Pleural Disease 2

Question 1

6 Etiologies of Secondary Spnt Pneumothorax

Answer 1

• COPD
• CF
• Lung malignancy
• Necrotizing PNA
• Catamenial (occuring w/ menses)
• Asthma/Sjogrens/ILD

Question 2

Is the clinical presentation more severe in SSP or PSP?

Answer 2

SSP (less reserve due to underlying lung disease)

Question 3

• Tx for all pts w/ SSP?
• Most require drainage
• ___ _____ is preferred over needle aspiration
• Again what do we always recommend for tx?

Answer 3

• Hospitalization
• Tube thoracostomy
• Smoking cessation

Question 4

A tension pneumothorax is a medical emergency bc/ it can lead to what?

Answer 4

Cardiac Arrest

Question 5

3 specific clinical findings of Tension Pneumo

Answer 5

• Worsening dyspnea
• Distended neck veins
• trachel deviation

Question 6

Tx for tension pneumo?

Answer 6

Immediate decompression

Needle decompression can be used as temporizing measure, but chest tube needs to be placed

Question 7

Acute hypoxemic respiratory failure following a systemic or pulmonary insult w/o evidence of HF

Answer 7

Acute Respiratory Distress Syndrome

Question 8

What are the 2 “hallmarks” of ARDS

Answer 8

• Clinical: bilateral radiograph opacities and hypoxEMIA
• Pathologic: diffuse alveolar damage

Question 9

• Is measured by periphal O2
• Is measured by ABG

Answer 9

• Peripheral: Hypoxic / Hypoxia
• ABG: Hypoxemia

Question 10

• A diagnosis of exclusion
• Must exclude acute decompensated HF and other causes of hypoxemic respiratory failure

Answer 10

Acute Respiratory Distress Syndrome (ARDS)

Question 11

What is the most severe form of acute lung injury

Answer 11

ARDS

Question 12

4 things needed to dx ARDS according to the _____ definition.

Answer 12

Berlin Definition

• Acute onset within 1 wk of insult
• Bilateral infiltrates
• Resp failure (not from HF or volume overload)
• Moderate-severe oxygen impairment

Question 13

• What causes *systemic insult* to cause ARDS? (1)
• *pulmonary insult* (2)
• Order them from most to least common (3)

(PROBABLY ON EXAM)

Answer 13

• Systemic: Sepsis
• Pulm: Diffuse PNA & Aspiration

1. Diffuse PNA
2. Sepsis
3. Aspiration

(PSA)

Question 14

2 key clinical findings of ARDS
(ON EXAM)

Answer 14

• Respiratory distress (tachypnea, accessory muscles, diaphoresis)
• Hypoxemia that is unresponsive to supplemental O2****

Question 15

CXR or CT chest of ARDS will show what 2 things?

(ON EXAM MAYBE)

Answer 15

• Diffuse / patchy infiltrates bilaterally
• Usually spares the costophrenic angles!***

Question 16

What diagnostic test MUST you get to dx ARDS?

Answer 16

Arterial Blood Gas (ABG)

(will show dramatic AA gradient w/ PE)

Question 17

Tx for ARDS

Answer 17

• Intubate
• Prone position

Question 18

Prognosis of ARDS

Answer 18

High mortality, especially w/ sepsis (90%)

Question 19

Patients w/ hx of ARDS may have emotional distress. What type of PTSD do they have?

Answer 19

Post-intensive care syndrome