Resp - Pneumothorax

Question 1

Definition of pneumothorax

Answer 1

-Accumulation of air in pleural space secondary to lung collapse

Question 2

Outline the pneumothorax classification

Answer 2

• Closed: intact chest wall, air leaks from lung into pleural cavity
• Open: defect in chest wall allows communication between pleural space and exterior
• Tension: air enters pleural cavity through 1 way valve and cannot stable —> mediastinal compression

Question 3

Causes (3) + examples of pneumothorax

Answer 3

• Spontaneous: no underlying disease (young thin men) OR underlying disease (COPD, Marfan’s, Ehler’s Danlos, pulmonary fibrosis, sarcoidosis)
• Trauma: rib fracture
• Iatrogenic: positive pressure ventilation, liver biopsy

Question 4

Symptoms of pneumothorax

Answer 4

• Sudden onset
• dyspnea
• pleuritic chest pain
• tension pneumothorax: respiratory distress, cardiac arrest

Question 5

Signs of pneumothorax

Answer 5

• Decreased chest expansion
• Resonant percussion
• Decreased breath sounds
• Tension PT: raised JVP, mediastinal shift, raised HR, low BP
• Crepitus: surgical emphysema

Question 6

Ix of pneumothorax

Answer 6

• ABG
• US
• CXR: collapse/translucent lung spaces, mediastinal shift (away), surgical emphysema, cause (rib fracture, bullae)

Question 7

Mx- Tension pneumothorax

Answer 7

• Resuscitate pt
• no CXR
• Large bore venflon 2nd ICS, mid-clavicle are line
• Insert ICD

Question 8

Mx- traumatic pneumothorax

Answer 8

• Resuscitate pt
• analgesia (morphine)
• 3 sided wet dressing (if sucking)
• insert ICD

Question 9

Pleural effusion: causes for exudate and transudates

Answer 9

1. Exudates: increased capillary permeability
   - Infection: pneumonia/TB
   - Neoplasm: bronchial, lymphoma, mesothelioma
   - Inflammation: RA/SLE
   - Infection
2. Transudates: increase in capillary hydrostatic or loss of oncotic pressure
   - Cardiac congestive failure
   - Renal failure
   - liver failure
   - hypothyroidism

Question 10

Pleural effusion: symptoms

Answer 10

• asymptomatic
• dyspnea
• pleuritic chest pain

Question 11

Pleural effusion: signs

Answer 11

• Tracheal deviation away from effusion
• Decreased expansion and air entry
• Stony dill percussion
• Bronchial breathing such above effusion
• look for signs of associated disease: Ca (cachexia, clubbing, lymph nodes), chronic liver disease, cardiac failure

Question 12

Pleural effusion: Ix

Answer 12

• Blood: FBC, U+E, LFT, TFT, ESR, look for Ca
• CXR: blunt costophrenic angles, mediastinal shift away, cardiomedialy (cause)
• US: used for tapping effusion
• CT
• Diagnostic tap: send for chemistry, bacteriology, cytology and immunology

Question 13

Pleural effusion: Mx

Answer 13

• Rx underlying cause
• May used drainage if symptomatic
• Persistent effusions may need surgery