Pneumothorax csv

Question 1

Definition

Answer 1

Pneumothorax occurs when air gains access to, and accumulates in, the pleural space. It is classified into spontaneous, traumatic, and tension types.

Question 2

Pathophysiology

Answer 2

Air enters the pleural space due to alveolar-pleural defect or trauma, causing lung collapse. In tension pneumothorax, intrapleural pressure exceeds atmospheric pressure, impairing venous return and cardiac output.

Question 3

Epidemiology

Answer 3

Incidence: 24/100,000 annually in men, 10/100,000 in women. Risk factors include smoking, tall and slender body build, and family history. Secondary spontaneous pneumothorax is common in patients with underlying lung disease.

Question 4

History

Answer 4

Symptoms include sudden-onset chest pain, dyspnea, and sometimes cough. Risk factors or a history of lung disease are often present.

Question 5

Examination

Answer 5

Examination findings may include reduced breath sounds, hyper-resonance on percussion, and tracheal deviation in tension pneumothorax.

Question 6

Investigations - Bedside

Answer 6

Clinical assessment, including history and physical examination, is crucial. Needle decompression for tension pneumothorax is urgent.

Question 7

Investigations - Bloods

Answer 7

Blood tests such as full blood count and clotting profile may be needed pre-intervention but are not diagnostic for pneumothorax.

Question 8

Investigations - Imaging

Answer 8

Chest X-ray is the first-line diagnostic tool. CT chest is more sensitive and can detect small pneumothoraces or co-existing conditions.

Question 9

Investigations - Special Tests

Answer 9

Specialized tests like arterial blood gas (ABG) may be required in hypoxic patients. Ultrasound is helpful in trauma settings or where X-ray is not feasible.

Question 10

Management - Conservative

Answer 10

Conservative management includes observation and supplemental oxygen in small, asymptomatic pneumothoraces.

Question 11

Management - Medical

Answer 11

Needle aspiration or chest drain insertion is indicated for symptomatic or large pneumothoraces. High-flow oxygen improves resolution rates.

Question 12

Management - Surgical

Answer 12

Surgical options include video-assisted thoracoscopic surgery (VATS) or thoracotomy with pleurodesis for recurrent or high-risk cases.

Question 13

Risks of Treatments

Answer 13

Procedural risks include infection, bleeding, and recurrence. High-flow oxygen may cause oxygen toxicity in hypercapnic patients.

Question 14

Benefits of Treatments

Answer 14

Symptom relief, improved lung expansion, and reduced recurrence rates with pleurodesis or surgical interventions.

Question 15

Medical and Laboratory Sciences

Answer 15

Chest X-ray and CT findings aid in diagnosis. Biomarkers or laboratory tests play a limited role.

Question 16

Prognosis

Answer 16

Prognosis depends on type and underlying cause. Recurrence rates are high, especially in secondary spontaneous pneumothorax.

Question 17

Complications

Answer 17

Complications include respiratory failure, shock in tension pneumothorax, and surgical morbidity.

Question 18

Differentials

Answer 18

Differentials include pleural effusion, pulmonary embolism, acute asthma, and myocardial ischemia.

Question 19

Cheat Sheet/Buzz Words

Answer 19

Buzzwords: Sudden chest pain, dyspnea, hyper-resonance, tracheal deviation, pleural effusion, tension pneumothorax.