Pneumothorax

Question 1

Pneumothorax

Answer 1

Air in the pleural space

Question 2

Main causes of Pneumothorax

Answer 2

• Spontaneous(rupture of pleural bleb, usually apical,congenital defects in connective tissue ,tall
  thin peope) or due to trauma
• Secondary – COPD, Bronchial Asthma, Ca, lung abscess

Question 3

Localized pneumothorax

Answer 3

if visceral pleura is adherent to parietal pleura

Question 4

Tension pneumothorax

Answer 4

valvular mechanism develops through which air can be sucked into
pleural space during inspiration but not exhaled during expiration → intra pleural pressure
remains positive throughout breathing →lung deflates further → mediastinal shift→ decreased
venous return to heart →decreased cardiac output

Question 5

Presenting Sx of Pneumothorax

Answer 5

Sudden onset unilateral pleuritic pain, progressively increasing SOB

Question 6

Examination findings of pneumothorax

Answer 6

trachea shifts to opposite side, decreased movements of affected side, decreased tactile
vocal fremitus, hyperresonant to percussion, reduced breath sounds

Question 7

Mx of Tension Pneumothorax

Answer 7

immediate aspiration by a thoracotomy

Question 8

Site of thoracotomy

Answer 8

Safety triangle - mid axillary line, anterior axillary fold, 5th ICS

Question 9

significance of safety triangle

Answer 9

no neurovascular bundle. but if messed up may damage the nerve to serratus anterior ( winging of scapula)

Question 10

How to know if the IC tube is working or not

Answer 10

Fluid levels will be swinging and once the patient improves, the swinging will stop. but if it’s continuously swinging ( bronchopleural fistula)

Question 11

How can the trachea deviate to the opposite side

Answer 11

Pneumothorax
Massive Pleural Effusion

Question 12

How can trachea get pulled to the same side

Answer 12

upper lobe fibrosis
upper lobe collapse

Question 13

Physical examination findings of Pneumothorax

Answer 13

Inspection- reduced chest movements on the affected side, hyperinflated chest
Palpation- reduced chest movements of the affected side, Trachea deviated to the opposite side, cardiac apex shifted to the opposite side
Percussion- Hyperresonance, reduced vocal fremitus, reduced vocal resonance
Auscultation- reduced breath sounds

Question 14

Mx of Primary pneumothorax

Answer 14

aspiration if patient breathless or rim of air ›2cm on CXR. IC tube
insertion if recurrent aspiration unsuccessful

Question 15

Mx of secondary pneumothorax

Answer 15

IC tube insertion if pt breathless , ›50 yrs, rim of air ›2cm on CXR or
simple aspiration