Chapter 27-pleural Diseases

Question 1

Each lung is covered by

Answer 1

Visceral pleura

Question 2

How does pleural fluid travel between lobes of the lungs

Answer 2

Visceral pleura dips into the fissures

Question 3

The inner side of the ribs and chest wall are covered by

Answer 3

Parietal pleura

Question 4

Pleural space is

Answer 4

Located between the parietal and visceral pleura

Question 5

What is a pleural effusion

Answer 5

An abnormal amount of fluid in the pleural space

Question 6

When interstitial pressure within the lung or chest wall is increased

Answer 6

Pleural fluid enters the pleural space

Question 7

A pleural effusion that forms while the pleural space is intact is called a

Answer 7

Transudate

Question 8

A pleural effusion with high protein in fluid is called a

Answer 8

Exudate

Question 9

Causes of transudate pleural effusion include

Answer 9

Chf 
Cirrhosis 
Nephrotic syndrome
Hypoalbuminemia 
Atelectasis

Question 10

Causes of exudate pleural effusion

Answer 10

Pneumonia
Tb
Lung cancer 
Pe 
Connective tissue disease

Question 11

How to detect pleural effusions on cxr

Answer 11

Lateral decubitus x ray

Or have patient sit up during pa or ap xray

Question 12

Risks to thoracentesis

Answer 12

Intercostal artery laceration
Infection
Pneumothorax

Question 13

What is pleurodesis

Answer 13

The process of fusing the parietal and visceral pleura together to prevent further pleural effusions

Question 14

What is a pneumothorax

Answer 14

Air in the pleural space

Question 15

What are the two causes of pneumothorax

Answer 15

Spontaneous and tramatic

Question 16

What are causes of traumatic pneumothorax

Answer 16

Gunshot
Stabbing
Blunt trauma-rib fracture that enters lung parenchyma

Question 17

What causes pneumothorax in neonates

Answer 17

High trans pulmonary pressure after birth

Question 18

How is neonatal pneumothorax diagnosed

Answer 18

Shifting of heart sounds

Trans illumination of the chest

Question 19

What are the two types of spontaneous pneumothorax

Answer 19

Primary-no underlying lung disease

Secondary-lung disease is present

Question 20

What type of patients typically have spontaneous primary pneumothorax

Answer 20

Tall, thin patients in late teens or early 20s

Question 21

When air in pleural space exceeds atmospheric pressure it is considered a ?

Answer 21

Tension pneumothorax

Question 22

In tension pneumothorax, medistinal shift will happen in which direction

Answer 22

Away from pneumothorax

Question 23

What happens physiologically as pressure in the chest rises

Answer 23

Decreased venous return due to pressure on the heart
Cardiac output decreases resulting in hypotension and tachycardia
Intrapulmonary shunting occurs through collapsed lung which worsens hypoxemia

Question 24

What is the placement for needle decompression of a tension pneumothorax

Answer 24

Second intercostal, midclavicular line.

Question 25

Clinical signs of tension pneumothorax

Answer 25

Diminished breath sounds
Hyper resonance
Tachycardia
Hypotension

Question 26

What is reexpansion pulmonary edema

Answer 26

Edema that occurs due to rapid reinflation of lungs

Question 27

How do we prevent reexpansion pulmonary edema

Answer 27

Limiting draining volume to 1000 mls

Slow draining of pmeumothorax by starting it with a water seal without suction

Question 28

Treatment of small pneumothorax

Answer 28

Administration of 100% oxygen to washout nitrogen

Question 29

Where can small bore catheters be placed to drain pneumothorax

Answer 29

Second intercostal at the midclavicular line

Laterally from 5-7 intercostal space

Question 30

How should patients with bpf be positioned

Answer 30

Lung with air leak down

Question 31

What is bronchopleural fistula

Answer 31

A hole between the large airways in the lungs and the pleural membrane