Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

RESP > PE pneumothorax pleural effusion ILD > Flashcards

PE pneumothorax pleural effusion ILD Flashcards

1
Q

what are the causes of PE?

A

usually arise from DVTs in proximal leg or iliac veins

rarely:
R ventricle post MI
septic emboli in R-sided endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the risk factors for PE?

A 
SPASMODICAL 
sex- female
pregnancy
age- high
surgery- 10d post-op straining at stool 
malignancy
oestrogen- OCP/HRT
DVT/PE previous hx 
immobility
colossal size 
antiphospholipid antibodies
lupus anti-coagulant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the symptoms of PE?

A

depends on size, number + distrubtion of emboli

dyspnoea
pleuritic pain
haemoptysis
syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the signs of PE?

A 
fever
cyanosis
tachycardia tachypnoea
RHF- hypotension, raised JVP, loud P2
evice of cause- DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what invx for PE?

A 
bloods- FBC UE clotting d-dimer
ABG
CXR
ECG
doppler US- thigh + pelvis
CTPA + venous phase of legs + pelvis

V/Q scan no longer used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what can be seen on ABG in PE?

A

normal or lowered paO2 + paCO2 + raised pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what can be seen on CXR in PE?

A

normal or
oligaemia
linear atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what can be seen on ECG in PE?

A

sinus tachycardia
RBBB
RV strain (inverted T in V1-V4)

S1 Q3 T3 rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how do you diagnose PE?

A

1) assess probability using Wells’ score
2) low-probability- D-dimer
- negative- excludes PE
- positive- CTPA
3) high probability- CTPA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what preventative treatment can be done for PEs?

A

risk assessment for all patients
TEDS
prophylactic LMWH
avoid OCP/HRT if at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the acute management of PE?

A

1) oxygen NRB 100%
2) analgesia - morphine +/- metoclopramide
3) if critically ill with massive PE consider thrombolysis- alteplase 50mg bolus stat (surgical or interventional embolectomy)

4) LMWH heparin eg enoxaparin 1.5mg/24h SC
5) further treatment depends on SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

if SBP <90 in PE what would you do?

A

give 500ml colloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

if SBP<90 still low after 500ml colloid in PE what would you do?

A

give inotropes

dobutamine- aim for SBP>90
consider addition of NORAD
consider thrombolysis- med or surg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

if SBP>90 in PE what would you do?

A

start warfarin

confirm dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the ongoing management of PE after acutely treating?

A

1) TEDS stocking in hospital
2) graduated compression stockings for 2yrs if DVT- prevents post-phlebitic syndrome

3)continue LMWH until INR>2 at least 5 days 
target INR= 2-3
duration:
- remedial cause- 3m
- no known cause- 6m
- on going cause- indefinite

4)VC filter if repeat DVT/PE despite anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a pneumothorax?

A

accumulation of air in pleural space with 2* lung collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how is a pneumothorax classified?

A

closed
open
tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a closed pneumothorax?

A

intact chest wall

air leaks from lung into pleural cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is an open pneumothorax?

A

defect in chest wall allows communication between PTX + exterior- may be sucking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is a tension pneumothorax?

A

air enters pleural cavity through one-way valve + cannot escape -> mediastinal compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the categories of causes of pneumothorax?

A

spontaneous- 1* + 2*
trauma
iatrogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the 1* spontaneous causes of pneumothorax?

A

1*- no underlying lung disease
young thin men- ruptured subpleural bulla
smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the 2* spontaneous causes of pneumothorax?

A 
2* -underlying lung disease
COPD
marfans, EDS
pulmonary fibrosis
sarcoidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the trauma causes of pneumothorax?

