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159 Cards in this Set

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Pseudomonas is a gram-_____ rod
negative
the most common pathogen isolated from patients who have been hospitalized longer than 1 week
P aeruginosa
Pseudomonas Aeruginosa X-ray Findings
Resembles _____ pneumonia
staph
Pseudomonas pneumonia with multiple cystic lucencies
?
Pseudomonas
?
Pseudomonas lung abscess
round thing
Pseudomonas lung abscess
round thing?
Klebsiella Pneumonia X-ray Findings
Produces excessive amounts of inflammatory ____
exudate
Klebsiella Pneumonia X-ray Findings

Affected lung gains volume and fissures bulge
Bulging ______ sign
fissure
Klebsiella with bulging fissure
Klebsiella with ....?
Cavitating Klebsiella pneumonia
?
Cavitating Klebsiella pneumonia
?
Commonest cause of nonbacterial pneumonia
Mycoplasma Pneumonia
Mycoplasma Pneumonia Primary atypical pneumonia

Organism: ______ agent=pleuropneumonia-like organism (PPLO) – probably a bacterium
Eaton
1/3 of all pneumonias in service personnel
Mycoplasma Pneumonia
Mycoplasma Pneumonia X-ray Findings

Acute ______ infiltrate
Lower lobes radiating from hila (early)
interstitial
Mycoplasma Pneumonia X-ray Findings

Late _______ infiltrates
Usually unilateral and almost always segmental
alveolar
Mycoplasma pneumonia
?
Mycoplasma pneumonia with B/L infiltrates
?
B/L infiltrates
Mycoplasma pneumonia with _____
Pneumocystis Pneumonia

Fungus pneumocystis ______
carinii
Pneumocystis Pneumonia

Most common cause of pneumonia in ______ hosts
immunocompromised
Pneumocystis Pneumonia

Often associated with :
CMV,
herpes simplex, and _______
MAI (mycobacterium avium-intracellular complex)
Pneumocystis Pneumonia X-ray findings

Most often central location, reticular infiltrate
Resembles ________
pulmonary edema
Pneumocystis Pneumonia X-ray findings

Pleural effusion ________
Hilar adenopathy does not occur
uncommon
PCP
?
PCP
?
PCP
?
PCP
?
SARS produces ______ airspace disease
patchy
Pneumococcal pneumonia can clear in ___ hrs
48
Staph produces loculated effusions and pneumato-_____
pneumatocoeles

(anything in the pleural space, think staph)
Pseudomonas - ____ lobes; multiple small lucencies
lower
Klebsiella - heavy exudate; bulging __________
fissure
Suspected pulm infection

If immunocompetent host-->
CXR normal---> ?
stop
Suspected pulm infection

If immunocompetent host-->
CXR abnormal---> ?
medical treatment

F/U with CXR
Suspected pulm infection

If immunocompetent host-->
CXR abnormal--->
failed medical treatment-->?
HRCT

if nonspecific, do guided BAL
Suspected pulm infection

If immunosuppressed host-->
CXR normal---> ?
HRCT

if nonspecific, do guided BAL
if specific findings --> medicine
Suspected pulm infection

If immunosuppressed host-->
CXR abnormal---> ?
see chart
with Pneumothorax
Must see _______ pleural white line
visceral
with Pneumothorax
Absence of lung markings ________
peripherally
Shift of mediastinal structures ?
none
towards
away
None = simple pneumothorax
Away from pneumothorax = tension pneumothorax
Never a shift toward side of pneumothorax
Visceral pleural white line marks the edge of the lung
?
?
?
tension pneumothorax
?
Pneumoperitoneum
?
Cavitary Lung Lesions

the big 3
TB
Abscess
Carcinoma

other things - yes, like fungus
What kind of cavity?

wall thickness: thick
inner margin: nodular
A/F level: maybe
Carcinoma
What kind of cavity?

wall thickness: thin
inner margin: smooth
A/F level: no
TB
t kind of cavity?

