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M1 > week 9 > Flashcards

week 9 Flashcards

1
Q

classifications of pneumothorax based off primary, secondary and iatrogenic

A

primary = spontaneous
secondary = underlying disease
iatrogenic = due to medical procedure

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2
Q

symptoms of spontaneous pneumothorax

A

dyspnoea acute
pleuritic chest pain

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3
Q

tension pneumothorax definition 4 main steps

A

when a one way valve devlops whereby every breath causes increased trap air

leading to increased intraplueral pressure

mediastinal shift
collapses of vessels

resulting in cardiopulmonary comprimise

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4
Q

risk factors for spontaneous and secondary pneumothorax (age groups, social and family)

A

PSP: young, skiny, male
SSP: old, underlying lung disease
smoking incl vape and weed
FHx

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5
Q

findings on pneumothorax 4 (2 are key)

A

trachea can be deviated to opposite side
reduced chest expansion on collapsed side
hyperesonance
reduced/absent breath sounds

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6
Q

investigations for suspected pneumothorax 5
General rule out others

A

troponin
inflammatory markers
ECG
CXR
Ct

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7
Q

what is the key diagnostic investigation for pneumothorax

A

CXR

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8
Q

PSP management (haemodynamically stable and haemodynamically unstable)

A

stable = observation
unstable = tube thorocastomy+drainage

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9
Q

SSP management

A

tube thorocastomy+drainage

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10
Q

secondary measure if pneumothorax recurrence

A

pleurodesis

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11
Q

pleurodesis types 2

A

can be chemical or mechanical

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12
Q

pleurodesis mechanism

A

triggers inflammation

leads to fibrosis

fills pleural space

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13
Q

what is required for pleurdesis to work? When does it not work?

A

symphis of visceral and parietal pleura

in non expansive lung there is no symphis

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14
Q

common chemical agent used in pleurodesis

A

TALC

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15
Q

pleural effusion

A

air/fluid in pleural space

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16
Q

transudative effusion vs exudative effusion

A

transudative due to abnomral hydrostatic forces

exudative due to increased capillary permeability

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17
Q

most common causes of transudative pleural effusion 3 (think major body organs)

A

HF
cirrohosis
PE

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18
Q

most common cause of exudate pleural effusion 3

A

malignancy
pneumonia
TB

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19
Q

different types of infective pleural effusions 3

A

para pneumonic
complex parapneumonic
empyema thoracis

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20
Q

parapneumonic effusion 3

A

no pus
negative cultures
normal pH and glucose

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21
Q

complex parapneumonic

A

no pus
low pH
potentially culture positive

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22
Q

empyema thoracis

A

pus
potentially positive culture

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23
Q

mech for development of malignant pleural effusion 2

A

primary malignancy from mesothelioma
metatstatic pleural spread

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24
Q

most common causes of malignant pleural effusion

A

breast cancer
lymphoma
mesothelioma

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25
Q

clinical findings in someone with pleural effusion 6

A

SOB
cough
clubbing
stony dull percusion
redcued/absent breath sounds
reduced chest expansion ipsilaterally

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26
Q

key diagnostic investigations in pleural effusion 2

A

thoracic ultrasound
CXR

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27
Q

other tests used when investigating an aspirate of pleural effusion 4

A

pH
glucose = if low maligancy
cell count
cytology

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28
Q

lights criteria in pleural effusion (when used and criteria)

A

used to determine exudative pleural effusion if one or more of the criteria is met

the criteria are if serum protein, serum LDH or pleural fluid LDH is highly elevated

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29
Q

VATS - video assisted thoracoscopic surgery vs thoracotomy

A

VATS: less invasive, less complex, reduced post op pain

Thoracotomy: greater access, more invasive, greater visibility

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30
Q

thoracentesis vs tube thoracostomy

A

throacentesis is a needle aspiration

tube thoracostomy is tube inserted to drain

31
Q

primary procedure in management of malignant pleural effusion

A

thoracentesis

32
Q

symptoms of PE 4

A

SOB
pleuritic pain
haemoptysis
dizziness

33
Q

clinical signs of PE

A

tachypnoea
tachycardia
hypotension
elevated JVP

34
Q

virchow’s triad

A

blood stasis
hypercoagulability
vessel wall injury

causes development of venous thrombus event

35
Q

definition of PE

A

obstruction of pulmonary artery by thrombus which is either provoked or unprovoked

