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21 Cards in this Set
- Front
- Back
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1. What is the next step in a patient presents with a large primary spontaneous pneumothorax?
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a. Perform either tube thoracostomy or needle aspiration to allow reexpansion of the left lung.
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2. Risk factors for primary spontaneous pneumothorax?
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a. Rupture of subpleural blebs. ( most common cause)
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3. Causes of secondary spontaneous pneumothorax?
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a. Bullous emphysematous disease
b. Cystic fibrosis c. Primary and secondary cancers d. Necrotizing infections with organisms such as Pneumocystis carinii e. Catamenial (pulmonary endometriosis, occurring usually with menstruation) f. Asthma |
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4. Pneumothorax?
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a. Condition whereby air enters the pleural space, thus preventing expansion of the lung parenchyma.
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5. Tension pneumothorax?
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a. Caused by a flap valve effect such that air enters the pleural space but cannot exit until the pleural pressure is so great that it prevents blood from entering the chest.
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6. Open pneumothorax?
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a. Injury to the full thickness of the chest wall such that the negative intrapleural pressure results in air being sucked directly through the chest wall defect, preventing air from being taken in through the trachea.
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7. Treatment of open pneumothorax
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a. Requires a mechanical covering over the chest.
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8. Flail chest?
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a. Injury to multiple ribs leading to a paradoxical inward movement of the affected chest region on inspiratory effort, resulting in little air movement.
b. Concerns in patients with this condition are lung dysfunction associated with injuries of the lungs and the flail segment and the development of atelectasis secondary to pain from the rib fractures. |
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9. Tube thoracostomy?
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a. Placement of a catheter (chest tube) into the pleural space to evacuate air, blood, or fluid to permit better ventilation.
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10. Initial management of pneumothorax?
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a. Requires reexpansion of the lung.
b. It is often required tube thoracostomy c. But thoracentesis or pleural catheter drainage can be attempted for smaller pneumothoraces (<30% of the width of the hemithorax). |
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11. Treatment of small, asymptomatic pneumothoraces (<15% of the width of the hemithorax)?
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a. Can the initially be observed with serial chest radiographs.
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12. In whom is primary pneumothorax usually seen?
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a. Young man (15 to 35 yo) without other risk factors for spontaneous pneumothorax.
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13. In whom is secondary pneumothorax most commonly seen?
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a. Older (>50) patients with COPD.
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14. When is surgery indicated for pneumothorax?
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a. For 1st time spontaneous pneumothorax when there is a persistent air leakage (3 to 5 days)
b. When the lung fails to reexpansion c. In patients who are at high risk for recurrence (bilateral pneumothoraces, a previous history of contralateral pneumothorax, significant bullous disease on radiograph) d. In patients who have limited access to medical care (those living in remote areas) e. In patients whose occupation produces an increased risk (scuba divers, pilots) |
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15. Recurrence rate for spontaneous pneumothorax?
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1. 30% after the 1st occurrence
2. 50% after 2nd 3. 80% of the 3rd b. Therefore, immediate surgical intervention is indicated after the 2nd recurrence. |
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16. Surgical treatment for pneumothorax?
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a. Pleurocentesis and resection of the blebs by either thoracoscopic approach or thoracotomy.
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17. A patient is seen by the pulmonologist for recurrent spontaneous pneumothorax. Which of the following is the most likely risk factor for this condition:
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a. Female gender
b. Age 55 to 70 c. Tall, thin physique d. History of TB e. Answer: C. spontaneous pneumothorax occurs more commonly in young men are tall and thin and in smokers |
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18. A 33-year-old woman who underwent multiple enterotomies for penetrating abdominal, has a subclavian central line place and subsequently develops "air hunger", which of the following is the most likely etiology?
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a. Pneumothorax. A fairly common complication of placement of a central venous catheter is pneumothorax.
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19. Which of the following presentations is most consistent with tension pneumothorax?
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a. Hypotension, diminished breath sounds on the left, tracheal deviation to the right, and chest x-ray demonstration of opacification of the left hemithorax.
b. Diminished breath sounds on the left and trachea deviation to the right!!! |
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20. In distinguishing between pleural effusion and pneumothorax, which of the following findings is more likely be found pleural effusion and not pneumothorax:
a. Respiratory rate of 33 b. Agitation c. Somnolence d. Dullness to percussion over the chest wall on the affected side? |
i. Answer: D.
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21. Complete.
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21. Complete.
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