Term
| Describe a pleuritic pain. |
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Definition
Sharp, stabbing pain.
Localised not radiating.
Usually unilateral.
Worsened on inspiration or with coughing. |
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Term
| What are the symptoms of pleural disease? |
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Definition
| Pleuritic pain, dyspnoea and a cough (producing sputum/ blood) |
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Term
|
Definition
| Inflammation of the pleura surrounding the lungs causing the pleura to stretch/stick therefore causing pain. |
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Term
| What are the clinical signs of pleural disease? |
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Definition
| Reduced chest expansion, pleural rub, mediastinal crunch, reduced vibrations on tactile vocal fremitus, reduced sound in vocal fremitus modified percussion notes. |
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Term
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Definition
| Sound caused by the sticking of inflamed pleura, can be heard above a pleural effusion. |
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Term
| What is a mediastinal crunch? |
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Definition
| A substernal crepitance, synchronous with the heartbeat, caused by air forced through the pleural folds as the heart contracts. |
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Term
| What different signs would you note with percussion in pleural disease? |
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Definition
| Hyporresonant in pneumothorax and stony dull with fluid in pleural effusion. |
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Term
| What are the clinical signs of pleural effusion? |
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Definition
| Reduced chest wall movement on affected side, mediastinal displacemnt away from effusion, stony dull on percussion and reduced sound/fremitus on auscultation. |
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Term
| On CXR what would you note in a pleural effusion? |
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Definition
| Reduced costo-phrenic angle and homogenous shadowing. |
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Term
| In pleural effusion what is a transudate? |
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Definition
| Fluid passed through a membrane due to a high hydrostatic pressure or a low oncotic pressure. Contains low levels of protein and low lactic de-hydrongenase. |
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Term
| Name a cause of transudate pleural effusion. |
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Definition
| Heart failure, hypoproteinaemia, hypothyroidism or ovarian tumor (fluid through diaphragm). |
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Term
| In pleural effusion what is an exudate? |
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Definition
| Fluid actively passed out of blood. Contains high levels of protein and high lactic dehydrogenase. |
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Term
| Name a cause of exudate pleural effusion. |
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Definition
| Pneumonia, TB, Cancer (cell debris and blood present), pulmonary infarct (cell debris and blood present) or trauma. |
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Term
|
Definition
| Leakage of lymph and chyle from the thoracic duct draining into the pleural space. Usually resulting from surgery. |
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Term
|
Definition
| The collection of pus in the pleural space. |
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Term
| Define a simple pneumothorax |
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Definition
| Intrapleural pressure= atmospheric pressure |
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Term
| Name a cause of a primary pneumothorax. |
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Definition
| Pleural bleb/ pulmonary bullae (usually in apical in young, tall, thin people). |
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Term
| Name a cause of a secondary pneumothorax. |
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Definition
| Lung disease eg. COPD, trauma, lung cancer or infection of the lungs. |
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Term
| Name types of trauma which may result in a pneumothorax. |
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Definition
| Open (chest wall puncture), closed eg. rib punctures lung and Iatrogenic eg. central venous access, liver/lung biopsy and +ve pressure ventilation. |
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Term
| Name respiratory signs found in pneumothorax. |
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Definition
| Tachypnoea, respiratory distress/arrest, asymmetrical lung expansion, distant or absent breath sounds, hyperresonace on percussion or decreased tactile vocal fremitus. |
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Term
| Name cardiovascular clinical signs found in pneumothorax |
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Definition
| Tachycardia, pulsus paradoxus, hypotension and raised JVP in tension pneumothroax. |
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Term
| Define a tension pneumothorax |
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Definition
| Intrapleural pressure > atmospheric pressure, caused by a one way falp valve into pleura. |
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Term
| Why is a tension pneumothorax a medical emergency? |
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Definition
| Increased pressure causes the lung to collapse, this pressure then crushes the other lung and heart. This can result in occlusion of the vena cava therefore increasing JVP. |
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Term
| What are the clinical signs of a tension pneumothorax? |
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Definition
| Tracheal deviation, increased JVP, low bloof pressure, high heart rate, shock and signs of simple pneumothorax. |
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Term
| In a tension pneumothorax, where would you place a needle thoracentesis? |
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Definition
| 2nd intercostal space, mid-clavicular line |
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Term
| Where would you place a chest drain? |
|
Definition
| 4th/5th intercostal space, mid axillary line, ABOVE RIB. |
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Term
| Before inserting a chest drain how would you effectively anaethatise the area? |
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Definition
| Nerve block the relevant intercostal nerve as well as the intercostal nerves above and below due to branching. |
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Term
| Define Inspiratory reserve volume. |
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Definition
| The volume of air breathed in by maximum inspiration after normal inspiration. |
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Term
|
Definition
| The volume of air used in normal inspiration. |
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Term
| Define inspiratory capacity |
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Definition
| Inspiratory reserve volume + tidal volume |
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Term
| Define Expiratory reserve volume |
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Definition
| The volume of air breathed out by maximum expiration after normal expiration. |
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Term
|
Definition
| The volume of air remaining in the lungs after maximum expiration. |
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Term
|
Definition
| The volume of air between maximum expiration and maximum inspiration. |
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Term
| Define total lung capacity. |
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Definition
| The volume of air from 0L to maximum inspiratory capacity. |
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Term
|
Definition
| The volume of air which is inhaled that does not take part in the gas exchange, because it remains in the conducting airways, or reaches alveoli that are not perfused or poorly perfused. |
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Term
| Where would you find laminar flow in the lungs? |
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Definition
| Small airways with low resistance |
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Term
| Where would you find turbulent air flow in the lungs? |
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Definition
| Trachea/main bronchi with high resistance. |
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Term
| What is the alveolar gas equation? |
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Definition
| PA02 = PIO2 – (PaCO2/RER) |
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Term
| What does the starling equation illustrate? |
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Definition
| The movement of fluid across capillary membranes therefore the physiology of accumulation/resorption of tissue fluid. |
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Term
| How are pulmonary vessels adapted to maintain pulmonary vascular resistance? |
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Definition
| High distensiblility and compressiblility. |
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Term
| What physical mechanisms increase pulmonary resistance? |
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Definition
| Low BP causes vessel diameter decrease therefore increasing resistance. Inspiration, increases lung volume causes increased alveolar volume therefore squeezing capillary and increasing resistance. |
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Term
| How does the pulmonary blood supply direct blood away from hypoxic alveoli? |
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Definition
| Smooth muscles of arterioles supplied with O2 from alveoli constrict as a result of decreased O2, therefore redirecting blood supply. |
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Term
| Name 2 functiosn of the lungs which are non-respiratory. |
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Definition
| The production of angiotensin converting enzyme and filters blood reducing the chance of thrombi from right side of the heart to the rest of the body. |
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