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Pulmonary > Lectures 4 and 5 > Flashcards

Lectures 4 and 5 Flashcards

1
Q

What is a pulmonary nodule?

A

A lesion that is both within and surrounded by pulmonary parenchyma (also called coin lesion)

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2
Q

A lesion > __ cm in diameter is called a mass

A

3cm

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3
Q

Less than 3 cm in size and not associated with atelectasis or lymphadenopathy

A

Pulmonary Nodule

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4
Q

1cm = __ mm

A

10 mm

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5
Q

What are some thoracic imaging tools?

A

CXR, Chest CT scan +/- IV contrast, PET/CT scan, chest MRI

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6
Q

CXR

A

Fast, inexpensive

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7
Q

What can a CXR detect evidence of?

A

Heart failure, pleural/pericardial effusions, pneumonia, lung nodule/mass

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8
Q

What is more sensitive than CXRs for detecting small nodules?

A

Chest CT scan

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9
Q

What does a chest CT scan provide evidence for?

A

COPD, TB, pneumonia, cancer, congenital abnormalities

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10
Q

What clinical symptoms can a chest CT help to diagnose?

A

Cough, SOB, chest pain, fever

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11
Q

Standard CT slices are __mm in width

A

5mm

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12
Q

High resolution CT scans and CT PE protocol CT scans are what width?

A

1mm

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13
Q

Which has more radiation exposure, CXR or chest CT?

A

Chest CT

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14
Q

Chest CT scan is not good for which patients?

A

IV contrast allergies and patients >400lbs

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15
Q

What does PET stand for

A

Position Emission Tomography

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16
Q

What is FDG?

A

Fluordeoxyglucose, contrast used for PET scan

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17
Q

What can a PET/CT scan be used for?

A

Diagnosis, staging, and monitoring treatment of cancers

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18
Q

What can a PET/CT scan show?

A

Areas of poor cardiac perfusion

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19
Q

A PET/CT scan cannot differentiate between what?

A

Inflammation vs malignancy

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20
Q

Which type of malignancies exhibit low FDG avidity?

A

Adenocarcinoma in situ (BAC) and carcinoid tumors

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21
Q

Lesions smaller than _ to __mm are too small for PET to characterize

A

8-10mm

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22
Q

What is a chest MRI utilized to asses?

A

Tumor size, extent, and invasion into other adjacent structures

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23
Q

What type of tumors can invade adjacent structures?

A

Mesothelioma and pancoast tumors

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24
Q

What is a great study to ascertain tissue planes- fat, muscle, bone, and vessels?

A

Chest MRI

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25
Q

Does chest MRI involve radiation?

A

No exposure to ionizing radiation

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26
Q

Chest MRI has limited use for what?

A

Limit3ed use for solitary pulmonary nodules not adjacent to other structures

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27
Q

Chest MRI should not be used for who

A

Metal implants, pacemakers, claustrophobia

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28
Q

Larger lesions are more likely to be what?

A

Malignant

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29
Q

Malignant lesions will have what?

A

A more irregular or speculated border

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30
Q

Benign lesions have what type of border?

A

Smooth and discrete border

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31
Q

Metastatic lesions can have what type of borders?

A

Smooth and discrete

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32
Q

What types of disease can have calcification?

A

Granulomatous disease and hamartomas

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33
Q

Patients with primary tumors, like osteosarcoma or chondrosarcoma may have what?

A

Pulmonary lesions with calcification

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34
Q

Lesions that are malignant tend to have an interval increase in size between what?

A

4-6 months

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35
Q

Nodules that grow very rapidly are more likely what?

A

Benign

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36
Q

What is SUV?

A

Standardized uptake value

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37
Q

Higher than normal physiological uptake is an SUV greater than what?

A

3

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38
Q

There is NOT one radiographic finding that is pathognomonic for what?

A

Cancer diagnosis

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39
Q

Infectious granulomas comprise about __% of all benign nodules

A

80

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40
Q

What are some types of infectious benign granulomas?

