Pneuomothorax and pleural effusion Flashcards Preview

Respiratory (LECTURE NOTES) > Pneuomothorax and pleural effusion > Flashcards

Flashcards in Pneuomothorax and pleural effusion Deck (46):
1

What is a pneumothorax

The presence of air in the pleural space

2

What is a primary pneumothorax

Where a pneumothorax has occured spontaneously without evidence of other lung disease

3

What is a secondary pneumothorax

Where a pneumothorax has occurred secondary to an underlying lung disease such as COPD or CF

4

Who is likely to present with a spontaneous primary pneumothorax

Healthy young, tall, thin man

5

Where do most pneumothoraces arise from

The rupture of subpleural blebs or bullae at the apex of an otherwise normal lung

6

Is smoking a risk factor for a pneumothorax

Yes

7

What is a tension pneumothorax

Where the lung is pushed down , the mediastinum is shifted to the opposite side and the venous return tot he heart and cardiac output is impaired

8

What is a key finding on a CXR of a tension pneumothorax

The trachea is deviated to one side

9

How does a traumatic pneumothorax occur

Puncture of the lung by a fractured rib

10

How might a Iatrogenic pneumothorax occur

Doctor induced - complication of invasive chest procedures such as the insertion of a catheter into the subclavian vein or during lung aspiration

11

WHat are the 2 most common clinical features of a pneumothorax

Acute pleuritic pain and breathlessness

12

What are the clinical signs of a pneumothorax

Reduced breath sounds and hyper-resonance on the side of the pneumothorax

13

What can be seen on a CXR of a pneumothorax

Black space with no lung markings

14

What are the limits of a small pneumothorax

Where the rim of air between the margin of the collapsed lung and chest wall is less than 2cm

15

What defines a large pneumothorax

Where the rim of air between the margin of the collapsed lung and chest wall is more than 2cm

16

What should be done for a small pneumothorax

Nothing - will resolve spontaneously

17

When is aspiration appropriate and where is this performed?

In a large pneumothorax
Second intercostal space in the mid-clavicular line

18

What is indicated if more than 2.5L of air has been aspirated

A persistent air leak from the lung

19

What does bubbling on respiration or coughing indicate

Continued drainage of air

20

When is surgical intervention required

For persistent or recurrent peumothoraces

21

What is involved in a pleurectomy

Removal of the parietal pleura

22

What is involved in a pleurectomy

Removal of the parietal pleura

23

What is a pleural effusion

A collection of fluid in the pleural space

24

What is the parietal pleura perfused by

The systemic circulation

25

What is the visceral pleura perfused by

The pulmonary circulation

26

Why does fluid not normally collect in the pleural space

The balance between fluid filtration by the parietal pleura and fluid absorption by the visceral pleura prevents this

27

What might cause the development of a pleural effusion

Increased capillary pressure
Reduced plasma oncotic pressure
Increased capillary permeability
obstruction of lymphatic drainage

28

What do patients most commonly present with when they have a pleural effusion

Dyspnoea
Sometimes pleuritic pain
Often features of associated disease (cardiac faulrue or carcinoma)

29

What are the signs fo pleural effusion

Decreased expansion on the side of the effusion
STONY DULLNESS
diminished breath sounds
reduced tactile vocal fremitus

30

What are the investgiations involved in diagnosing a pleural effusion

CXR: dense white shadow with a concave upper edge
Ultrasound: helpful in localising loculated eddusions and in positioning chest tubes
CT: helpful in detecting pleural tumours and in assessing the underlying lung and mediastinum
Pleural fluid aspiration: this is the key initial investigation

31

What indicate that the effision is an exudate

A protein level of more than 30 and a lactate dehydrogenase level of more than 200

32

What does a blood stained aspirate point towards

Malignancy, pulmonary infarction or severe inflammation

33

What does pus indicate

Empyema

34

What does milky white fluid suggest

A chylothorax

35

What is suggestive of a haemothorax

Frank blood

36

What are the predominant cells in acute inflammation or infection

Neutrophils

37

What are the cells found in chronic effusions particularly caused by TB or malignancy

Lymphocytes

38

What is radiologically guided biopsy is particularly useful in diagnosing?

Malignant disease of the pleura

39

What are the 4 main causes of transudative pleural effusions

Cardiac failure
renal failure
hepatic cirrhosis
hypoproteinaemia (malnutrition or nephrotic syndrome)

40

What relieves dyspnoea

Drainage of the fluid by needle aspiration or intercostal chest tube

41

How is an empyema produced

A secondary infection of an effusion with multiplication of bacteria in the pleural space (pus in the pleural cavity)

42

What is the initial antibiotic treatment for empyema

Co-amoxiclav with metronidaxole

43

What is the key treatment for empyema?

Drainage of the pus

44

What do connextive tissue diseases that are associated with effusions characteristically have

A low glucose content

45

What is Dressler's syndrome ?

It consists of inflammatory pericarditis and pleurisy of uncertain aetiology following an MI or cardiac operation (4-6 weeks after)

46

What is an unusual cause of a pleural effusion but is a medical emergency

Rupture of the oesophagus