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Foundations-Pulmonary > Pleural Dz > Flashcards

Pleural Dz Flashcards

1
Q

Pleura

A

Serous membrane

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2
Q

Viscerla pleura

A

covers the lungs and adjoining structures (blood vessels, bronchi, nerves)

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3
Q

Parietal Pleura

A
  • attached to the chest wall

- covers the diaphragm

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4
Q

Pleural cavity

A
  • Potential space between the two pleurae

- Allows smooth inhalation and exhalation, the fluid prevents friction

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5
Q

Costal pleura

A

Lines inner ribs

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6
Q

Diaphragmatic Pleura

A

lines diaphragm

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7
Q

Costodiaphragmatic Recesses

A

-Spaces between costal and diaphragmatic pleura

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8
Q

Pleuritis causes

A

Infection:

  1. Viral*
  2. Bacterial
  3. Fungal
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9
Q

Pleuritis clinical presentation

A
  1. SHARP CP- Aggravated by breathing, coughing, sneezing
  2. Fever, chills
  3. Cough
  4. SOB
    * depends on underlying cause
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10
Q

Pleuritis PEx

A

Pleural friction rub

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11
Q

Pleuritis Treatment

A
  1. NSAIDS: Naproxen
  2. Steroids: Prednison-For refractory pain
  3. Proton Pump Inhibitor: Omeprazole- prophylactic tx of GI upset due to NSAIDS
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12
Q

What is often the presenting sx in Lupus pleuritis

A

Pleurisy!

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13
Q

Lupus pleuritis diagnostics

A
  1. Serologic testing for SLE: ANA, anti-dsDNA
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14
Q

Lupus pleuritis Tx

A

NSAIDS

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15
Q

Rheumatoid pleuritic common signs

A
  1. Pleuritic CP
  2. Fever
  3. +/- Dyspnea
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16
Q

Rheumatoid pleuritic causes

A
  1. Exudative “rheumatoid” effusion
  2. Drug-induced pleuritis: methotrexate, infliximab
  3. Empyema
  4. Bronchopleural fistula
  5. Hemopneumothorax
  6. Pyopneumothorax
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17
Q

What is the most common pleural dz?

A

Pleural effusion

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18
Q

What is pleural effusion a result of?

A
  1. Excess fluid production AND/OR

2. Decreased lymphatic absorption

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19
Q

What are the 4 major causes of pleural effusions

A
  1. Congestive heart failure
  2. Pneumonia
  3. Malignancy
  4. Pulmonary embolism
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20
Q

What are the two distinct categories of pleural effusions?

A
  1. Transudative effusions

2. Exudative effusions

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21
Q

Pleural effusion clinical presentation

A
  1. Dyspnea
  2. Cough
  3. Pleuritic chest pain
    * Variability depending on underlying disease
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22
Q

Pleural effusion PEx

A
  1. Dullness to percussion
  2. Decreased or absent tactile
    fremitus
  3. Decreased breath sounds
  4. No voice transmission
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23
Q

What is the best CXR view for pleural effusion?

A

CXR in lateral decubitus view

  • can detect as little as 50cc of fluid
  • more sensitive
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24
Q

CXR findings

A
  1. Blunt costophrenic angle

2. Meniscus laterally

25
Q

What is more sensitive than CXR in diagnosing a pleural effusion?

A

CT chest

  • Detect as little as 2-10cc fluid
  • Distinguish pleural thickening from fluid
26
Q

When would you consider a CT angiogram?

A

Rule out PE

27
Q

What do we use Lights criteria for?

A

differentiate between transudative fluid vs. exudative fluid

28
Q

How sensitive is cytology analysis of pleural fluid?

A

60%

Look for malignancy this way

29
Q

Indications for thoracentesis

A
  1. Newly detected pleural effusion- for diagnostic purposes
  2. Therapeutic sx relief
  3. Imaging suggest complicated effusion (located)
  4. Empyema
  5. Atypical features of CHF
30
Q

When is a thoracentesis contraindicated?

A

Small volume fluids= <1 cm thickness on a lateral decubitus film

31
Q

What is one of the main complication of a thoracentesis?

