Where do you insert a chest drain
4-6 ICS, MAL
Where do you aspirate air in pneumothorax
2 ICS, MCL
5 Risk factors for pneumothorax
- COPD,
- Genetics: Ehlers-Danlos, Marfans,
- Smoking,
- Mechanical ventilator
- Sex (M>F)
- Age
4 causes for acute onset of SOB
PE, Pneumothorax, Foreign bodies, Anxiety
Management of suspected PE (Rx + Ix)
Give LMWH then do CTPA. If PE found, give warfarin but continue LMWH until INR is appropriate (3-5 days)
Thrombolyse if massive PE and pat is haemodynamically compromised ie hypotensive
Warfarin increases risk of clotting initially from deactivation of Protein C and S
Name 5 ECG signs of PE
- Sinus tachycardia
- RBBB (?R straining)
- Right Axis Deviation (?R straining)
- R straining (T wave inversion and ST depression in inferior and anterior leads)
- S1 Q3 T3: deep S wave in lead I, Q wave in III, inverted T wave in III
- AF
List causes of these opacities in CXR
- Interstitial or alveolar shadowing (fluffy)
- Reticulo-nodular (lines and dots)
- Homogenous
- Masses or cavitations
1a Fluid (oedema) -> HF, bilaterally
1b Pus -> pneumonia, unilateral
1c Blood -> pulmonary haemorrhage in vasculitis (rare)
- Interstitial pulmonary fibrosis including asbestosis, extrinsic allergic alveolitis
- Fluid
- Bilat: pleural effusion
- Uni: collapsed lung - Tumours, granulomas, abscesses
Inflammatory nodules
TB – cavitating coin lesion
Which type of lung disease has FEV1/FVC ratio < 70? Which has > 70?
<70 is obstructive
> 70 is restrictive
4 antibiotics for TB and their MOA
RIPE: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Rifampicin: inhibits DNA-dependent RNA polymerase
Isoniazid: inhibiting mycolic acid synthesis needed for TB’s cell wall
Pyrazinamide: unknown. Possible accumulate acid and disrupt mbn potential
Ethambutol: disrupt cell wall synthesis