A

Histoplasmosis, coccidiomycosis, mycobacterium

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41
Q

Inflammatory nodules compression __% of benign nodules

A

10%

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42
Q

What are some examples of inflammatory benign nodules?

A

Rheumatoid, Wegener granulomatous is, Sarcoidosis

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43
Q

What is a Hamartoma?

A

Benign tumor of the lung comprised of cartilage, fat, muscle

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44
Q

What type of benign lung tumor has “popcorn” calcifications?

A

Hamartoma

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45
Q

What is GGO?

A

Ground Glass opacities

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46
Q

What is the f/u recommendation for a GGO <5mm in size?

A

Follow up CT scan in 6 months

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47
Q

What is the f/u of a GGO 6-10 mm in size?

A

Follow up CT scan in 3 months

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48
Q

What is the f/u recommendation for a GGO >10mm in size?

A

Recommend biopsy or resection if amenable

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49
Q

If GGOs are stable, they are generally followed how often?

A

Every 3-6 months, for a total of 36 months

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50
Q

When was cigarette smoking declared a health hazard?

A

Saturday January 11, 1964 by the surgeon general

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51
Q

What is the biggest risk factor for lung cancer?

A

Smoking- 85-90%, depends on packs smoked/year

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52
Q

What are some other risk factors for lung cancer?

A

Occupational/environmental and genetic factors, benign lung disease, ionizing radiation, second hand smoke/third hand smoke

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53
Q

What occupational/environmental factors can put you at risk for lung cancer?

A

Radon, asbestos, wood smoke, diesel exhaust, air pollution

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54
Q

What types of gases and chemicals are found in cigarettes?

A

Hydrogen cyanide, carbon monoxide, butane, ammonia, toluene, arsenic, lead, chromium, and cadmium

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55
Q

What can cause lung cancer in non smokers?

A

Secondhand smoke

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56
Q

What else has secondhand smoke been associated with?

A

Heart disease in adults and SIDS, ear infections, and asthma in children

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57
Q

What is cotinine?

A

An alkaloid found in tobacco and is also a metabolite of nicotine

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58
Q

What is cotinine used as?

A

A biomarker for exposure to tobacco smoke

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59
Q

Tobacco smoke can cling where?

A

To walls and ceilings and can be absorbed into carpets, draperies, and furniture upholsteries

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60
Q

Smoking accounts for atleast what % of cancer deaths?

A

30%

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61
Q

Smoking increases the risk of what types of cancer?

A

Nasopharyngeal, laryngeal, bladder, esophageal, pancreas, breast, stomach, colorectal, uterine

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62
Q

What are the two main subtypes of lung cancer?

A

Small cell and non-small cell

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63
Q

What are the 3 types of non-small cell?

A

Adenocarcinoma, squamous cell carcinoma, large cell carcinoma

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64
Q

What is a subtype of adenocarcinoma?

A

Bronchoalveolar carcinoma

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65
Q

What are the 3 subtypes of small cell lung cancer?

A

Classic small cell, large cell neuroendocrine, combined

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66
Q

What is the most common type of lung cancer?

A

Adenocarcinoma

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67
Q

90% of all epithelial lung cancers are comprised of what?

A

Adenocarcinoma, squamous cell carcinoma, large cell carcinoma and small cell carcinoma

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68
Q

The remaining 10% of epithelial lung cancers are comprised of what?

A

Undifferentiated carcinomas, carcinoid, and rarer tumor types

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69
Q

Malignant epithelial neoplasm lacking glandular or squamous differentiation

A

Large cell carcinoma

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70
Q

Usually presents are large peripheral mass with prominent necrosis

A

Large cell carcinoma

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71
Q

Tend to occur centrally and are classically associated with a history of smoking

A

Squamous cell carcinoma

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72
Q

Central and peripheral squamous cell carcinomas may show what?

