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25 Cards in this Set
- Front
- Back
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what causes pleural transudative effusions?
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elevated capillary pressure in visceral or parenteral pleura (ie CHF)
decreased plasma oncotic pressure (ie hypoalbuminemia) |
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what causes pleural exudative effusions?
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increased permeability of pleural surface
decreased lymphatic flow from pleural surface secondary to damage to pleural membranes/vasculature |
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what is transudate?
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extravascular fluid with low protein content and a low specific gravity (<1.012)
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what is oncotic pressure?
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a form of osmotic pressure exerted by proteins in blood plasma that usually tends to pull water into the circulatory system
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how do you distinguish transudate from exudate?
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exudative effusions have at least:
- pleural/serum protein (>0.5) - pleural/serum LDH (>0.6) - LDH >2/3's upper limit of normal (transudate has none) |
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how much pleural fluid must accumulate before an effustion can be detected on CXR?
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~250 mL
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which CXR position is most helpful for detecting pleural effusion?
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lateral decubitus
(also determines if fluid is free or loculated) |
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what is left lateral decubitus position?
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lying on your left side
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what labs should you send for effusions collected by thoracentesis?
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"4 C's"
- chemistry (glucose, protein) - cytology - cell count (CBC w/ diff) - culture |
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what (3) things should you think about with elevated pleural fluid amylase?
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esophageal rupture
pancreatitis malignancy |
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what is milky, opalescent pleural fluid?
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chylothorax
(lymph in the pleural space) [opalescent = little opacity] |
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what should you think with purulent pleural fluid?
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empyema
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what should you suspect when you find an exudative pleural effusion that is primarily lymphocytic?
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TB
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what should you think when you see a pleural effusion with a pH <7.2?
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parapneumonic effusion (pneumonia) or
empyema |
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how do you treat transudative effusions?
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diuretics
sodium restriction thoracentesis (if causing dyspnea) |
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how do you treat exudative effusions?
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treat underlying dz
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how do you txt parapneumonic effusions?
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uncomplicated: antibx
complicated: - chest tube - intrapleural thrombolytics (strepto-/urokinase) - surgical lysis of adhesions |
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after what (3) procedures should you order a CXR to r/o pneumothorax?
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transthoracic needle aspiration
thoracentesis central line placement |
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what is first-line txt in a sponataneous pneumothorax?
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supplemental oxygen
(hastens resorption of air in pleural space) |
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which way does the mediastinum shift in a pneumothorax?
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toward the side of the pneumonthorax
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what is the recurrence rate of a primary (simple) spontaneous pneumothorax?
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50% in 2 years
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which way does the mediastinum shift in a tension pneumothorax?
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away from the side of the pneumothorax
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what are the clinical features of a tension pneumothorax?
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hypotension
JVD shift of trachea away from pneumothorax decr breath sounds on affected side hyperresonance on affected side |
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what are most cases of malignant mesothelioma due to?
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asbestos exposure
(prognosis: a few months) |
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what are the common clinical findings in a pt with malignant mesothelioma?
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dyspnea
wt loss cough bloody effusion |
