Pleural D/os, Pe

Front 1

abnormal accumulation of fluid in the pleural space

Back 1

pleural effusion

Front 2

where does the air in a pneumothorax usually come froM?

Back 2

inside the lung

Front 3

tension pneumothorax: defn and pathophys

Back 3

ball valve leak where air readily moves out of lung but air flow back ins't possible. air progressively accumulates and high pressures attained result in this.

Common when person is receiving positive pressure mechanical vent.

Front 4

Difference between primary and secondary spontaneous pneumothorax

Back 4

Primary: occurs without any apparently underlying lung disease

Secondary: occurs in association with pre-existing pulmonary or chest wall disease

Front 5

What pulmonary diseases are associated with secondary spontaneous pneumothorax?

Back 5

1) COPD (most common)
2) interstitial diseases
3) Neoplastic
4) Infectious
5) miscellaneous

Front 6

Signs and sx of pneumothorax

Back 6

Chest pain - sharp and stabbing

Cough - non productive, results from comprsesion of lung by large effusion of pneumothorax

Shortness of breath

Pleural friction rub

Dullness to percussion and diminished breath sounds

Hyperresonant percussion and diminished breath sounds

Front 7

What is the best postiion for CXR demonstrating pleural effusions?

Back 7

Lateral decubitus

Front 8

How is a small pneumothorax best visualized on CXR?

Back 8

on exhalation

Front 9

What is thoracentesis used for?

Back 9

1) Confirms presence of pleural effusion

2) Biochem, microbiologic, and cytologic analysis of pleural fluid often useful to determine cause of effusion

Front 10

exudate vs transudate?

Back 10

transudate: low protein
exudate: high protein

Front 11

Common causes of transudative pleural effusions

Back 11

1) CHF
2) Cirrhosis
3) Nephrotic syndrome
4) Low protein - hypoalbuminemia

Front 12

Common causes of exudative pleural effusions

Back 12

1) Cancer
2) Pneumonia
3) Tuberculosis
4) Drug reaction
5) Uremia
6) Rheumatoid systemic arthritis
7) Asbestosis

Front 13

The presence of (transudate, exudate) indicates the pleura itself isn't inflamed are directly involved

Back 13

Transudate

Front 14

most common cause of pleural effusion

Back 14

CHF

Front 15

Mech of primary spontaneous pneumothorax

Back 15

Usually rupture of apical bleb

Front 16

Features of Pneumothorax on Chest X-Ray

Back 16

exhalation reduces air in
lung, with denser appearance
air in pleural space remains
black

see edge of visceral pleura

see no lung markings

Front 17

Diagnosis of transudate: what does it result from?

Back 17

Oncotic or hydrostatic pressure imbalances
Originates in lung, pleura, peritoneal or retroperitoneal cavity
Think SYSTEMIC !

Front 18

Diagnosis of exudate: what does it result from?

Back 18

(THINK LOCAL !)
Pleural and lung inflammation (capillary leak)
Impaired pleural lymphatic drainage
Fluid movement from peritoneal space

Front 19

T/F Empyemas require chest tube drainage or surgery for resolution

Back 19

T

Front 20

impaction of material into branches of pulmonary arterial bed

Back 20

pulmonary embolism

Front 21

3 mechs of clot formation

Back 21

1) Blood stasis

2) Damage to vessel wall (intima)

3) Alterations in clotting system/hypercoagulability state

Front 22

T/F Superficial vein thrombosis rarely leads to PE

Back 22

T

Front 23

Sx and signs of DVT

Back 23

1) Pain/tenderness

2) Swelling

3) Erythema

4) Pain with dorsiflexion

5) Nne

Front 24

Dx of DVT

Back 24

1) Venography
2) Duplex Doppler - documenting flow in major veins of lower leg
3) Impedance pethysmography

Front 25

Prevention of DVT

Back 25

Low dose heparin, low molecular weight hep, pneumatic compression device

Front 26

Tx of DVT

Back 26

Bed rest
Anticoagulation: hep followed by coumadin
Thrombolysis: urokinase or streptokinase

Front 27

Sx of PE

Back 27

Frequently sudden, both otherwise non-specific

1) Dyspnea (most common)

2) Pleuritic pain

3) apprehension

4) Cough

5) Fever

Front 28

What are uncommon Sx of PE?

Back 28

Hemoptysis, sweats, syncope, chills

Front 29

Signs of PE

Back 29

1) Tachypnea (>20)
2) Tachycardia (>100)
3) Crackles
4) Temp >30

Front 30

What will PE be on CXR?

Back 30

Normal or non-specific.

Front 31

What lab tests should be ordered?

Back 31

1) CXR
2) Blood gases: CO2 and O2 alterations
3) EKG
4) CBC
5) lung scan
6) CT scan
7) Pulmonary angiogram (gold standard)

Front 32

Gold standard for PE dx

Back 32

Pulmonary angiogram

Front 33

What are the most helpful dx tests for PE? Which is the most commonly used?

Back 33

Most helpful: Pulmonary angiogram, Lung V/Q scan

Most common: CT

Front 34

Prognosis of PE

Back 34

1) 30% die w/o tx
2) Tx lowers mortality to 10%
3) Complete resolution in 2/3
4) lasting disability is uncommon

Front 35

What is d-dimer and what is it useful for testing?

Back 35

fibrin degradation product. These are elevated in active/significant clot.

Front 36

The role of D-dimer testing is therefore limited to the ruling out of __

Back 36

embolism

Front 37

Hemorrhage and infarction due to a PE is from what kind of PE?

Back 37

Submassive pulmonary emboli. The idea is if it had caused sudden death, there wouldn't be time for these kinds of changes to accumulate.

Front 38

What do infarcts from PE look like?

Back 38

wedge shaped, red

Front 39

T/F Outright pulmonary infarction is uncommon and usually due to chronic conditions

Back 39

T

Front 40

Organization of clot: defn

Back 40

endothelial cells grow into clot and start to form new channels (canalization), so bulk of thrombus shrinks.

Front 41

Why does recanalization after PE cause pulmonary hypertension?

Back 41

Decrease in cross-sectional area in circulation of lung --> increased pressure