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Y1 RESPIRATORY > Chest Wall, Pleural and Pulmonary Disorders > Flashcards

Chest Wall, Pleural and Pulmonary Disorders Flashcards

1
Q

What are the symptoms of chronic pulmonary infection? (5)

A 
Shadow on CXR
Weight loss
Persistant sputum production
Chest pain
SOB
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2
Q

What are the risk factors for chronic pulmonary infection?

A

Abnormal innate host defence
Repeated insult
Abnormal host response

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3
Q

How do you differentiate between an intrapulmonary abscess and an empyema?

A

Typically follow a preceding illness - use CT

ABSCESS: looks like an orange
EMPYEMA: pus in the pleural space - looks like a banana, D sign on CXR

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4
Q

How do you manage an empyema?

A

Drainage

IV/oral antibiotics

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5
Q

Define bronchiectasis and give management options…

A

Localised irreversible dilatation of bronchial tree, bronchi can collapse and makes it difficult to clear infection
No treatment via antibiotics, stop smoking, vaccinate

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6
Q

Define pulmonary oedema and give signs…

A

Accumulation of fluid in the lung (similar to pneumonia but pus not infected)
RESTRICTIVE pattern, dyspnoea, pink frothy sputum

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7
Q

Give a localised and generalised cause of pulmonary oedema

A

Pneumonia

ARDS

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8
Q

What is ARDS? Appearance of CXR? What can it lead to?

A

Acute lung injury due to direct trauma or secondary to severe systemic illness
BILATERAL ALVEOLAR SHADOWING
Fibrosis —> chronic restrictive lung disease

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9
Q

Describe the basic anatomy of the pleura…

A

Visceral layer covering lungs and forming fissures
Parietal layer covering mediastinum, diaphargm, thorax
No pleura at hilum

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10
Q

What is pleural effusion? Appearance of CXR?

A

Fluid in the pleural space

Meniscus visible - lung being pushed into fluid

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11
Q

List signs of a pleural effusion

A

Reduced chest expansion
Reduced breath sounds
Stony dull percusion note

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12
Q

List diagnostic techniques in pleural effusion

A

CXR
Cytology
Pleural aspirate
Pleural biopsy

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13
Q

What is an exudate in the pleural space of pH less than 7.2 highly suggestive of?

A

Empyema

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14
Q

What are the features of a transudate?

Which conditions cause transudate? (3)

A

Protein less than 30g/l LDH less than 200
Heart failure
Nephrotic syndrome
Pericarditis

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15
Q

What are the features of an exudate?

Which conditions cause exudate? (5)

A 
Protein more than 30g/l LDH more than 200
TB 
Pneumonia 
Cancer 
MI 
Pancreatitis
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16
Q

Pleural effusions can be clinically detected when more than 300ml is present. True/False?

A

False Only when more than 500ml is present

17
Q

How much fluid is required in pleural effusion to be detected on a CXR?

A

More than 300ml

18
Q

What is a pneumothorax? Signs?

A

Air in the pleural space —> uncoupling of lung from chest wall

Dyspnoea, pleuritic chest pain, hypersonance, reduced
chest expansion and breath sounds

19
Q

Who is more likely to get a spontaneous pneumothorax?

A

Tall, thin males

20
Q

How is pneumothorax treated?

A

Needle aspirate 2nd ICS, mid-clavicular line

Chest drain 5th ICS mid-axillary line with large cannula if unresolved

21
Q

Investigations used for pneumothorax…

A

CXR

CT chest

22
Q

What is a tension pneumothorax? Signs?

A

Progressive build up of air in pleural space

Tachycardia, hypotension, elevated JVP, trachea deviation AWAY from side of injury, hyperesonance, reduced breath sounds

23
Q

Common causes of tension pneumothorax…

A 
Respiratory disease
Misplaced/ blocked drain
CPR
Trauma
Ventilation
24
Q

What is cor pulmonale? How does it arise?

A

Right heart failure due to pulmonary hypertension Alveolar damage causes reduced gas exchange (hypoxia), causing pulmonary vasoconstriction which builds up pressure in the right heart

25
Q

List some symptoms and signs of pulmonary hypertension

A 
Ankle oedema 
Progressive breathlessness 
Elevated JVP
Ascites 
Parasternal heave/tricuspid regurgitation
26
Q

How do pulmonary embolisms most commonly arise?

A

Thrombus from legs gets stuck in pulmonary arteries

27
Q

What are the 3 components of Virchow’s Triad?

A

Damage to endothelium
Abnormal blood flow
Hypercoagulable blood

28
Q

What are some symptoms of PE?

A

Sudden breathlessness
Sudden pleuritic pain
Tachypnoea
Fever

29
Q

If D-dimer is undetected in investigations, rule out PE diagnosis completely. True/False?

A

True

30
Q

Apart from D-dimer, what are useful investigations to do for PE?

A

V/Q scan (show underperfused areas)

CTPA is gold standard for diagnosis

31
Q

What are some risk factors for pleural infection?

A 
DM
Immunosuppression
GI reflux
Alcohol misuse
IV drug abuse

Y1 RESPIRATORY (12 decks)

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