36
Q

classifications of PE 3

A

haemodynamically stable
submassive PE
massive PE

37
Q

submassive PE characteristics 2

A

systolic>90 (no hypotension)
RV dysfunction

38
Q

massive PE characteristics 3

A

sustained hypotension <90
pulselessness
HR<40

39
Q

provoking factors for a PE (think what causes clotting) 5

A

recent immobilisation
smoking
birth control
obesity
cancer

40
Q

well’s score and what this indicates for D-dier

A

predicts liklihood of a venous thrombus event

if low do D-dimer test if high proceed to management

41
Q

ECG signs in PE (all signs of right sided dysfunction)

A

tachycardia
RBBB
RAD

42
Q

key diagnostic tool in PE

A

CTPA - CT pulmonary angiography

43
Q

what is CTPA

A

CT pulmonary angiography which visualises pulmonary vasculature

44
Q

investigations for PE

A

ECG, ECHO, CTPA, D-Dimer if indicative wells score

45
Q

management of haemodynamically stable PE

A

oxygen support
anticoagulation

46
Q

management of haemodynamically unstable PE

A

ICU review
thrombolysis considered

47
Q

drug of choice in anticoagulation of PE

A

Apixaban

48
Q

characteristics of pulmonary circulation

A

low pressure
low resistance
vessels have thinner walls
pulmonary capillaries larger than systemic capillaries

49
Q

symptoms of pulmonary hypertension 5

A

SOB
chest pain
syncope
exercise intolerance
fatigue

50
Q

clinical signs of pulmonary hypertension

A

raised JVP
systolic murmur
right sided HF

51
Q

what heart side heart failure is pulmonary hypertension associated with

A

Left sided

52
Q

classifications of pulmonary hypertension 5 (the groups)

A

group 1 = idiopathic
group 2 = associated w heart disease
group 3 = associated w lung disease
group 4 = associated w PA obstruction
group 5 = multiple systems

53
Q

key cause of pulmonary hypertension

A

vascular remodelling due to endoethial proliferation or fibrosis

54
Q

gold standard investigation in pulmonary hypertension

A

cardiac catheritization

55
Q

definition of pulmonary hypertension

A

patients with a mean pulmonary artery pressure>20mmHg

56
Q

3 pathways of pulmonary hypertension management

A

endothelin pathway
nitric oxide pathway
protocyclin pathway

57
Q

endothelin pathway in pulmonary hypertension

A

block endothelin which causes vasoconstriction

use endothelin receptor anatgonsist

58
Q

nitric oxide pathway

A

use medication like nitric oxide to create vasodilatory effect

59
Q

prostocyclin pathway

A

prostocyclin analogues which like prostocylcin vasodilate, stop platelets and smooth muscle cell proliferation

60
Q

prostocylins function 3

A

vasodilatory
stop platelet agglutination
stop smooth muscle cell proliferation

61
Q

what is the best maneouvre film to see a pneumothorax

A

expiratory film

62
Q

what key radiological feature is evident in pulmonary oedema (hard)

A

air bronchograms

63
Q

bochdalek hernia 3 characteristics (whether congenital or acquired and position of presentation)

A

congenital
bilateral
at the back

64
Q

morgagni hernia 2 characteristics (whether congenital or acquired and position of presentation)

A

congenital
middle

65
Q

hiatus hernia

A

abdominal content through oesophageal hiatus into upper chest

66
Q

high risk groups for anaemia

A

children
pregnant women
women

67
Q

most common cause of anaemia

A

iron deficiency

68
Q

social determinants of anaemia 3

A

gender = higher in women
lower social economic countries = likely refelects poor diet
geography = poor diet+greater infection

69
Q

when do you do a d-dimer for pe

A

when the wells criteria score is less than 4 aka when there is low indication of PE

70
Q

what is another diagnostic technique you can do for PE and when is this commonly done 4

A

V/Q scan
do when contraidnications to cTPA including:
- allergy to contrast
- kidney impairement
- pregnant
- children

71
Q

common ecg findings on a pe and theoretical findings

A

sinus tachycardia, often nothing else

theoretical finding: is S1Q3T3

72
Q

in tension pneumothorax does the trachea deviate away from the area of collapse or towards

A

away

73
Q

in normal lung collapse can trachea deviate towards or away from collapsed lung

A

towards

M1 (13 decks)

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