A

Extensive central necrosis and cavitation

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73
Q

Most common type of lung cancer, especially in never smokers

A

Adenocarcinoma

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74
Q

Most commonly found in the lung periphery, but can occur centrally

A

Adenocarcinoma

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75
Q

Bronchioloalveolar carcinoma grows where?

A

Within the alveoli without invasion and can present as a ground glass opacity

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76
Q

What are the subtypes of adenocarcinoma?

A

BAC, mutinous adenocarcinomas, papillary adenocarcinomas

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77
Q

Why is lung cancer so deadly?

A

Aggressive biology of the disease, lack of an effective screening test, absence of symptoms until locally advanced or metastatic disease is present

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78
Q

What is the clinical presentation of lung cancer?

A

Cough, dyspnea, hemoptysis, recurrent pneumonia’s, weight loss, chest pain

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79
Q

Signs and symptoms of more extensive disease

A

Bone pain, dysphagia, hoarseness, neurological abnormalities, horner’s syndrome, superior vena cava syndrome

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80
Q

What are some neurological abnormalities seen in extensive disease?

A

HA, syncope, cognitive impairment

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81
Q

What is Horner’s syndrome

A

Ptosis, anhidrosis, miosis

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82
Q

What are some diagnostic tools for lung cancer?

A

CT guided needle biopsy, bronchoscope +/- lavage, endobronchial ultrasound biopsy (EBUS), video-assisted thoracoscopic surgery (VATs), thoracentesis

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83
Q

What is the staging of cancer?

A

TNM
T=tumor
N=nodes
M=metastasis

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84
Q

Lung cancers tend to spread via three main routes:

A
  1. Blood
  2. Lymphatics
  3. Direct invasion
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85
Q

Lung cancers commonly metastasize to these areas

A

Brain, bone, liver, adrenal glands

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86
Q

For lung lesions greater than 2cm, the following is recommended:

A

HMRI or head CT with contrast, PET/CT scan, bone scan

if an extrathoracic lesion is detected, further work up will be needed

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87
Q

What is the treatment for stage 1 lung cancer?

A

Surgical resection; and adjuvant therapy in the future

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88
Q

What type of adjuvant therapy is used to treat stage 1 lung cancer?

A

Chemotherapy/radiation or a combo of both

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89
Q

What is the treatment for stage 2 lung cancer?

A

Surgical resection + adjuvant therapy

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90
Q

What is the treatment for stage 3A lung cancer?

A

Chemoradiation, surgical resection in selected patients

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91
Q

What is the future management for someone with stage 3A lung cancer?

A

Neoadjuvant combined therapy to downstage primary tumor

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92
Q

What is the treatment for stage 3B lung cancer?

A

Chemoradiotherapy

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93
Q

What is the treatment for stage 4 lung cancer?

A

Cisplatin-based chemothearpy* surgical resection if solitary metastasis lesion with resectable primary tumor

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94
Q

What are some surgical and non surgical options for lung cancer?

A

VATs resection, segmentectomy, lobectomy, pneumonectomy, robotic lobectomy, sleeve lobectomy, radiofrequency ablation (RFA), photodynamic therapy (PDT)

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95
Q

What type of resection is good for small lesions in the peripheral of the lung?

A

Wedge resection

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96
Q

What is the VATs procedure?

A

Removing entire lobe, need to isolate 3 structures

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97
Q

What are the 3 structures that need to be isolated in a VATs lobectomy?

A

Bronchus, pulmonary artery and pulmonary vein

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98
Q

What is a segmentectomy?

A

Taking out a smaller segment of the lobe, not as small as wedge but not as large as a lobectomy

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99
Q

What is a pneumonectomy used for?

A

Patients with centrally located tumors close to the bronchus, mesothelioma too

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100
Q

What is a sleeve lobectomy used for?

A

If tumor is sitting on top of or invading the upper lobe airways

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101
Q

How does radiofrequency ablation work?

