MISC Flashcards
Where does mesothelioma often metastasize to?
Hilar lymph nodes and liver
Define massive hemothorax, what can happen to the neck veins?
greater than 1500 cc blood into thorax? Neck veins can distend from compression or be flat from hypovolemia
T/F: pulse oximeter assures adequate ventilation
FALSE but it can tell you for sure if there is inadequate ventilation, may give false pos in CO poisoning
How is a solitary fibrous tumor attached to the pleura?
By a pedicle, this is not a malignant tumor–usually, if it is it will be pleiomorphic
Which genes are involved in both small cell and non-small cell carcinomas?
p53
Where are common sites for mets in adenocarcinoma of the lung?
peribronchial and hilar lymph nodes
What is the Tx for a pulmonary contusion? What are the Sx similar to?
PEEP ventilation; similar to ARDS
Where does most diaphragmatic injury as a result of BLUNT trauma occur? What about ones that are asymptomatic?
blunt left and asymptomatic right
How to evaluate pleural effusion?
first do CXR then thoracentesis
What is the function of methionine 358 in the A1AT molecule?
It acts as bait and elastase cleaves (bites) a peptide bond on the carboxyl side of the methionine which allows A1AT to create jaws that trap the elastase binding site
What is the triad of laryngeal injury?
Subcutaneous emphysema, palpable fracture, and hoarseness
Where are 3 areas empyema may come from?
blood, lung parenchyma, or subdiaphragmatic/liver abscesses
What is the most common type of tumor to find in pleura?
Metastatic especially from lung, breast, and ovaries
Most diseases involve pleural fluid glucose below what in an effusion?
60
What’s the deal with the Pittsburgh variant of A1AT deficiency?
They are A1AT deficient but also have a bleeding disorder bc rather than act on elastase A1AT acts on THROMBIN
In which patient with PEA would a thoracotomy not be indicated in?
one who has blunt trauma
if the protein is in the 7-8 range in a pleural effusion what should you think?
Multiple myeloma and Waldenstroms macroglobulinemia
Levels around what value are concerning for LDH pleural fluid levels? i.e. malignancy, pargonismiasis, empyema, and rheumatoid pleurisy
1000 IU
What kind of needle and where does it go for pericardiocentesis?
16 or 18 gauge needle at left xiphisternal jxn
What are 3 functions of pleural mesothelial cells?
Balance coagulation and fibrinolysis, act as phagocytes, and produce CT
What 4 things can cause increased pleural fluid production?
Increase in permeability, increase in microvascular pressure, decrease in oncotic pressure, and decreased pleural pressure
What is the most common microscopic finding with mesothelioma?
Epithelioid
What are lights diagnostic criteria to define pleural fluid as an exudate?
If LDH in pleural fluid to serum fluid ratio is greater than .6, if pleural protein and serum protein ratio is greater than .5, or if pleural fluids LDH is greater than 2/3 the upper limits of the normal serum LDH at that lab
Which lung cancer is associated with pleural retractions?
Adenocarcinoma, but pleural plaques would be mesothelioma which is not a lung cancer per se
What is the major WBC present in pleural fluid?
mostly macrophages and then some lymphocytes
How does bronchoalveolar carcinoma grow? What is the distribution in the sexes?
lepidically or along the alveolar septa, this is a slower growing subtype of adenocarcinoma and it affects the sexes equally
Which 3 organisms are found in recurrent infections with cystic fibrosis?
Pseudomonas, staph, and aspergillus
What is really being affected in cystic fibrosis?
Epithelial glands
If the aorta is disrupted where will the following displace: trachea, right mainstem, left mainstem, and esophagus
trachea right, right mainstem elevated and right, left mainstem depressed and esophagus, right
ZZ individuals with A1AT are at risk for what other organ dysfunction aside from panacinar emphysema?
Non-alcoholic liver cirrhosis
What is the function of ASO hybridization?
This is Allele Specific Oligonucleotide hybridization and can be used to detect single, specific genotypes
How do you insert the laryngoscope and move the tongue when doing orotracheal intubation?
Hold laryngoscope in left hand put on right side of tongue and sweep to left
What is the Tx for open pneumothorax?
Airtight dressing on 3 sides and chest tube placed remotely from the wound
What is the Tx of a small tracheobronchial tear? Large?
Small is to manage airway, large is surgery (greater than 1/3 the lumen of trachea)
Why do CF patients have foul smelling stools?
Because the inability to secrete bile and pancreatic enzymes from their blocked hepatobiliary ducts leads to malabsorption and fatty stools usually smell
What do agitation and being obtunded indicate regarding airway obstruction?
Agitation is hypoxia, Obtunded is hypercarbia
What is the Tx of diaphragmatic trauma and why?
surgery because of risk for intraperitoneal injury
What is the real, physiological function of alpha-1 antitrypsin?
To inhibit ELASTASE, though the name implies it is trypsin, that was really only in vitro