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Medical Studies 1 > Week 9 Respiratory > Flashcards

Week 9 Respiratory Flashcards

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USMLE® Step 1 flashcards
1
Q

define pneumothorax

A

gas/air in the pleural space that usually arises from a bronco-pleural fistula (hole in the broncho-pleural space) or chest wall trauma

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2
Q

what are the classifications of pneumothorax

A

Primary spontaneous (PSP)
Secondary spontaneous (SSP)
iatrogenic
penetrating trauma

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3
Q

what is primary spontaneous pneumothorax

A

pneumothorax with no underlying lung disease (more common ages 15-34)

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4
Q

what is secondary spontaneous pneumothorax

A

occurs with underlying lung disease (COPD/emphysema, infection, malignancy, CF, Cystic lung disease)
-most common in individuals >55 y/o

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5
Q

what is iatrogenic pneumothorax

A

complication from a medical procedure resulting in pneumothorax

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6
Q

what is penetrating trauma pneumothorax

A

trauma to the chest wall (injury) resulting in air entry at lungs

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7
Q

list the symptoms of spontaneous pneumothorax

A

-chest pain
-dyspnoea
-tachycardia
-hypoxia
-coughing
-fatigue & cyanosis

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8
Q

why does pneumothorax present with chest pain

A

air in the pleural space irritates the pleurae, causing sharp pain

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9
Q

why does pneumothorax present with dyspnoea

A

the collapsed lung reduces lung capacity, limiting oxygen in take

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10
Q

why does pneumothorax present with tachycardia

A

the heart pumps faster to compensate for reduced oxygen delivery

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11
Q

why does pneumothorax present with hypoxia

A

collapsed lung impairs gas exchange, lowering oxygen levels in the blood

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12
Q

why does pneumothorax present with cough

A

body reflexively trying to clear the airways

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13
Q

why does pneumothorax present with cyanosis and fatigue

A

low oxygen levels in the blood

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14
Q

what is tension pneumothorax

A

rare situation where a one-way valve effect results in progressive increase in intrapleural pressure, resulting in mediastinal shift, collapse of the great vessels and ventricle, ultimately leading to cardiopulmonary compromise

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15
Q

list the symptoms of tension pneumothorax

A

dyspnoea
chest pain
hypoxemia
tachycardia
tachypnoea
progressive hypotension

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16
Q

list the risk factors for pneumothorax

A

smoking
lung disease
sub pleural blebs
male

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17
Q

explain smoking as a risk factor for pneumothorax

A

airway inflammation damages lung tissue and weakens the alveoli, making them more susceptible to rupture and leakage into the pleural space

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18
Q

explain lung disease as a risk factor for pneumothorax

A

impairs lung function and makes it easier for air to escape into the pleural cavity

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19
Q

explain sub pleural blebs as a risk factor for pneumothorax

A

small, blister like formations on the lung’s surface, can rupture and release air into the pleural space, leading to pneumothorax

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20
Q

explain make sex as a risk factor for pneumothorax

A

males are 3-6x more likely to present with pneumothorax

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21
Q

what would the ‘inspection’ show for pneumothorax

A

-chest wall trauma due to injury
-increased work of breathing
-use of accessory muscles

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22
Q

what would be present on palpation in a pneumothorax patient

A

tracheal deviation, trachea may deviate to opposite side (common to also be at midline)

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23
Q

what would be present on chest expansion in pneumothorax patient

A

reduced ipsilateral chest expansion (same side as the pneumothorax)

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24
Q

what would be present on percussion in a pneumothorax patient

A

hyper resonant (extra air in the pleural space)

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25
Q

what would be present on auscultation in a patient with pneumothorax

A

reduced or absent breath sounds (muffled by excess air)

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26
Q

list the investigations for pneumothorax

A

vital signs
blood tests
ECG
CXR
CT

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27
Q

CXR for pneumothorax

A

key diagnostic tool, looking for if you are unable to trace lung markings to the lung borders

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28
Q

CT for pneumothorax

A

used as primary investigation, can determine underlain lung pathology for SSP

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29
Q

Management for primary pneumothorax

A

-typically self resolves
-simple aspiration

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30
Q

Management for secondary pneumothorax

A

-typically requires chest tube insertion due to underlying lung disease and greater risk of complications

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31
Q

whats pleurodesis

A

it uses agents to damage pleura (inflammation of mesothelial cells) leading to scar tissue, similar to how sealant hardens.