A

A small barb is inserted into the lesion and small metal wires are opened, the wires heat and burn the tumor

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102
Q

What type of procedure can be done on an unresectable lung tumor and for esophageal cancers

A

Photodynamic therapy

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103
Q

How does photodynamic therapy work?

A

Infuse patient with an ultraviolet sensitive chemical (need to be protected for UV light until procedure), come back 24 hours later and use a bronchoscope with a UV probe and burn/irritate the tumor cells

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104
Q

What is a poorly differentiated neuroendocrine tumor that commonly occurs as a large hilar mass with bulky mediating adenopathy?

A

Small cell carcinoma

105
Q

What type of lung cancer has a rapid doubling time, high growth fraction, and early development of widespread metastases?

A

Small cell carcinoma

106
Q

Small cell carcinoma is almost exclusively found in who?

A

Smokers, most commonly heavy smokers

107
Q

What is the two stage system of small cell carcinoma?

A

Limited disease and extensive disease

108
Q

What is limited disease for small cell carcinoma?

A

Disease confused to the ipsilateral hemithorax and within a single radiotherapy field

109
Q

What is extensive disease for small cell carcinoma?

A

Metastatic disease outside the ipsilateral hemithorax

110
Q

What % of patients will have extensive stage small cell carcinoma?

A

60-70%

111
Q

What % of patients will have limited stage small cell carcinoma?

A

30-40%

112
Q

What is the prognosis for limited disease small cell carcinoma?

A

15-20 mos and a 5 year survival rate of 10-13%

113
Q

What is the prognosis for extensive disease small cell carcinoma?

A

8-13 mos, 5 year survival rate of 1-2%

114
Q

What type of lung cancer is characterized by neuroendocrine differentiation and relatively indolent clinical behavior?

A

Carcinoid tumor

115
Q

What are Carcinoid tumors made out of?

A

Made up of peptide and amine producing cells

116
Q

Where do carcinoid tumors arise?

A

GI tract* thymus, lung, ovaries

117
Q

What is the most common primary lung neoplasm in children?

A

Carcinoid tumor

118
Q

What are the 2 main cell types of carcinoid tumors?

A

Typical carcinoid ad atypical carcinoid

119
Q

Typical carcinoid cells

A

Excellent prognosis and are about 4x more common than atypical

120
Q

Atypical carcinoid

A

Greater tendency to metastasize, dont respond well to treatment options, not good prognosis

121
Q

What do the carcinoid tumors look like?

A

Round, ovoid opacities and may be hilar or perihilar

122
Q

Carcinoid tumors commonly arise where?

A

Proximal airways causing bronchial obstruction

123
Q

What are the signs and symptoms of carcinoid tumors?

A

Cough, wheeze, hemoptysis, recurrent pneumonia, asymptomatic, carcinoid syndrome, acromegaly

124
Q

What is the treatment of choice for carcinoid tumors?

A

En bloc surgical resection

125
Q

What are the non-surgical treatment for carcinoid tumors?

A

Intraluminal, bronchoscope resection may be an alternative as well as radiation therapy

126
Q

Is chemo and radiation helpful for metastatic carcinoid tumors?

A

No, play a very limited role

127
Q

What is also known as a superior sulcus tumor?

A

Pancoast tumor

128
Q

Tumor located in the pulmonary apex, adjacent to the subclavian vessels

A

Pancoast tumor/ superior sulcus tumor

129
Q

Where do pancoast tumors typically spread?

A

Ribs, vertebrae, subclavian vessels, and brachial plexus

Can also involve the recurrent laryngeal nerve, vagus nerve, and sympathetic ganglion

130
Q

A majority of pancoast tumors are what type of cells?

A

Squamous cell carcinomas

131
Q

What type of diagnosis if mandatory for pancoast tumors?

A

Histologic diagnosis is mandatory prior to definitive treatment

132
Q

Why is histologic a diagnosis mandatory for treatment of pancoast tumors?

