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Block 9 Week 4 > Baker/Parks > Pleura, Smoking, Etc > Flashcards

Baker/Parks > Pleura, Smoking, Etc Flashcards

1
Q

what are the 3 most common congenital lung abnormalities?

A
  1. agenesis/hypoplasia
  2. foregut cysts
  3. pulmonary sequestration
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2
Q

what can cause agenesis/hypoplasia of the lungs?

A

anything that impedes normal lung expansion in utero

can affect one lung or single lobes

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3
Q

what is a foregut cyst?

A

abnormal detachment of primitive foregut

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4
Q

what is pulmonary sequestration?

A

lung tissue w/o connection to airway system

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5
Q

what are the 2 types of pulmonary sequestration?

A

internal (intralobar)

external (extralobar)

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6
Q

what causes atelectasis?

A

inadequate expansion of air space

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7
Q

what are the 3 types of acquired atelectasis?

A
  1. resorption
  2. compression
  3. contraction
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8
Q

what is the most common cause of resorption collapse?

A

obstruction of a bronchus by mucous or a mucopurulent plug (post-op)

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9
Q

what IS atelectasis?

A

airless pulmonary parenchyma

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10
Q

T/F: atelectasis can be neonatal or acquired

A

TRUE

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11
Q

what is the pathophys of resorption atelectasis?

A

airway obstruction leads to resorption of o2 w/i alveoli (blood is shunted from arteries to veins & doesn’t get oxygenated)

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12
Q

what are 3 things that can cause resorption atelectasis?

A
  1. secretions/exudates
  2. aspiration of foreign body
  3. neoplasm
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13
Q

what can cause compression atelectasis?

A

anything in the pleural cavity > fluid, tumor, blood, air

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14
Q

what can cause contraction atelectasis?

A

pulmonary fibrosis

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15
Q

does atelectasis cause post-op fever?

A

nope

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16
Q

what are the 5 Ws that cause post-op fever?

A
  1. wind > pneumonia
  2. water > UTI
  3. wound > infection
  4. walking > DVT/PE
  5. wonder drugs > iatrogenic
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17
Q

what is the pleural space & what is usually in it?

A

potential space

~15mL of lubricating serous fluid

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18
Q

what is most pleural dz d/t?

A

pleural dz is usu secondary to some other condition

EXCEPT MESOTHELIOMA

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19
Q

what is a pleural effusion?

A

XS accumulation of pleural fluid

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20
Q

T/F: pleural effusions are always symptomatic

A

FALSE

can be symptomatic or asymptomatic

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21
Q

what are the 2 types of pleural effusions?

A

transudative

exudative

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22
Q

what type of pleural effusion is NON inflammatory?

A

transudative

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23
Q

what type of pleural effusion is typically from a hydrostatic mechanism?

A

transudative

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24
Q

what type of pleural effusion is inflammatory?

A

exudative

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25
Q

what type of pleural effusion do you get w/ infection?

A

exudative

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26
Q

what type of pleural effusion has high protein?

A

exudative

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27
Q

what type of pleural effusion is cloudy?

A

exudative

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28
Q

what type of pleural effusion has fluid LDH LESS THAN 2/3 of serum upper limit?

A

transudative

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29
Q

what type of pleural effusion has <45 mg/dL cholesterol?

A

transudative

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30
Q

what type of effusion has higher albumin content?

A

transudative (this is the weird one)

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31
Q

what are Light’s criteria?

A

indicate an EXUDATE

  1. protein (f) / protein (s) > 0.5
  2. LDH (f) / LDH (s) > 0.6
  3. LDH (f) > 2/3 upper limit of normal for serum
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32
Q

how many of Light’s criteria do you need to confirm an exudate?

A

only one

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33
Q

T/F: Light’s criteria are sensitive but not very specific

A

TRUE
sensitive
specificity is ~80%

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34
Q

which type of pleural effusion has higher LDH?