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32
Q

how to treat a tension pneumothorax

A

insert a large bore cannula into the 2nd ICS MCL

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33
Q

Define pleural effusion

A

abnormal or excess fluid in the pleural space

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34
Q

define empyema

A

prescience of pus in the pleural space eg pneumonia

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35
Q

define haemothorax

A

presence of blood in the pleural space eg chest wall trauma/injury

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36
Q

define chylothorax

A

presence of chyle in the pleural space eg thoracic duct trauma/inury

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37
Q

define urinothorax

A

presence of urine in the pleural space eg Gastrourinary trauma/injury

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38
Q

what are the causes of pleural effusion

A

-abnormal increased hydrostatic or decreased osmotic forces (transudate)
-increased permeability (exudate)
-disruption of fluid-containing structure

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39
Q

example of abnormal hydrostatic/osmotic force causing pleural effusion

A

increased hydrostatic force in HF

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40
Q

example of increased permeability causing pleural effusion

A

inflammation leading to pleural abnormality

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41
Q

example of disruption to fluid containing structure causing pleural effusion

A

thoracic duct, oesophageal and vessel injury

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42
Q

most common causes of transudative pleural effusion

A

HF
Liver cirrhosis
Nephrotic syndrome

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43
Q

most common causes of exudative pleural effusion

A

malignancy
infection
pericardial disease

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44
Q

list the forms of infective pleural effusions

A

parapneumonic
complex parapneumonic
empyema thoracis

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45
Q

what is parapneumonic infective pleural effusions

A

an accumulation of fluid in the pleural cavity that occurs alongside a lung infections, such as pneumonia, without direct bacterial invasion of the pleura

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46
Q

what is complex parapneumonic pleural effusion

A

a more severe form of para-pneumonic effusion, characterised by an increased amount of pleural fluid with a higher risk of complications, often requiring drainage or intervention

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47
Q

what is empyema thoracis infective pleural effusion

A

a purulent or infected pleural effusion where bacteria invade the pleural space, leading to the accumulation of pus in the pleural cavity, typically requiring drainage and antibiotic treatment

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48
Q

describe the mechanism for the development of malignant pleural effusion

A

primary cancer–>tumour growth–>enter lymph or blood–>pleural invasion–>implantation and growth–>inflammatory response–>increased vascular permeability–>Pleural effusion

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49
Q

what are the clinical presentations of pleural effusion (history)

A

dyspnoea
cough
chest pain

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50
Q

describe dyspnoea in pleural effusion

A

related to the mechanical effects on the diaphragm/chest wall and shunting

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51
Q

describe cough in pleural effusion

A

related to the mechanical effects on the airways

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52
Q

describe chest pain in pleural effusion

A

sharp pleuritic chest pain, related to parietal pleural inflammation or infiltration

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53
Q

list the clinical presentations upon exam for pleural effusion

A

HF signs
Infective signs
tracheal deviation
Chest expansion
Percussion
Auscultation

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54
Q

describe HF signs as a presentation in Pleural effusion

A

elevated JVP, clubbing, calf pain

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55
Q

describe infective signs as a presentation in Pleural effusion

A

enlarged lymph nodes, etc indicative of infections

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56
Q

describe tracheal deviation as a presentation in pleural effusion

A

trachea may deviate to opposite side in the instance of plural effusion

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57
Q

describe chest expansion as a presentation in pleural effusion

A

reduced on ipsilateral (same) side of the body

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58
Q

describe percussion as a presentation of pleural effusion

A

stony dullness due to reduced resonance of percussion over fluid medium

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59
Q

describe auscultation as a presentation of pleural effusion

A

reduced or absent breath sounds, may have bronchial breathing at lung-effusion interface