A

Because they can be adenocarcinomas, small cell carcinomas, mesothelioma, and lymphomas

133
Q

What is the clinical presentation of pancoast tumors?

A

Shoulder pain 44-96% Horners Syndrome 14-50%

134
Q

What is Horners Syndrome?

A

Miosis (constriction of pupils) Enophthalmos (sunken eyes) Anhidrosis (lack of sweating) Ptosis (drooping of eyelid)

135
Q

What is the most common treatment for pancoast tumors?

A

Preoperative chemo/radiation therapy followed by surgical resection

136
Q

What are some examples of cancers that spread to the lungs?

A

Malignant melanoma, sarcomas, carcinomas of the: breast, kidney, bladder, colon, prostate

137
Q

Covers the lung parenchyma and extends between the lobes

A

Visceral pleura

138
Q

Covers the inner surface of the thoracic cavity, diaphragm and mediastinum

A

Parietal pleura

139
Q

The visceral pleura contains no_____ ___, while the parietal pleura does

A

Pain fibers

140
Q

Intercostal nerves supply what?

A

The costal pleura and the peripheral portion of the diaphragm

141
Q

The central portion of the diaphragm is supplied by what?

A

Nerve endings form the phrenic nerve

142
Q

The patient pleura is drained by what?

A

Lymphatic system in the upper abdomen

143
Q

The visceral pleura is drained by what?

A

Pulmonary venous system

144
Q

What is the primary function of the pleura?

A

Provide a smooth surface, which reduces friction as the pleurae move against each other

145
Q

Under normal conditions, there is a small amount of fluid found in the pleural cavity;

A

Approximately 1-10mLs (0.1-0.2mL/kg)

146
Q

What is the normal pH of pleural fluid?

A

7.6-7.64

147
Q

What is the protein count for pleural fluid

A

Less than 2%, 1-2g/dL

148
Q

What is the WBC count for pleural fluid normally?

A

Fewer than 1000 WBCs per cubic millimeter

149
Q

Pleural fluid has an LDH less than what % of plasma?

A

50%

150
Q

How if the pleural fluid formed?

A

Starling’s law of transcapillary exchange

151
Q

What is hydrostatic pressure?

A

Within the capillaries, pressure as the “pushing force” pushing fluid out of the capillaries

152
Q

What is oncotic pressure?

A

Pulling force; pulling fluid from surrounding tissues into capillaries

153
Q

What is oncotic pressure created by?

A

The difference in the concentration of solutes in the fluid inside the capillaries as opposed to the outside

154
Q

As fluid leaves the capillaries as a result of hydrostatic pressure, what cannot pass through the walls?

A

albumin and other large proteins

155
Q

As fluid leaves the capillaries, what rises?

A

Oncotic pressure, pulling more water into capillaries in order to balance the solute concentration

156
Q

What happens when hydrostatic pressure is greater than oncotic pressure?

A

Fluid will leave the capillaries

157
Q

What happens when the oncotic pressure is greater than the hydrostatic pressure?

A

Fluid will enter the capillaries

158
Q

How is the pleural fluid reabsorbed?

A

Via the lymphatic stomata of the parietal pleura (hypothesis only)

159
Q

Abnormal accumulation of fluid in the pleural cavity

A

Pleural effusion

160
Q

Pleural effusion is an indicator of what?

A

A pathological process; a manifestation of an underlying illness

161
Q

WHat is the most common cause of pleural effusions?

A

Increased hydrostatic pressure- CHF

162
Q

How can pneumonia cause a pleural effusion?

A

Due to increased capillary permeability

163
Q

How can atelectasis cause a pleural effusion?

A

Increased (-) intrapleural pressure

164
Q

How can nephrotic syndrome/hypoalbuminemia cause pleural effusions?

A

Decreased oncotic pressure

165
Q

How can lymphoma cause a pleural effusion?

A

Decreased visceral pleural drainage

166
Q

How can a mediastinal node cause pleural effusions?

