Pulmonary: Pleural Diseases And Pulmonary Circulation

Front 1

what is a pleural effusion

Back 1

Abnormalcollection of fluid in the pleural space

Front 2

classified as a sign of disease but not a disease by itself

Back 2

pleural effusion

Front 3

Increasedproduction due to increased hydrostatic or decreased oncotic pressures

Back 3

transudate

Front 4

Increasedproduction due to abnormal capillary permeability

Back 4

exudate

Front 5

Decreasedlymphatic clearance

Back 5

exudate

Front 6

direct infection of the pleural space that is grossly purulent/turbulent

Back 6

empyema

Front 7

bleeding into the pleural space

Back 7

hemothorax

Front 8

caused by high cholesterol

Back 8

chyloform

Front 9

pleural effusions are exudates thataccompany bacterial pneumonias

Back 9

Parapneumonic

Front 10

abnormal accumulation of circulatory system fluid results in what

Back 10

transudate

Front 11

this accumulation is can be due to what two things

Back 11

1. increased hydrostatic pressure

2. decreased oncotic pressure (colloid osmotic pressure)

Front 12

most common cause of transudate

Back 12

CHF

Front 13

other causes of transudate

Back 13

1. nephrotic syndrome

2. cirrhosis

3. atelectasis

Front 14

what occurs when local factors increase vascular permeability

Back 14

exudate

Front 15

the light's criteria are exclusive to what

Back 15

exudates

Front 16

what is the light's criteria

Back 16

1.Pleural fluid protein/serum protein >0.5

2.Pleural fluid LDH/serum LDH >0.6

or

Pleural fluid LDH more than two-thirds normal upper limit for serum

Front 17

5 leading causes of pleural effusions in the US

Back 17

1. CHF

2. Pneumonia

3. Cancer

4. pulmonary embolus

5. viral disease

Front 18

of the previous 5, which one can sometimes be either a transudate or an exudate

Back 18

pulmonary embolus

Front 19

signs and symptoms of pleural effusion

Back 19

dyspnea

cough

pleuritic chest pain

Front 20

small effusions are normally what

Back 20

asymptomatic and have no findings on physical exam

Front 21

physical exam findings of pleural effusions

Back 21

1. dullness to percusion

2. decreased breath sounds

3. audible plueral friction rub

4. Egophony

5. bronchial breath sounds

Front 22

what can occur in massive pleural effusions

Back 22

lung collapse

mediastinal shift to contralateral side

Front 23

lab tests are order depending on what

Back 23

the appearance of the pleural fluid

Front 24

what is ordered for bloody fluid

Back 24

hematocrit

Front 25

what is ordered for cloudy or turbid fluid

Back 25

centrifugation

Front 26

what is ordered for purid odor

Back 26

stain and culture

could be possible aerobic infection

Front 27

Tovisualize fluid on a standardupright CXR, you need at leasthow much fluid

Back 27

75 to 100 CC's

Front 28

Back 28

pleural effusion on CT

Front 29

what view is the best choice for detecting smaller effusions, and differentiating loculations & empyema from new effusions or scarring

Back 29

lateral decubitus

Front 30

Pleural Effusion index. How is PEI calculated?

Back 30

100times the maximum width of the right pleural effusion, divided by the maximalwidth of the hemithorax of the affected side

Front 31

treatment for transudate pleural effusions

Back 31

treat underlying condition

Front 32

what is the gold standard treatment for pleural effusions

Back 32

thoracentesis

Front 33

pleural fluid must be drain in what case

Back 33

empyema

Front 34

lab findings for empyema

Back 34

1. pleural fluid PH under 7.2

2. glucose under 40 mg

3. positive gram

Front 35

accumulation of air within the pleural space

Back 35

pneumothorax

Front 36

pneumothorax can be either what

Back 36

spontaneous or traumatic

Front 37

two types of spontaneous pneumo's

Back 37

primary and secondary

Front 38

secondary occurs________.

Back 38

as aresult of a complication of preexisting lung disease

Front 39

population group for primary pneumo's

Back 39

tall, thin med 20-40

smokers

family history

Front 40

can pneumo's be iatrogenic

Back 40

yes caused by thoracic needle aspirations, baro trauma, thoracentesis or lung biopsy, or subclavian catheter placement

Front 41

primarny spontaneous is also thought be be a rupture of what

Back 41

small blebs

Front 42

clinical manifestations of pneumo's

Back 42

unilateral pleuritic chest pain

dyspnea

palpitations

Front 43

signs can present as_______.

