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Finals Revision Flashcards > Resp - Pneumothorax, Pleural Effusion, Pneumonia, Pulmonary HTN, Sarcoidosis, PE > Flashcards

Resp - Pneumothorax, Pleural Effusion, Pneumonia, Pulmonary HTN, Sarcoidosis, PE Flashcards

1
Q

Pneumothorax - what is it?

A

Pneumothorax - is when air gets in the pleural space separating the lung from the chest wall

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2
Q

Pneumothorax - what are 4 causes?

A
  1. Spontaneous
  2. Trauma
  3. Iatrogenic e.g. lung biopsy
  4. Pathology - infection, COPD
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3
Q

Pneumothorax - what is the investigation of choice?

A

Erect chest x-ray

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4
Q

Pneumothorax - what would you see on a chest x-ray?

A

Area between lung tissue and chest wall with no lung markings

Line demarcating lung edge, where lung markings end and pneumothorax begins

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5
Q

Pneumothorax - what is the stepwise management?

A
  1. No SoB, <2cm rim of air on CXray - no treatment, resolve by itself, reassess in 2-4 weeks
  2. If SoB, >2cm rim of air on CXray - aspiration and reassess
  3. If aspiration fails twice - CHEST DRAIN
  4. Unstable patients or bilateral or secondary pneumothoraces - CHEST DRAIN
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6
Q

Pneumothorax - what is a tension pneumothorax?

A

Tension pneumothorax caused by trauma to chest wall creating one way valve:

Air can get into pleural space during inspiration
Air can’t escape during expiration

So more air drawn into pleural space with each breath, can’t escape, pressure builds inside mediastinum, pushes mediastinum across (away from TP), kinks big vessels, can cause cardiorespiratory arrest

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7
Q

Pneumothorax - signs of tension pneumothorax on examination and obs?

A

Reduced air entry to affected side

Tachycardic

Hypotension

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8
Q

Pneumothorax - what would a tension pneumothorax show on XRAY?

A

Tracheal deviation away from pneumothorax side

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9
Q

Pneumothorax - management of tension pneumothorax?

A

Insert a large bore cannula into the second intercostal space in the midclavicular line

Once pressure is relieved with cannula, do chest drain fro definitive management

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10
Q

Pleural effusion - what is it?

A

Collection of fluid in pleural cavity

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11
Q

Pleural effusion - what are the two types of fluid it can be?

A

Exudative - high protein count >3g/dL

Transudative <3g/dL

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12
Q

Pleural effusion - what are exudative causes?

A

Exudative causes related to inflammation

Inflammation results with protein leaking out of tissues into pleural space

‘EX’udative - meaning moving out

Lung cancer
Pneumonia
Rheumatoid A
TB

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13
Q

Pleural effusion - what are transudative causes?

A

Transudative causes relate to fluid moving into the pleural space

‘TRANS’udative - meaning moving across

Congestive Cardiac Failure
Hypothyroidism
Hypoalbuminaemia - liver disease, less protein in blood so reduced oncotic pressure, so fluid moves out of blood vessels as oncotic pressure from albumin (protein), isn’t there to keep fluid in

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14
Q

Pleural effusion - what are the symptoms?

A
  1. SoB
  2. Pleuritic pain
  3. Non-productive cough
  4. Extra-pulmonary symptoms depending on underlying cause e.g. weight loss in malignancy
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15
Q

Pleural effusion - what are the signs?

A

Stony dull percussion over effusion

Reduced breath sounds

Tracheal deviation away from effusion if massive (>1000ml)

Reduced chest expansion

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16
Q

Pleural effusion - what imaging do you do and what do you see?

A

Chest X-Ray

Blunting of costophrenic angles
Meniscus if big effusion
Fluid in lung fissures
Tracheal deviation away from effusion

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17
Q

Pleural effusion - what other investigation can you do?

A

Pleural paracentesis and analysis

Analyse for protein count, pH, glucose, lactate dehydrogenase, microbiology testing

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18
Q

Pleural effusion - management

A

Should be directed towards underlying cause

  1. Small effusion - conservative management may be appropriate, as may resolve by fixing underlying cause
  2. Large effusion - pleural aspiration, effusion may recur, may need to repeat aspiration
  3. Chest drain - used to drain effusion and prevent it recurring
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19
Q

Pneumonia - what is it?

