Management of Pneumothorax in Adult Males: Clinical Scenarios and Recommendations

ACCP;2001
BTS;2010
ERS;2015
Q1
25 year old male with sudden onset pleuritic chest pain, denies dyspnoea. Sats are 97% on air. CXR shows right
sided pneumothorax 2.5cm measured at hilum. How should the pneumothorax be managed?
A.
Pleural aspiration
B.
Intercostal chest drain with underwater
seal
C.
Intercostal chest  drain with -8cm water
wall suction
D.
Admit overnight on 15litres humidified
oxygen
E.
Discharge with follow up CXR in 1-2
weeks
 
25 
year old male with sudden onset pleuritic chest pain, denies dyspnoea. Sats are 97% on air.
CXR shows right sided pneumothorax 
2.5cm
 
measured at hilum. How should the pneumothorax
be managed?
A.
Pleural aspiration
B.
Intercostal chest drain with underwater
seal
C.
Intercostal chest  drain with -8cm water
wall suction
D.
Admit overnight on 15litres humidified
oxygen
E.
Discharge with follow up CXR in 1-2
weeks
Thorax 
2010;65(Suppl 2):ii18-ii31  (page ii21)
Q2
60 year old male present with right sided pleuritic pains and dyspnoea.  Sats was 97% on air and CXR shows
1.5cm right side pneumothorax measured at hilum. Pleural aspiration was done and a follow up CXR shows
reduction in size of pneumothorax to 0.5cm measured at hilum.
This patient is a current cigarette smoker with 20 pack year history. He has a diagnosis of COPD with 2
exacerbation in the past 12 months, one requiring BiPAP for hypercapnic acidaemic respiratory failure.
What is the next management step?
A.
Admit overnight for observation on room
air
B.
Admit overnight on 15Litres  oxygen
C.
Repeat pleural aspiration with 16G
cannula
D.
Treat persistent pneumothorax with 12FG
Seldinger intercostal drain.
E.
Treat persistent pneumothorax with wide
bore Argyl drain
 
60 
year old male present with right sided pleuritic pains and dyspnoea.  Sats was 97% on air and
CXR shows 
1.5cm
 
right side pneumothorax measured at hilum. Pleural aspiration was done and a
follow up CXR shows reduction in size of pneumothorax to 
0.5cm
 
measured at hilum.
This patient is a current cigarette smoker with 20 pack year history. He has a diagnosis of 
COPD
with 2 exacerbation in the past 12 months, one requiring BiPAP for hypercapnic acidaemic
respiratory failure
.
What is the next management step?
A.
Admit overnight for observation on room
air
B.
Admit overnight on 15Litres  oxygen
C.
Repeat pleural aspiration with 16G
cannula
D.
Treat persistent pneumothorax with 12FG
Seldinger intercostal drain.
E.
Treat persistent pneumothorax with wide
bore Argyl drain
at risk of resp failure
 no role for repeated pleural aspiration
60 
year old male present with right sided pleuritic pains and dyspnoea.  Sats was 97% on air and
CXR shows 
1.5cm
 
right side pneumothorax measured at hilum. Pleural aspiration was done and a
follow up CXR shows reduction in size of pneumothorax to 
0.5cm
 
measured at hilum.
This patient is a current cigarette smoker with 20 pack year history. He has a diagnosis of 
COPD
with 2 exacerbation in the past 12 months, one requiring BiPAP for hypercapnic acidaemic
respiratory failure
.
What is the next management step?
A.
Admit overnight for observation on room
air
B.
Admit overnight on 15Litres  oxygen
C.
Repeat pleural aspiration with 16G
cannula
D.
Treat persistent pneumothorax with 12FG
Seldinger intercostal drain.
E.
Treat persistent pneumothorax with wide
bore Argyl drain
at risk of resp failure
 no role for repeated pleural aspiration
Q3
58 year old male presents with pleuritic type chest pains and dyspnoea. Current smoker of 10 cig daily.
Previously diagnosed with asthma with only PRN inhalers-no exacerbation this year.
RR 20, sats 95% on air, bp 120/70, pulse 100 regular.
examination: tympanic percussion note on right side, reduced breath sounds
CXR: 1.4cm pneumothorax measured at hilar level
Next step in management?
A.
Admit, observe overnight
B.
Admit, 15 litres oxygen overnight
C.
Aspirate with cannula
D.
Discharge with follow up CXR next week
E.
Seldinger intercostal drain
 
