Pneumothorax

Question 1

What is primary pneumothorax?

Answer 1

spontaneous pneumothorax

Question 2

What classic patient ‘type’ does pneumothorax present in?

Answer 2

young, tall, slim men

Question 3

What is often the cause of primary pneumothorax?

Answer 3

rupture of a pleural bled (thin walled air containing space thought to be congenital defects in the connective tissue of the alveolar walls)

Question 4

What is secondary pneumothorax?

Answer 4

pneumothorax occurring in conjunction with pre-existing lung diseases such as COPD, infection or cystic fibrosis OR iatrogenic causes such as instrumentation of the thorax

Question 5

Give 4 clinical presentations associated with simple pneumothorax:

Answer 5

1) sudden onset chest pain (unilateral)
2) sudden onset breathlessness
3) shock
4) similar symptoms in the past but not sought medical attention

Question 6

What is imaging technique is used to diagnose pneumothorax?

Answer 6

plain X-ray (assess the pleura to edge lung distance

Question 7

When would a CT scan be used to investigate pneumothorax?

Answer 7

if the thorax remains abnormal following resolution of the pneumothorax

Question 8

Describe the affect recreational drug use has on pneumothorax risk:

Answer 8

drugs like cannabis cause bullae and associated emphysema, therefore increasing pneumothorax risk

Question 9

When would observation/ monitoring be used to manage pneumothorax?

Answer 9

for patients with mild symptoms and a pneumothorax of <2cm

Question 10

Give 3 pieces of discharge advice given to those recovering from a recent pneumothorax:

Answer 10

1) do not fly
2) do not go diving
3) stop smoking

Question 11

When would aspiration be used to manage pneumothorax?

Answer 11

for symptomatic patients with a pneumothorax of >2cm

Question 12

Give 3 pieces of equipment used in lung aspiration for pneumothorax?

Answer 12

1) French gauge needle
2) three-way tap
3) 50mL syringe

Question 13

True or false: aspiration is used in treatment of traumatic pneumothorax

Answer 13

false - aspiration is contraindicated in traumatic pneumothorax

Question 14

What imaging is used to assess lung reinflation in pneumothorax treatment?

Answer 14

repeat chest X-ray

Question 15

When is a pleural intercostal drain used to treat pneumothorax? (3)

Answer 15

1) if aspiration fails to inflate the lungs
2) the patient is very breathless
3) patient has tension pneumothorax

Question 16

Where should a pleural intercostal drain be inserted?

Answer 16

mid-axillary line in the 4th intercostal space

Question 17

Describe how a pleural intercostal drain works?

Answer 17

a tube is inserted into the mid-axillary line, 4th intercostal space which is connected to an underwater drain or bottle which are kept below the level of the patient’s chest

Question 18

What is pleurodesis?

Answer 18

Artificial production of adhesions between the parietal and visceral pleura, usually done with a chemical sclerosing agent, such as talc or doxycycline

Question 19

What is a ‘recurrent’ pneumothorax defined as?

Answer 19

any case where pneumothorax has occurred more than once

Question 20

What is a potential complication associated with lung aspiration or chest drain?

Answer 20

re-expansion pulmonary oedema (sudden re-expansion leads to fluid in lung parenchyma for unknown reason)

Question 21

What is tension pneumothorax?

Answer 21

severe pneumothorax involving displacement of the mediastinal structures and haemodynamic compromise often cause by trauma creating a one-way parenchymal flap

Question 22

Give three findings associated with pneumothorax that may be found in a full respiratory examination:

Answer 22

1) affected lung is hyper-resonant on percussion
2) tracheal deviation AWAY from the affected side
3) auscultation-reduced breath sounds

Question 23

Describe the pathophysiology of pneumothorax:

Answer 23

alveolar and atmospheric pressure is greater than intrapleural pressure meaning any connections between alveoli and pleural space will lead to air moving down a pressure gradient, increasing intrapleural pressure, compressing the lung