A

Infection of the lung tissue

Causes inflammation of lung tissue and sputum filling the airways and alveoli

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20
Q

Pneumonia - what are the three classifications of pneumonia?

A

COMMUNITY ACQUIRED PNEUMONIA - pneumonia developed outside of hospital

HOSPITAL ACQUIRED PNEUMONIA - develops >48 hours after hospital admission

ASPIRATION PNEUMONIA - develops as a result after inhaling foreign material

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21
Q

Pneumonia - what is the presentation?

A 
SoB
Productive cough
Fever
Haemoptysis
Pleuritic chest pain
Confusion
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22
Q

Pneumonia - what are the signs (obs)?

A 
Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion

These obs can indicate sepsis secondary to pneumonia

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23
Q

Pneumonia - what are the signs on chest examination?

A

Bronchial breath sounds - heard on inspiration and expiration

Focal coarse crackles - this is the sound of air passing through the sputum

Dullness to percussion

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24
Q

Pneumonia - CRB65 and CURB65

A

CRB65 out of hospital

CURB65 in hospital

In CRB65, if score is anything other than 0, consider referral to hospital

Score predicts mortality, used to help guide whether to admit patient to hospital

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25
Pneumonia - what are the parameters of CURB65?
``` C - confusion U - urea >7 R - resp rate >30 B - <90 systolic <60 diastolic 65 - age >65 ```
26
Pneumonia - CURB65 scores
0/1 - consider home treatment >2 consider hospital admission >3 consider ICU assessment
27
Pneumonia - common causes
50% streptococcus pneumoniae | 20% haemophilus influenzae
28
Pneumonia - what two headings can community acquired pneumonia be divided into, and what are the features of each?
Typical - classical symptoms Atypical - insidious onset - extrapulmonary symptoms - caused by an organism that can't be cultured in the normal way or detected using gram stain - don't respond to penicillins - treated with macrolides, tetracyclines
29
Pneumonia - investigations and diagnosis
``` Bedside: Obs Sputum sample Urinary sample ECG ``` ``` Bloods: FBC U&Es CRP Blood cultures ``` Imaging: Chest X-ray
30
Pneumonia - management of CAP
Always follow local area guidelines CAP: Mild - 5 day course oral amoxicillin or macrolide (if allergic to pencillin) Moderate - 7 to 10 day course of dual antibiotics, amoxicillin and macrolide (Doxycycline if allergic to penicillin) Severe - IV co-amoxiclav and a macrolide, 7-10 days, may be extended to 14-21
31
Pneumonia - management of HAP
Follow local area guidelines Mild - co-amoxiclav 625mg TDS Severe - IV Tazocin 4.5g TDS
32
Pulmonary HTN - what is it?
It is increased resistance and pressure of blood in the pulmonary arteries, which causes strain on the right side of the heart trying to pump blood through lungs Causes a back pressure of blood into systemic venous system
33
Pulmonary HTN - what are the causes?
COPD SLE PE Sarcoidosis
34
Pulmonary HTN - what is main presenting symptom?
SoB
35
Pulmonary HTN - what are the signs?
Raised JVP Hepatomegaly Peripheral oedema Tachycardia
36
Pulmonary HTN - Investigations
ECG Chest X-Ray Echo - used to estimate pulmonary artery pressure
37
Pulmonary HTN - what changes do you see on the ECG?
Right ventricular hypertrophy Right axis deviation Right bundle branch block
38
Pulmonary HTN - what changes do you see on Chest X-Ray?
Dilated pulmonary arteries Right ventricular hypertrophy
39
Pulmonary HTN - management of primary pulmonary HTN
Treating underlying cause like SLE or PE IV prostanoids - epoprostenol Endothelin receptor antagonists (potent vasoconstrictor of vascular smooth muscle) - macitentan Phosphodiesterase -5 inhibitors - sildenafil