wall thickness: thick
inner margin: smooth
A/F level: yes
Abscess
obvious lesion
thick walled cavity
smooth
no A/F level
could be carcinoma
?
not sure
?
not sure
?
Mycobacterium tuberculosis
The bacilli have 4 potential fates:
(1) they may be killed by the immune system,
(2) they may multiply and cause primary TB,
(3) they may become dormant and remain asymptomatic, or
(4) they may proliferate after a latency period (reactivation disease). Reactivation disease may occur following either (2) or (3) above.
Mycobacterium tuberculosis
Chest radiographs may show a patchy or _____ infiltrate
nodular
Mycobacterium tuberculosis
TB may be found in any part of the lung, but ______-lobe involvement is most common.
upper
Mycobacterium tuberculosis
The _______ view may better demonstrate apical abnormalities
lordotic
Mycobacterium tuberculosis
Reactivation is indicated by the following:
1) Cavity formation is indicative of advanced infection and is associated with a high bacterial load.
2) Noncalcified round infiltrates may be confused with lung carcinoma.
Homogeneously calcified nodules (usually 5-20 mm) are tuberculomas and represent old infection rather than active disease
3) Miliary TB is characterized by the appearance of numerous small nodular lesions, resembling millet seeds, on chest radiography
If the TB lesion gets worse or better, it is ______ disease.
ACTIVE
Homogeneously calcified nodules (usually 5-20 mm) are tuberculomas and represent old infection rather than _____ disease
active
Ghon Lesion
?
Calcified Ghon lesion
?
calcified ghon lesion
?
Ranke Complex
?
TB
?
TB
?
miliary TB
?
miliary TB
?
A solitary nodule in the lung can be totally innocuous or _______
potentially a fatal lung cancer
Solitary Pulmonary Nodule:
After detection the initial step in analysis is to compare the film with prior films if available. A nodule that is unchanged for how long? is almost certainly benign.
two years
Solitary Pulmonary Nodule:
If the nodule is completely calcified or has central or stippled calcium it is benign? or malignant?.
benign
Solitary Pulmonary Nodule:
Nodules with irregular calcifications or those that are off center should be considered suspicious, and need to be worked up further with a _______ or _______
PET scan or biopsy
Calcification and Lung Nodules:

If Laminated, ?
TB granuloma
Calcification and Lung Nodules:

If Central or target, ?
Histoplasmoma
Calcification and Lung Nodules:

If Popcorn?
Hamartoma
Lung Masses Incidence:

On routine survey, ___% are malignant nodules
<5
Lung Masses Incidence:

At surgery, 40% of nodules are cancer, 40% _______
granulomas
Causes of Lung Nodules-in order
Granulomas
Bronchogenic carcinoma
Hamartomas
Metastases
If a lesion doubles in volume >6 weeks and <16 months, usually benign? or malignant?
malignant


What is the lesion if it triples in volume in the same time?
inflammation, maybe
How can you tell that a nodule has doubled in volume?
Increase in diameter of 25%
the most common fatal cancer in the US, accounting for 28% of all cancer deaths
Bronchogenic carcinoma
Smoking is responsible for as many as _?_% of cases of Bronchogenic Carcinoma
85
Cell Types of lung carcinoma
adenocarcinoma (40%)
squamous cell (17%)
small oat cell (25%)
large cell (15%)
other carcinomas (3%)
Chest radiographs may show the following:
Pulmonary nodule, mass, or infiltrate
Mediastinal widening
Atelectasis
Hilar enlargement
Pleural effusion
Squamous Cell Carcinoma is found in a central location how often?
(2/3)
What do you see when Squamous cell carcinoma is in the center
Mass
Atelectasis
"Reverse S sign of Golden"
Post-obstructive pneumonia
What do you see when squamous cell carcinoma is in the Peripheral location (1/3) ?
May cavitate
Squamous cell carcinoma

Most closely associated with _____
smoking
Golden S sign
?
golden s sign
?
Adenocarcinoma
Usually peripheral nodule

______ lobe distribution (69%)
Upper
adenocarcinoma
?
adenocarcinoma
?
hamartoma
?
hamartoma
?
hamartoma
?
hamartoma
?
hamartoma
look behind heart
?
Mediastinal Masses

Anterior (T’s)
Terratoma
Thymoma
Thyroid
Lymphoma (t-cell)
Mediastinal Masses

Middle
Aneurysm
Adenopathy ie. Carcinoma, Sarcoidosis
Lymphoma
Esophagus ie. HH
Mediastinal Masses

Posterior
Neurogenic (90%)
Radiological Mediastinum
?
Lymphoma
?
thymoma
?
thymoma
?
Aneurysm
?
Sarcoid
1,2,3 sign
?
Ganglioneuroma
?
ganglioneuroma
?
ganglioneuroma
?
Chronic Obstructive Lung Disease:
The presence of airflow obstruction due to ________
chronic bronchitis or emphysema
The airflow obstruction generally is progressive and may be partially reversible in ________
chronic bronchitis
Chronic bronchitis is defined clinically as the presence of a chronic productive cough for 3 months during each of __?_ consecutive years (other causes of cough being excluded)
2
Emphysema is defined as an abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious _______
fibrosis
Chronic bronchitis is defined in clinical terms and ______ in terms of anatomic pathology
emphysema
Breathlessness is the most significant symptom, but it usually does not occur until the _____ decade of life
sixth
The primary cause of COPD is exposure to _______
tobacco smoke
Frontal and lateral chest radiographs reveal signs of hyperinflation, including
?
a flattening of the diaphragm,
increased retrosternal air space, and
a long narrow heart shadow.
With complicating pulmonary hypertension, the hilar vascular shadows are prominent, with possible ____ ventricular enlargement
right
HRCT scan is highly specific for diagnosing emphysema, as the outlined _______ are not always visible on a radiograph (usually not necessary for diagnosis)
bullae
Endotracheal Tubes

