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Medical Studies 1 > Resp Week 9 > Flashcards

Resp Week 9 Flashcards

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USMLE® Step 1 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
Q

What are 6 clinical signs of pleural effusion

A

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
Q

What are 8 investigative process used for findings associated with pleural effusion

A

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
Q

Outline video-assisted thoracoscopic surgery

A

Minimally invasive surgical approach that used small incisions and a thoracoscope to access and treat pleural diseases

Reduced postoperative pain

Less complex procedure

28
Q

Outline thoracotomy

A

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
Q

What are management options for pleural infection

A

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
Q

What are management options for malignant pleural effusion

A

‘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
Q

Outline thoracentesis, inc therapeutic and large volume

A

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
Q

What are 5 benefits of performing large volume thoracocentesis

A

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
Q

What is the diagnostic value of clear, low viscosity straw coloured pleural fluid

A

Indicative of transudate

34
Q

What is the diagnostic value of serosanguinous (blood) pleural fluid

A

No diagnostic value

35
Q

What is the diagnostic value of frank bloody pleural fluid

A

Indicative of malignancy

36
Q

What is the diagnostic value of milky/turbid pleural fluid

A

Infection, chylothorax, cholesterol effusion

37
Q

What is diagnostic value of putrid smelling pus in pleural fluid

A

Infection, likely from anaerobes

38
Q

Define pulmonary embolism

A

Obstruction of a pulmonary artery, or a branch thereof, by a thrombus created elsewhere in the body

39
Q

What are the 2 classifications of PE

A

Sub-massive

Massive

40
Q

Define sub-massive PE

A

Systolic BP >90 and right ventricular dysfunction

41
Q

Define massive PE

A

Sustained hypotension, ionotropic failure, pulselessness, sustained bradycardia

42
Q

What are 10 signs/symptoms associated with PE

A

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
Q

What is virchows triad

A

Blood stasis, vessel wall injury, hypercoagulable state

Key factors that contribute to thrombosis

44
Q

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

A

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
Q

Outline the pathophysiology of PE

A

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
Q

What are 6 investigative processes that can be used for the diagnosis of PE

A

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
Q

What is the Wells criteria

A

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
Q

What are the 7 factors in the Wells criteria and what are the points associated with them

A

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
Q

What are 3 factors involved in the management of PE and provide a brief description of each

A

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
Q

What are 6 signs/symptoms of pulmonary HTN

A

Dyspnea

Fatigue

Exercise intolerance

Weakness

Anginal chest pain

Syncope

51
Q

Identify 4 common causes of pulmonary HTN and provide a brief description of each

A

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
Q

What are 5 investigative processes that can be used in the diagnosis of pulmonary HTN

A

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
Q

What are 4 management approaches for pulmonary HTN

A

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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