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Medical Studies 1 > Resp Week 9 > Flashcards

Resp Week 9 Flashcards

1
Q

Describe primary spontaneous pneumothorax

A

No underlying lung disease

More common in 15-34yo age group and tall thin males

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2
Q

Describe secondary spontaneous pneumothorax

A

Occurs with underlying lung disease e.g COPD/emphysema, malignancy, infection, CF, cystic lung disease

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3
Q

Describe iatrogenic pneumothorax

A

Complication from a medical procedure resulting in pneumothorax

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4
Q

What are 4 symptoms associated spontaneous pneumothorax and what is the underlying pathology for each

A

Chest pain - air in the pleural space irritates the pleural, causing sharp pain

Dyspnea - the collapsed lung reduces lung capacity, limiting O2 intake

Tachycardia - the heart pumps faster to compensate for reduced oxygen delivery

Hypoxia - the collapsed lung impairs gas exchange, lowering oxygen levels in the blood

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5
Q

Explain the concept of tension pneumothorax

A

It is a rare situation where a one-way valve effect results in progressive increase in intrapleural pressure, resulting in mediastinal shift, collapse of the great vessels and ventricle, and ultimately cardiopulmonary compromise

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6
Q

What are 4 risk factors for pneumothorax and provide a brief description of each

A

Smoking - airway inflammation > dmg lung tissue + weaken alveoli > more susceptible to rupture

Lung disease - impairs lung function and makes it easier for air to escape into pleural cavity

Sub-pleural blebs - small, blister formations on lung surface which can rupture and release air into pleural space

Male sex - 3-6x more likely

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7
Q

What are 5 clinical signs associated with pneumothorax

A

Use of accessory muscles and increased work of breathing can be seen upon inspection

Tracheal deviation may be observed

Chest expansion reduced on ipsilateral side as pneumothorax

Percussion should be hyper-resonant

Auscultation shows reduced or absent breath sounds

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8
Q

What are 5 investigative processes you would undertake in a patient w suspected pneumothorax

A

Vital signs - RR, HR, BP, SpO2

Blood tests - other differentials, inflammatory markers, serum troponin, D-dimer (for PE)

ECG - MI or pericarditis

CXR - key diagnostic for pneumothorax

CT - can determine underlying lung pathology for SSP

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9
Q

Describe the management of primary spontaneous pneumothorax

A

Resuscitation and airway stabilisation always comes first

Rx options include observation, aspiration, tube thoracostomy (chest drain insertion)

If haemodynamically stable, a conservative approach is favoured over intervention in appropriately selected individuals

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10
Q

Describe the management of secondary pneumothorax

A

Typically requires chest tube insertion due to underlying lung disease and greater risk of complications

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11
Q

Describe pleurodesis

A

It is the obliteration of the pleural space by the induction of pleural fibrosis

Induction can occur by chemical agent of mechanical abrasion

The aim of this is to injure the pleural, as inflammation and denudement of the mesothelial cells leads to chronic inflammation and fibrosis, meaning the scar tissue can cover the hole in the lung

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12
Q

Define empyema and give an example pathology

A

The presence of pus in the pleural space

E.g pneumonia

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13
Q

Define haemothorax and give an example pathology

A

The presence of blood in the pleural space

E.g chest wall trauma/injury

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14
Q

Define chylothorax and give an example pathology

A

The presence of chyle in the pleural space

E.g thoracic duct trauma/inury

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15
Q

Define urinothorax and give an example pathology

A

Presence of urine in the pleural space

E.g genitourinary trauma/injury

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16
Q

What are 3 broad mechanisms of pleural effusion and give an example of each

A

Abnormal hydrostatic or osmotic forces (transudate) - e.g increased hydrostatic pressure in HF

Increased permeability (exudate) - e.g inflammation leading to pleural abnormality

Disruption of fluid-containing structure - e.g thoracic duct, oesophageal, vessel injury

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17
Q

What are 3 common causes of transudative pleural effusions

A

Heart failure

Liver cirrhosis

Nephrotic syndrome

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18
Q

What are 3 common exudative causes of pleural effusions

A

Malignancy

Infection

Pericardial disease

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19
Q

What are 3 classifications of infective pleural effusions

A

Parapneumonic

Complex parapneumonic

Empyema thoracis

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20
Q

Define parapneumonic infective pleural effusions

A

An accumulation of fluid in the pleural cavity that occurs alongside a lung infection, such as pneumonia, without direct bacterial invasion of the pleura