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60
Q

what are the investigations for pleural effusion

A

vital signs
inflammatory markers
troponin
d-dimer
ECG
CXR
Thoracic ultrasound
CT

61
Q

why do vitals in pleural effusion

A

RR, HR, BP,SPO2, to determine presence of infection or underlying cause

62
Q

why check inflammatory markers in pleural effusion

A

WCC and CRP to look for indications of inflammation or infection

63
Q

why check troponin in pleural effusion

A

collection of serum troponin levels to look for MI

64
Q

why check d dimer in pleural effusion

A

to rule out a pulmonary embolism

65
Q

why check ECG in pleural effusion

A

to investigate MI or pericarditis

66
Q

why check CXR in pleural effusion

A

key dx tool to determine effusion of pleura

67
Q

why check thoracic ultrasound in Pleural effusion

A

key diagnostic test, not really available though

68
Q

what are the options for surgery in managing pleural conditions

A

VATS: video assisted thoracoscopic surgery

Thoracotomy

69
Q

pros of VATS for pleural diseases

A

less invasive
reduced post operative pain
less complex

70
Q

pros of thoracotomy for pleural diseases

A

greater access
greater visibility of procedure
superior outcomes generally

71
Q

treatments for pleural infection

A

-antibiotics if bacterial
-drainage of pleural fluid
-fibrinolytics
-mucolytics

72
Q

describe antibiotic use for treating pleural infection

A

antibiotics are used to target and eliminate the underlying infection in pleural disease, playing a crucial role in controlling and eradicating the infectious microorganisms responsible for the condition

73
Q

describe drainage of pleural fluid in treating pleural infection

A

effectively draining infected plural fluid bia thoracentesis or chest tube placement

74
Q

describe fibrinolytic use in treating pleural infection

A

fibrinolytics, such as tissue plasminogen activator (tPA) help break down fibrin clots and adhesions in the pleural space, facilitating the drainage of infected pleural fluid and improving lung re-expansion

75
Q

describe mucolytics use in treating pleural infection

A

mucolytics, such as DNase, are used to reduce the viscosity of thick and purulent pleural fluid, aiding in its removal and helping create a more conducive environment for other treatments in complex pleural infections

76
Q

list the management for malignant pleural effusion

A

watch and wait
pleurodesis
VATS
IPC

77
Q

describe watch and wait as a management for malignant pleural effusion

A

a conservative approach involving regular monitoring without immediate intervention for asymptomatic or minimally symptomatic malignant pleural effusion to assess disease progression

78
Q

describe pleurodesis as management for malignant pleural effusion

A

a procedure to induce adhesion between layers of pleura, preventing further fluid accumulation in pleural space, often using substances like talc or doxycycline

79
Q

describe VATS aș a management for malignant pleural effusion

A

minimally invasive surgical technique for diagnosing and treating malignant pleural effusion , including pleural biopsy, drainage and pleruodesis

80
Q

describe IPC use as management for malignant plural effusion

A

long term drainage device inserted into the plural space to allow repeated drainage and management of malignant pleural

81
Q

what are the benefits of large volume thoracentesis

A

-assessment of fluid chemistry and cytology (dx)
-symptom relief
-enables non expansive lung to be relieved
-enables rate of fluid re accumulation to ascertained
-leaves room for alternative approaches if cytology is inconclusive

82
Q

what is lights criteria

A

used to classify pleural effusion

83
Q

clear, low viscosity, straw coloured fluid in pleural effusion = what dx

A

suggests transudate

84
Q

serosangiunous (blood) pleural effusion= what dx

A

none (indicates little bit of RBC)

85
Q

frank bloody in pleural effusion = what dx

A

indicates malignancy (not all malignancy have frank bloody)

86
Q

milky/turbid in pleural effusion = what dx

A

infection, chylothorax, cholesterol effusion

87
Q

putrid smelling pus in pleural effusion = what dx

A

infection , likely from anaerobes

88
Q

mechanism for pneumothorax

A

-fistula/puncture to chest wall
-pressure in the pleura exceeds the alveolar presure
-leading to air entry into the pleural space
-deflation of the lung (atelectasis)

89
Q

mechanism for PE

A

-Virchow’s triad (hypercoagulations, venous stasis, vessel injury)
-blood clot develops in the deep veins of the legs
-clot dislodges and migrates into IVC–> RA->RV->lodges in pulmonary arteries

90
Q

what are the classifications for PE

A

sub massive and massive

91
Q

what is a sub massive PE

A

systolic BP>90 and right ventricular dysfunction

92
Q

what is a PE

A

obstruction of a pulmonary artery, or a branch thereof, by a thrombus created elsewhere in the body

93
Q

what is a massive PE

A

sustained hypotension, inotropic failure, pulselessness, sustained bradycardia

94
Q

list the signs and symptoms of PE

A

Pleuritic chest pain
dyspnoea
haemoptysis
palpitations
unilateral oedema
dizziness
tachypnoea
hypoxia
hypotension
calf tenderness

