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99 Cards in this Set
- Front
- Back
what is a pleural effusion |
Abnormalcollection of fluid in the pleural space |
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classified as a sign of disease but not a disease by itself |
pleural effusion |
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Increasedproduction due to increased hydrostatic or decreased oncotic pressures |
transudate |
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Increasedproduction due to abnormal capillary permeability |
exudate |
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Decreasedlymphatic clearance |
exudate |
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direct infection of the pleural space that is grossly purulent/turbulent |
empyema |
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bleeding into the pleural space |
hemothorax |
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caused by high cholesterol |
chyloform |
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pleural effusions are exudates thataccompany bacterial pneumonias |
Parapneumonic |
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abnormal accumulation of circulatory system fluid results in what |
transudate |
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this accumulation is can be due to what two things |
1. increased hydrostatic pressure 2. decreased oncotic pressure (colloid osmotic pressure) |
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most common cause of transudate |
CHF |
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other causes of transudate |
1. nephrotic syndrome 2. cirrhosis 3. atelectasis |
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what occurs when local factors increase vascular permeability |
exudate |
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the light's criteria are exclusive to what |
exudates |
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what is the light's criteria |
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 |
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5 leading causes of pleural effusions in the US |
1. CHF 2. Pneumonia 3. Cancer 4. pulmonary embolus 5. viral disease |
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of the previous 5, which one can sometimes be either a transudate or an exudate |
pulmonary embolus |
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signs and symptoms of pleural effusion |
dyspnea cough pleuritic chest pain |
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small effusions are normally what |
asymptomatic and have no findings on physical exam |
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physical exam findings of pleural effusions |
1. dullness to percusion 2. decreased breath sounds 3. audible plueral friction rub 4. Egophony 5. bronchial breath sounds |
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what can occur in massive pleural effusions |
lung collapse mediastinal shift to contralateral side |
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lab tests are order depending on what |
the appearance of the pleural fluid |
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what is ordered for bloody fluid |
hematocrit |
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what is ordered for cloudy or turbid fluid |
centrifugation |
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what is ordered for purid odor |
stain and culture could be possible aerobic infection |
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Tovisualize fluid on a standardupright CXR, you need at leasthow much fluid |
75 to 100 CC's |
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pleural effusion on CT |
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what view is the best choice for detecting smaller effusions, and differentiating loculations & empyema from new effusions or scarring |
lateral decubitus |
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Pleural Effusion index. How is PEI calculated? |
100times the maximum width of the right pleural effusion, divided by the maximalwidth of the hemithorax of the affected side |
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treatment for transudate pleural effusions |
treat underlying condition |
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what is the gold standard treatment for pleural effusions |
thoracentesis |
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pleural fluid must be drain in what case |
empyema |
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lab findings for empyema |
1. pleural fluid PH under 7.2 2. glucose under 40 mg 3. positive gram |
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accumulation of air within the pleural space |
pneumothorax |
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pneumothorax can be either what |
spontaneous or traumatic |
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two types of spontaneous pneumo's |
primary and secondary |
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secondary occurs________. |
as aresult of a complication of preexisting lung disease |
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population group for primary pneumo's |
tall, thin med 20-40 smokers family history |
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can pneumo's be iatrogenic |
yes caused by thoracic needle aspirations, baro trauma, thoracentesis or lung biopsy, or subclavian catheter placement |
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primarny spontaneous is also thought be be a rupture of what |
small blebs |
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clinical manifestations of pneumo's |
unilateral pleuritic chest pain dyspnea palpitations |
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signs can present as_______. |
Respiratorydistress Tachycardia Tachypnea |
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test of choice for pneumo |
CXR |
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Left side pneumo |
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life threatening pneumo where positive air pressure pushes lungs, trachea, and heart to the contralateral side |
tension |
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what treatment might be required for large pneumo's |
chest tube water seal |
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30% of which type of pneumo has recurrence |