A

Decreased lymphatic drainage

167
Q

What is the clinical presentation of pleural effusions?

A

Dyspnea, cough, chest pain, lower extremity edema (CHF), night sweats, fevers, weight loss (TB, malignancy)

168
Q

What physical findings can point to a pleural effusion?

A

Dullness to percussion, decreased tactile fremitus, diminished or inaudible breath sounds, egophony (E to A transition)

169
Q

How is a pleural effusion diagnosed?

A

> 150mL usually seen on upright chest radiographs as blunting of the costophrenic angle

170
Q

CT scans can detect what?

A

Very small pleural effusions that can easily be missed by chest radiographs

171
Q

When should a thoracentesis be done?

A

Worth an effusion of unknown cause

172
Q

What are some C/Is for thoracentesis?

A

Systemic anticoagulation, area of infected skin on chest wall

173
Q

How much fluid should be drained during a single thoracentesis?

A

1.5-2.0 L

174
Q

Why should no more than 1.5-2.0 L of fluid be drained with a thoracentesis?

A

Re-expansion pulmonary edema (RPE)

175
Q

RPE

A

Hypoxia injury, mechanical stress (can be caused by draining too much fluid during thoracentesis)

176
Q

What are the 4 types of fluid that can accumulate in the pleural space?

A
  1. Serous fluid
  2. Chyle
  3. Blood
  4. Pus
177
Q

Serous fluid accumulating in the pleural space is called what?

A

Hydrothorax

178
Q

Chyle accumulating int he pleural space is called what?

A

Chylothorax

179
Q

Blood accumulating in the pleural space is called what?

A

Hemithorax

180
Q

Pus accumulating in the pleural space is called what?

A

Empyema

181
Q

Pleural fluid analysis

A

Protein, LDH, cytology, culture and gram stain, specific gravity, CBCD, glucose, pH

182
Q

What is Light’s criteria used for?

A

Pleural fluid analysis; transudative or exudative

183
Q

What is Light’s criteria?

A

Fluid is an exudate if 1 or more of the following criteria are met

184
Q

Criteria for exudative fluid

A
  1. Ratio of pleural fluid level of LDH to serum LDH is >0.6
  2. Pleural fluid level of LDH is > 2/3 upper limit of reference range for serum LDH
  3. Ratio of pleural fluid level or protein to serum level of protein is > 0.5
185
Q

Transudative effusions are largely due to what?

A

Imbalances in hydrostatic and oncotic pressures in the chest

186
Q

What can cases a transudative effusion?

A

CHF, atelectasis, nephrotic syndrome, cirrhosis

187
Q

What are the 2 sub categories of transudative effusions?

A

Caused by either hypoalbuminemia or cardiovascular issues

188
Q

What type of cardiovascular problems can cause transudative effusion?

A

Fluid overload, HF, constrictive pericarditis

189
Q

What can cause hypoalbuminemia, causing a transudative effusion?

A

Nephrotic syndrome, chronic infection, malabsorption, liver failure

190
Q

What is Meig’s Syndrome?

A

Ascites, pleural effusion, and a benign ovarian tumor (fibroma)

191
Q

What can cause an exudative fusion?

A

Disease in any organ

192
Q

Exudative effusions are more commonly a result of what?

A

Pleura/lung inflammation or impaired lymphatic drainage

193
Q

3 causes of exudative effusions

A

Pneumonia, malignancy, pulmonary embolism

194
Q

Exudative effusions can be caused by what?

A

Malignancy, inflammation, infection

195
Q

What types of malignancy can cause exudative effusions?

A

Bronchial carcinomas, metastases

196
Q

What types of infection can cause exudative effusions?

A

Acute- empyema

Chronic- TB

197
Q

What types of inflammation can cause an exudative effusion?

A

Granulomatous disorders, rheumatoid arthritis, SLE, pulmonary infarct

198
Q

What can cause empyema?