A

Pneumothorax

32
Q

Transudative effusions

A

Result from systemic imbalances in hydrostatic

and oncotic forces

33
Q

Causes for Transudative effusions

A
  1. Heart Failure
  2. Nephrotic syndrome
  3. Hepatic hydrothorax
34
Q

Exudative effusions

A

Pleural capillary permeability ↑ leading to elevated protein/cellular content

35
Q

Causes for Exudative effusions

A
  1. Malignancy
  2. Infectious
  3. PE
  4. Postcardiac injury
36
Q

Chylothorax

A

Build up up cholesterol

37
Q

long term management of pleural effusion

A
  1. PRN thoracentesis
  2. PleurX catheter- Refactory effusions
  3. Pleurodesis: Surgical and Chemical (Talc, Bleomycin)
38
Q

Pneumothorax

A
  • Presence of air or gas in the pleural cavity

- Usually spontaneous

39
Q

Primary Spontaneous Pneumothorax (PSP)

A

Occurs without a precipitating event in a person without known lung disease

40
Q

Secondary Spontaneous Pneumothorax (SSP)

A

Occurs as complication of an underlying lung disease

41
Q

What is the #1 cause for Pneumothorax?

A

Smoking= 91%

42
Q

What is the most common population of a spontaneous Pneumothorax?

A

Tall, thin, young men from age 20-40

43
Q

Spontaneous Pneumothorax clinical presentation

A

Sudden onset of dyspnea (80%) and pleuritic CP (90%)***

44
Q

Indication for CT chest in a Spontaneous Pneumothorax

A
  1. Differentiate pneumothorax from large subpleural bullae
  2. Evaluate for underlying lung pathology
    3.
45
Q

What indicates a Spontaneous Pneumothorax on an US?

A

Absence of “sliding lung sign”

46
Q

Define what a small pneumothorax is and treatment

A

< or equal to 2-3 cm= Observe

47
Q

Define what a large pneumothorax is and treatment?

A

> 3 cm

Needle aspiration

48
Q

Indication for chest tube

A
  1. No response to needle aspiration
  2. Secondary spontaneous pneumothorax (SSP)
  3. Recurrent PSP
  4. Hemothorax
49
Q

What is a Video Assisted Thoracoscopy? (VATS)

A

Pleurodesis by:

  1. Pleural abrasion
  2. Partial pleurectomy
50
Q

Indications for VATS

A
  1. Persistent air leakr
  2. Recurrence
  3. Chest tube required on first occurrence
  4. Job where recurrence could be harmful to others (ie. Pilot), 4. bleb/bullae resection (COPD pt)
51
Q

Secondary Spontaneous Pneumothorax treatment

A
  1. Hospitalized

2. Chest tube> Thoracentesis

52
Q

Tension Pneumothorax clinical presentation

A
  1. Worsening dyspnea
  2. Hypotension
  3. Diminished BS
  4. Distended neck veins
  5. Tracheal deviation
53
Q

Tension Pneumothorax Treatment

A

IMMEDIATE decompression

Chest tube

54
Q

Tension Pneumothorax CXR findings

A
  1. Mediastinal shift and tracheal
    deviation to contralateral side
  2. Ipsilateral flattening or
    inversion of diaphragm
55
Q

Hallmark clinical presentation of acute respiratory distress

A
  1. Bilateral radiographic opacities
  2. Hypoxemia
  3. Significant SOB 6-72 hrs after inciting event
56
Q

Hallmark pathologic findings acute respiratory distress

A

Diffuse alveolar damage

57
Q

CXR findings in acute respiratory distress

A
  1. Diffuse or patchy B/L infiltrates

2. Usu. spare the costophrenic angles

58
Q

Acute respiratory distress diagnostics

A

ABG:

  • Hypoxemia
  • acute respiratory alkalosis
  • PaO2/FiO2 < 300 mm Hg
  • Increased alveolar-arterial oxygen (A-a) gradient
59
Q

Acute respiratory distress treatment

A
  1. Intubation
  2. Mechanical ventilation
  3. Prone positioning in bed
  4. DVT and GI prophylaxis
    * HIGH MORTALITY

Foundations-Pulmonary (9 decks)

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