Empyema and Pneumothorax

Question 1

What are some mechanisms of Pneumothorax development?

Answer 1

Birth
Penetrating Trauma
Blunt Force Trauma
Barotrauma

Question 2

What are the S/Sx of a Pneumothorax?

Answer 2

Dyspnea
Cough
Chest Px
Hypoxemia
Shock

Hyperresonance (air buildup)
Decreased Breath sounds
Tracheal deviation
Crepitance

Question 3

How would you Dx a pneumothorax?

Answer 3

CXR or CT

tracheal deviation away (TENSION)
(tracheal deviation towards (routine))

Question 4

What are some risk factors for a spontaneous pneumothorax?

Answer 4

RENTY- spontan.
Rupture of Subpleural bleb or cyst
Young, tall white dudes (20 to 40)
Elderly COPD'ers
Neonates
Tumors

Question 5

When is surgical intervention implicated for Spontaneous Pneumos?

Answer 5

Incomplete expansion
Bilat
Recurrent
>48hrs of air leak

Question 6

What is the condition known as if there is purulent fluid in the parietal space?

Answer 6

Empyema

Question 7

What are the stages of Empyema development?

Answer 7

Stages include (EFO) Exudative –> Fibrinopurulent –> Organizing

Question 8

What are some common Empyema causative microogranisms?

Answer 8

S. pneumoniae
(pneumococci and streptococci are listed as well??)
S. aureus
Pseudomonas 
Klebsiella
E. Coli
Proteus
Salmonella
Bacteroides

Question 9

What is the Tx for an empyema?

Answer 9

Thoracentesis
Tube drainage
Rib resection drainage
Open Flap Drainage (ELOESSER FLAP)

Question 10

What are risk factors for Lung Abscesses?

Answer 10

Gingivodental Dz (SEVERE)
Seizurse
Cerebrovascular accident
ALCOHOLISM MC
ANESTHESIA

Question 11

What are the S/Sx of lung abscesses?

Answer 11

Sputum 
Fever and chills
Weight loss
Dyspnea and Fatigue
Hemoptysis

Question 12

Where do the majority of lung abscess occur?

Answer 12

Right LUNG!!!

Question 13

What tests would you order to definitively Dx a Lung Abscess?

Answer 13

CXR
CT
Transtrachial Aspiration
Early bronchoscopy

Question 14

What is the bacteriology of most lung abscesses?

Answer 14

Anaerobic 65%
Typically model oral flora
Polymicrobial

Question 15

What is the Tx for lung abscesses?

Answer 15

Abx (PCN, Clinda)
Chest physiotherapy
Bronchoscopy
Postural drainage

Question 16

When would surg. be indicated for a lung abscess?

Answer 16

> 6cm
Persistent Tox after 2wks medical therapy
6-8wks w/out healing
Bronchiectatic changes on CXR
Hemoptysis
Empyema complication or bronchopleural fistula (chronic pneumo)

Question 17

When is tube drainage indicated?

Answer 17

Only severely ILL patients unresponsive to conservative management?

Question 18

Bronchiectasis is defined as what?

What is the most common cause?

Answer 18

Abnormal irreversible dilatation of bronchi

Cystic Fibrosis (can also be caused by Karatgener’s or conn. tissue disorders such as Ehlers-Danlos)

Question 19

Bronchiectasis are more common in men or women?

Answer 19

Women

Question 20

What is the clinical presentation of a bronchiectasis PT?

Answer 20

Persistent cough
Fetor oris (bad breath)
Hemoptysis (bronchiectasis MC of massive hemoptysis)
Recurrent respiratory infxn
Rales
Clubbing

Question 21

What studies would you order to definitively Dx a PT with suspected bronchiectasis?

Answer 21

CT scan
Bronchoscopy/Bronchography (r/o obstruction)
CXR (Not diagnostic, but will be abnormal; can)
V/Q scan (good for kids)

Question 22

MC infective organisms of bronchiectasis?

Answer 22

H. influenzae in normal PTs

Cystic Fibrosis PTs –> MC will be Pseudomonas