Baker/Parks > Pleura, Smoking, Etc Flashcards
what are the 3 most common congenital lung abnormalities?
- agenesis/hypoplasia
- foregut cysts
- pulmonary sequestration
what can cause agenesis/hypoplasia of the lungs?
anything that impedes normal lung expansion in utero
can affect one lung or single lobes
what is a foregut cyst?
abnormal detachment of primitive foregut
what is pulmonary sequestration?
lung tissue w/o connection to airway system
what are the 2 types of pulmonary sequestration?
internal (intralobar)
external (extralobar)
what causes atelectasis?
inadequate expansion of air space
what are the 3 types of acquired atelectasis?
- resorption
- compression
- contraction
what is the most common cause of resorption collapse?
obstruction of a bronchus by mucous or a mucopurulent plug (post-op)
what IS atelectasis?
airless pulmonary parenchyma
T/F: atelectasis can be neonatal or acquired
TRUE
what is the pathophys of resorption atelectasis?
airway obstruction leads to resorption of o2 w/i alveoli (blood is shunted from arteries to veins & doesn’t get oxygenated)
what are 3 things that can cause resorption atelectasis?
- secretions/exudates
- aspiration of foreign body
- neoplasm
what can cause compression atelectasis?
anything in the pleural cavity > fluid, tumor, blood, air
what can cause contraction atelectasis?
pulmonary fibrosis
does atelectasis cause post-op fever?
nope
what are the 5 Ws that cause post-op fever?
- wind > pneumonia
- water > UTI
- wound > infection
- walking > DVT/PE
- wonder drugs > iatrogenic
what is the pleural space & what is usually in it?
potential space
~15mL of lubricating serous fluid
what is most pleural dz d/t?
pleural dz is usu secondary to some other condition
EXCEPT MESOTHELIOMA
what is a pleural effusion?
XS accumulation of pleural fluid
T/F: pleural effusions are always symptomatic
FALSE
can be symptomatic or asymptomatic
what are the 2 types of pleural effusions?
transudative
exudative
what type of pleural effusion is NON inflammatory?
transudative
what type of pleural effusion is typically from a hydrostatic mechanism?
transudative
what type of pleural effusion is inflammatory?
exudative
what type of pleural effusion do you get w/ infection?
exudative
what type of pleural effusion has high protein?
exudative
what type of pleural effusion is cloudy?
exudative
what type of pleural effusion has fluid LDH LESS THAN 2/3 of serum upper limit?
transudative
what type of pleural effusion has <45 mg/dL cholesterol?
transudative
what type of effusion has higher albumin content?
transudative (this is the weird one)
what are Light’s criteria?
indicate an EXUDATE
- protein (f) / protein (s) > 0.5
- LDH (f) / LDH (s) > 0.6
- LDH (f) > 2/3 upper limit of normal for serum
how many of Light’s criteria do you need to confirm an exudate?
only one
T/F: Light’s criteria are sensitive but not very specific
TRUE
sensitive
specificity is ~80%
which type of pleural effusion has higher LDH?
exudative
LDH is released during tissue damage, which suggests inflammation, which is exudative
what are 2 types of exudative pleural effusions?
pleuritis
empyema
what is the etiology of empyema?
usu contiguous spread (pneumonia) but can be from distant source
what are the 2 possible outcomes of empyema?
- resolve completely
2. organize & cause permanent respiratory restriction
what are the 3 types of transudative effusions?
- hydrothorax
- hemothorax
- chylothorax
what color is hydrothorax fluid?
clear or straw-colored
what 2 things are assoc w/ hydrothorax?
CHF & pulmonary edema
what is hemothorax?
frank blood in the pleural space
why do you get a hemothorax?
trauma or vascular rupture
what does chylothorax fluid look like?
milky bc it’s lymphatic fluid
what can cause chylothorax?
- thoracic duct trauma
2. obstruction w/ secondary lymph rupture
what is a pneumothorax?
air in the pleural space
what is pneumothorax most commonly assoc w/?
emphysema
asthma
TB
T/F: trauma can cause a pneumothorax
TRUE
via perforating injury to the chest wall
who gets spontaneous idiopathic pneumothorax?
relatively young pts
what is spontaneous pneumothorax caused by?
rupture of small peripheral blebs
T/F: spontaneous idiopathic pneumothorax is often a one-time event
FALSE
often recurrent
what is a tension pneumothorax?
progressively worsening pneumothorax
what is tension pneumo assoc w/?
mechanical ventilation
how do you dx tension pneumo?
CLINICALLY
NOT RADIOLOGY
what are the physical exam findings for tension pneumo?