40
Sarcoidosis - what is it?
It is a granulomatous inflammatory condition Usually chest symptoms, but has multiple extra-pulmonary manifestations
41
Sarcoidosis - what are granulomas?
Granulomas are nodules of inflammation full of macrophages
42
Sarcoidosis - what is the cause of these granulomas?
Cause of granulomas developing is unknown
43
Sarcoidosis - what is the typical incidence?
Young adulthood Again aged round 60
44
Sarcoidosis - what is the classic 'exam' patient
20-40 year old black woman presenting with dry cough and SoB, may have nodules on shins
45
Sarcoidosis - what organs are affected?
Can affect almost any organ in the body: ``` Lungs (90%) Heart Eyes Skin Kidneys Bones CNS/PNS ```
46
Sarcoidosis - how are lungs affected?
1. Mediastinal lymphadenopathy 2. Pulmonary fibrosis 3. Pulmonary nodules
47
Sarcoidosis - how is liver affected?
Liver nodules Cirrhosis Cholestasis
48
Sarcoidosis - how are the eyes affected?
1. Uveitis 2. Conjunctivitis 3. Optic neuritis
49
Sarcoidosis - how is the skin affected?
1. Erythema Nodosum - red nodules on shins caused by inflammation of subcut fat 2. Lupus pernio - raised purple lesions commonly on cheek and nose
50
Sarcoidosis - how is the heart affected?
1. Bundle branch block 2. Heart block 3. Myocardial muscle involvement
51
Sarcoidosis - how are the kidneys affected?
1. Kidney stones - due to hypercalcaemia 2. Nephrocalcinosis 3. Interstitial nephritis
52
Sarcoidosis - how is the CNS affected?
1. Encephalopathy | 2. Nodules
53
Sarcoidosis - how is the PNS affected?
1. Facial nerve palsy | 2. Mononeuritis multiplex
54
Sarcoidosis - how are the bones affected?
1. Arthralgia | 2. Arthritis
55
Sarcoidosis - What is Lofgren's syndrome?
Specific presentation of sarcoidosis, triad of: 1. Erythema nodosum 2. Bilateral hilar lymphadenopathy 3. Polyarthralgia
56
Sarcoidosis - what investigations do you do?
Blood tests Chest XRAY Histology from biopsy - gold standard
57
Sarcoidosis - what blood tests do you do and what findings do you get from them?
Serum ACE - raised Hypercalcaemia - key finding Serum soluble interleukin-2 recepetor - raised CRP - raised
58
Sarcoidosis - what do you see on chest Xray?
Shows hilar lymphadenopathy
59
Sarcoidosis - what characteristic finding do you get with histology?
Biopsy made from mediastinal lymph nodes Non-caseating granulomas with epitheloid cells
60
Sarcoidosis - what is the treatment?
Mild/no symptoms - no treatment, should resolve spontaneously When treatment is required - 1st line oral steroids, 6-24 months, also give bisphosphonates to protect bones 2nd line - methotrexate, azathioprine
61
Pulmonary Embolism (PE) - what is it?
Condition where a blood clot forms in the pulmonary arteries Usually as a result of a DVT from the pelvis or leg and travelled to pulmonary arteries
62
PE - what happens when thrombus is in pulmonary arteries?
Blocks blood flow to lung tissue, creates strain on right side of heart
63
PE - what are the symptoms?
``` Dyspnoea Pleuritic chest pain Cough with or without blood Unilateral, painful, swollen leg Dizziness Syncope ```
64
PE - what are the signs? (obs)
Tachycardia (>100bpm) Low grade fever Low O2 sats <94% Hypotension <90mmHg
65
PE - what are the steps in diagnosis?
1. Perform a wells score 2. If score>4 PE likely, straight for CTPA 3. If score<4 PE unlikely, d-dimer within 4 hours, then if positive, then do CTPA
66
PE - what other investigations can you do?
ECG, echo, troponin - markers to assess right ventricular strain/failure ABG - pO2 low pCO2 low - high resp rate, blow off extra CO2, low blood CO2, causes respiratory alkalosis
67
PE - initial management
Anticoagulation: Apixaban or Rivaroxaban LMWH (dalteparin) when NOACs aren't suitable

Finals Revision Flashcards (49 decks)

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