58 year old male presents with pleuritic type chest pains and dyspnoea. Current smoker of 10 cig
daily. Previously diagnosed w
ith 
asthma
 
with only PRN inhalers-no exacerbation this year.
RR 20, sats 95% on air, bp 120/70, pulse 100 regular.
examination: tympanic percussion note on right side, reduced breath sounds
CXR: 
1.4cm pneumothorax 
measured at hilar level
Next step in management?
A.
Admit, observe overnight
B.
Admit, 15 litres oxygen overnight
C.
Aspirate with cannula
D.
Discharge with follow up CXR next week
E.
Seldinger intercostal drain
Small volume
Secondary spontaneous pneumothorax
Aspiration, post procedure CXR, if smaller, admit
for observation then discharge
If post procedure CXR unchanged-intercostal
drain
Q4
25 year old presents with rapid onset right side chest pains. CXR shows right sided pneumothorax
and undergoes  needle aspiration of 2 litres. Post procedure CXR shows a very small apical
pneumothorax and was discharged with clinic follow up. Prior to discharge he informs you that he
is due to fly out to Ibiza in 4 weeks time for a holiday. How long after radiological resolution of a
primary spontaneous pneumothorax should the patient refrain from air travel?
A.
1 day
B.
1 week
C.
1 month
D.
1 year
E.
Air travel contraindicated in
spontaneous pneumothorax
 
25 year old presents with rapid onset right side chest pains. CXR shows right sided pneumothorax
and undergoes  needle aspiration of 2 litres. Post procedure CXR shows a very small apical
pneumothorax and was discharged with clinic follow up. Prior to discharge he informs you that he
is due to fly out to Ibiza in 4 weeks time for a holiday. How long after radiological resolution of a
primary spontaneous pneumothorax should the patient refrain from air travel?
A.
1 day
B.
1 week
C.
1 month
D.
1 year
E.
Air travel contraindicated in
spontaneous pneumothorax
Thorax 2010;65(Suppl 2):ii18-ii31 (page ii23)
Q5
45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday.
Whilst there, he was involved in a road bicycle collision and sustained a
pneumothorax. He was treated with a chest drain and full re-expansion achieved.
When would he be safe to fly back home to UK in a commercial plane?
A.
2 days following resolution of
traumatic pneumothorax
B.
2 weeks following resolution of
traumatic pneumothorax
C.
2 months following resolution of
traumatic pneumothorax
D.
2 years following resolution of
traumatic pneumothorax
E.
Banned from flying due to
traumatic pneumothorax
 
45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday.
Whilst there, he was involved in a road bicycle collision and sustained a
pneumothorax. He was treated with a chest drain and full re-expansion achieved.
When would he be safe to fly back home to UK in a commercial plane?
A.
2 days following resolution of
traumatic pneumothorax
B.
2 weeks following resolution of
traumatic pneumothorax
C.
2 months following resolution of
traumatic pneumothorax
D.
2 years following resolution of
traumatic pneumothorax
E.
Banned from flying due to
traumatic pneumothorax
Ideally 2 weeks
’-based on relative low
grade evidence
Thorax 
2011;66:i1-i30 (page i6)
Managing passengers with stable
respiratory disease planning air travel:
British Thoracic Society recommendations
Q6
45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday.
Whilst there, he was involved in a road bicycle collision and sustained a
pneumothorax. He was treated with a chest drain and full re-expansion achieved.
When is he safe to dive?
A.
after successful Video assisted
thoracoscopic surgery (VATS)
B.
2 weeks after resolution of traumatic
pneumothorax
C.
after bilateral surgical pleurectomy
and associated with normal lung
function and normal thoracic CT scan
performed after surgery
D.
after traumatic pneumothorax
healed and demonstrated normal
lung function including flow volume
loop and normal thoracic CT scan
E.
scuba diving contraindicated due to
traumatic pneumothorax
 