A

exudative

LDH is released during tissue damage, which suggests inflammation, which is exudative

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35
Q

what are 2 types of exudative pleural effusions?

A

pleuritis

empyema

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36
Q

what is the etiology of empyema?

A

usu contiguous spread (pneumonia) but can be from distant source

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37
Q

what are the 2 possible outcomes of empyema?

A
  1. resolve completely

2. organize & cause permanent respiratory restriction

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38
Q

what are the 3 types of transudative effusions?

A
  1. hydrothorax
  2. hemothorax
  3. chylothorax
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39
Q

what color is hydrothorax fluid?

A

clear or straw-colored

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40
Q

what 2 things are assoc w/ hydrothorax?

A

CHF & pulmonary edema

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41
Q

what is hemothorax?

A

frank blood in the pleural space

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42
Q

why do you get a hemothorax?

A

trauma or vascular rupture

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43
Q

what does chylothorax fluid look like?

A

milky bc it’s lymphatic fluid

44
Q

what can cause chylothorax?

A
  1. thoracic duct trauma

2. obstruction w/ secondary lymph rupture

45
Q

what is a pneumothorax?

A

air in the pleural space

46
Q

what is pneumothorax most commonly assoc w/?

A

emphysema
asthma
TB

47
Q

T/F: trauma can cause a pneumothorax

A

TRUE

via perforating injury to the chest wall

48
Q

who gets spontaneous idiopathic pneumothorax?

A

relatively young pts

49
Q

what is spontaneous pneumothorax caused by?

A

rupture of small peripheral blebs

50
Q

T/F: spontaneous idiopathic pneumothorax is often a one-time event

A

FALSE

often recurrent

51
Q

what is a tension pneumothorax?

A

progressively worsening pneumothorax

52
Q

what is tension pneumo assoc w/?

A

mechanical ventilation

53
Q

how do you dx tension pneumo?

A

CLINICALLY

NOT RADIOLOGY

54
Q

what are the physical exam findings for tension pneumo?

A
  1. no breath sounds
  2. hyperresonance
  3. contralateral deviation of trachea/mediastinum
55
Q

why is tension pneumo a medical emergency?

A

reduced cardiac output!

56
Q

how do you fix a tension pneumo?

A

needle thoracostomy in the anterior 2nd intercostal space at the midclavicular line

57
Q

even though you’re not supposed to dx tension pneumo on CXR, what does it look like?

A

no pulmonary structures

possible contralateral shift

58
Q

what type of pleural tumor is more common: primary or secondary

A

secondary/metastatic

59
Q

what are the most frequent cancers that met to the lung?

A

the slide says lung & breast

i think it means prostate & breast

60
Q

T/F: malignant mesothelioma is common

A

FALSE

uncommon

61
Q

malignant mesothelioma is ?-related in 90% of cases

A

asbestos

62
Q

T/F: smoking increases your risk of mesothelioma

A

FALSE!!!!!!!!!!!!!!!

risk is not worsened by smoking! it’s like the ONLY ONE!

63
Q

how long is the latent period of mesothelioma?

A

25-45 years

64
Q

what is the presentation of mesothelioma?

A

chest pain
dyspnea
recurrent pleural effusion
asbestosis (in 20% of pts)

65
Q

can malignant mesothelioma spread?

A

YES

to liver & other distant organs

66
Q

what is the death rate of malignant mesothelioma in 12 months?

A

50%

survival is rare after 2 years

67
Q

what other “peri” structures can be affected by mesothelioma?

A

peritoneum
pericardium
peritoneum

68
Q

exposure to WHAT is strongly correlated to mesothelioma?

A

asbestos
20% of mesothelioma pts have asbestosis
50% of peritoneal mesothelioma pts have asbestosis

69
Q

what is cystic fibrosis?

A

disorder of ion transport in epithelial cells that affects fluid secretion in exocrine glands & the epithelial lining of resp, GI, & reproductive tracts

70
Q

what mutation is assoc w/ CF?

