105 - Pleurisy

Question 1

What is pleurisy?

Answer 1

Inflammation of the pleura - due to pneumonia or lung disease

Question 2

What management options are there for a pneumothorax?

Answer 2

Allow spontaneous resorption
Needle Aspiration
Chest drain
Surgery - talc pleurodesis, pleurectomy
Endobronchial valve

Question 3

What are the 2 types of tension pneumothorax?

Answer 3

+ve pressure ventilation - air can’t escape from the pleura, but more air is forced in on inspiration - gets bigger
Flap valve, air is brought in through trauma wound but the flaps shut on expiration trapping air

Question 4

What is the management of a tension pneumothorax?

Answer 4

Immediate - 100% high flow 02

Needle thoracocentesis - 2nd ICS, mid clavicular line, hear hiss, then drain

Question 5

What is the key sign on a Xray of a pleural effusion?

Answer 5

Blunting of the costaphrenic angle

Question 6

What investigations would you do for a pleural effusion?

Answer 6

Chest X ray
Ultrasound
Aspiration

Question 7

What are the 2 classes of fluid that come out of an aspiration of a pleural effusion

Answer 7

Transudate - Less than 30 protien - due to organ failures

Exudate - More than 30 protein. Acidic - Ph <7.2. Cloudy. Due to cancer, TB, inflammation, trauma, PE..

Question 8

Where is turbulent air flow?

Answer 8

Trachea

Question 9

Where is transitional air flow?

Answer 9

Bronchial tree

Question 10

Where is laminar air flow?

Answer 10

In the broncioles

Question 11

How do you measure dead space in the resp system?

Answer 11

Bohr equation

or Fowlers method (estimate anatomical dead space)

Question 12

How is pulmonary vascular resistance changed?

Answer 12

Passively - recruitment of collapsed vessels, distension of existing vessels.

Actively - HPV - Hypoxic pulmonary vasocontriction - alveolar hypoxia contricts the small pulmonary arteries, which is used a birth and to direct blood away from diseased lung
- Pulmonary vascular resistance - normally very small, decreases on exercise, increases in hypoxia, increases in high + low lung volumes

Question 13

Where is there the most resistance in the airways?

Answer 13

Half in nasopharynx

Question 14

Where is there the most resistance in the lungs?

Answer 14

90% in the central airways - bronchi

10% in peripheral airways

Question 15

What causes the biggest effect on FEV1:FVC when it narrows?

Answer 15

Median sized airways - bronchi

Question 16

what is the normal FEV:FVC ratio (spirometry)

Answer 16

0.75 - 0.8

Question 17

How long after breathing out as far as possible is FEV (forced expiratory volume) measured?

Answer 17

1 second

Question 18

How is FVC measured? Forced vital capacity

Answer 18

The lowest point reached when breathing out as far as possible.

Question 19

What occurs to the FEV:FVC ration in an obstructive abnormality?

Answer 19

It falls below 0.75

Question 20

What occurs to the FEV:FVC in a restrictive condition?

Answer 20

It is normal or higher than normal (as can’t breath out as much due to pain of restriction)

Question 21

What are the metabolic functions of the lung?

Answer 21

Renin-angiotensin system - Angiotensin 1 is converted to angiotensin II in the lung
Inactivation of some amines and purines
Activation of arachidonic acid