95
Q

describe pleurtic chest pain in PE

A

sharp chest pain worsened by deep breathing or coughing, often associated with pleurisy or pleural inflammation

96
Q

describe dyspnoea in PE

A

SOB due to reduced oxygen exchange

97
Q

describe hameoptysis in PE

A

coughing up blood or blood-tinged sputum, which can occur when PE damages lung tissue

98
Q

describe palpitations in PE

A

irregular or rapid heart beats, due to strain on heart

99
Q

describe unilateral oedema in PE

A

swelling in one limb, typically due to DVT in affected leg (which can lead to PE)

100
Q

describe dizziness in PE

A

feeling lightheaded or unsteady, due to reduced O2 supply to brain

101
Q

describe tachypnoea in PE

A

rapid breathing as body attempt to compensate for decreased O2 levels

102
Q

describe hypoxia in PE

A

inadequate oxygen in body tissues, serious consequence in PE that leads to oxygen deficiency

103
Q

describe hypotension in PE

A

low BP in serious PE, which can indicate haemodynamic compromise

104
Q

describe calf tenderness in PE

A

pain and tenderness in calf, often indicates DVT (risk factor for PE)

105
Q

list the risk factors for PE

A

inherited conditions
recent surgery
immobilisation
smoking

106
Q

describe inherited conditions as a risk factor for PE

A

genetic clotting disorders such as Factor V Leiden deficiency make you higher risk

107
Q

describe recent surgery as a risk factor for PE

A

increased likelihood of inflammatory mediators in bloodstream post surgery

108
Q

describe immobilisations as a risk factor for PE

A

leads to blood stasis forming within the vasculature

109
Q

describe smoking as a risk factor for PE

A

introduces toxin into the body–> eliciting vessel damage

110
Q

what are the cardiopulmonary effects of PE

A

-occlusion of pulmonary artery leading
-increased RV afterload
-increased RV pressure due to tricuspid regurgitation
-reduced RV contractility and RV SV
-reduced LV preload
-reduced CO and SBP
-reduced coronary perfusion
-RV ischaemia

111
Q

list the investigations for PE

A

CBE, EUC, troponin
ECG
CTPA
VQ scan
Echo
D-dimer

112
Q

describe CBE,EUC, troponin use in dx PE

A

provides assessment of bloods for checking haemodynamic state

113
Q

describe ECG use in dx PE

A

enables detection of changes in heart rhythm or signs of RV strain often seen in PE

114
Q

describe CTPA use in dx PE

A

high res CT that visualises PA, allows for definitive dx of PE and severity of PE

115
Q

describe VQ scan use in dx PE

A

compares ventilation and perfusion, highlighting areas where airflow and blood flow don’t match (indicating PE)

116
Q

describe echo use in dx PE

A

looking for signs of RV strain or S1Q3T3 (large S wave (1), Q wave (3), inverted T (3))

Q and T on lead III

117
Q

describe D dimer use in dx PE

A

blood test to measure breakdown product of blood clots, used to rule out PE if negative and prompt further investigation if positive

118
Q

list the factors of well criteria and their worth

A

-Clinical signs and symptoms of DVT (3)
-PE most likely dx (3)
-Tachycardic (1.5)
-immobilisation for at least 3 days or recent surgery 4 weeks (1.5)
-previous DVT or PE (1.5)
-haemeoptysis (1)
-malignancy treatment within six moths or palliative care (1)

119
Q

what is wells criteria

A

tool used to dx PE
-score of 4.0 warrants further testing

120
Q

list the management for PE

A

Anticoagulation
thrombolysis
analgesia

121
Q

describe anticoagulation for managing PE

A

administration of blood thinning meds to prevent formation of blood clots in PE

122
Q

describe thrombolysis for managing PE

A

use of clot dissolving drugs to rapidly break down existing blood clots in sever or life threatening pulmonary embolism

123
Q

describe analgesia for managing PE

A

pain relief medications to manage pleuritic chest pain, a common symptom of PE

124
Q

list the clinical signs and symptoms of pulmonary HTN

A

dyspnoea
fatigue
exertion intolerance
weakness
anginal chest pain
syncope

125
Q

describe dyspnoea as a sign of pulmonary HTN

A

increased pressure in the pulmonary arteries makes it harder for blood to pass through the lungs, reducing oxygen exchange. The heart struggles to pump effectively, causing shortness of breath, especially during exertion.

