Respiratory - Pneumothorax and Embolism

Question 1

what are the 3 main causes of pneumothorax

Answer 1

1. tall young skinny males
   2.older patients with underlying lung disease
   3.trauma- subclavian lines eg

Question 2

how are pneumothorax classified

Answer 2

spontaneous and traumatic

spontaneous further divided into primary and secondary

primary - no underlying lung disease (tall slim teenage boys, marfans)

secondary - underlying lung problems eg copd,asthma,cystic fibrosis,pneumocystitis pneumonia

Question 3

pneumothorax

Answer 3

air leaking out of the lung and into the pleural cavity
leaving air between the viscera and the parietal layer

Question 4

Hx for pneumothorax

Answer 4

sudden onset
one sided
pleuritic chest pain and shortness of breath
PMHx smoking

Question 5

what is found on auscultation for pneumothorax

a.fine inspiratory crackles
b.coarse crepitations
c.increased breath sounds on affected side
d.decreased breath sounds on affected side

Answer 5

d.decreased breath sounds on affected side

Question 6

subcutaneous emphysema

Answer 6

air in the soft tissue from trapped air in the lungs
treat pneumothorax to treat

Question 7

a tension pneumothorax can be ..

a.primary only
b.secondary only
c.primary or secondary

Answer 7

c.primary or secondary

pushes the mediastinum to the other side and pushes the diaphragm down , patient will be in tripod position and emergency treatment needed

2nd ICS midclavicular line cannula required for needle decompression

Question 8

patient with a stable pneumothorax what treatment should be done

a.emergency needle decompression
b.do nothing
c.aspirate

Answer 8

b.do nothing

Question 9

patient with a large stable pneumothorax what treatment should be done

a.emergency needle decompression
b.do nothing
c.aspirate

Answer 9

c.aspirate
seldinger drain

Question 10

life threatening condition in which a dislodged thrombi occludes pulmonary vasculature usually originating from a DVT

Answer 10

pulmonary embolism

can lead to RH strain or cardiac arrest

Question 11

risk factors for pulmonary embolism

Answer 11

recent surgery, cancer,thrombophillia, prolonged bed rest,infection, pregnancy/hrt/cp

Question 12

symptoms of pulmonary embolism

Answer 12

acute breathlessness
pleuritic chest pain
haemoptysis
syncope
cough

Question 13

signs of pulmonary embolism

Answer 13

temp, cyanosis, increased HR, decreased BP, increased JVP,pleural rub, signs of DVT - red hot swollen leg

Question 14

CONCERNING signs in pulmonary embolism

Answer 14

sycope, HR increase, RHF, systolic BP <90 for >15 mins

Question 15

d dimer test helps rule………. pulmonary embolism

a.in
b.out

Answer 15

b.out

sensitive but not specific

use an adjusted d dimer score if over 50 years

Question 16

why is a cxr done in suspected pulmonary embolism

Answer 16

to look for differentials eg infection or pneumonia

Question 17

first course of action in suspected PE

a.calculate wells score
b.d dimer
c.cxr
d.ctpa

Answer 17

a.calculate wells score

then ctpa with iodinated contrast

if contraindicated then do a v/q scan ie in pregnancy

Question 18

if there is a delay in getting a ctpa what should be done in suspected PE

Answer 18

GIVE ANTICOAGULANTS IF NO CONTRAINDICATIONS

Question 19

first treatment for PE

a.o2 resus
b.anticoagulation with LMWH
c.thrombolysis if hameodynamically unstable
d.thrombectomy

Answer 19

a.o2 resus

b.anticoagulation with LMWH (3 - 6 months)

c.thrombolysis if hameodynamically unstable ONLY
(collapsed or bp <90 for >15 mins)

if this fails then
d.thrombectomy

Question 20

if patient has an unprovoked pneumothorax and you have taken baseline bloods and performed a physical exam what should be done next

a.nothing
b.further investigation

Answer 20

a.nothing

only investigate further if relevant clinical signs

Question 21

prevention of PE

Answer 21

LMWH
compression stockings
stop HRT/pill