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21
Q

Define complex parapneumonic

A

A more severe form of parapneumonic effusion characterised by an increased amount of pleural fluid with a higher risk of of complications, often requiring drainage or intervention

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22
Q

Define empyema thoracis

A

A purulent or infected pleural effusion where bacteria invade the pleural space, leading to the accumulation of pus in the pleural cavity, typically requiring drainage and antibiotic treatment

23
Q

Describe the mechanism for the development of malignant pleural effusion

A

Primary cancer

Then, tumour growth

Then, entry of tumour into lymph and blood

Then, this invades the pleural space

Then, there is implantation and growth in the pleura

Then, inflammatory response

Then, increased vascular permeability

Then, pleural effusion

24
Q

What are 3 symptoms of pleural effusion

A

Dyspnea

Cough

Chest pain

25
What are 6 clinical signs of pleural effusion
HF signs - elevated JVP, clubbing etc Infective signs - enlarged lymph nodes etc Tracheal deviation - may happen in opposite side of pleural effusion Chest expansion - reduced on ipsilateral side Percussion - stony dullness Auscultation - reduced or absent breath sounds
26
What are 8 investigative process used for findings associated with pleural effusion
Vital signs Inflammatory markers e.g WCC and CRP Troponins D-dimer ECG CXR - key diagnostic test to determine effusion of pleura Thoracic ultrasound - key diagnostic test but not readily available CT scan
27
Outline video-assisted thoracoscopic surgery
Minimally invasive surgical approach that used small incisions and a thoracoscope to access and treat pleural diseases Reduced postoperative pain Less complex procedure
28
Outline thoracotomy
Conventional open-chest surgery that involves a larger incision to access and manage pleural diseases and related conditions Greater visibility of procedure Superior outcomes in more severe cases
29
What are management options for pleural infection
Antibiotics Fibrinolytics - e.g tPA help break down fibrin clots and adhesions in pleural space Mucolytics - e.g DNase used to reduce viscosity of thick and purulent pleural fluid, aiding in its removal Drainage of pleural fluid can be achieved through procedures like thoracentesis or chest tube placement
30
What are management options for malignant pleural effusion
‘Watch and wait’ - conservative approach involving regular monitoring Pleurodesis - procedure to induce adhesion between layers of pleura, preventing further fluid accumulation in the pleural space, often using substances like talc or doxycycline VATS - minimally invasive surgical technique for diagnosing and treating malignant pleural effusion Indwelling pleural catheter (IPC) - long term drainage device inserted into the pleural space to allow repeated drainage and management of pleural effusion
31
Outline thoracentesis, inc therapeutic and large volume
Sampling of pleural fluid when patients presents with pleural effusion Therapeutic thoracentesis describes drainage of larger volumes of fluid air for diagnosis and management Large volume thoracentesis is the first line of approach in most cases of undiagnosed effusion
32
What are 5 benefits of performing large volume thoracocentesis
Enables assessment of fluid chemistry and cytology Enables doctors to gauge the symptomatic benefits of fluid removal Enables non-expansile lung to be relieved Enables the rate of reaccumulation to be ascertained Leaves fluid so leaves room for alternative approaches if cytology is inconclusive
33
What is the diagnostic value of clear, low viscosity straw coloured pleural fluid
Indicative of transudate
34
What is the diagnostic value of serosanguinous (blood) pleural fluid
No diagnostic value
35
What is the diagnostic value of frank bloody pleural fluid
Indicative of malignancy
36
What is the diagnostic value of milky/turbid pleural fluid
Infection, chylothorax, cholesterol effusion
37
What is diagnostic value of putrid smelling pus in pleural fluid
Infection, likely from anaerobes
38
Define pulmonary embolism
Obstruction of a pulmonary artery, or a branch thereof, by a thrombus created elsewhere in the body
39
What are the 2 classifications of PE
Sub-massive Massive
40
Define sub-massive PE
Systolic BP >90 and right ventricular dysfunction
41
Define massive PE