spontaneous |
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pulmonaryhypertension with elevated pulmonary vascular resistance |
pulmonary hypertension |
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it affects what population |
middle age or young women |
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it may present sometimes as what |
Right-side heart failure |
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main cause of secondary pulmonary HTN |
COPD |
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how is pulmonary HTN medically treated |
vasodilators oxygen therapy anticoagulation |
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pulmonary hypertension |
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what is Cor Pulmonale |
RightVentricular hypertrophy |
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it is failure from what |
pulmonary disease |
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most common cause of Cor Pulmonale |
COPD |
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symptoms of Cor Pulmonale |
1. chronicproductive cough 2. exertionaldyspnea 3. wheezingrespirations 4. fatigability 5. weakness |
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signs of Cor Pulmonale |
1. Cyanosis 2. Clubbing 3. Distendedneck veins 4. RVheave or gallop 5. Hepatomegalywith tenderness 6. Dependentedema |
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testing for Cor Pulmonale |
EKG |
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RV function is tested how |
Echocardiogram |
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treatment for Cor Pulmonale |
Treatmentis directed at the underlying pulmonary cause. |
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thrombus in pulmonary artery or branches |
pulmonary embolism (PE) |
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Thirdleading cause of death in hospitalized patients |
PE |
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most common embolus |
thrombus |
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why do thrombi in the leg rarely cause PE's |
because only a small portion of them get above the popliteal or ileofemoral region |
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most patients with PE's will also have what |
DVT |
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classic triad of clinical manifestations for PE's |
1. Dyspnea 2. Pleuritic chest pain 3. Hemoptysis |
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most common symptom of PE |
Tachypnea |
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other signs and symptoms |
Seizures Syncope Abdominalpain Fever Productivecough Wheezing Decreasinglevel of consciousness Newonset of atrial fibrillation |
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70% of patients will have what abnormality on EKG |
Sinustachycardia |
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testing for PE |
arterial blood gases CXR positive d-dimer (high sensitivity, low specificity) |
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arterial blood gas will show what |
respiratory alkalosis |
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what CXR finding is suspicious for PE |
Profoundhypoxia in the setting of normal |
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avascular markings distal to area of embolus |
Westermark Sign |
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pleuralbase of increasedmarking. |
hampton's hump |
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what does hampton's hump finding represent |
interparenchymalhemorrhage |
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initial screening and test of choice for PE |
helical CT |
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how is a V/Q scan helpful |
low probability only rules out PE in patients with low clinical suspicion |
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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 |
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gold standard test for detecting PE |
PulmonaryArteriography |
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test good for detecting proximalextremity thrombosis |
venous ultrasound |
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treatment for PE |
anticoagulation heparin and warfarin (coumadin) |
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heparin treatment |
load80units/kg IV, then maintenance infusion of 18 units/kg/hr Maintain aPTT of1.5-2.5 times normal. Adjustdose based on repeat aPTTvalues. |
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what happens if you don't achieve adequate coagulation level in the first 24 hours |
increases risk 5 fold |
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what does aPTT stand for |
activated partial thromboplastin time |
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which type of heparin has a longer plasma half life |
LowMolecular Weight Heparin |
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how is it administered |
subcutaneously |
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warfarin treatment |
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 |
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target international normalized ration (INR) |
2.5 |
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INR above what increases risk of bleeding |
4 |
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is warfarin safe to use in pregnancy |
no, category x |
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what doe you use instead |
LMWH |
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risk involved with prolonged therapy for PE |
hemorrhage |
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what PE therapy mustuse in the first 24 hours to be effective |
ThrombolyticTherapy |
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types of thrombolytic therapy |
Streptokinase Urokinase recombinant tissue plasminogen activator |
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Absolutecontraindications for PE therapy |
strokein past 2 months active internal bleeding |
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major contraindications |
uncontrolledHTNsurgery or trauma in last 6 weeks |
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possible treatment for high risk patients |
IVC filter |