45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday.
Whilst there, he was involved in a road bicycle collision and sustained a
pneumothorax. He was treated with a chest drain and full re-expansion achieved.
When is he safe to 
dive
?
A.
after successful Video assisted
thoracoscopic surgery (VATS)
B.
2 weeks after resolution of traumatic
pneumothorax
C.
after bilateral surgical pleurectomy
and associated with normal lung
function and normal thoracic CT scan
performed after surgery
D.
after traumatic pneumothorax healed
and demonstrated normal lung
function including flow volume loop
and normal thoracic CT scan
E.
scuba diving contraindicated due to
traumatic pneumothorax
 inappropriate, 5-10% recurrence
rates
 commercial flight
 spontaneous pneumothorax, not
traumatic
Q7
80 year old COPD patient admitted to day case for scheduled CT guided percutaneous lung biopsy of 1.6cm left
lower lobe mass lesion. Procedure was complicated by significant coughing fits during after the procedure and
subsequently developed haemoptysis. CXR 4 hours post procedure was done at 16:00 and is shown. What is
the next step in management?
A.
Discharge, clinic next week
B.
Admit for observation
C.
Pleural aspiration
D.
Seldinger intercostal drain
E.
Wide bore Argyl drain
80 year old 
COPD
 patient admitted to day case for scheduled CT guided percutaneous lung biopsy
of 1.6cm left lower lobe mass lesion. Procedure was complicated by significant coughing fits
during after the procedure and subsequently developed haemoptysis. CXR 4 hours post
procedure was done at 16:00 and is shown. What is the 
next step in management
?
A.
Discharge, clinic next week
B.
Admit for observation
C.
Pleural aspiration
D.
Seldinger intercostal drain
E.
Wide bore Argyl drain
Management of Spontaneous
Pneumothorax 2010;65(Suppl 2):ii18-1131
80 year old 
COPD
 patient admitted to day case for scheduled CT guided percutaneous lung biopsy
of 1.6cm left lower lobe mass lesion. Procedure was complicated by significant coughing fits
during after the procedure and subsequently developed haemoptysis. CXR 4 hours post
procedure was done at 16:00 and is shown. What is the 
next step in management
?
A.
Discharge, clinic next week
B.
Admit for observation
C.
Pleural aspiration
D.
Seldinger intercostal drain
E.
Wide bore Argyl drain
Management of Spontaneous
Pneumothorax 2010;65(Suppl 2):ii18-1131
80 year old admitted for biopsy. Post
procedure CXR shows:
Q8
68 year old female admitted for cancer 2ww surgery for bowel cancer and is needing central venous access.
Right internal jugular vein cannulation was attempted with difficulty and then patient complained of rapid
onset dyspnoea and right side pleuritic pain. CXR showed 1.4cm right pneumothorax, satisfactory central line
tip position. Surgical team wishes to press on with scheduled laparotomy.
What do you suggest as management plan?
A.
Pleural aspirate
B.
Postpone surgery, observe overnight
with 15litres oxygen
C.
Postpone surgery, observe overnight
on room air
D.
Seldinger drain and proceed with
cancer surgery
E.
Wide bore Argyl drain and proceed
with cancer surgery
 
68 year old female admitted for cancer 2ww surgery for bowel cancer and is needing central
venous access
. 
Right internal jugular vein cannulation was attempted with difficulty and then
patient complained of rapid onset dyspnoea and right side pleuritic pain. CXR showed
 
1.4cm right
pneumothorax
, 
satisfactory central line tip position. Surgical team wishes to press on with
scheduled laparotomy
.
What do you suggest as management plan?
A.
Pleural aspirate
B.
Postpone surgery, observe overnight
with 15litres oxygen
C.
Postpone surgery, observe overnight
on room air
D.
Seldinger drain and proceed with
cancer surgery
E.
Wide bore Argyl drain and proceed
with cancer surgery
Iatrogenic pneumothorax
Less than 2cm  
probably doesn’t matter
Need mechanical ventilation for surgery
therefore need treating with intercostal
drain, Seldinger would suffice
Q9
60 year old male with copd, current cigarette smoker admitted for exacerbation. CXR shows
1.8cm  left pneumothorax and therefore treated with Seldinger 12FG intercostal drain. On day 3
of hospital admission the drain remains swinging and bubbling.
When should you involve the thoracic surgeon?
A.
On first presentation to hospital with
pneumothorax
B.
Persistent air leak beyond 4 days
C.
After 2 days of bubbling chest drain
D.
After 2 days of unsuccessful wall suction
aiming for -12cm water
E.
After unsuccessful talc pleurodesis
 
