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OS 213 Respiratory Exam 2 > Pleuromediastinal Disorders > Flashcards

Pleuromediastinal Disorders Flashcards

1
Q

Symptoms related to pleural diseases

A

compression
Invasion
Irritation

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2
Q

Normal volume of pleural fluid

A

15-20ml

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3
Q

Pleural effusion

A

Blunting of the costophrenic sulcus
200-300 ml of pleural fluid
Most dependent portion -> first to be filled

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4
Q

Things to look fo if you suspect atelectasis

A

Trachea midline?

Interpaces narrow?

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5
Q

Thing to look for if you suspect a mass

A

mediastinal shift

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6
Q

Fluid enters the pleural space from the?

A

Capillaries in the parietal pleua
Interstitial spaces of the lung via the visceral pleura
Peritoneal cavity via small holes in the diaphragm

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7
Q

How is pleural fluid removed?

A

via the lymphatics

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8
Q

First step when dealing with pleural effusion

A

determine wether the effusion is a transudate or an exudate

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9
Q

Advantage of an ultrasound

A

demonstrate loculation early

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10
Q

Thoracentesis

A

Needle -> (T7/T8)

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11
Q

Systemic factors affect the formation and absorption of pleural fluid are altered

A

transudative pleural effusion

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12
Q

Local factors that influence the formation and absorption of pleural fluid are altered

A

Exudative pleural effusion

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13
Q

Lghts’s criteria

A

PF protein/S protein >0.5
PF LDH/S LDH >0/6
PF LDH more than 2/3 normal upper limit for serum

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14
Q

If exudative pleural effusion…

A 
Description
Glucose level
Amylase level
DIff count
Microbiologic studies
Cytologyq
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15
Q

Effusion due to heart failure

A

increased amount of fluids in the lung interstitial spaces exit in part across the visceral pleura.

Patient is treated with diuretics

If it persists despite the diuretics, thoracentesis

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16
Q

Hepatic hydrothorax

A

approx. 5% of patients with cirrhosis and ascites

direct movement of peritoneal fluid through small holes in the diaphragm into the pleural space

Usually right-sided and frequently large enough to produce severe dyspnea

Liver transplant

if not candidate, insertion of a transjugular intrahepatic portal systemic shunt

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17
Q

Parapneumonic effusion

A

associated with bacterial pneumonia, lung abscess or bronchiectasis

serous or frank pus

can be demostrated with lateral decubitus radiograph

If free fluid separates the lun from the chest wall by more than 10 mm on the decubitus radiograph, a therapeutic thoracentesis should be performed

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18
Q

Factors indicating the likely need for a procedure more invasive than a thoracentesis

A

Loculated PF
PF pH below 7.20
PF glucose less than 60 mg/dl
(+) grams stain or culture of the pleural fluid
The presence of gross pus in the pleural space

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19
Q

If the fluid recur after the secoond treatment at thoracentesis in the absence of complicating factors….

A

Surgical drainage

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20
Q

If the fluid cannot be completely removed with the therapeutic thoracentesis, consideration should be given to…

A

inserting a chest tube and instilling a thrombolytic streptokinase, 250,000 units or urokinase, 100 000 units

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21
Q

Stages of Parapneumonic effusion

A

Exduative
Fibrinopurulent (Empyema)
Organization stage

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22
Q

Exudative phase

A 
Small to moderate in size
Normal glucose level
Dependent in location
Do not show signs of loculation
Meniscus sign on chest  ray; crescent shape in CT

TREATMENT: Thoracentesis

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23
Q

Fibrinopurulent stage

A

Increassed PMN
Decreased glucose level and pH
Fluid becomes particulate, tendency to loculate

Treatment: VATS

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24
Q

organization Stage

A

Fibrothorax
Development of pleural peel/trapped lung

Treatment: Surgery (Decortications)

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25
Q

Process of removing peel

A

Decortication

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26
Q

Effusion secondary to malignancy

A

patients complain of dyspnea
PF is an exudate and its glucose level may be reduced if the tumor burden in the pleural space is high

PF is usually serosanguinous

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27
Q

Three tumors that cause approximately 75% of all malignant pleural effusions

A

Lung
Breast
Lymphoma

28
Q

If the patient’s lifestyle is compromised by dyspnea, and if the dyspnea is relieved by thoracentesis….

A

Tube thoracotomy with sclerosing agent (talc, 5g or doxycycline 500mg)

Outpatient insertion of a small indwelling catheter

Thoracoscopy with pleural abrasio or the insufflation of talc

29
Q

PRimary tumors that arise from the mesothelial cells that line the pleural cavitiesm most are related to asbestos exposure

A

Mesothelioma

-chest pain, chortness of breath

30
Q

CXR finding in mesothelioma

A

Pleural effusion, generalized pleural thickening and shrunken hemithorax

31
Q

Diagnosis of Mesotheloma

A

Thoracoscopy or open pleural biopsy

32
Q

Treatment for MEsothelioma

A

symptomatic

33
Q

EFfusion secondary to pulmonary embolizatio

A

More often exudative

Westermark sign : wedge spaced opacity on CT

34
Q

Tuberculous pleuritis

A

Hypersensitivity reaction to tuberculous protein in the pleural space

Exudate with predominantly smally lymphocyte

35
Q

Diagnosis of TB pleuritis

A

High levels of TB markers (ADA>45 IU/L. gamma interferon >140pg.ml)

