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PULM 1 > pleural disorders > Flashcards

pleural disorders Flashcards

1
Q

procedure used to obtain a sample of fluid from the space around the lungs via needle insertion; used as diagnostic tool in new pleural effusion (except if CHF) and therapeutically

A

thoracentesis

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2
Q
  • pleural effusion that forms in the pleural space adjacent to a pneumonia
A

Parapneumonic effusion (PPE)

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3
Q

4 C/I to thoracentesis

A
  • coagulopathy (INR > 2, plts < 25k)
  • severe lung dz on opposite side
  • mechanical ventilation PEPP
  • site of insertion has known bullous dz
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4
Q

meniscus sign is indicative of?

A

pleural effusion

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5
Q

what should you always do after thoracentesis

A

get a CXR

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6
Q

poorly treated PPE develops a fibrinous reaction of the pleura leading to what?

A

loculated effusion

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7
Q
  • Fluid is trapped w/in the fissures, or btwn pleural layers when they are partly fused.
  • occur most typically with exudative pleural effusions, particularly parapneumonic effusions or hemothorax
  • typically needs surgical procedure to fix
A

loculated effusions

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8
Q

most common complication of thoracentesis

A

pneumothorax

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9
Q

5 other thoracentesis complications

A
  • re-expansion pulmonary edema (don’t take off more than 1L)
  • hemothorax
  • infection
  • hypotension
  • hepatic or splenic puncture
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9
Q

5 other thoracentesis complications

A
  • re-expansion pulmonary edema (don’t take off more than 1L)
  • hemothorax
  • infection
  • hypotension
  • hepatic or splenic puncture
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10
Q

what should you also order to r/o chylothorax

A

triglyceride levels

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11
Q

Light criteria says its exudative if 1 of these 3 are present

A
  • pleural protein/serum protein over 0.5
  • pleural fluid LDH/serum LDH over 0.6
  • plerual LDH > 2/3 the upper limit of normal serum LDH
    If none of these apply then it is transudate
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12
Q

what kind of effusion occurs when systemic factors cause either increased hydrostatic presusre or decreased oncotic pressure

transudate vs exudate

A

transudate

WBC < 1000

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12
Q

what kind of effusion occurs when systemic factors cause either increased hydrostatic presusre or decreased oncotic pressure

transudate vs exudate

A

transudate

WBC < 1000

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13
Q

what kind of effusion occurs when there is increased capillary permeability d/t infection or inflammation

transudate vs exudate

A

exudate

WBC > 1000

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14
Q

CHF, nephrotic syndrome, cirrhosis, pulm. edema, ascities, hypoalbuminemia, malnutrition

these are all etiologies of what kind of pleural effusion

A

etiologies of transudative effusion

15
Q

TB, cancer, pneumonia, pancreatitis, pulmonary infarction, systemic LE

these are etiologies of what kind of pleural effusion

A

exudative

16
Q

CLASSICAL MANAGEMENT OF TENSION PNEUMOTHORAX

A

decompression with needle thoracostomy

patients will need a chest tube after

17
Q

where is needle inserted with thoracostomy

A
  • 2nd rib space at mid clavicular line
18
Q

what kind of pneumothorax

pleural cavity pressure < atm pressure

A

closed PTX

19
Q

what kind of pneumothorax

pleural cavity pressure = atm. pressure

A

open PTX

20
Q

what kind of pneumothorax

pleural cavity pressure greater than atm pressure

A

tension PTX

21
Q

compare P.E. of pleural effusion w/ PTX what do they both have? what is different?

A
  • BOTH: decreased breath sounds & fremitus
  • percussion: effusion has dullness vs PTX has hyperresonance
22
Q
  • no known lung dz; rupture of apical subpleural blebs d/t shear force
  • mostly affects tall young men

primary vs secondary PTX?

A

Primary

23
Q

has underlying lung dz like asthma or COPD

primary or secondary PTX?

A

secondary

24
Q

tx for PTX if small + asymp. vs symp + mod-large

A
  • small & no sx: observation
  • sx and bigger: chest tube
25
Q

any type of pneumothorax where positive air pressure pushes trachea, great vessels or heart to opposite side; air is trapped during expiration

A

TENSION PTX

26
Q

on CXR, decreased peripheral markings extending into the periphery is indicative of

A

PTX

27
Q

PE of tension PTX

A
  • increased JVP
  • systemic hypotension
  • pulsus paradoxus
28
Q

what do you call this: visceral pleural line running parallel w/ ribs

also what is is it associated with?

A

companion lines
associated w/ pneumothorax

PULM 1 (8 decks)

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