A

CFTR gene

71
Q

what happens in the airway cells in pts w/ CF?

A

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)

72
Q

what happens in sweat duct cells in pts w/ CF?

A

chloride can’t get INTO the cell (this is why sweat tests work)

73
Q

what is the finding in CF pts if you do a sweat chloride test?

A

CF pts have ELEVATED sweat chloride

74
Q

what is the most serious complication of CF?

A

pulmonary disease

75
Q

why do CF pts get chronic infections?

A

viscous mucous

76
Q

pts w/ CF are often colonized by which organisms?

A

staph aureus
pseudomonas
(often resistant organisms!)

77
Q

now for the fun part

A

aw yis

78
Q

how many cigs are in one pack?

A

20

79
Q

how much does a pack a day habit cost after 10 years?

A

$18k

80
Q

what % of adults smoke?

A

20.8%

81
Q

do men or women have higher rates of smoking?

A

men

82
Q

what level of education has the highest rate of smoking?

A

GED

grad degree has lowest rate

83
Q

what race has the highest rate of smoking?

A

native american/alaska native (asians are lowest)

84
Q

T/F: smoking is still on the rise

A

false!

it’s been declining since about 1980

85
Q

T/F: ads have nothing to do with smoking

A

false

there were 2 slides full of ads so i figure we should be aware of this

86
Q

what is the leading cause of preventable death in the US?

A

smoking!

87
Q

what causes more deaths: HIV or smoking

A

smoking

88
Q

smoking accounts for what % of all cancer cases?

A

25-30%

89
Q

what % of lung cancer in men is d/t smoking?

A

90%

90
Q

what % of lung cancer in women is d/t smoking?

A

78%

91
Q

what are the 4 main vascular effects of smoking?

A
  1. CAD
  2. Cerebrovascular dz
  3. peripheral vasc dz
  4. abdominal aortic aneurysm
92
Q

who should be screened for AAA?

A

men aged 65-75 who have smoked >100 cigs in their life

93
Q

how can smoking impact fetuses?

A

low birthweight

prematurity

94
Q

what is particularly important to be mindful of in females over 35 yo?

A

tobacco + oral contraceptives > can cause MI, stroke, VTE

95
Q

in smokers that quit, when does the risk for cardiac events decrease by 50%?

A

~1 year after quitting

approaches that of never-smokers ~2 years

96
Q

when does the risk of stroke appraoch that of never-smokers after quitting smoking?

A

~15 years

97
Q

what are the 2 main practical day-to-day benefits of quitting smoking?

A
  1. chronic cough resolves

2. SOB improves

98
Q

how long does it take for chronic cough to resolve in 1/2 of pts that quit?

A

a few weeks

99
Q

how long does it take for SOB to improve after quitting?

A

1-9 mos

100
Q

T/F: screening for tobacco use should begin before the doctor even enters the room

A

TRUE

101
Q

what increases the likelihood that a Dr will intervene & that a pt will quit smoking?

A

when office staff asks about & documents smoking status

3x more likely that Dr. will intervene, 2x more likely that pt will quit

102
Q

where should you put a pt’s smoking hx?

A

social hx

“ongoing problem” list

103
Q

T/F: you should not address the problem of smoking at every visit, bc the pt already knows it’s an issue

A

FALSE

you SHOULD address it every time

104
Q

what are the 5 As of helping a pt quit smoking?

A
  1. Ask
  2. Advise
  3. Assess
  4. Assist
  5. Arrange
105
Q

what are the 5 Rs of helping a pt quit (think motivational interviewing)?

A
  1. Relevance
  2. Risks
  3. Rewards
  4. Roadblocks
  5. Repeat
106
Q

the physician’s advice alone increases rates of smoking cessation by what %?

A

30%

107
Q

what is inversely related to the sale rates of cigarettes?

A

price

as price goes up, sales go down

Block 9 Week 4 (5 decks)

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