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Respiratory (LECTURE NOTES) > Pneuomothorax and pleural effusion > Flashcards

Pneuomothorax and pleural effusion Flashcards

1
Q

What is a pneumothorax

A

The presence of air in the pleural space

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2
Q

What is a primary pneumothorax

A

Where a pneumothorax has occured spontaneously without evidence of other lung disease

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3
Q

What is a secondary pneumothorax

A

Where a pneumothorax has occurred secondary to an underlying lung disease such as COPD or CF

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4
Q

Who is likely to present with a spontaneous primary pneumothorax

A

Healthy young, tall, thin man

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5
Q

Where do most pneumothoraces arise from

A

The rupture of subpleural blebs or bullae at the apex of an otherwise normal lung

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6
Q

Is smoking a risk factor for a pneumothorax

A

Yes

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7
Q

What is a tension pneumothorax

A

Where the lung is pushed down , the mediastinum is shifted to the opposite side and the venous return tot he heart and cardiac output is impaired

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8
Q

What is a key finding on a CXR of a tension pneumothorax

A

The trachea is deviated to one side

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9
Q

How does a traumatic pneumothorax occur

A

Puncture of the lung by a fractured rib

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10
Q

How might a Iatrogenic pneumothorax occur

A

Doctor induced - complication of invasive chest procedures such as the insertion of a catheter into the subclavian vein or during lung aspiration

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11
Q

WHat are the 2 most common clinical features of a pneumothorax

A

Acute pleuritic pain and breathlessness

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12
Q

What are the clinical signs of a pneumothorax

A

Reduced breath sounds and hyper-resonance on the side of the pneumothorax

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13
Q

What can be seen on a CXR of a pneumothorax

A

Black space with no lung markings

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14
Q

What are the limits of a small pneumothorax

A

Where the rim of air between the margin of the collapsed lung and chest wall is less than 2cm

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15
Q

What defines a large pneumothorax

A

Where the rim of air between the margin of the collapsed lung and chest wall is more than 2cm

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16
Q

What should be done for a small pneumothorax

A

Nothing - will resolve spontaneously

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17
Q

When is aspiration appropriate and where is this performed?

A

In a large pneumothorax

Second intercostal space in the mid-clavicular line

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18
Q

What is indicated if more than 2.5L of air has been aspirated

A

A persistent air leak from the lung

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19
Q

What does bubbling on respiration or coughing indicate

A

Continued drainage of air

20
Q

When is surgical intervention required

A

For persistent or recurrent peumothoraces

21
Q

What is involved in a pleurectomy

A

Removal of the parietal pleura

22
Q

What is involved in a pleurectomy

A

Removal of the parietal pleura

23
Q

What is a pleural effusion

A

A collection of fluid in the pleural space

24
Q

What is the parietal pleura perfused by

A

The systemic circulation

25
Q

What is the visceral pleura perfused by

A

The pulmonary circulation

26
Q

Why does fluid not normally collect in the pleural space

A

The balance between fluid filtration by the parietal pleura and fluid absorption by the visceral pleura prevents this

27
Q

What might cause the development of a pleural effusion

A

Increased capillary pressure
Reduced plasma oncotic pressure
Increased capillary permeability
obstruction of lymphatic drainage

28
Q

What do patients most commonly present with when they have a pleural effusion

A

Dyspnoea
Sometimes pleuritic pain
Often features of associated disease (cardiac faulrue or carcinoma)

29
Q

What are the signs fo pleural effusion

A

Decreased expansion on the side of the effusion
STONY DULLNESS
diminished breath sounds
reduced tactile vocal fremitus

30
Q

What are the investgiations involved in diagnosing a pleural effusion

A

CXR: dense white shadow with a concave upper edge
Ultrasound: helpful in localising loculated eddusions and in positioning chest tubes
CT: helpful in detecting pleural tumours and in assessing the underlying lung and mediastinum
Pleural fluid aspiration: this is the key initial investigation

31
Q

What indicate that the effision is an exudate

A

A protein level of more than 30 and a lactate dehydrogenase level of more than 200

32
Q

What does a blood stained aspirate point towards

A

Malignancy, pulmonary infarction or severe inflammation

33
Q

What does pus indicate

A

Empyema

34
Q

What does milky white fluid suggest

A

A chylothorax

35
Q

What is suggestive of a haemothorax

A

Frank blood

36
Q

What are the predominant cells in acute inflammation or infection

A

Neutrophils

37
Q

What are the cells found in chronic effusions particularly caused by TB or malignancy

A

Lymphocytes

38
Q

What is radiologically guided biopsy is particularly useful in diagnosing?

A

Malignant disease of the pleura

39
Q

What are the 4 main causes of transudative pleural effusions

A

Cardiac failure
renal failure
hepatic cirrhosis
hypoproteinaemia (malnutrition or nephrotic syndrome)

40
Q

What relieves dyspnoea

A

Drainage of the fluid by needle aspiration or intercostal chest tube

41
Q

How is an empyema produced

A

A secondary infection of an effusion with multiplication of bacteria in the pleural space (pus in the pleural cavity)

42
Q

What is the initial antibiotic treatment for empyema

A

Co-amoxiclav with metronidaxole

43
Q

What is the key treatment for empyema?

A

Drainage of the pus

44
Q

What do connextive tissue diseases that are associated with effusions characteristically have

A

A low glucose content

45
Q

What is Dressler’s syndrome ?

A

It consists of inflammatory pericarditis and pleurisy of uncertain aetiology following an MI or cardiac operation (4-6 weeks after)

46
Q

What is an unusual cause of a pleural effusion but is a medical emergency

A

Rupture of the oesophagus

Respiratory (LECTURE NOTES) (19 decks)

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