60 year old male with copd, current cigarette smoker admitted for exacerbation. CXR shows 1.8cm  left
pneumothorax and therefore treated with Seldinger 12FG intercostal drain. On day 3 of hospital admission the
drain remains swinging and bubbling.
When should you involve 
the thoracic surgeon
?
A.
On first presentation to hospital with
pneumothorax
B.
Persistent air leak beyond 4 days
C.
After 2 days of bubbling chest drain
D.
After 2 days of unsuccessful wall suction aiming
for -12cm water
E.
After unsuccessful talc pleurodesis
 
Q10
The following are risk factors for developing persistent air leaks following
pneumothoraces, except:
A.
Female gender
B.
Lower diffusion capacity of lung for CO
C.
History of smoking
D.
Diabetes mellitus
E.
Chronic steroid use
 
The following are risk factors for developing
 
persistent air leaks
 
following
pneumothoraces, 
except:
A.
Female gender
B.
Lower diffusion capacity of lung for CO
C.
History of smoking
D.
Diabetes mellitus
E.
Chronic steroid use
Others: COPD, 
lower FEV
1 
(diffusion capacity CO would be risk
factors in persistent air leak after LVRS)
Chest
. 2017 Aug; 152(2): 417-423
Management of Persistent Air Leaks
Q11
In chemical pleurodesis, the following have been used as sclerosants  to cause inflammatory
response in pleural space, except:
A.
Doxycycline
B.
Tetracycline
C.
gold
D.
Silver nitrate
E.
Low virulence strain S.pyogenes incubated
in benzylpenicillin
 
In chemical pleurodesis, the following have been used as 
sclerosants
  
to cause inflammatory
response in pleural space,
 
except
:
A.
Doxycycline
B.
Tetracycline
C.
gold
D.
Silver nitrate
E.
Low virulence strain S.pyogenes incubated
in benzylpenicillin
Talc: most common, most effective
Bleomycin: high cost, toxicity
end
 
Slide Note
Embed
Share

In this medical case study, two scenarios of adult males presenting with pleuritic chest pain and pneumothorax are discussed. The first scenario involves a 25-year-old with sudden onset chest pain, while the second scenario involves a 60-year-old with COPD. Recommendations for managing pneumothorax, including pleural aspiration and chest drain insertion, are provided based on the individual patient's history and clinical findings.

  • Pneumothorax
  • Chest Pain
  • Pleuritic
  • COPD
  • Chest Drain

Uploaded on Sep 23, 2024 | 0 Views


Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

E N D

Presentation Transcript


  1. ACCP;2001 BTS;2010 ERS;2015

  2. Q1 25 year old male with sudden onset pleuritic chest pain, denies dyspnoea. Sats are 97% on air. CXR shows right sided pneumothorax 2.5cm measured at hilum. How should the pneumothorax be managed? A. B. Pleural aspiration Intercostal chest drain with underwater seal Intercostal chest drain with -8cm water wall suction Admit overnight on 15litres humidified oxygen Discharge with follow up CXR in 1-2 weeks C. D. E.

  3. 25 year old male with sudden onset pleuritic chest pain, denies dyspnoea. Sats are 97% on air. CXR shows right sided pneumothorax 2.5cm measured at hilum. How should the pneumothorax be managed? A. B. Pleural aspiration Intercostal chest drain with underwater seal Intercostal chest drain with -8cm water wall suction Admit overnight on 15litres humidified oxygen Discharge with follow up CXR in 1-2 weeks C. D. E. Thorax 2010;65(Suppl 2):ii18-ii31 (page ii21)

