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Question 1

pleural effusion

• define
• types
• cause
• symptoms
• signs
• Ix
• Mx

Answer 1

define
- excess fluid in the pleural space

types

• transudative <25g/L
• exudative >35g/L

causes

• transudative - renal/ liver/ heart failure (CCF), nephrotic syndrome, Meig’s syndrome (RHS), hypothyroidism
• exudative - cancer, infection (pneumonia, TB), CTD (RA, SLE)

symptoms

• SOB
• reduced walking distance
• pleuritic chest pain

signs

• De chest expansion
• tracheal deviation away frrom affected side
• dull to percussion
• DE breath sounds and DE vocal resonance
• bronchial breathing above fluid

Ix

• bedside - cardio, resp, peripheral oedema, ECG
• blood - FBC, WCC, Hb, LFT, CRP, UE
• imagine - CXR (fluid in fissures, fluid level (white), costodiaphragmatic blunting
• pleural aspirate - yellow and turbid, low glucose and high LDH (empyema), amylase (pancreatitis), low complement (RA, SLE), low glucose (TB, autoimmune)

light’s criteria

• if protein between 25-25g/L
• exudative if pleural:serum fluid protein >0.5, pleural:serum LDH>0.6, LDH >2/3 upper limit

Mx

• asymptomatic - conservative
• symptomatic - uss-guided aspirate
• large or empyema - drain
• • IVabx in empyema

Question 2

pneumothorax

• define
• types
• cause
• symptoms
• signs
• Ix
• Mx

Answer 2

define
- air in pleural cavity, leads to compression of lung and possibly tension pneumothorax (compression of aa/ vv)

types

• pneumothorax
• tension pneumothorax - reduced heart function, return to heart

causes

• idio - weed smoker, young males
• trauma
• iatro - biopsy, mech vent, central line
• secondary - COPD/ asthma, marfans, ehlers-danlos, TB and pneumonia, fibrotic lung (IPF, CF), cancer

symptoms

• pleuritic chest pain, unilateral
• SOB sudden onset

signs

• reduced chest expansion
• hyperresonant percussion
• De vocal resonance and breath sounds
• tension - haemodynamic compromise - tachycardia and hypotension, tracheal deviation to opp side

Ix

• bed - cardio, resp exam, obs
• blood - CRP, WCC, ESR, FBC
• imaging - CXR

Mx - primary pneumothorax

• <2cm - conservative
• > 2cm or symptoms - aspiration (2ics MCL 16 guage cannula just above third rib to avoid NVSC bundle

Mx - tension

• A-E
• large bore cannula into 2ics - aspirate
• then insert chest drain - in triangle of safety (5ics, mid axillary line (lats), ant axillary line (pecs major)

Mx - secondary

• <1cm AND asymptomatic - none but admit for 24hrs and O2
• 1-2cm AND asymp - aspiration and observe and if unsuccessful&raquo_space; chest drain
• > 2cm OR SOB - ic drain and admit

Question 3

IE

• define
• RF
• cause
• symptoms
• signs
• Ix
• Dx
• Mx
• complications

Answer 3

define
- vegatation of bacteria that has attached to valve

RF
- IVDU, congenital heart disease, valve heart disease, prosthetic valve, hx of Ie, intravasc device, haemodialysis, HIV

cause

• staph aureus - skin
• strep viridans
• staph epidermidis
• enterococci
• strep bocis
• fungi
• HACEK - haem, actinobacillus, cardiobacterium, eikenella, kingella

symptoms

• fever, malaise, anorexia, wt loss, night sweats
• myalgia, arthralgia
• abdo pain, cough, pleuritic pain

signs
- MAJOR PEN

Ix

• bed - BM, obs, cardio, resp, abdo exam if abdo pain
• blood - FBC, WCC (IN), CRP and ESR (IN), Hb, LFT, UE, blood cultures from 3 diff sites, 12 hours apart
• imaging - CXR, ECG
• specialist - transthoracic ECHO (vegetations), transoesophageal echo (dx)

Dx

• 2 major, 1 minor and 3 major, 5 major
• major - echo, 2 blood cultures
• minor - echo and blood cutlures not to major standard, IVUD, immuno (GN, oslers node, roths spot, RF) /vasc picture (janeway lesions, emobli), >38 degrees, heart condition

Mx

• IV abx for 6 weeks - benzyl pen
• surgery - obstruction, large veg, valvular damage, infected prosthetic valve, severe HF, haemodynamic instability, persistent bacteraemia, repeated emboli, aortic root abscess

Question 4

AS

• define
• cause
• symptoms
• signs
• Ix
• Mx

Answer 4

define

- narrowing of aortic valve

Question 5

AR

• define
• cause
• symptoms
• signs
• Ix
• Mx

Answer 5

a

Question 6

MS

• define
• cause
• symptoms
• signs
• Ix
• Mx

Answer 6

a

Question 7

MR

• define
• cause
• symptoms
• signs
• Ix
• Mx

Answer 7

a

Question 8

pulmonary stenosis/ regurg

• define
• cause
• symptoms
• signs
• Ix
• Mx

Answer 8

a