Respiratory Flashcards
What is a pulmonary embolus?
A blockage in the pulmonary arterial system
Usually associated with a deep vein thrombosis (DVT) develops in the deep veins of the lower limb
Can be caused by fat, air, tumour tissue
PE/DVT risk factors
Above 50
Prolonged immobilisation
Pregnancy
Malignancy
Genetic predisposition
Large clots
Treatment for DVT and PE
Blood thinning drugs - intravenous heparin followed by oral warfarin
How does a PE present on a CXR?
Cannot make out costophrenic angle - area appears opaque/white
PE not usually seen on CXR - but small pleural effusion may be seen
PE - incidence, prevalence, epidemiological, aetiology, clinical features
incidence - 50,000 in UK in year 2013/14
prevalence - M=F
epidemiological - increases with age, 30% greater in male
aetiology - Virchow a triad - venous stasis, vessel wall damage, hypercoagulability
clinical features - chest pain, dyspnoea, tachypnoea
Why would a CT be needed after PE is ruled out on CXR?
High D-dimer score
What is a VQ scan?
Ventilation-perfusion scan is a nuclear medicine scan that uses radioactive material to examine airflow and blood flow in the lungs
What is d-dimer?
D dimer is a fibrin degradation found in blood after blood clot is degraded
What is a pneumothorax?
Collapsed lung - air escapes lung
Air fills space outside of lung between lung and chest wall creating pressure and lung cannot expand as much
What are the two types of Pneumothorax?
 spontaneous
Tension
What can have an affect on the symptoms of a Pneumothorax?
Size of the air leak at the speed of which occurs
How can a severe pneumothorax be diagnosed compared to a milder case?
A severe pneumothorax may be diagnosed through a physical exam
In a milder case must be diagnosed through a CT
What can cause a spontaneous pneumothorax thorax?
Rupture of subpleural bleb
COPD
Cystic fibrosis
Lung cancer/mets
Oesophageal cancer
Pneumonia
Long abscess

What can cause a Tension pneumothorax?
Central venous access
Lung biopsy
Post laparoscopy
Blunt trauma/rib fracture
Artificial ventilation
Why wouldn’t pneumothorax be classed as a tension pneumothorax?
The area of damage tissue creates a one-way valve leading to a severe oxygen shortage and a low BP, progressing to cardiac arrest unless treated
What typically occurs when there is a small spontaneous Pneumothorax?
Small pneumothorax is typically resolved by themselves especially in those with no underlying lung disease
How can a larger pneumothorax or pneumothorax is with severe symptoms be treated?
The air may be aspirated with a syringe or a one-way chest drain is inserted to allow the air to escape
What method of treatment may be used as treatment if there is a significant risk of repeated episodes of pneumothorax?
Pluerodesis Which is sticking the lung along the Chest wall
Surgical measure
What is a lobar collapse?
The collapse of an entire lobe of the lung
What is lobar collapse - how does it happen?
Occurs due to proximal occlusion of a bronchus causing a loss of aeration (loss of supply of air)
The remaining air is gradually absorbed and the one loses its volume
What are risk factors/ causes of lobar collapse?
Bronchogenic CA - bronchus (adult, smokers)
In young adult or older child - asthma - mucus plugging of the major airways
If an infant inhaled in foreign body such as a peanut
Retention of secretions is a frequent cause of postop collapse
In ventilated patients including neonates collapse when the ET tube is inserted too far entering one main Bronchos
What is a radiological signs of lobar collapse?
Can include:
Tracheal displacement towards the side of collapse
mediastinal shift towards the side of collapse
elevation of the hemidiaphragm
reduced vessel count on the side of the collapse
herniation of the opposite lung across the midline
A hillar mass, which also suggests carcinoma as the cause
other evidence of malignant disease (example rib metastasis, lymphangitis, effusion)
The presence of a foreign body; however these are very easy to see the presence of
ET tube is it cited to low?
What is consolidation?
What pathologies consolidation a common sign of?
Clinical term for solidification into form dense mass
Consolidation is a common sign in pneumonia
What is another example of consolidation?
Alveolar spaces become filled with fluid
This fluid can be pulmonary oedema inflammatory exudate, puss, inhaled water or blood
What is pneumonia?
It’s an inflammatory condition of the lung
What is the cause of pneumonia?
Usually caused by infection with viruses or bacteria