  4. Q2 60 year old male present with right sided pleuritic pains and dyspnoea. Sats was 97% on air and CXR shows 1.5cm right side pneumothorax measured at hilum. Pleural aspiration was done and a follow up CXR shows reduction in size of pneumothorax to 0.5cm measured at hilum. This patient is a current cigarette smoker with 20 pack year history. He has a diagnosis of COPD with 2 exacerbation in the past 12 months, one requiring BiPAP for hypercapnic acidaemic respiratory failure. What is the next management step? A. Admit overnight for observation on room air B. Admit overnight on 15Litres oxygen C. Repeat pleural aspiration with 16G cannula D. Treat persistent pneumothorax with 12FG Seldinger intercostal drain. E. Treat persistent pneumothorax with wide bore Argyl drain

  5. 60 year old male present with right sided pleuritic pains and dyspnoea. Sats was 97% on air and CXR shows 1.5cm right side pneumothorax measured at hilum. Pleural aspiration was done and a follow up CXR shows reduction in size of pneumothorax to 0.5cm measured at hilum. This patient is a current cigarette smoker with 20 pack year history. He has a diagnosis of COPD with 2 exacerbation in the past 12 months, one requiring BiPAP for hypercapnic acidaemic respiratory failure. What is the next management step? A. Admit overnight for observation on room air B. Admit overnight on 15Litres oxygen C. Repeat pleural aspiration with 16G cannula D. Treat persistent pneumothorax with 12FG Seldinger intercostal drain. E. Treat persistent pneumothorax with wide bore Argyl drain at risk of resp failure no role for repeated pleural aspiration

  6. 60 year old male present with right sided pleuritic pains and dyspnoea. Sats was 97% on air and CXR shows 1.5cm right side pneumothorax measured at hilum. Pleural aspiration was done and a follow up CXR shows reduction in size of pneumothorax to 0.5cm measured at hilum. This patient is a current cigarette smoker with 20 pack year history. He has a diagnosis of COPD with 2 exacerbation in the past 12 months, one requiring BiPAP for hypercapnic acidaemic respiratory failure. What is the next management step? A. Admit overnight for observation on room air B. Admit overnight on 15Litres oxygen C. Repeat pleural aspiration with 16G cannula D. Treat persistent pneumothorax with 12FG Seldinger intercostal drain. E. Treat persistent pneumothorax with wide bore Argyl drain at risk of resp failure no role for repeated pleural aspiration

  7. Q3 58 year old male presents with pleuritic type chest pains and dyspnoea. Current smoker of 10 cig daily. Previously diagnosed with asthma with only PRN inhalers-no exacerbation this year. RR 20, sats 95% on air, bp 120/70, pulse 100 regular. examination: tympanic percussion note on right side, reduced breath sounds CXR: 1.4cm pneumothorax measured at hilar level Next step in management? A. Admit, observe overnight B. Admit, 15 litres oxygen overnight C. Aspirate with cannula D. Discharge with follow up CXR next week E. Seldinger intercostal drain

  8. 58 year old male presents with pleuritic type chest pains and dyspnoea. Current smoker of 10 cig daily. Previously diagnosed with asthma with only PRN inhalers-no exacerbation this year. RR 20, sats 95% on air, bp 120/70, pulse 100 regular. examination: tympanic percussion note on right side, reduced breath sounds CXR: 1.4cm pneumothorax measured at hilar level Next step in management? Small volume Secondary spontaneous pneumothorax A. Admit, observe overnight B. Admit, 15 litres oxygen overnight C. Aspirate with cannula D. Discharge with follow up CXR next week E. Seldinger intercostal drain Aspiration, post procedure CXR, if smaller, admit for observation then discharge If post procedure CXR unchanged-intercostal drain

  9. Q4 25 year old presents with rapid onset right side chest pains. CXR shows right sided pneumothorax and undergoes needle aspiration of 2 litres. Post procedure CXR shows a very small apical pneumothorax and was discharged with clinic follow up. Prior to discharge he informs you that he is due to fly out to Ibiza in 4 weeks time for a holiday. How long after radiological resolution of a primary spontaneous pneumothorax should the patient refrain from air travel? A. B. C. D. E. 1 day 1 week 1 month 1 year Air travel contraindicated in spontaneous pneumothorax

