Class Notes

Question 1

Stenocardial and pleuritic is found

Answer 1

Pulmonary embolism

Question 2

How does pleuritic chest pain feel

Answer 2

Sharp stabbing chest pain

Question 3

What does dull chest pain indicate

Answer 3

Stenocardial

Question 4

Side effect of an SSRI

Answer 4

Pulmonary hypertension

Question 5

Types of pneumothorax

Answer 5

Tension
Iatrogenic
Spontaneous

Question 6

Types of spontaneous pneumothorax

Answer 6

Primary and secondary

Question 7

What is the difference between primary spontaneous pneumothorax and secondary

Answer 7

Primary is without lung disease present aspiration is enough, while in secondary lung disease is present such as COPD and cystic fibrosis

Question 8

What can happen in tension pneumothorax

Answer 8

Due to shot wound, air will move to the plural space and increase pressure and mediastinum will shift to the opposite side and can obstruct great vessels

Question 9

Which type of pneumothorax is considered a medical emergency

Answer 9

Tension pneumothorax

Question 10

Treatment of tension pneumothorax

Answer 10

Place a catheter or a drainage in to the 2nd intercostal space

Question 11

What is considered a big pneumothorax

Answer 11

Later of air bigger than 2CM

Question 12

What is done in a big pneumothorax

Answer 12

Drainage

Question 13

What is considered a small pneumothorax

Answer 13

Smaller than 2CM can happen if a catheter is placed in the the plural space

Question 14

What is done in case of small pneumothorax

Answer 14

If there are no symptoms just give O2 and wait (conservative treatment)

Question 15

What is done in secondary pneumothorax

Answer 15

Chest drainage is needed

Question 16

Where to place chest drainage

Answer 16

Safe triangle

Question 17

Where to place aspiration

Answer 17

2nd intercostal space

Question 18

How do we insert anything through the chest

Answer 18

We go over the rib and we use local anaesthesia since below the rib there’s artery vein nerve

Question 19

When is X-ray preformed for pneumothorax

Answer 19

On diagnosis, after 6 hours and after 24 hours

Question 20

What is the conservative treatment for pneumothorax

Answer 20

Wait observe and give O2

Question 21

What is pleurodesis

Answer 21

Injecting tetracycline, iodine, belomycin, talk or tissue glues which causes inflammation and cause the pleura to stick

Question 22

Indications of pleurodesis

Answer 22

• Primary spontaneous pneumothorax drained for more than 5-7 days
• Secondary spontaneous pneumothorax
• to prevent recurrent pneumothorax and plural effusions

Question 23

Main complications of pleurodesis

Answer 23

Painful - give lidocaine intrapleurally, painkillers or opioids

Question 24

What is a plural effusion

Answer 24

Fluid in the pleural cavity which can be transudate or exudate based on (lights criteria)

Question 25

What can cause a transudate pleural effusion

Answer 25

Heart failure Liver failure Nephrotic syndrome…. Less than 0.5 protein and 0.6 LDH

Question 26

What is lights criteria

Answer 26

If the fluid has protein ratio over >0.5 LDH serum LDH>0.6 Pleural fluid LDH>2/3 ofULN serum LDH Then it is an exudate and further tests are required If not then it is a transudate and no further tests are required

Question 27

What can cause exudate pleural effusion

Answer 27

``` Infection Neoplasm Immunological disease Pneumonia TB More than 0.5 protein and 0.6 LDH ```

Question 28

When is it more common to be needed to evacuate the fluid

Answer 28

If it’s an exudate since symptoms start showing up

Question 29

What is done in case of malignancy and pleural exudate

Answer 29

Pleurodesis because it will probably relapse

Question 30

What is done after identifying a pleural exudate

Answer 30

We need to find the underlying disease and treat it

Question 31

What indicates an immediate chest drainage

Answer 31

Pleural fluid of PH lower than 7.2

Question 32

What can effusions rich in lymphocytes be caused by

Answer 32

Malignancy, TH, lymphoma, heart failure, rheumatoid arthritis or chylothorax

Question 33

What could effusion rich in eosinophils be caused by

Answer 33

Pneumothorax

Question 34

What is chylothorax

Answer 34

(Rare cause of pleural effusion) yellow millet liquid, rich in triglycerides more than 1.24 mmol/L

Question 35

What is empyma

Answer 35

Infected fluid in pleural cavity and is and indication for chest drainage and in some cases is treated surgically

Question 36

How does empyma look

Answer 36

Thick yellow green pus

Question 37

What is hemothorax

Answer 37

The hematocrit is over 50% of peripheral blood | It could be misleading in cases of empeyema and malignancy causes effusion so we need to find hematocrit percentage

Question 38

What should be done in the case of a hemothorax and why

Answer 38

We need to drain it (CHEST DRAINAGE) | High risk of empyma development and can lead to fibrothorax