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1
Q

what is a pneumothorax

A

air in the pleural space

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2
Q

pneumothorax classification based on causes

A

a) primary: tall, thin, young healthy male smoker
b) secondary: pre-existing condition (COPD, asthma, CF)
c) traumatic

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3
Q

pneumothorax symptoms

A

SOB
pleuritic chest pain

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4
Q

pneumothorax signs

A
  • hyper-resonant
  • reduced chest expansion
  • reduced breath sounds
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5
Q

tension pneumothorax presentation

A
  • trachea deviates away from the lesion
  • tachycardia, hypotension, respiratory distress
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6
Q

pneumothorax investigations

A
  • chest x-ray: black
  • CT CAP if trauma
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7
Q

primary pneumothorax management

A

< 2cm: observe and discharge
> 2cm: needle aspiration, chest drain if unsuccessful

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8
Q

secondary pneumothorax management

A

< 2cm: needle aspiration, chest drain if unsuccessful
> 2cm: chest drain
< 1cm: oxygen and observe

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9
Q

tension pneumothorax management

A

emergency do not investigate!!

i. needle decompression (5th ICS) + oxygen
-> open thoracostomy in trauma
ii. chest drain + analgesia after decompression

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10
Q

recurrent or persistent pneumothorax treatment

A

VATS (cardiothoracic referral)

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11
Q

how to check chest drain is in pleural cavity

A

water rises on inspiration, falls on expiration

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12
Q

most common community acquired pneumonia

A

streptococcus pneumoniae (+ve)

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13
Q

community acquired pneumonia associated with COPD

A

haemophilus influenza (-ve)

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14
Q

community acquired pneumonia associated with IVDUs

A

staphylococcus aureus (+ve)

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15
Q

community acquired pneumonia associated with recent flu

A

staphylococcus aureus

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16
Q

community acquired pneumonia associated with alcoholics

A

klebsiella (-ve)

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17
Q

mycoplasma pneumonia associations and presentation

A

young uni students
atypical (dry cough, haemolytic anaemia)

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18
Q

legionella pneumophilia associations and presentation

A

airconditioning
atypical (hyponatraemia)

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19
Q

community acquired pneumonia associated with HIV

A

pneumocystis jirovecii

20
Q

most common hospital acquired pneumonia

21
Q

pneumonia associated with bronchiectasis

A

pseudomonas aeruginosa, haemophilus

22
Q

pneumonia symptoms

A

cough with productive green sputum
pleuritic chest pain
SOB
fever, rigours

23
Q

pneumonia signs

A

reduced chest expansion
coarse crackles
dull percussion
increased vocal resonance

24
Q

pneumonia investigations

A
  • Bedside: sputum sample
  • Bloods: FBC, U&Es, LFTs, CRP, culture, ABG
  • CXR: consolidation
  • Special: pleural fluid MCS
25
pneumonia severity score
CURB-65 confusion urea >7 RR >30 Blood pressure < 90 systolic 65 or older
26
pneumonia management
CURB 0-1: outpatient amoxicillin CURB 2: admit with amoxicillin + clarithromycin CURB 3: admit with coamoxiclav + clarithromycin -> amoxicillin covers typical -> clarithromycin covers atypical
27
aspiration pneumonia antibiotic
metronidazole
28
MRSA pneumonia management
IV vancomycin
29
pneumonia management if penicillin allergy
doxycycline
30
pneumonia management for staphylococcus aureus
flucloxacillin + amoxicillin
31
aspiration pneumonia causes
intubation, surgery swallowing difficulty (MS) -> commonly affects right lobe
32
pseudomonas pneumonia management
IV gentamycin
33
additional medication for pneumonia patient with COPD
give prednisolone
34
pneumonia complications
- infection spread: effusion, sepsis, empyema (staph associated with abscess) - structural: bronchiectasis, pneumothorax
35
pneumonia follow up test
CXR 6 weeks after
36
first line antibiotic for hospital acquired pneumonia (>48hrs hospital)
co-amoxiclav
37
what is bronchiectasis
irreversible bronchi dilatation
38
congenital causes of bronchiectasis
- cystic fibrosis (most common) - Kartagener's syndrome (bronchiectasis, inverted heart, sinusitis, infertility)
39
infective causes of bronchiectasis
- TB (most common worldwide) - ABPA
40
bronchiectasis symptoms
- chronic productive cough - copious amounts of white sputum - haemoptysis - SOB
41
bronchiectasis signs
- clubbing - coarse crackles
42
bronchiectasis investigations
Bedside: - sputum MCS (pseudomonas, haemophilus) Bloods: - routine bloods - serum IgE (IgE + eosinophils -> ABPA) Imaging: - first line: CXR tram-lines - diagnostic: HRCT chest signet rings Special: - genetic testing - CF test
43
bronchiectasis management
- airway clearance with physiotherapy - surgery if localised
44
bronchiectasis recurrent infections prophylaxis
azithromycin
45
bronchiectasis CXR sign
tram-track lines
46
bronchiectasis HRCT chest sign
signet rings

medicine can be fun (12 decks)

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