  10. 25 year old presents with rapid onset right side chest pains. CXR shows right sided pneumothorax and undergoes needle aspiration of 2 litres. Post procedure CXR shows a very small apical pneumothorax and was discharged with clinic follow up. Prior to discharge he informs you that he is due to fly out to Ibiza in 4 weeks time for a holiday. How long after radiological resolution of a primary spontaneous pneumothorax should the patient refrain from air travel? A. B. C. D. E. 1 day 1 week 1 month 1 year Air travel contraindicated in spontaneous pneumothorax Thorax 2010;65(Suppl 2):ii18-ii31 (page ii23)

  11. Q5 45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday. Whilst there, he was involved in a road bicycle collision and sustained a pneumothorax. He was treated with a chest drain and full re-expansion achieved. When would he be safe to fly back home to UK in a commercial plane? A. 2 days following resolution of traumatic pneumothorax 2 weeks following resolution of traumatic pneumothorax 2 months following resolution of traumatic pneumothorax 2 years following resolution of traumatic pneumothorax Banned from flying due to traumatic pneumothorax B. C. D. E.

  12. 45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday. Whilst there, he was involved in a road bicycle collision and sustained a pneumothorax. He was treated with a chest drain and full re-expansion achieved. When would he be safe to fly back home to UK in a commercial plane? A. 2 days following resolution of traumatic pneumothorax 2 weeks following resolution of traumatic pneumothorax 2 months following resolution of traumatic pneumothorax 2 years following resolution of traumatic pneumothorax Banned from flying due to traumatic pneumothorax Ideally 2 weeks -based on relative low grade evidence B. C. D. E. Thorax 2011;66:i1-i30 (page i6) Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations

  13. Q6 45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday. Whilst there, he was involved in a road bicycle collision and sustained a pneumothorax. He was treated with a chest drain and full re-expansion achieved. When is he safe to dive? A. after successful Video assisted thoracoscopic surgery (VATS) 2 weeks after resolution of traumatic pneumothorax after bilateral surgical pleurectomy and associated with normal lung function and normal thoracic CT scan performed after surgery after traumatic pneumothorax healed and demonstrated normal lung function including flow volume loop and normal thoracic CT scan scuba diving contraindicated due to traumatic pneumothorax B. C. D. E.

  14. 45 year old male has travelled to Sharm El-Sheikh, Egypt for a scuba diving holiday. Whilst there, he was involved in a road bicycle collision and sustained a pneumothorax. He was treated with a chest drain and full re-expansion achieved. When is he safe to dive? inappropriate, 5-10% recurrence rates commercial flight A. after successful Video assisted thoracoscopic surgery (VATS) 2 weeks after resolution of traumatic pneumothorax after bilateral surgical pleurectomy and associated with normal lung function and normal thoracic CT scan performed after surgery after traumatic pneumothorax healed and demonstrated normal lung function including flow volume loop and normal thoracic CT scan scuba diving contraindicated due to traumatic pneumothorax B. C. spontaneous pneumothorax, not traumatic D. E.

  15. Q7 80 year old COPD patient admitted to day case for scheduled CT guided percutaneous lung biopsy of 1.6cm left lower lobe mass lesion. Procedure was complicated by significant coughing fits during after the procedure and subsequently developed haemoptysis. CXR 4 hours post procedure was done at 16:00 and is shown. What is the next step in management? A. B. C. D. E. Discharge, clinic next week Admit for observation Pleural aspiration Seldinger intercostal drain Wide bore Argyl drain

  16. 80 year old COPD patient admitted to day case for scheduled CT guided percutaneous lung biopsy of 1.6cm left lower lobe mass lesion. Procedure was complicated by significant coughing fits during after the procedure and subsequently developed haemoptysis. CXR 4 hours post procedure was done at 16:00 and is shown. What is the next step in management? A. B. C. D. E. Discharge, clinic next week Admit for observation Pleural aspiration Seldinger intercostal drain Wide bore Argyl drain Management of Spontaneous Pneumothorax 2010;65(Suppl 2):ii18-1131