Positive PCR for TB

Culture of the PF, needle biopsy of the pleura or thoracoscopy

AFB smear

36
Q

Chylothorax

A

Thoracic duct is disrupted and chyle accumulates in the pleural space

Most common cause: TRAUMA

37
Q

Thoracentesis of chylothorax

A

milky flid, and biochemical analysis revelas a TG level > 110mg/dl

presence of chylomicrons

Sudan Blue staim

38
Q

Treatment for chylothorax

A

Pleuroperitoneal shunt

Should not undergo prolonged tube thoracotomy with chest tube drainage because this will lead to manutrition and immunologic incompetence

39
Q

Hemothorax

A

Bloody pleural fluid,

Hematocrit should be obtained.

If HCT is >50% that of the peripheral blood, the patient has hemothorax

If pleural hemorrhage exceeds 200ml/hr consider thoracotomy

40
Q

Transudative PF

A 
CHF
Cirrhosis
Pulmonary emolization
Nephrotic syndrome
Peritoneal dialysis
SVC obstruction
Myxedema
Urinothorax
41
Q

Presence of gas in the pleural space

A

Pneumothorax

42
Q

Spontaneous pneumothorax

A

Occurs without antecedent trauma

43
Q

Traumatic pneumothorax

A

Results from penetrating or non-penetrating chest injuries

treated with tube thoracotomy unless they are very small

44
Q

If a hemopneumothorax is present

A

one chest tbe should be placed in the superior part of the hemithorax, and another should be placed in the inferior part of the hemithorax.

45
Q

Iatrogenic pneumothorax

A

type of traumatic pneumothorax

46
Q

Pneumothorax in which the pressure in the pleural space is positive throughout the Respiratory cycle

A

Tension Pneumothorax

47
Q

Why is (+)pleural pressure life threatening

A

Ventilation is severly compromised
(+) pressure is transmitted to the mediastinum which result in decreased venous return to the heart and reduced cardiac output

48
Q

How to relieve pressure for pneumothorax

A

A large bore needle should be inserted as a medical emergency

49
Q

Primary SPontaneous Pneumothorax

A

due to rupture apical pleural blebs, small cystic spaces that lie within or immediately under the visceral pleura

Most are due to chronic obstructive pulmonary disease

50
Q

Secondary spontaneous pnumothorax

A

TReated with tube thoracotomy and the instillation of a sclerosing agent such as doxycycline or talc

51
Q

Disorders of the Mediastunum

A

Anterior
Middle - congenital
Posterior - neurogenic

52
Q

extends from the sternum anteriorly to the pericardium and brachiocephalic vessels posteriorly

A

Anterior Mediastinum

53
Q

Lies between the anterior and posterior mediastinum, Contains the heart; the ascending and transverse arches of the aorta, the VC, the brachiocephalic arteries and veins

A

middle mediastinum

54
Q

Bounded by the pericardium and trachea anteriorly and ther vertebral column posteriorly, COntains the descending thoracic aorta; esophagusl thoracic duct; azygos and hemiazygos beins. and the posterior group of mediastinal lymph nodes

A

Posterior Mediastinum

55
Q

FIrst step in evaluating mediastinal masses

A

Place it one of the three compartments

56
Q

Most valuable imaging tchnique for evaluating mediastinal masses and is the only imaging technique that should be done in most instances

A

Mediastinal Masses

57
Q

Difficult to diagnose - in biopsy, middle of mass is mostly necrotic tissue

A

Mediastinal Masses

58
Q

Principles of management

A

assess resectability

59
Q

Anterior Mediastinal Tumor

A

Lymphoma

Thymoma

60
Q

Posterior MEdiastinal Tumor

A

Predominantly neurogenic

61
Q

Most cases are either due to esophageal perforation or occur after median sterntomy for cardiac surgery

A

Acute Mediastinitis

62
Q

Acutely ill with chest pain and dyspnea due to the mediastinal infection. Spontaneously or as a complication of esophagoscopy. Treatment is exploration of the mediastinum with primary repair of the esophageal tear and drainage

A

Esophageal Rupture

63
Q

Performed in cardiac surgeries like CABG. Commonly present with wound drainage. Other presentations include sepsis or a widened mediatinum

A

Median Sternotomy

64
Q

Gas in the interstices of the mediastinum

A

Pneumomediastnum

65
Q

Three main causes of Pneumomediastinum

A

Alveolar rupture with dissection of air into the mediastinum

Perforation or rupture of the esophagus, trachea or main bronchi

Dissection of air from the neck or the abdomen into the mediastinum

66
Q

PE of pneumomediastinum

A

reveals subcutaneous emphysema in the supresternal notch and Hamman’s sign

OS 213 Respiratory Exam 2 (15 decks)

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