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MS1 > Week 9 Resp > Flashcards

Week 9 Resp Flashcards

1
Q

Types of Pneumothorax

A

Spontaneous
Primary (PSP): no underlying lung disease
Secondary (SSP): underlying lung disease eg COPD or malignancy
Traumatic
Latrogenic: complication of a medical procedure
Penetrating trauma:

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2
Q

Risk Factors of Pneumothorax

A

PSP: most common 15-34
SSP: most common over 50
3-6x more likely for males
Risk factors: smoking, fam history, sub plueural blebs, underlying lung disease

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3
Q

Presenting symptoms and differentials for pneumothorax

A

Symptoms
Acute onset Dyspnoea
Chest pain (often pleuritic)
NB: intensity varies very much/ young may be very little pain
Differentials
PE, Pleuritis,MI, pericarditis, Musculoskeltal inflammation

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4
Q

Clinical Sings of Pneumothroax

A

Inspection: Chest wall trauma, work of breathing, use of accessory ,muscles
Trachea: sometimes deviated to opposite side
Chest expansion reduced on same (ipsilateral) side
Percussion: hyper-resonant
Auscultation: reduced or absent breath sounds

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5
Q

Pneumothroax investigations:

A

Blood tests:
- Inflammatory markers (WCC and CRP)
- Troponins (to check for MI)
- D-Dimer (shows PE)
ECG:
- Rule out MI and pericarditis
CXR:
- main tool
- Check for abscences f lung markings, visceral pleural line
- Tracheal deviation
CT

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6
Q

Tension Pneumothorax

A

One way valve effects results in intrapleural pressure, resulting in mediastinal shift, collapse of great vessels and ventricle —> cardiopulmonary compromise
Signs and symptoms:
-Dyspnoea, chest pain, tachypnoea, tachycardia, hypoxaemia, progressive hypertension, signs of pneumothorax )decreased BS and hyper res)

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7
Q

Managment of Tension Pneumothorax

A

Needs urgent decompression
Needle decompression in 2nd ICS mid claviclular
Or tube thortacosotmy

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8
Q

management for a small, asymptomatic primary spontaneous pneumothorax?

A

Observation and oxygen therapy. Small pneumothoraces may resolve on their own with supplemental oxygen to help reabsorption.

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9
Q

treatment for a large or symptomatic primary spontaneous pneumothorax

A

Needle aspiration or chest tube insertion to remove air from the pleural space and allow lung re-expansion.

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10
Q

When is surgical intervention considered for primary spontaneous pneumothorax

A

Surgical options, such as video-assisted thoracoscopic surgery (VATS), are considered after recurrent episodes or persistent air leaks despite chest tube drainage.

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11
Q

What is pleurodesis and when is it used

A

Pleurodesis is a procedure that causes the pleural layers to adhere, preventing future pneumothorax. It’s used after recurrent spontaneous pneumothorax or in patients with high risk of recurrence.

Talc, doxycycline, and sterile betadine are common agents used to induce pleural adhesion in pleurodesis

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12
Q

What factors increase the risk of recurrence of a pneumothorax

A

Smoking, underlying lung disease (e.g., COPD), and prior pneumothorax increase the risk of recurrence, making preventive strategies like pleurodesis more important.

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13
Q

Three mechanisms for fluid in pleural space (broad)

A
  • Abnormal hydrostatic or osmotic forces (transudate)
    Eg: increases hydrostatic due to fluid overload during HF
  • Increased permeability (exudate)
    Eg: usually due to neoplasm or inflamation
  • Disruption of the fluid continuing structure within the pleural cavity
    Eg: Blood vessels, oesophagus, thoracic duct
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14
Q

Common causes of Pleural effusion

A

Heart Faiure, malignancy, infection, post surgical, pericardial disease, liver cirrhosis
More common in adults
25% are idiopathic

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15
Q

Symptoms of Pleural effusion and signs

A

Symptoms
Dyspnoea (due to increased weight on diaphragm and increased work of breathing)
Cough
Chest pain (usually pluertic)
Signs
Clubbing
tar staining
Enlarged lymph nodes
Chest wall scares
Raised JVP
Maybe deviated trachea to opposite side
Reduced chest expansion
Stony dull percussion
Reduced or absent breath sounds

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16
Q

Investigations for pleural effusions

A

CXR, Thoracic ultrasound, CT scan
Also things to rule out others such as
WCC and CRP
Troponin
D-Dimer
ECG

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17
Q

Thoracentesis

A

aspiration of pleural fluid
1st line approach - drain 1-1.5L
Allows
-assessment of fluid eg cytology
-Gauge symptomatic benefits
-Help identify non expansive lung
Estimation of rate of re accumulation

18
Q

Diagnostic evaluation of pleural effusion based on fluid

A

-clear low viscosity suggested transudate
-Frank bloody suggests malignancy, benign asbestosis, Post cardiac injury syndrome, pulmonary fraction, trauma, or thoracic endometriosis
-Milky fluid suggests infection, chyothorax, or cholesterol
-Putrid smelling suggestions infection
-Urine like suggests urinothorax

