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Respiratory > Pneumothorax and pulmonary embolism > Flashcards

Pneumothorax and pulmonary embolism Flashcards

1
Q

Give 8 risk factors for primary spontaneous pneumothorax

A 
Smoking
Tall, slim build
Male
Asian ethnicity
Marfan syndrome
Family history
Diving
Flying
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2
Q

What is the definition of primary spontaneous pneumothorax?

A

Spontaneous pneumothorax occurring in the absence of underlying lung disease

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3
Q

What is the definition of secondary spontaneous pneumothorax?

A

Spontaneous pneumothorax occurring in the presence of underlying lung disease

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4
Q

What causes a catamenial pneumothorax?

A

Endometriosis of the pleura

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5
Q

What is the gold standard investigation for pneumothorax?

A

CT

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6
Q

What should be checked before insertion of a chest drain?

A

Coagulation profile

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7
Q

What do ALL patients require after intervention for pneumothorax?

A

Repeat CXR

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8
Q

What is the first line management of a tension pneumothorax?

A

14G cannula into 2nd intercostal space, mid-clavicular line

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9
Q

How is the size of a pneumothorax determined on CXR?

A

Measure interpleural distance at level of the hilum

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10
Q

What is the first line management of a breathless patient with a 1cm primary spontaneous pneumothorax?

A

Aspirate with a 16-18G cannula

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11
Q

What is the first line management of a patient with a 3cm primary spontaneous pneumothorax?

A

Aspirate with a 16-18G cannula

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12
Q

What is the first line management of a non-breathless patient with a 1cm primary spontaneous pneumothorax?

A

Consider discharge and review in outpatient department in 2-4 weeks

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13
Q

What is the next line of management of a patient with a 3cm primary spontaneous pneumothorax whose symptoms are not improved by aspiration?

A

Admit to hospital

Insert 8-14Fr chest drain

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14
Q

What is the first line management of a breathless patient with a 1cm secondary spontaneous pneumothorax?

A

Admit to hospital

Insert 8-14Fr chest drain

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15
Q

What is the first line management of a non-breathless patient with a 1cm secondary spontaneous pneumothorax?

A

Aspirate with a 16-18G cannula

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16
Q

What is the first line management of a non-breathless patient with a 0.5cm secondary spontaneous pneumothorax?

A

Admit to hospital
High flow oxygen
Observe for 24 hours

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17
Q

What is the next line of management of a patient with a 1.5cm secondary spontaneous pneumothorax which is 1.2cm after aspiration?

A

Admit to hospital

Insert 8-14Fr chest drain

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18
Q

Where should a chest drain be inserted?

A

Mid-axillary line, 5th intercostal space (triangle of safety)

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19
Q

What are the borders of the safe triangle?

A

Lateral edge of pectoralis major
Lateral edge of latissimus dorsi
5th intercostal space
Top of axilla

20
Q

What intervention for recurrent pneumothorax has the lowest recurrence rate?

A

Open thoracotomy and pleurectomy

21
Q

What is the advantage of video-assisted thoracoscopic pleurectomy in management of recurrent pneumothorax?

A

Lower morbidity

22
Q

Give 6 indications for referral to surgery for pneumothorax

A 
First contralateral pneumothorax
Second ipsilateral pneumothorax
Bilateral spontaneous pneumothorax
High-risk occupation
Pregnancy
Persistent air leak despite chest drain
23
Q

When can someone fly after a pneumothorax?

A

1 week post check CXR

24
Q

What advice should be given to divers after pneumothorax?

A

Avoid diving indefinitely until definitive bilateral pleurectomy AND post-op CT and lung function tests

25
Q

Give 7 NICE major risk factors for pulmonary embolism

A 
DVT
Previous VTE
Active cancer
Surgery within the last 2 months
Significant immobility
Lower limb trauma or fracture
Pregnancy or up to 6 weeks postpartum
26
Q

Give 8 NICE non-major risk factors for pulmonary embolism

A 
Obesity (BMI>30)
Age 60+
COCP use
One or more significant medical comorbidities
Thrombophilia
Long distance sedentary travel
Varicose veins
Superficial venous thrombosis
27
Q

Which 2 factors score 3 points each on the Wells score?

A

Signs of DVT

PE is most likely or equally likely diagnosis

28
Q

Which 4 factors score 1.5 points each on the Wells score?

A

Tachycardia
Previous VTE
Surgery in the last 4 weeks
Immobilisation for 3+ days

29
Q

Which 2 factors score 1 point each on the Wells score?

A

Malignancy with treatment in the last 6 months or palliative treatment
Haemoptysis

30
Q

What kind of chest pain is associated with a pulmonary embolism or pneumothorax?

A

Pleuritic

31
Q

Give 4 red flag symptoms for a massive pulmonary embolism

A

Syncope
Elevated JVP
Hypotension
Right parasternal heave

32
Q

Give 4 ECG changes that might be associated with a pulmonary embolism

A

Sinus tachycardia
Right axis deviation
Right bundle branch block
S1Q3T3 pattern

33
Q

What is the definition of an unprovoked pulmonary embolism?

A

No proven risk factor in the previous 3 months

34
Q

What is the appropriate management: possible pulmonary embolism, Wells score 4.5 or above?

A

CT pulmonary angiogram

35
Q

What is the appropriate management: possible pulmonary embolism, Wells score 4 or below?

A

D-dimer

36
Q

Give 4 things that can cause a raised D-dimer

A

Disseminated intravascular coagulation
Deep vein thrombosis
Pulmonary embolism
Inflammation

37
Q

What is the disadvantage of a V/Q scan over a CTPA in pregnant women?

A

More radiation given to child

38
Q

What is the disadvantage of a CTPA over a V/Q scan in pregnant women?

A

More radiation to mother’s breasts which are more sensitive to radiation in pregnancy

39
Q

What should be done to exclude malignancy in patients under 40 with an unprovoked pulmonary embolism?

A

CXR
Urinalysis
Full set of bloods

40
Q

What should be done to exclude malignancy in patients over 40 with an unprovoked pulmonary embolism?

A

CXR
Urinalysis
Full set of bloods
CT chest/abdomen/pelvis

41
Q

Apart from excluding malignancy, what should be checked in ALL patients with an unprovoked pulmonary embolism?

A

Antiphospholipid antibodies

42
Q

When should patients with an unprovoked pulmonary embolism be tested for hereditary thrombophilia?

A

If they have a first degree relative with a VTE history

43
Q

When should the PERC criteria be considered when ruling out a PE without a d-dimer?

A

Wells score below 3

44
Q

What are the 8 PERC criteria that must NOT be present for a PE to be ruled out?

A 
Age 50+
HR 100+bpm
Previous VTE
Surgery or trauma in the past 4 weeks
Haemoptysis
Exogenous oestrogen
O2 sats <95%
Unilateral leg swelling
45
Q

Which ECG finding is the most commonly seen finding in a pulmonary embolism?

A

Sinus tachycardia

Respiratory (6 decks)

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