Pleurisy - 105

Question 0

What is the difference between a transudate and exudate?

Answer 0

Transudate - clear, low protein content. Causes include left sided heart failure & hypothyroidism
Exudate - cloudy, high protein content. Suggestive of inflammation. Causes include pneumonia, Tb, cancer (infection or malignancy)

Question 1

A young, tall, thin, male smoker has sudden onset of chest pain. What is a likely cause?

Answer 1

Pleural bleb

Question 2

What is the size difference between a small and large pneumothorax?

Answer 2

2cm.

Question 3

How would you treat a small pneumothorax? (<2cm)

Answer 3

You wouldn’t normally.

Question 5

Where would you insert a chest drain?

Answer 5

4th/5th intercostal space, mid-axillary line. Above rib to miss intercostal vessels and nerves

Question 6

Where would you insert the needle to relieve a tension pneumothorax?

Answer 6

2nd intercostal space, mid-clavicular line. - Needle Thoracentesis

Question 7

Where would the perfect VQ ratio be?

Answer 7

At the base of the lungs.

Question 8

What is the definition of Simple Pneumothorax & what are the causes?

Answer 8

Intrapleural pressure = atmospheric pressure
causes: # spontaneous - pleural bleb (usually apical in young tall & thin) and lung disease (eg COPD)
# Trauma - open (chest wall puncture) and closed (rib puncture)
# Iatrogenic

Question 9

What is the definition of Tension Pneumothorax & what is the cause?

Answer 9

Intrapleural pressure > Atmospheric pressure

cause: progressive build-up of air within the pleural space (one way valve)

Question 10

what are the signs of simple pneumothorax?

Answer 10

increase heart rate and respiratory rate. Hypoxia/cyanosis. No tracheal deviaiton

Question 11

what are the signs of tension pneumothorax?

Answer 11

collapsed lung, mediastinum shifts from affected side, tracheal deviation, crushes other lung and heart, occludes vena cavaand increased JVP

Question 12

What are the signs/symptoms of a pleural effusion?

Answer 12

#physical signs - reduced chest wall movement on affected side, mediastinal displacement away from the PE, stony dull on percussion and reduced sounds/vibrations on auscultation/fremitus
#radiological signs - reduced costophrenal angle and shadows

Question 13

what is the Inspiratory Reserve Volume (IRV)?

Answer 13

volume of air breathed in by max inspiration after normal inspiration

Question 14

what is tidal volume?

Answer 14

volume of normal breathing

Question 15

what is inspiratory capacity?

Answer 15

tidal volume + inspiratory reserve volume

Question 16

what is the Expiratory reserve volume

Answer 16

volume breathed out in max expiration after normal expiration

Question 17

what is vital capacity?

Answer 17

tidal volume + inspiratory reserve volume + expiratory reserve volume

Question 18

what is the residual volume?

Answer 18

the volume left in the lungs after max expiration

Question 19

what is the functional residual capacity?

Answer 19

the volume left in the lungs after normal respiration

Question 20

what is dead space, anatomical dead space and pathological dead space?

Answer 20

#area with no perfusion
#respiratory airways - trachea, bronchi to the terminal bronchioles
#eg. bullae

Question 21

what is the alveolar gas equation?

Answer 21

PAO2=PIO2-(PaCO2/RER)
PAO2=Alveolar pp of O2
PIO2=pp of O2 in inspired air
PaCO2=Arterial pp of CO2
RER=Resp echange rate ~8