- no breath sounds
- hyperresonance
- contralateral deviation of trachea/mediastinum
why is tension pneumo a medical emergency?
reduced cardiac output!
how do you fix a tension pneumo?
needle thoracostomy in the anterior 2nd intercostal space at the midclavicular line
even though you’re not supposed to dx tension pneumo on CXR, what does it look like?
no pulmonary structures
possible contralateral shift
what type of pleural tumor is more common: primary or secondary
secondary/metastatic
what are the most frequent cancers that met to the lung?
the slide says lung & breast
i think it means prostate & breast
T/F: malignant mesothelioma is common
FALSE
uncommon
malignant mesothelioma is ?-related in 90% of cases
asbestos
T/F: smoking increases your risk of mesothelioma
FALSE!!!!!!!!!!!!!!!
risk is not worsened by smoking! it’s like the ONLY ONE!
how long is the latent period of mesothelioma?
25-45 years
what is the presentation of mesothelioma?
chest pain
dyspnea
recurrent pleural effusion
asbestosis (in 20% of pts)
can malignant mesothelioma spread?
YES
to liver & other distant organs
what is the death rate of malignant mesothelioma in 12 months?
50%
survival is rare after 2 years
what other “peri” structures can be affected by mesothelioma?
peritoneum
pericardium
peritoneum
exposure to WHAT is strongly correlated to mesothelioma?
asbestos
20% of mesothelioma pts have asbestosis
50% of peritoneal mesothelioma pts have asbestosis
what is cystic fibrosis?
disorder of ion transport in epithelial cells that affects fluid secretion in exocrine glands & the epithelial lining of resp, GI, & reproductive tracts
what mutation is assoc w/ CF?
CFTR gene
what happens in the airway cells in pts w/ CF?
chloride can’t get OUT of the cell to go into the mucus, so the mucus is dehydrated (Na & Water go from the mucus into the cell still)
what happens in sweat duct cells in pts w/ CF?
chloride can’t get INTO the cell (this is why sweat tests work)
what is the finding in CF pts if you do a sweat chloride test?
CF pts have ELEVATED sweat chloride
what is the most serious complication of CF?
pulmonary disease
why do CF pts get chronic infections?
viscous mucous
pts w/ CF are often colonized by which organisms?
staph aureus
pseudomonas
(often resistant organisms!)
now for the fun part
aw yis
how many cigs are in one pack?
20
how much does a pack a day habit cost after 10 years?
$18k
what % of adults smoke?
20.8%
do men or women have higher rates of smoking?
men
what level of education has the highest rate of smoking?
GED
grad degree has lowest rate
what race has the highest rate of smoking?
native american/alaska native (asians are lowest)
T/F: smoking is still on the rise
false!
it’s been declining since about 1980
T/F: ads have nothing to do with smoking
false
there were 2 slides full of ads so i figure we should be aware of this
what is the leading cause of preventable death in the US?
smoking!
what causes more deaths: HIV or smoking
smoking
smoking accounts for what % of all cancer cases?
25-30%
what % of lung cancer in men is d/t smoking?
90%
what % of lung cancer in women is d/t smoking?
78%
what are the 4 main vascular effects of smoking?
- CAD
- Cerebrovascular dz
- peripheral vasc dz
- abdominal aortic aneurysm
who should be screened for AAA?
men aged 65-75 who have smoked >100 cigs in their life
how can smoking impact fetuses?
low birthweight
prematurity
what is particularly important to be mindful of in females over 35 yo?
tobacco + oral contraceptives > can cause MI, stroke, VTE
in smokers that quit, when does the risk for cardiac events decrease by 50%?
~1 year after quitting
approaches that of never-smokers ~2 years
when does the risk of stroke appraoch that of never-smokers after quitting smoking?
~15 years
what are the 2 main practical day-to-day benefits of quitting smoking?
- chronic cough resolves
2. SOB improves
how long does it take for chronic cough to resolve in 1/2 of pts that quit?
a few weeks
how long does it take for SOB to improve after quitting?
1-9 mos
T/F: screening for tobacco use should begin before the doctor even enters the room
TRUE
what increases the likelihood that a Dr will intervene & that a pt will quit smoking?
when office staff asks about & documents smoking status
3x more likely that Dr. will intervene, 2x more likely that pt will quit
where should you put a pt’s smoking hx?
social hx
“ongoing problem” list
T/F: you should not address the problem of smoking at every visit, bc the pt already knows it’s an issue
FALSE
you SHOULD address it every time
what are the 5 As of helping a pt quit smoking?
- Ask
- Advise
- Assess
- Assist
- Arrange
what are the 5 Rs of helping a pt quit (think motivational interviewing)?
- Relevance
- Risks
- Rewards
- Roadblocks
- Repeat
the physician’s advice alone increases rates of smoking cessation by what %?
30%
what is inversely related to the sale rates of cigarettes?
price
as price goes up, sales go down
