pancreatitis, or transfusion with severe hypoxemia and bilateral opacities not explained by heart failure.
Acute respiratory distress syndrome · Neonatal respiratory distress syndrome vs Acute respiratory distress syndrome
Group 1 ____: idiopathic, heritable such as BMPR2, drug-induced, or associated PAH without left-heart, lung/hypoxia, or thromboembolic cause.
Pulmonary arterial hypertension · Pulmonary arterial hypertension vs Secondary pulmonary hypertension groups
Hypotension, JVD, muffled heart sounds, pulsus paradoxus, and electrical alternans.
Cardiac tamponade · Cardiac tamponade vs Tension pneumothorax
Keep going
Every pair in this review has a free page in the library with a side-by-side comparison and a practice question. Work through the ones you missed in the self-test first.