126
Q

describe fatigue aș a sign of pulmonary HTN

A

As the right side of the heart works harder to pump blood against the high resistance in the pulmonary arteries, the body receives less oxygenated blood, leading to fatigue and muscle weakness

127
Q

describe exertion intolerance as a sign of pulmonary HTN

A

Reduced cardiac output during physical activity leads to a mismatch between oxygen supply and demand, causing early fatigue and breathlessness with minimal exertion.

128
Q

describe anginal chest pain in pulmonary HTN

A

The increased workload on the right ventricle (RV) leads to RV hypertrophy, and eventually, the demand for oxygen by the heart muscle surpasses supply, leading to chest pain, much like angina in coronary artery disease

129
Q

describe syncope in pulmonary HTN

A

With severe pulmonary hypertension, the heart may not pump enough blood to meet the body’s demands, especially during exertion. This can cause a temporary drop in blood flow to the brain, leading to fainting (syncope)

130
Q

what is pulmonary HTN

A

pulmonary hypertension is a condition where elevated pressure in the pulmonary arteries leads to right heart strain and reduced oxygenation

131
Q

identify the common causes of pulmonary HTN

A

idiopathic (primary)
drug induced
heritable
portal HTN

132
Q

what is portal HTN

A

elevated BP within the portal vein system, can lead to pulmonary HTN die to increased blood flow and pressure in lungs

133
Q

list the investigations for pulmonary HTN

A

ECG
echocardiography
V/Q scan
chest CT
PFT’s

134
Q

describe the use of ECG in pulmonary HTN

A

helps assess heart rhythm and identify signs of right heart strain, which can be indicative of pulmonary HTN

135
Q

describe the use of V/Q scan in pulmonary HTN

A

detects V/Q mismatch to identify PE, which is a potential cause of pulmonary HTN

136
Q

describe the use of echo in pulmonary HTN

A

evaluation of cardiac structure and function , including right ventricular size and function

137
Q

describe the use of chest CT in pulmonary HTN

A

enables identification of PE, vascular changes, and lung abnormalities associated with pulmonary HTN

138
Q

describe the use of PFT’s in pulmonary HTN

A

measures lung function parameters, admin assessment of lung condition that can contribute to pulmonary HTN

139
Q

identify the management for pulmonary HTN

A

lifestyle modifications
anticoagulants
oxygen
supportive care

140
Q

describe lifestyle modification as management for pulmonary HTN

A

encourage patients to adopt heart healthy lifestyle, exercise, low salt, smoking cessation

141
Q

describe anticoagulants as management for pulmonary HTN

A

for pt at risk of blood clots, especially in cases of chronic thromboembolic pulmonary HTN

142
Q

describe oxygen therapy as management for pulmonary HTN

A

can help alleviate hypoxia and improve exercise capacity in pt with low levels of oxygen

143
Q

describe supportive care as a management for pulmonary HTN

A

-procedures like pulmonary thromboendarterectomy may be indicated to remove chronic thromboembolic obstruction
-lung or heart-lung transplants also an option

144
Q

what classifies as exudative according to lights criteria

A

-fluid protein/serum troponin >0.5
-fluid LDH/Serum LDH > 0.6
*>2/3 of upper limit of normal serum LDH

145
Q

what classifies as transudative according to lights criteria

A

-fluid protein/serum troponin <0.5
-fluid LDH/Serum LDH < 0.6
*<2/3 of upper limit of normal serum LDH

146
Q

mechanism for transudative PE

A

-decreased oncotic pressure eg liver cirrhosis or increased hydrostatic pressures eg HF
-increased fluid diffusion into lung and pleural interstitial
-lymph drainage is overwhelmed
-fluid escapes into pleural cavity
-transudative PE

147
Q

mechanism for malignancy exudative PE

A

-malignancy produces proteases that increase blood vessel permeability
-angiogenesis to keep up with cell proliferation
-formation of incomplete capillaries increases permeability
-increased permeability of pleura
-increased fluid entering the pleural cavity

148
Q

mechanism for infective exudative PE

A

-inflammation response increases blood vessel permeability
-inflammatory mediators bring more WBC’s to the site of infection
-increases permeability of pleura
-fluid enters the pleural cavity

Medical Studies 1 (15 decks)

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