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1
Q

what is a pneumothorax

A

air in the pleural space

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2
Q

pneumothorax classification based on causes

A

a) primary: tall, thin, young healthy male smoker
b) secondary: pre-existing condition (COPD, asthma, CF)
c) traumatic

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3
Q

pneumothorax symptoms

A

SOB
pleuritic chest pain

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4
Q

pneumothorax signs

A
  • hyper-resonant
  • reduced chest expansion
  • reduced breath sounds
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5
Q

tension pneumothorax presentation

A
  • trachea deviates away from the lesion
  • tachycardia, hypotension, respiratory distress
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6
Q

pneumothorax investigations

A
  • chest x-ray: black
  • CT CAP if trauma
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7
Q

primary pneumothorax management

A

< 2cm: observe and discharge
> 2cm: needle aspiration, chest drain if unsuccessful

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8
Q

secondary pneumothorax management

A

< 2cm: needle aspiration, chest drain if unsuccessful
> 2cm: chest drain
< 1cm: oxygen and observe

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9
Q

tension pneumothorax management

A

emergency do not investigate!!

i. needle decompression (5th ICS) + oxygen
-> open thoracostomy in trauma
ii. chest drain + analgesia after decompression

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10
Q

recurrent or persistent pneumothorax treatment

A

VATS (cardiothoracic referral)

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11
Q

how to check chest drain is in pleural cavity

A

water rises on inspiration, falls on expiration

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12
Q

most common community acquired pneumonia

A

streptococcus pneumoniae (+ve)

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13
Q

community acquired pneumonia associated with COPD

A

haemophilus influenza (-ve)

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14
Q

community acquired pneumonia associated with IVDUs

A

staphylococcus aureus (+ve)

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15
Q

community acquired pneumonia associated with recent flu

A

staphylococcus aureus

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16
Q

community acquired pneumonia associated with alcoholics

A

klebsiella (-ve)

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17
Q

mycoplasma pneumonia associations and presentation

A

young uni students
atypical (dry cough, haemolytic anaemia)

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18
Q

legionella pneumophilia associations and presentation

A

airconditioning
atypical (hyponatraemia)

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19
Q

community acquired pneumonia associated with HIV

A

pneumocystis jirovecii

20
Q

most common hospital acquired pneumonia

21
Q

pneumonia associated with bronchiectasis

A

pseudomonas aeruginosa, haemophilus

22
Q

pneumonia symptoms

A

cough with productive green sputum
pleuritic chest pain
SOB
fever, rigours

23
Q

pneumonia signs

A

reduced chest expansion
coarse crackles
dull percussion
increased vocal resonance

24
Q

pneumonia investigations

A
  • Bedside: sputum sample
  • Bloods: FBC, U&Es, LFTs, CRP, culture, ABG
  • CXR: consolidation
  • Special: pleural fluid MCS
25
Q

pneumonia severity score

A

CURB-65
confusion
urea >7
RR >30
Blood pressure < 90 systolic
65 or older

26
Q

pneumonia management

A

CURB 0-1: outpatient amoxicillin
CURB 2: admit with amoxicillin + clarithromycin
CURB 3: admit with coamoxiclav + clarithromycin

-> amoxicillin covers typical
-> clarithromycin covers atypical

27
Q

aspiration pneumonia antibiotic

A

metronidazole

28
Q

MRSA pneumonia management

A

IV vancomycin

29
Q

pneumonia management if penicillin allergy

A

doxycycline

30
Q

pneumonia management for staphylococcus aureus

A

flucloxacillin + amoxicillin

31
Q

aspiration pneumonia causes

A

intubation, surgery
swallowing difficulty (MS)
-> commonly affects right lobe

32
Q

pseudomonas pneumonia management

A

IV gentamycin

33
Q

additional medication for pneumonia patient with COPD

A

give prednisolone

34
Q

pneumonia complications

A
  • infection spread: effusion, sepsis, empyema (staph associated with abscess)
  • structural: bronchiectasis, pneumothorax
35
Q

pneumonia follow up test

A

CXR 6 weeks after

36
Q

first line antibiotic for hospital acquired pneumonia (>48hrs hospital)

A

co-amoxiclav

37
Q

what is bronchiectasis

A

irreversible bronchi dilatation

38
Q

congenital causes of bronchiectasis

A
  • cystic fibrosis (most common)
  • Kartagener’s syndrome (bronchiectasis, inverted heart, sinusitis, infertility)
39
Q

infective causes of bronchiectasis

A
  • TB (most common worldwide)
  • ABPA
40
Q

bronchiectasis symptoms

A
  • chronic productive cough
  • copious amounts of white sputum
  • haemoptysis
  • SOB
41
Q

bronchiectasis signs

A
  • clubbing
  • coarse crackles
42
Q

bronchiectasis investigations

A

Bedside:
- sputum MCS (pseudomonas, haemophilus)
Bloods:
- routine bloods
- serum IgE (IgE + eosinophils -> ABPA)
Imaging:
- first line: CXR tram-lines
- diagnostic: HRCT chest signet rings
Special:
- genetic testing
- CF test

43
Q

bronchiectasis management

A
  • airway clearance with physiotherapy
  • surgery if localised
44
Q

bronchiectasis recurrent infections prophylaxis

A

azithromycin

45
Q

bronchiectasis CXR sign

A

tram-track lines

46
Q

bronchiectasis HRCT chest sign

A

signet rings

medicine can be fun (12 decks)

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