Sustained hypotension, ionotropic failure, pulselessness, sustained bradycardia
42
What are 10 signs/symptoms associated with PE
Pleuritic chest pain - worsened by deep breath or cough Dyspnea - due to reduced O2 exchange Haemoptysis - when PE damages lung tissue Palpitations - due to strain on heart Unilateral oedema - typically due to DVT Dizziness - due to reduced O2 to brain Tachypnoea - compensate for decreased O2 levels Hypoxia - due to inadequate O2 in body tissue Hypotension - sign of haemodynamic compromise Calf tenderness - indicative of DVT
43
What is virchows triad
Blood stasis, vessel wall injury, hypercoagulable state Key factors that contribute to thrombosis
44
What are 4 risk factors for PE and provide a brief description of each
Inherited conditions - genetic clotting disorders e.g factor V Leiden deficiency Recent surgery - increased likelihood of inflammatory mediators in the bloodstream Immobilisation - leads to blood stasis in vasculature Smoking - introduces toxins into the body
45
Outline the pathophysiology of PE
3 key stages: infarction, abnormal gas exchange, cardiovascular compromise Occlusion of distal pulmonary vessels which results in reduced blood flow and ultimately pulmonary infarct Then, less blood flow is available for gas exchange which leads to hypoxia Then, there is increased pulmonary vascular resistance due to blockage from clot Then, this results in reduced right ventricular outflow and dilatation, resulting in compromised cardiac output
46
What are 6 investigative processes that can be used for the diagnosis of PE
CBE, EUC, troponin - assess for haematological causes ECG - large S wave, Q wave or inverted T wave CTPA - visualises pulmonary arteries for definitive diagnosis VQ scan - compares ventilation and perfusion, highlighting areas where airflow and blood flow do not match, indicating PE Echocardiogram - look for signs of RV strain D-dimer - used to rule out PE when results are negative
47
What is the Wells criteria
One tool used to diagnose PE Clinical scoring system that combines multiple risk factors to help stratify the likelihood of PE A Wells score of 4.0 warrants further testing
48
What are the 7 factors in the Wells criteria and what are the points associated with them
Clinical signs/symptoms of DVT - 3.0 PE most likely diagnosis - 3.0 Tachycardic - 1.5 Immobilisation for at least 3 days or surgery within the last 4 weeks - 1.5 Previous DVT or PE - 1.5 Haemoptysis - 1.0 Malignancy Rx within 6mo or palliative - 1.0
49
What are 3 factors involved in the management of PE and provide a brief description of each
Anticoagulation - administration of blood thinning meds to prevent formation of and progression of thrombi Thrombolysis - use of clot-dissolving drugs to rapidly break down existing blood clots Analgesia - pain relief meds to manage pleuritic chest pain
50
What are 6 signs/symptoms of pulmonary HTN
Dyspnea Fatigue Exercise intolerance Weakness Anginal chest pain Syncope
51
Identify 4 common causes of pulmonary HTN and provide a brief description of each
Idiopathic - unknown or unidentifiable cause (aka primary pulmonary HTN) Drug induced - triggered using specific meds or drugs Heritable - from genetic mutations and passed down within families Portal HTN - elevated BP within portal vein system, which can lead to pulmonary HTN due to increased blood flow and pressure in lungs
52
What are 5 investigative processes that can be used in the diagnosis of pulmonary HTN
ECG echo - provides information on RV size and fn VQ scan - ID PE which can be a cause of pulmonary HTN Chest CT - ID PE, vascular changes, and lung abnormalities associated with pulmonary HTN PFTs - measure lung fn parameters, aiding in assessment of lung conditions that can contribute to pulmonary HTN
53
What are 4 management approaches for pulmonary HTN
Lifestyle modification - encourage Pt to adopt heart healthy lifestyle, including regular exercise, low salt diet, and smoking cessation Anticoagulants - for Pt at risk of blood clots, especially in cases of chronic thromboembolic pulmonary HTN Oxygen - help alleviate hypoxia and improve exercise capacity Supportive care - for certain types of pulmonary HTN, surgical options like pulmonary thromboendarterectomy may be indicated to remove chronic thromboembolic obstructions / lung or heart-lung transplantation is considered in advanced cases

Medical Studies 1 (16 decks)

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