Back 43

Respiratorydistress

Tachycardia

Tachypnea

Front 44

test of choice for pneumo

Back 44

CXR

Front 45

Back 45

Left side pneumo

Front 46

life threatening pneumo where positive air pressure pushes lungs, trachea, and heart to the contralateral side

Back 46

tension

Front 47

what treatment might be required for large pneumo's

Back 47

chest tube water seal

Front 48

30% of which type of pneumo has recurrence

Back 48

spontaneous

Front 49

pulmonaryhypertension with elevated pulmonary vascular resistance

Back 49

pulmonary hypertension

Front 50

it affects what population

Back 50

middle age or young women

Front 51

it may present sometimes as what

Back 51

Right-side heart failure

Front 52

main cause of secondary pulmonary HTN

Back 52

COPD

Front 53

how is pulmonary HTN medically treated

Back 53

vasodilators

oxygen therapy

anticoagulation

Front 54

Back 54

pulmonary hypertension

Front 55

what is Cor Pulmonale

Back 55

RightVentricular hypertrophy

Front 56

it is failure from what

Back 56

pulmonary disease

Front 57

most common cause of Cor Pulmonale

Back 57

COPD

Front 58

symptoms of Cor Pulmonale

Back 58

1. chronicproductive cough

2. exertionaldyspnea

3. wheezingrespirations

4. fatigability

5. weakness

Front 59

signs of Cor Pulmonale

Back 59

1. Cyanosis

2. Clubbing

3. Distendedneck veins

4. RVheave or gallop

5. Hepatomegalywith tenderness

6. Dependentedema

Front 60

testing for Cor Pulmonale

Back 60

EKG

Front 61

RV function is tested how

Back 61

Echocardiogram

Front 62

treatment for Cor Pulmonale

Back 62

Treatmentis directed at the underlying pulmonary cause.

Front 63

thrombus in pulmonary artery or branches

Back 63

pulmonary embolism (PE)

Front 64

Thirdleading cause of death in hospitalized patients

Back 64

PE

Front 65

most common embolus

Back 65

thrombus

Front 66

why do thrombi in the leg rarely cause PE's

Back 66

because only a small portion of them get above the popliteal or ileofemoral region

Front 67

most patients with PE's will also have what

Back 67

DVT

Front 68

classic triad of clinical manifestations for PE's

Back 68

1. Dyspnea

2. Pleuritic chest pain

3. Hemoptysis

Front 69

most common symptom of PE

Back 69

Tachypnea

Front 70

other signs and symptoms

Back 70

Seizures

Syncope

Abdominalpain

Fever

Productivecough

Wheezing

Decreasinglevel of consciousness

Newonset of atrial fibrillation

Front 71

70% of patients will have what abnormality on EKG

Back 71

Sinustachycardia

Front 72

testing for PE

Back 72

arterial blood gases

CXR

positive d-dimer (high sensitivity, low specificity)

Front 73

arterial blood gas will show what

Back 73

respiratory alkalosis

Front 74

what CXR finding is suspicious for PE

Back 74

Profoundhypoxia in the setting of normal

Front 75

avascular markings distal to area of embolus

Back 75

Westermark Sign

Front 76

pleuralbase of increasedmarking.

Back 76

hampton's hump

Front 77

what does hampton's hump finding represent

Back 77

interparenchymalhemorrhage

Front 78

initial screening and test of choice for PE

Back 78

helical CT

Front 79

how is a V/Q scan helpful

Back 79

low probability only rules out PE in patients with low clinical suspicion

Front 80

Back 80

PE

CT scan shows a pulmonary embolus within the posterobasal segment of the right lower lobe artery. The artery is enlarged compared with adjacent patent vessels

Front 81

gold standard test for detecting PE

Back 81

PulmonaryArteriography

Front 82

test good for detecting proximalextremity thrombosis

Back 82

venous ultrasound

Front 83

treatment for PE

Back 83

anticoagulation

heparin and warfarin (coumadin)

Front 84

heparin treatment

Back 84

load80units/kg IV, then maintenance infusion of 18 units/kg/hr

Maintain aPTT of1.5-2.5 times normal.

Adjustdose based on repeat aPTTvalues.

Front 85

what happens if you don't achieve adequate coagulation level in the first 24 hours

Back 85

increases risk 5 fold

Front 86

what does aPTT stand for

Back 86

activated partial thromboplastin time

Front 87

which type of heparin has a longer plasma half life

Back 87

LowMolecular Weight Heparin

Front 88

how is it administered

Back 88

subcutaneously

Front 89

warfarin treatment

Back 89

Oraltherapy continued for at least 3 months after PE

Startin the hospital with heparin

Takesup to 7 days to get to therapeutic state

Initialdose stated from 2.5-10mg daily

Front 90

target international normalized ration (INR)

Back 90

2.5

Front 91

INR above what increases risk of bleeding

Back 91

4

Front 92

is warfarin safe to use in pregnancy

Back 92

no, category x

Front 93

what doe you use instead

Back 93

LMWH

Front 94

risk involved with prolonged therapy for PE

Back 94

hemorrhage

Front 95

what PE therapy mustuse in the first 24 hours to be effective

Back 95

ThrombolyticTherapy

Front 96

types of thrombolytic therapy

Back 96

Streptokinase

Urokinase

recombinant tissue plasminogen activator

Front 97

Absolutecontraindications for PE therapy

Back 97

strokein past 2 months

active internal bleeding

Front 98

major contraindications

Back 98

uncontrolledHTNsurgery

or

trauma in last 6 weeks

Front 99

possible treatment for high risk patients

Back 99

IVC filter