19
Q

Pleural Infection Symptoms

A

Dyspnoea
Cough
Chest pain (often pleurtic)
Fevers/night sweats
Malaise

20
Q

Investigations for Pleeural infection

A

Blood
Inflammatory markers WCC and CRP
Blood culture
imaging
CXR
Thoracic ultrasound
CT
Sampling of pleural fluid

21
Q

Pleural infection management

A

Consists of two parts:
evacuate infected fluid
-Chest tube
-fibrinolytic
-mucolytic
-surgery
Eradicate infection
-Broad spectrum antibiotics

22
Q

Malignant pleural effusion

A

Dyspnoea
Cough
Chest pain
+ ones related to cancer eg:
Anorexia
Weight loss
Fever

23
Q

Thoracocentesis

A

Draining of pleural fluid

24
Q

Pulmonary embolism Classifications

A

Provoked vs Unprovoked
Haemodynamically stable vs sub massive vs massive
Haemodynamically stable = normal blood pressure and heart rate
Sub massive= systolic BP above 90, but right ventricular dysfunction
Massive= sustained hypotension (below 90 for 15mins), needs ionotropic support, lack of pulse, sustains HR below 40

25
Q

Pathophysiology of PE

A
  1. Infarction due to reduced blood flow
  2. Abnormal gas exchange —> hypoxia due o low blood flow
  3. Cardiovascular compromise due to increased resistance leads to right ventricle dilation
26
Q

Clinical symptoms of PE

A

-Dyspnoea
-Chest pain - pleuritic (sharp pain worse when leaning forward and breathing)
-Leg swelling and pain if DVT present
-dizziness (due to hypertension)
-Haemoptysis

27
Q

Clinical signs of PE

A
  • Tachycardia
  • Tachpnoea
  • Hypoxia
  • Hypotension (massive PE)
  • Elevated JVP (if right ventricle dilation is present)
  • leg oedema and tender calf palpation if DVT is present
28
Q

Risks for PE

A

Genetic abnormalities
Not moving for a long time (eg flights or staying in hospital for ages)
Having cancer
Smoking
Birth control
Having a baby
Previous PE
Obesity

29
Q

Well criteria for PE

A

Clinical signs and symtpoms of DVT (3 points)
PE most likely diagnoses (3 points)
Heart rate over 100bpm (1.5 points)
Immobilisation of 3 days in past 4 weeks (1.5 weeks)
Previous DVT or PE (1.5 points)
Haemoptysis (1)
Cancer treatment in last 6 months (1 point)
If 5 points or over, warrants imaging

30
Q

Investigations for PE

A

D dimer:
only do if pass wells score above 4
Bloods:
CBE, EUC, coagulation, Troponin (right ventricular strain)
thrombophilla screens
ECG
CTPA
VQ scan
Echocardiogram

31
Q

ECG findings suggesting PE

A
  • Tachycardia
  • Right bundle branch block
  • Right axis deviation
    S1Q3T3
  • Large S wave one lead 1
  • Q wave in lead 3
    Inverted T waves in lead 3
32
Q

Management of PE

A
  • Anticoagulation to prevent further clot formation
    IF HEAMODYNAMICALLY STABLE
  • O2 if needed
  • analgesia if needed
    IF HEAM UNSTABLE
  • all of above +
    Early review by ICU
    Consider thrombolysis and additional therapies if appropriate
33
Q

Emphysema

A

Collection of pus in the pleural cavity, gram positive

34
Q

Bacteria that causes pleural infections most commonly

A

Gram positive, especially streptococcus

35
Q

Normal pulmonary pressure

A

Normal is 25/8mmHG with an average pressure (mean) of 15
Upper limit of the mean pressure is 20mmHG

36
Q

Clickable classifications of Pulmonary hypertension

A

Pulmonary Arterial hypertension
- Idiopathic/heritable
PH associated with left heart disease
PH associated with lung disease
PH associated with pulmonary artery obstructions

37
Q

Presenting symptoms of Pulmonary hypertension

A

-Dyspnoea
-Fatigue
-Exercise intolerance
-Weakness
-Chest pain
-Syncope
+ symptoms of associated diseases
+ family and personal medical history
+ medication history

38
Q

Clinical signs of Pulmonary Hypertension

A
  • Rasied JVP
  • Loud P2 Heart sound
  • Early systolic ejection click
  • Left Parasternal heave
39
Q

CXR findings for pulmonary hypertension

A

Enlarged right atria
Prominent pulmonary outflow tract
Enlarged pulmonary arteries
Pruning of peripheral pulmonary vessels

40
Q

Group 1 pulmonary hypertension

A

-idiopathic

41
Q

Treatment of pulmonary hypertension

A
  • Nitric Oxide —> vasodilation and proliferation
  • Endothelin —> vasodilation and anti proliferation
  • Prostacyclin —> vasodilation and anti proliferation

MS1 (16 decks)

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