Pneumothorax, Pulmonary HTN, Hemoptysis- Clin med Exam 1

Patient presents with non exertional, pleuritic and unilateral chest pain. On exam they have increased hyperressonance to percussion, decreased tactile fremitus and decreased breath sounds on affected side. Films show a DEEP SULCUS SIGN. What is the diagnosis and what is tx?
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Patient presents with non exertional, pleuritic and unilateral chest pain. On exam they have increased hyperressonance to percussion, decreased tactile fremitus and decreased breath sounds on affected side. Films show a DEEP SULCUS SIGN. What is the diagnosis and what is tx?
Spontaneous pneumothorax
TX: Observation if it is small, Chest tube placement if large
What diagnostic tests should be ordered in someone with a pneumothorax? What will you see?
CXR with EXPIRATORY VIEW. Will see decreased peripheral lung markings, mediastinal shift.
What is a pneumothorax?
Presence of air in the pleural space- generally reflects damage to pleural surface or intro of external air
What will you see in a patient with a tension pneumothorax?
Positive air pressure PUSHES lungs, trachea and great vessels to opposite side
Will have Increased JVP, pulsus paradoxus, hypotension, shock, tracheal shift
When do you do a needle aspiration?
If TENSION pneumothorax is followed by chest tube placement
What is pulmonary HTN?
Increase in pulmonary vascular resistance which leads to RVH and Right heart failure
Patient presents with chest pain, SOB, systemic hypotension, RUQ pain. On Chest x ray you see enlarged pulmonary arteries. What is dx and what is treatment?
Pulmonary hypertension
TX: Relieve underlying cause
Calcium channel blockers
How do you diagnosis hemoptysis?
CXR
Sputum C&S
CT Chest with contrast
Bronchoscopy
Bronchial ateriogram
What is the treament for hemoptysis?
Place in lateral decubitus with affected side down
Embolization XRT to tumor
Surgical resection
Diuretics for CHF
What can you see on Physical exam with pulmonary hypertension?
Accentuated S2, Signs of right sided heart failure (Increased JVP, periphreal edema, ascites
Patient presents with dyspnea, accentuated S2, signs of right sided heart failure such as increased JVP, peripheral edema and ascites. What is diagnosis, and what will your order to get definitive diagnosis?Pulmonary HTN Right sided heart catheterization (GOLD STANDARD)What will an ECG show in someone with Pulmonary HTN?Cor pulmonale, RVH, right axis deviationWhat will you see on chest xray of a patient with pulmonary HTN?enlarged pulmonary arteries Interstitial/alveolar edema, signs of HFWhat is FIRST LINE TREATMENT FOR Vasoreactive pulmonary HTN?Calcium channel blockersIf a patient presents with MASSIVE HEMOPTYSIS, where is the bleeding most likely coming from?Arterial erosion25 year old female presents with chest pain, dyspnea and you find out that this started while she was menstrating. What is possible dx?Catamenial PTXWhat population is most commonly affected by a spontaneous pneumothorax?Tall, thin men aged 20-40 who smokePatient presents with physical exam findings as follows: Increased hyperresonance to percussion, decreased breath sounds decreased fremitus and non exertional chest pain and dyspnea. What is dx?Pneumothorax