A

penetrating

blunt +/- rib fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the iatrogenic causes of pneumothorax?
subclavian CVP line insertion positive pressure ventilation transbronchial biopsy liver biopsy
26
what are the symptoms of pneumothorax?
sudden onset dypsnoea pleuriti chest pain tension- respiratory distress, cardiac arrest
27
what are the signs of pneumothorax?
chest - reduced expansion - resonant percussion - reduced breath sounds - reduced VR tension- raised JVP, mediastinal shift, tachy, low bp crepitus- surgical emphysema
28
what invx would you do for pneumothorax?
ABG US CXR- expiratory film helpful
29
what can you see on CXR in pneumothorax?
translucency + collapse (2cm rim=50% vol loss) mediastinal shift away from PTX surgical emphysema cause- rib fractures, pulmonary disease eg bullae
30
what is the acute management of tension pneumothorax?
resuscitate patient no CXR large bore venflon into 1nd ICS mid clav line insert ICD
31
what is the acute management of traumatic pneumothorax?
resuscitate patient analgesia- morphine 3-sided wet dressing if sucking insert ICD
32
what is the acute management of 1* pneumothorax?
if not SOB +/or rim>/2cm then consider discharge if SOB +/or rim>2cm- aspirate- if successful consider discharge if unsuccessful insert ICD
33
what is the acute management of 2* pneumothorax?
if SOB + >50yo + rim>/2cm- insert ICD if not then aspirate- if successful admit for 24h if unsuccessful insert ICD
34
what is light's criteria for an exudate pleural effusion?
serum protein ratio>0.5 serum LDH ratio>0.6 LDh is 0.6xULN effusion protein>35g/L
35
what is the light's criteria for transudate pleural effusion?1
effusion protein <25g/L
36
what are the causes of exudate pleural effusion?
exudates- increase cap permeability infection- pneumonia, TB neoplasm- bronchial, lymphoma, mesothelioma inflammation- RA, SLE infarction
37
what are the causes of transudate pleural effusion?
transudate- raised cap hydrostatic or decreased oncotic pressure CCF renal failure hypothyroidism decreased albumin- nephrosis, liver failure, enteropathy meig's syndrome- R pleural effusion, ascites, ovarian fibroma
38
what are the symptoms of pleural effusion?
asymptomatic dyspnoea pleuritic chest pain
39
what are the signs of pleural effusion? in CHEST
``` tracheal deviation AWAY from effusion reduced expansion stony dull percussion reduced air entry bronchial breathing just above effusion decreased VR ```
40
what are the SIGNS of associated diseases with pleural effusion?
cancer- cachexia, clubbing, HPOA, LNs, radiation burn, radiation tattoo chronic liver disease cardiac failure RA, SLE hypothyroidism
41
what investigations would you do for pleural effusion?
``` bloods- FBC UE LFT TFT Ca ESR CXR US- helps tapping volumetric CT Diagnostic tap ```
42
what can you see on CXR for pleural effusion?
blunt costophrenic angles dense shadow with meniscus mediastinal shift AWAY cause- coin lesion, cardiomegaly
43
what do you send the diagnostic tap for in pleural effusion?
chemistry- protein, LDH, ph, glucose, amylase bacteriology- MCS, auramine stain, TB culture cytology immunology- SF, ANA, complement
44
in a diagnostic tap what would you see in empyema, cancer, TB, RA + SLE?
raised protein decreased glucose <3.3mM decreased ph<7.2 raised LDH>0.6 xserum/ULN
45
in a diagnostic tap what would you see in an oesophageal rupture?
``` decreased ph<7.2 raised amylase (also in pancreatitis) ```
46
when would you do a pleural biopsy?
if pleural fluid is inconclusive | ct guided with Abrams needle
47
what is the management pleural effusion?
treat underlying cause drainage if symptomatic 2L/24h- repeated aspiration or ICD if recurrent malignant effusion: chemical pleurodesis persistent effusions: surgery
48
what are the principle features of ILD?
dyspnoea dry cough abnormal CXR/CT restrictive spirometry
49
what are the causes of ILD?
``` environmental- asbestosis, silicosis hypersensitivity- EAA infection- TB, viral, fungi idiopathic- CFA/idiopathic pulmonary fibrosis drugs associated with systemic disease ```
50
what are the drug causes of ILD?
``` BANS ME bleomycin, busulfan amiodarone nitrofurantoin sulfasalazine methotrexate, methysergide ```
51
what are the associated systemic diseases with ILD?
sarcoidosis RA SLE, systemic sclerosis, sjogren's, MCTD UC, ankylosing spondylitis
52
what are the upper zone causes (location) of ILD?
``` A PENT aspergillosis- ABPA pneumoconiosis- coal, silica extrinsic allergic alveolitis negative sero-arthropathy TB ```
53
what are the lower zone causes (location) of ILD?
``` STAIR sarcoidosis (mid zone) toxins- BANS ME asbestosis idiopathic pulmonary fibrosis rheum- RA, SLE, scleroderma, sjogrens, PM/DM ```
54
what is obstructive sleep apnoea?
intermittent closure/collapse of pharyngeal airway leading to apnoeic episodes during sleep
55
what are the risk factors of obstructive sleep apnoea?
``` obesity male smoker alcohol idopathic pulmonary fibrosis structural airway pathology eg micrognathia NM disease eg MND ```
56
what investigations would you do for obstructive sleep apnoea?
SPO2 | polysomnography is DIAGNOSTIC
57
what is the treatment of obstructive sleep apnoea?
weight loss avoid smoking + alcohol CPAP during sleep via nasal mask surgery to relieve pharyngeal obstruction- tonsillectomy or uvulopalatpharyngoplasty
58
what are the clinical features of obstructive sleep apnoea?
1) nocturnal snoring, choking, gasping, apnoeic, episodes 2) daytime morning headache, somnolence, less memory + attention, irritability, depression
59
what are the complications of obstructive sleep apnoea?
pulmonary HTN type 2 resp failure cor pulmonale
60
what brief advice can you give for smoking cessation?
ASK, ADVISE, ACT ask- enquire smoking status advise- best way to sotp is with support + medication act- provide details of where to get help eg NHS stop smoking helpline
61
how do you facilitate quitting smoking?
1) refer to specialist stop smoking service 2) nicotine replacement- gum, patches 3) varenicline- selective partial nicotine receptor agonist- 23% abstinence at 1 yr, start while still smoking 4) bupropion another option

RESP (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions