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3- Respiratory Medicine > Pneumothorax > Flashcards

Pneumothorax Flashcards

1
Q

Pneumothorax definition

A

Presence of air in the pleural cavity with partial or total collapse of lung

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2
Q

3 main types of pneumothorax

A

Spontaneous
Traumatic
Iatrogenic

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3
Q

What is primary spontaneous pneumothorax

A

Pneumothorax that occurs without precipitating event in a person does not have known lung dx

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4
Q

Main location of rupture in primary spontaneous pneumothorax

A

Rupture of subpleural blebs especially at the apices of lungs

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5
Q

Main population at risk of PSP

A

Young male with tall and thin aesthenic physic

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6
Q

Pathophysiology of spontaneous pneumothorax

A

From expansion of alveoli beneath pleura
Leading to rupture of alveolar walls and overlying pleura

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7
Q

What is the mechanism of tension pneumothorax

A

Valve like mechanism where air enters during inspiration but cannot leave during expiration
Tension build sup

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8
Q

X ray findings of tension pneumothorax

A

Partial or complete collapse of lung towards hilum
Increased translucency
Absence of lung markings in greater part of i psi lateral hemithorax
Mediastinal shift to contralateral side
Ipsilateral diaphragmatic depression
Ipsilateral increase in intercostal spaces
Increased vascularity of contralateral lung

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9
Q

Secondary spontaneous pneumothorax causes

A

COPD
Pulmonary tuberculosis
Enterogenous cyst
RDS of newborn
Pulmonary neoplasm
Bullous lung dx

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10
Q

What is traumatic pneumothorax

A

Caused by penetrating or blunt trauma to chest with air entering pleural space

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11
Q

Different ways air enter pleural space in traumatic pneumothorax

A

Directly through chest wall
Through visceral pleural penetration
Through Alveolar rupture resulting from sudden chest compression

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12
Q

Which type of pleural effusion is often associated with traumatic pneumothorax

A

Hemothorax

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13
Q

Event leading to haemo -pneumothorax

A

Rib fractures
Penetrating chest wound
Perforating chest wounds
Surgical procedures in chest cavity including oesophagus

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14
Q

Definition of iatrogenic pneumothorax

A

Pneumothorax after Complication of diagnostic or therapeutic intervention

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15
Q

Main causes of iatrogenic pneumothorax

A

Subclavian percutaneous catheterisation (central lines, pacemaker insertion )
Transthoracic lung biopsies
Trans bronchial lung biopsies
Thoracocentesis
Chest tube malfunction

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16
Q

Population at risk of catamenial pneumothorax

A

Women 30-40 yo

17
Q

What is catamenial pneumothorax

A

Cyclical chest pain from presence of endometrial tissue in pleural space

18
Q

what do the symptoms start in catamenial pneumothorax

A

Within 48h of menstruation

19
Q

Main symptoms in catamenial pneumothorax

A

Right sided chest pain
Shortness of breath

20
Q

Conditions associated with catamenial pneumothorax

A

Endometriosis
Infertility

21
Q

What is persistent pneumothorax

A

Continued air leak from an in situ chest drain more tan 48h after insertion

22
Q

Main causes of persistent pneumothorax

A

Kinking of the tube
Malposition of tube
Lung parenchymal tube
Bronchopleural fistula
Oesophageal pleural fistula

23
Q

Consequence of pneumothorax in healthy lungs

A

Partial or total collapse of lung
Minimal arterial hypoxemia
Diminished exercise tolerance

24
Q

Consequence of tension pneumothorax

A

Mediastinal shift to contralateral side
Compression of lung
Impairment of venous return to heart and severe ventilation perfusion defect

25
Q

When can pneumothorax result in acute respiratory failure

A

Obstructive airway
Severe pulmonary dx

26
Q

History of pneumothorax

A

Chest pain - sharp, stabbing, on the side of chest involved
Dyspnea with cyanosis , sweating. Faintness

27
Q

Respiratory Examination findings in pneumothorax

A

Respiratory distress
Tachypnoea
Asymmetric lung expansion
Mediastinal and tracheal shift (tension pneumothorax )
Distant / absent breath sounds
Hyperresonance
Decreased tactile fremitus
Adventitious lung sounds (crackles , wheeze)

28
Q

Cardiovascular exam findings

A

Pulsus paradoxus
Hypotension
JVD
Cardiac apical displacement
Tachycardia

29
Q

Investigation

A

Chest xray
Ct scan

30
Q

Treatment of small pneumothorax

A

If less than 1.5cm, no distress of patient -> Allow spontaneous reabsorption
With serial xray to follow progression

Heimlich valve with one way disposable one way valve for self limiting pneumothorax

31
Q

Treatment tension pneumothorax

A

Wide bore intercostal catheter connected to underwater seal and suction
Done in 2nd intercostal space anterior , mid clavicular line

32
Q

Function of treatment with chemical pleurodesis

A

Achieve adhesion between parietal and visceral layer of pleura

33
Q

Chemical used in chemical pleurodesis for adhesion of parietal and visceral pleural layers

A

10% silver nitrate
Iodized talc powder
50% glucose though thoracospe into pleural space
Bleomycin in malignancies

34
Q

Indication for surgery in pneumothorax

A

Persisten air leak
2nd recurrence
Contralateral pneumonectomy
Contralateral diseased lung
Specialized occupation - pilot , deep sea diver
Remote from reasonable medical care

35
Q

Contraindications to VATS

A

Chronic pneumothorax with restrictive membrane over visceral pleural that can interfere with full re expansion of lung

3- Respiratory Medicine (12 decks)

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