Lungs: Restrictive Extrinsic Conditions - Kyphoscoliosis, Pleural Effusions, Pneumothorax, Tension Pneumothorax, Neuromuscular Disorders (GBS, MG) Flashcards

1
Q

How does kyphoscoliosis affect lung function

A

Deviation of the normal curvature of the spine in the sagittal, coronal plane => restrictive lung problems

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2
Q

Pleural effusions

-presentation, examination findings

A
No hemi diaphragm
Meniscus
Dense white shadowing
Locular effusions
Fluid sinks to the bottom, compresses lung above
Decreased expansion
Mediastinal shift to contralateral side
Stony dull percussion
Bronchial breathing at level of effusion
Decreased VF/TF
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3
Q

What is the difference between a chest drain, pleural tap and thorascopy

A

Chest drain - drainage of air, blood, fluid, pus out of pleural space => reexpansion of lung
-Seldinger kit

Pleural tap - drainage of pleural fluid for sampling

Thorascopy - laproscopic technique to view lung and pleura, take lung biopsies and insert talc

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4
Q

What info can you get from a pleural tap

A

Physical appearance

Protein and LDH often change together
-transudate < 25 LIGHTS CRITERIA 35 < exudate

AFB - TB culture
MCS - microbe culture
Cytology - cells

Glucose and pH often change together

  • if low, likely
    • infection/empyema
    • malignancy
    • RA, TB, SLE
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5
Q

What is the difference between transudate and exudate?

-what are the most common causes

A

Transudate

  • due to increased hydrostatic pressure or low oncotic pressure
  • low in protein and LDH
  • systemic causes

Exudate

  • due to inflammation and capillary permeability
  • high in protien and LDH
  • infection, inflammation, malignancy
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6
Q

What is the Lights Criteria

A

Exudate if at least 1 of the criteria met

  1. Pleural protein: Serum protein
    - ratio > 0.5
  2. Pleural LDH: Serum LDH
    - ratio > 0.6
  3. Pleural LDH greater than 2/3 upper limit of normal serum LDH
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7
Q

How would you manage a

  • parapneumonic effusion
  • empyema
  • malignant effusion
  • bilateral effusion
A

Parapneumonic effusion - secondary to pneumonia

  • no infection in transudate
  • manage pneumonia, no need to drain

Empyema - pus from infection in pleural space
-drain exudate, identify microbe, ABx

Malignant effusion - cancer cells in exudate increase production of fluid and decrease absorption

  • lung, breast, lymphoma mets
  • mesothelioma
  • pleurodesis with talc to prevent formation of effusions

Bilateral effusion - transudate due to systemic issues
-treat underlying cause

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8
Q

Causes of

  • primary pneumothorax
  • secondary pneumothorax
A

No underlying pathology
Tall, thin patients
Presence of bullae on apices of lung
Often smokers

Trauma
Lung disease - asthma, CF, PCP, cancer, sarcoma, COPD
AI affecting lungs
Congenital - CF, Marfans, EDS

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9
Q

Pneumothorax

  • presentation
  • investigation, diagnosis
A

Pneumothorax
Sudden onset SOB, pleuritic pain

TP -
Insp => air moves into PS
Exp => valve on lung closes
Increased air in PS => compress heart

Reduced chest expansion, reduce breath sounds on affected side

CXR => loss of lung markings on affected side

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10
Q

Management of

  • primary pneumothorax
  • secondary pneumothorax
  • tension pneumothorax
A

Primary
2cm+ / SOB?
-yes - aspiration & OPD => chest drain & admit
-no - OPD

Secondary
2cm+ / SOB?
-yes - chest drain & admit
No - 1-2cm?
-yes - aspirate & admit => chest drain & admit
-no - admit and observe

Tension

  • needle decompression 5ICS MAL
  • high flow O2, chest drain
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11
Q

What neuromuscular conditions may cause a restrictive lung disease
-management

A

GBS, MG

-IVIG, plasmapheresis

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