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Medical Studies 1 > 9.1 & 9.2 Pneumothorax > Flashcards

9.1 & 9.2 Pneumothorax Flashcards

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USMLE® Step 1 flashcards
1
Q

Primary vs secondary vs iatrogenic pneumothorax

A

Primary: Absence of existing lung pathology
Secondary: Existing lung pathology
Iatrogenic: Pneumothorax secondary to invasive procedure or surgery

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2
Q

What is a tension pneumothorax? List one way if can occur

A
  • Accumulation of air in pleural space, displacing other mediastinal structures
  • Example: this can occur in traumatic injury if a flap of tissue create a one-way valve, causing air enter and stay in the pleura
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3
Q

What is a simple, generalised definition of pneumothorax?

A

Air in pleural space (pneumatic tires: full of air)

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4
Q

What classification of pnuemothorax do primary and secondary fall under?

A

Sponatenous (unless specified tension)

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5
Q

What classification of pneumothorax does iatrogenic pneumothorax fall under?

A

Traumatic

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6
Q

In what age group is primary/secondary pneumothorax most common?

A

Primary: 15-34
Secondary: >55

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7
Q

Is pneumothorax more common in men or women?

A

Men

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8
Q

List some risk factors for pneumothorax

A
  • Smoking
  • Sub-pleural blebs
  • Underlying lung disease
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9
Q

Presenting symptoms of a patient with suspected pneumothorax. What is the intensity of these symptoms?

A
  • Dyspnoea (often acute onset)
  • Chest pain (often pleuritic)
  • Intensity is highly variable!
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10
Q

Differential diagnoses other than pneumothorax for same symptoms

A
  • Pulmonary embolism
  • Pleuritis
  • Acute coronary syndrome
  • Pericarditis
  • Musculoskeletal inflammation
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11
Q

Will physical exam always be abnormal in pneumothorax patients?

A
  • No
  • It can sometimes be normal
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12
Q

Which side does the trachea deviate to during pneumothorax?

A

Opposite side to pneumothorax

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13
Q

How is chest expansion changed during pneumothorax?

A

Reduced on ipsilateral side

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14
Q

Percussion note during pneumothorax

A

Hyper-resonant

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15
Q

Invesitgations for a patient with suspected pneumothorax

A
  • Observations (RR, HR, BP, SpO2)
  • Blood tests (for other differentials): CRP, WCC, troponins, d-dimer
  • ECG
  • CXR
  • Maybe CT Chest
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16
Q

Risk factors for tension pneumothorax

A
  • Trauma
  • Positive pressure/mechanical ventilation
  • CPR
17
Q

Symptoms and signs of tension pneumothorax in sponatenously breathing (i.e. self-breathing) patients

A
  • Dyspnoea
  • Chest pain
  • Tachypnoea
  • Tachycardia
  • Hypoxaemia
  • Signs of pneumothorax
18
Q

Is tension pneumothorax a clinical or radiological diagnosis?

A
  • Clinical
  • It cannot be diagnosed with radiology; this is merely suggestive
19
Q

What step always comes first in pneumothorax management

A
  • Resuscitation
  • Airway stabilisation
20
Q

Treatment recommendations for primary spontaneous pneumothorax in haemodynamically stable patient

A
  • Observation
  • Monitoring
21
Q

Treatment recommendations for primary spontaneous pneumothorax in NOT haemodynamically stable patient

A
  • Tube thoracostomy (remove substances from pleura)
  • Drainage to under-water sealed drain
22
Q

What is the estimated rate of recurrence of pneumothorax following 1st PSP?

A
  • Up to 30%
  • Most likely to occur in first month to year
23
Q

What is the estimated rate of recurrence of pneumothorax following 2nd PSP?

A
  • 60-70%
24
Q

Risk factors for pneumothorax recurrence

A
  • Female
  • Tall stature
  • Low BMI
  • Smoking
  • Large initial pneumothorax
25
Q

Do most pnuemothorax patients need definitive management to prevent recurrence?

A
  • Not usually
  • Only those with high risk jobs or hobbies
26
Q

What procedure is used for definitive management to prevent pneumothorax recurrence?

A

Pleurodesis

27
Q

What is passive atalectasis?

A

Pleural effusion or pneumothorax eliminates contact between pleural layers

28
Q

Does pleurodesis require symphysis of the lung? Why?

A
  • Yes
  • Without it, the triggering of inflammation will not allow the adherence of the pleural layers
29
Q

Describe management of secondary spontaneous pneumothorax

A
  • Resuscitation and airway stabilisation
  • Thoracostomy (drainage)
30
Q

3-year recurrence rate of secondary spontaneous pneumothorax

A

50%

31
Q

Should patients have definitive management to prevent recurrence of secondary spontaneous pneumothorax?

A

Yes

32
Q

How can a tension pneumothorax cause hypotension and shock?

A
  • Pleural space expands and fills with air
  • This compresses surrounding blood vessels, decreasing the amount of blood that can return to the heart
  • As a consequence, the heart can pump less blood, and so hypotension occurs
33
Q

Effect of pleural effusion and pneumothorax on vocal resonance?

A

Decrease

Medical Studies 1 (90 decks)

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