  17. 80 year old COPD patient admitted to day case for scheduled CT guided percutaneous lung biopsy of 1.6cm left lower lobe mass lesion. Procedure was complicated by significant coughing fits during after the procedure and subsequently developed haemoptysis. CXR 4 hours post procedure was done at 16:00 and is shown. What is the next step in management? 80 year old admitted for biopsy. Post procedure CXR shows: A. B. C. D. E. Discharge, clinic next week Admit for observation Pleural aspiration Seldinger intercostal drain Wide bore Argyl drain Management of Spontaneous Pneumothorax 2010;65(Suppl 2):ii18-1131

  18. Q8 68 year old female admitted for cancer 2ww surgery for bowel cancer and is needing central venous access. Right internal jugular vein cannulation was attempted with difficulty and then patient complained of rapid onset dyspnoea and right side pleuritic pain. CXR showed 1.4cm right pneumothorax, satisfactory central line tip position. Surgical team wishes to press on with scheduled laparotomy. What do you suggest as management plan? A. Pleural aspirate B. Postpone surgery, observe overnight with 15litres oxygen C. Postpone surgery, observe overnight on room air D. Seldinger drain and proceed with cancer surgery E. Wide bore Argyl drain and proceed with cancer surgery

  19. 68 year old female admitted for cancer 2ww surgery for bowel cancer and is needing central venous access. Right internal jugular vein cannulation was attempted with difficulty and then patient complained of rapid onset dyspnoea and right side pleuritic pain. CXR showed 1.4cm right pneumothorax, satisfactory central line tip position. Surgical team wishes to press on with scheduled laparotomy. What do you suggest as management plan? Iatrogenic pneumothorax Less than 2cm probably doesn t matter A. Pleural aspirate B. Postpone surgery, observe overnight with 15litres oxygen C. Postpone surgery, observe overnight on room air D. Seldinger drain and proceed with cancer surgery E. Wide bore Argyl drain and proceed with cancer surgery Need mechanical ventilation for surgery therefore need treating with intercostal drain, Seldinger would suffice

  20. Q9 60 year old male with copd, current cigarette smoker admitted for exacerbation. CXR shows 1.8cm left pneumothorax and therefore treated with Seldinger 12FG intercostal drain. On day 3 of hospital admission the drain remains swinging and bubbling. When should you involve the thoracic surgeon? A. On first presentation to hospital with pneumothorax B. Persistent air leak beyond 4 days C. After 2 days of bubbling chest drain D. After 2 days of unsuccessful wall suction aiming for -12cm water E. After unsuccessful talc pleurodesis

  21. 60 year old male with copd, current cigarette smoker admitted for exacerbation. CXR shows 1.8cm left pneumothorax and therefore treated with Seldinger 12FG intercostal drain. On day 3 of hospital admission the drain remains swinging and bubbling. When should you involve the thoracic surgeon? A. On first presentation to hospital with pneumothorax Persistent air leak beyond 4 days After 2 days of bubbling chest drain After 2 days of unsuccessful wall suction aiming for -12cm water After unsuccessful talc pleurodesis B. C. D. E.

  22. Q10 The following are risk factors for developing persistent air leaks following pneumothoraces, except: A. B. C. D. E. Female gender Lower diffusion capacity of lung for CO History of smoking Diabetes mellitus Chronic steroid use

  23. The following are risk factors for developing persistent air leaks following pneumothoraces, except: A. B. C. D. E. Female gender Lower diffusion capacity of lung for CO History of smoking Diabetes mellitus Chronic steroid use Others: COPD, lower FEV1 (diffusion capacity CO would be risk factors in persistent air leak after LVRS) Chest. 2017 Aug; 152(2): 417-423 Management of Persistent Air Leaks

  24. Q11 In chemical pleurodesis, the following have been used as sclerosants to cause inflammatory response in pleural space, except: A. Doxycycline B. Tetracycline C. gold D. Silver nitrate E. Low virulence strain S.pyogenes incubated in benzylpenicillin

  25. In chemical pleurodesis, the following have been used as sclerosants to cause inflammatory response in pleural space, except: Talc: most common, most effective Bleomycin: high cost, toxicity A. Doxycycline B. Tetracycline C. gold D. Silver nitrate E. Low virulence strain S.pyogenes incubated in benzylpenicillin

  26. end

Related


More Related Content

giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#