A

complication of pneumonia, where bacteria escape into the pleural space

199
Q

What else can cause an empyema?

A

Trauma, esophageal rupture, complication of lung surgery, thoracentesis, chest tube placement

200
Q

What is the patho behind an empyema?

A

Pneumonia -> parapneumonic effusion -> complicated parapneumonic effusion -> empyema

201
Q

5-10% of patients with pneumonia can develop what?

A

A parapneumonic effusion

202
Q

Empyema fluid analysis

A

Grossly purulent, pH level less than 7.2, WBC>50,000, glucose <60mg/dL, LDH >1,000

203
Q

What is the treatment for empyema?

A

Drainage!!!

204
Q

What else is used as treatment for empyema?

A

Abx therapy with thoracentesis, intrapleural fibrinolytic/Abx infusion, VATs thorascopy with tube drainage, Clagett window, decorticating and pulmonary resection

205
Q

What is a Clagett Window

A

Open drainage of the empyema cavity

206
Q

What are some causes for a malignant pleural effusion?

A

Increased capillary permeability, disruption of capillary endothelium, impaired lymphatic drainage, direct invasion of pleural space by tumor, malnourishment or hypoalbuminemia

207
Q

What are the primary sites of MPEs

A

Lung, lymphoma, breast, ovary

208
Q

What is the life expectancy for an ovarian MPE?

A

9.4 months

209
Q

What is the life expectancy for a breast MPE?

A

7.4 months

210
Q

What is the life expectancy for an NSCLCa MPE?

A

4.3 months

211
Q

What is the life expectancy for a small cell carcinoma MPE?

A

3.7 months

212
Q

What are some treatment options for an MPE?

A

Thoracentesis and treatment of malignancy, repeat thoracentesis* tube thoracostomy, chemical pleurodesis, indwelling catheters, pleurectomy/decortication

213
Q

When is a repeat thoracentesis used as treatment for an MPE?

A

For people who cannot tolerate the chemo or radiation

214
Q

What is a medical procedure in which the pleural space is artificially obliterated by causing the visceral and parietal pleural to stick together?

A

Pleurodesis

215
Q

What are the two ways to do a pleurodesis?

A

Instillation of a chemical sclerosis, pleural abrasion (mechanical)

216
Q

What are some indications for a pleurodesis?

A

Recurrence of effusion or pneumothorax, lung re-expansion after thoracentesis symptomatic improvement after thoracentesis* inability to control effusion with chemo

217
Q

What are the sclerosis agents used for a pleurodesis?

A

Talc, Doxycyline, Bleomycin, Quinacrine, Minocycline

218
Q

We know the3 pleurodesis was successful if…

A

Adequate pleural drainage from the chest tubes, ability or lung to re-expand fully, uniform distribution of sclerosis agent, apposition of the pleural membranes

219
Q

What two companies make the indwelling catheters used to treat MPEs?

A

Denver Biomedical makes PleurX and Bard makes Aspira

220
Q

What are some indications for an indwelling catheter?

A

Rapid recurrence of effusion, failure of lung re-expansion faster thoracentesis, symptomatic improvement after thoracentesis, inability to control effusion with chemo

221
Q

What are some pros of indwelling catheters?

A

Less pain, shorter hospital stay

222
Q

What are some cons of indwelling catheters?

A

Obstruction of catheter, risk of infection, loculation of the effusion

223
Q

Presence of air of gas in the pleural cavity is called what?

A

Pneumothorax

224
Q

How does air enter into the intrapleural space and cause a pneumothorax?

A

Through trauma or more commonly through the lung parenchyma across the visceral pleura

225
Q

What are the types of pneumothorax

A

Primary spontaneous, secondary spontaneous, traumatic, and tension

226
Q

Primary spontaneous PTX occurs in who?

A

People without underlying lung disease, patients typically aged 18-40 years, tall, thin and often smokers

227
Q

How does a primary spontaneous PTX occur?

