Random revision Flashcards
Primary vs secondary pneumothorax
Primary - tall people
Secondary - in someone with lung conditions
Iatrogenic pneumothorax causes
NIV, CVC insertion
What is another cause of pneumothorax
Trauma
How do you manage pneumothorax
If primary and under 2cm - discharge
If over 2cm - chest drain
If secondary and 1-2cm - needle aspiration with 14G needle
if over 2cm - chest drain
Discharge and follow up advice in pneumothorax
F/U in 2 to 4 weeks
Discharge - no air travel until 1 week after and x ray is clear
No scuba diving unless bilateral surgical pleurectomy and normal CT
Complications of chest drain
Immediately- failure, pain, pneumothorax, haemothorax
Later - infection, haematoma, long thoracic nerve palsy
Later than that - scar
What is a flail chest
3 rib fractures which cause asymmetrical breathing - as seen on chest x ray
Manage with analgesia, chest physio and surgical fixation
Pleural effusion - management
21 G needle + 50ml syringe for aspiration
If the contents are cloudy or if the pH of the contents are less than 7.2 with suspected infection, insert a chest drain.
Treat underlying cause
What do you do with the pleural effusion aspirate
Check:
Protein level - raised above 30g/L in exudative causes
LDH (marker of cell damage) - raised in exudative causes
pH
Send for MC&S
Glucose - if low - RA or TB
Blood - TB, PE or mesothelioma
Amylase - raised in pancreatitis or oesophageal perforation
What criteria do you use to tell you if this is transudative or exudative if the protein isn’t above 30g/L exactly?
Light’s criteria:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
How do you treat recurrent pleural effusion?
Pleurodesis
Repeat aspirations
SOB drugs
Indwelling pleural catheter
What is pleurodesis
Where a drug is put into the lung pleura space to obliterate it so that nothing collects there
How would you differentiate between cancer vs infective cause of pleural effusion?
Lymphocytes - malignancy (chronic)
Neutrophils mainly - infection (acute)
How do you differentiate between tension pneumothorax and simple pneumothorax?
Tension pneumothorax - hypotension and SOB, tracheal deviation
Simple pneumothorax - pleuritic chest pain
How do you deal with a tension pneumothorax?
14G needle immediately, second intercostal space - skip the cxr
Where do you insert the needle for the tension pneumothorax?
You go ABOVE the THIRD rib, MCL, to avoid the nerve, artery, vein bundle that runs UNDER The ribs
(always aim high, above, over)
Cystic fibrosis - symptoms / other conditions
Aspergillus - ABPA
Bronchiectasis
Chest infections
Clubbing
Cirrhosis - jaundice
Diarrhoea / constipation
Diabetes mellitus
Meconium ileus
Malabsorption
Male sterility
Nasal polyps / sinusitis
What is the most common gene mutation for CF?
F508, class 2 mutation aka incorrect folding of the CFTR protein
more than 900 gene mutations
What is the problem with CF?
CF transmembrane conductance regulator, a cAMP dependent chloride channel, chromosome 7
Investigations for CF
Sweat test - NaCl high in sweat, over 60
Guthrie heel prick test for Immunoreactive trypsinogen
CXR
What do you see on CXR on someone with CF?