Tip should be about 5cm above ___
carina
Endotracheal Tubes

Tip may change by __cm with flexion/ extension
2
Balloon should never distend tracheal walls; if >2.8 cm, suspect ____
laceration
Most common malposition: tip in right mainstem bronchus
Leads to ______
atelectasis
Tube in larynx or pharynx leads to what problems?
_________
Damage vocal chords
Aspiration
Tracheostomy

Tip half-way between stoma and carina
About what vertebral level ?
T3
Tracheostomy

Tip placement not affected by flexion/ extension
Width of tube about 2/3 width of _______
trachea
Tracheostomy Problems:

Immediately after (3)
Subcutaneous emphysema
Pneumomediastinum
Pneumothorax
Tracheostomy

Cuff should not be >1½ times diameter of _____
lumen
Long term Tracheostomy complication
Tracheal stenosis
Central Venous Catheters Problems

Most often malpositioned in RA or _______
Arrythmias in RA; inaccurate CVP readings elsewhere
internal jugular
Central Venous Catheters Problems:

Occasionally outside blood vessel
Look for sharp bends in _____
catheter
Central Venous Catheters Problems:

Arterial placement suggested by _______ flow
pulsatile
Central Venous Catheters Complications
Air embolism
Pneumothorax (5%)
Hemothorax
Cardiac perforation
Sepsis
Venous perforation
PICC Lines Percutaneous Intravascular Central Catheters:

Used for long-term intravenous access
Because of small size
Inserted through ______ vein
antecubital
PICC Lines Percutaneous Intravascular Central Catheters:

Tip should lie within ____
SVC
Pulmonary Artery Catheters:
Swann-Ganz catheters
Aid in differentiating cardiac from non-cardiac ______ edema
pulmonary
Pulmonary Artery Catheters Where:

Tip should lie within right or left pulmonary artery
_?_cm from hila
2


Balloon inflated only when measurements are made
Pulmonary Artery Catheters Problems:

Most common significant complication is ________
From occlusion by catheter
From embolization off of catheter
pulmonary infarction
Pulmonary Artery Catheters :

Uncommon complications
Cardiac arrhythmia
Pulmonary artery perforation
Intracardiac knotting
Pleural Drainage Tubes Where:

Ideal position is anterosuperior for ________
Pneumothorax
Pleural Drainage Tubes Where:

Ideal position is Posteroinferior for ________
effusion



Usually work well no matter where positioned None of the side holes should lie outside of the thoracic wall
Pleural Drainage Tubes Problems
Bleeding 2° laceration of intercostal artery
Laceration of liver or spleen on insertion
Insertion into the lung may lead to
Lung laceration
BP fistula
Rapid expansion of lung may lead to pulmonary edema
Pacemakers

Catheter should have _____ curves
gentle
Pacemakers Where

Tip positioned at apex of _____ ventricle
right


Tip may have slight bend as it abuts wall of right ventricle
Not a sharp bend
Pacemakers Where:

Some pacers may also have lead(s) in ____ atrium and/or coronary sinus
right
Pacemakers Problems
Fracture of leads at pacer, tip or site of venous access
Leads can perforate heart ➙ cardiac tamponade
Look for sharp bends in leads 2° perforation of blood vessel
Leads may be ectopically placed, e.g. hepatic vein
Pacemaker battery may migrate subcutaneously
Nasogastric Tubes Where:

Tip should be in _____
stomach
Nasogastric Tubes Where:

At least __ cm of tube should extend into stomach
Many have side holes that extend up to 10cm on tube
10
Most commonly malpositioned of all tubes and lines
Nasogastric Tubes
Nasogastric Tubes Problems:

Perforation usually involves ___________
Can also perforate stomach
cervical esophagus
Nasogastric Tubes Problems:

Indwelling tube leads to G-E reflux
May cause esophagitis and ____
stricture
Feeding Tubes:

Tip of feeding tube should be in _______
duodenum
Feeding Tubes:
Complications:

Perforation by guide wire
Too proximal ➙ ________
aspiration
copd
?
copd
?
copd
?
copd
?
copd
?