A

Caused by rupture of small pulmonary blebs

228
Q

Secondary spontaneous PTX occurs in who?

A

Pts with underlying lung disease, COPD most common

229
Q

What are some other causes of secondary spontaneous PTX

A

Severe asthma, CF, lung infections (TB, necrotizing PNA), sarcoidosis, Marfan syndrome, lung cancer, sarcomas, catemenial PTX

230
Q

Pneumothorax caused by trauma

A

Most common due to penetration of sharp bony point at a new rib fracture

231
Q

What are some iatrogenic causes of pneumothorax?

A

Central venous catheter placement, CT guided needle biopsy of lung, thoracentesis, mechanical ventilation

232
Q

Sign and symptoms of PTX

A

Dyspnea, chest pain, shoulder pain, percussion -> hyperresonant, decreased tactile fremitus, decreased/absent breath sounds

233
Q

What is used to diagnose a pneumothorax?

A

CXR, CCT, chest ultrasound

234
Q

What is the treatment for a PTX?

A

Conservative management for small PTX, chest decompression via chest tube or pigtail catheter

235
Q

Oxygen and pneumothorax

A

Supplemental O2 should be given to maintain adequate oxygenation, but it also lowers the partial pressure of nitrogen, which can accelerate the rate of absorption of air from pleura cavity and hasten lung re-expansion

236
Q

What is Graham’s law of diffusion?

A

Gases move form high to low concentrations

237
Q

What are some other treatments for PTX?

A

Pleurodesis, surgery- VATs blebectomy

238
Q

What is a tension PTX?

A

Progressive build-up of air within the pleural space

239
Q

What is a tension PTX usually due to?

A

Lung laceration via trauma or iatrogenic, which allows air to escape into the pleural space

240
Q

The progressive build up of air in a tension PTX causes what?

A

Pushes the mediastinum to the opposite hemithorax and obstructs venous return to the heart causing cardiac arrest

241
Q

What is a clinical presentation of a tension PTX?

A

Diaphoretic/cyanotic, tachycardia, hypotension, chest pain

242
Q

Classic physical exam findings for a tension PTX

A

Deviation of trachea to contralateral side, hyper-expanded chest, absent breath sounds, distended neck veins

243
Q

What is a common cause of morbidity and mortality in children under the age of 2?

A

Foreign body aspiration

244
Q

80% of foreign body aspiration occurs in children at what age?

A

<3 years old, peak incidence of 1-2 years old

245
Q

What are the most common aspirated foreign bodies?

A

Nuts

246
Q

Infants and toddlers tend to aspirate on what?

A

Food items

247
Q

Non-food items are more commonly aspirated by who?

A

Older children

248
Q

What are some factors can make foreign body aspiration more dangerous?

A

Roundness, failure to break apart easily, smooth slippery surface

249
Q

Signs and symptoms of a foreign body aspiration

A

severe respiratory distress, cyanosis, mental status change = medical emergency
Strider, hoarseness, dyspnea, wheezing

250
Q

What diagnostic tools are useful for foreign body aspiration?

A

CXR

251
Q

What can a lower airway FBA cause?

A

Hyperinflated lungs, atelectasis, pneumonia

252
Q

What are late manifestations of an FBA?

A

Pulmonary abscesses and bronchiectasis

253
Q

What is almost always successful in FB removal?

A

Rigid/Flexible Bronchoscopy

254
Q

What does Rigid/ Flexible Bronchoscopys allow for?

A

Control of airway, good visualization, manipulation of object, and ready management of hemorrhage

255
Q

Surgery may be needed if what?

A

If the FBs cannot be removed

256
Q

Thoracentesis is needed for what?

A

Any new or unexplained pleural effusion

257
Q

Pleurodesis and indwelling catheters provide excellent treatment options for what?

A

Patients with recurrent/malignant effusions

258
Q

FBA should be suspected when?

A

In children who have sudden onset of lower respiratory symptoms

Pulmonary (3 decks)

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