Smoking and pnuemothorax

Question 1

All cause mortality of smokers compared to non-smokers

Answer 1

15% increase

Question 2

Predictors of dependence?

Answer 2

Smoking on waking

High number of cigarettes smoked per day

Question 3

Reducing tobacco consumption

Answer 3

PRICE

Plain packaging
Smoke free legislation (–> decreased ACS)
Pharmacotherapy
Counselling

Question 4

Most effective pharmacotherapy

Answer 4

Varenicline

Nicotine receptor partial agonist

S/E: Nausea ? suicidal ideation

Question 5

Bupropion

Answer 5

Dopamine and noradrenaline reuptake inhibitor

S/E: Seizures and Suicidal ideation

Question 6

Primary spontaneous pneumothorax

Answer 6

Smoking
Family Hx
Marfans

Recurrence = 25-50%

Question 7

Secondary spontaneous pneumothorax

Answer 7

COPD +++ 50-70% SSP
PJP, CF, TB

Usually more dangerous than PSP
Mortality = 16%
Recurrence rate in COPD >50%

Question 8

Monitoring guidelines

Answer 8

Small and clinically stable = discharge and repeat CXR in 2 weeks

Small and SOB or large and clinically stable = catheter aspiration. If successful = repeat CXR 4 hours and discharge if PTx stable

Large and unstable or failed aspiration = small bore ICC

Question 9

PTx recurrence prevention

Answer 9

Thoracotomy and pleurectomy
VATS pleuradesis
Talc pleuradesis

SMOKING CESSATION

Question 10

When is a plural catheter needed for an effusion?

Answer 10

pH <7.2

Question 11

When are wide bore catheters indicated?/

Answer 11

Empyema or haemothorax

Question 12

What is lights criteria?

What does it indicate?

Answer 12

Pleural protein to serum protein ratio >0.5
Pleural fluid LDH to serum LDH ratio >0.6
Pleural fluid LDH >2/3rds upper value of serum LDH

Indicates if an effusion is exudative
High specificity but low sensitivity