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clin med pulmonology > plural space / mediastinal disorders > Flashcards

plural space / mediastinal disorders Flashcards

1
Q

What is pleural effusion

A

accumulation of fluid in the pleural space

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2
Q

What is the most common pleural disease

A

Pleural effusion

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3
Q

What is transudative effusion

A

decreased oncotic or increased hydrostatic pressure

too much fluid OR too few proteins in fluid (fluid overload)

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4
Q

What is exudative effusion

A

inflammation = increased capillary permeability

generally infectious agents or malignancy

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5
Q

how will a patient present with pleural effusion

A

shortness of breath
orthopnea
PND
chest pain
dry cough

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6
Q

What may be seen on PE with pleural effusion

A

dullness ot percussion (over fluid)
Diminished breath sounds
decreased tactile fremitus
E -> A egophony

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7
Q

What is lymphatic fluid called

A

chyle

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8
Q

How can you workup a pleural effusion

A

CXR
US (more sensitive)
Thoracentesis (dx and therapeutic)

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9
Q

What sign may you see on CXR with pleural effusion

A

Meniscus sign

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10
Q

If there is lots of fluid in the lungs, what should be your differentials

A

Malignancy
CHF
Ascites
TB

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11
Q

If the pleural effusion is bilateral, what should be your differentials

A

CHF or malignancy

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12
Q

How much fluid do the lungs need to have to be able to see the meniscal sign

A

200mL

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13
Q

If pleural effusion is right sided, what should be your differentials

A

CHF

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14
Q

If the effusion is left sided, what should be your differentials

A

Esophageal rupture
pancreatic
post-CABG

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15
Q

What are contraindications for thoracentesis

A

overlying wound/skin infection
small fluid accumulation
bleeding disorders

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16
Q

What are complications of thoracentesis

A

pneumothorax
bleeding
SOB/Cough
spleen/liver puncture
vasovagal

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17
Q

What labs get run on pleural fluid

A

Glucose
RBC / WBC
Protein/ amylase/ triglycerides
LDH
pH
Cytology
Gram stain and culture

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18
Q

What criteria is used to determine whether effusion is transudative or exudative

A

Lights criteria

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19
Q

If pleural fluid is blood tinged, what is the likely cause

A

malignancy
PE
Trauma

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20
Q

If pleural fluid has gross blood, what is the likely cause

A

hemothorax

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21
Q

If pleural fluid is turbid/milky colored, what is the likely cause

A

chylothorax

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22
Q

If pleural fluid is gross pus, what is the cause

A

empyema

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23
Q

If pleural fluid has low glucose, what is the cause

A

malignancy
infection
rheumatologic

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24
Q

If pleural fluid has high amylase, what is the likely cause

A

Pancreatitis
GI malignancy
Esophageal rupture

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25
Q

If pleural fluid has a low pH, what is the likely cause

A

bacterial infection
TB
malignancy
hemothorax
esophageal rupture

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26
Q

If there are increased eosinophils in pleural fluid, what is the underlying cause

A

air
pneumothorax
hemothorax
infarct
**NOT TB or Cancer

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27
Q

What is a hemothorax

A

pooling of blood in the pleural space

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28
Q

What causes hemothorax

A

generally secondary to blunt trauma

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29
Q

How much blood volume can hide in a hemothorax

A

40%

30
Q

What are clues for a hemothorax MOI

A

MVC > 35mph
Fall> 15ft
Ejection> 10ft
LOC

31
Q

How will a hemothorax present

A

rapid development
+/- hemodynamic instability

32
Q

What is the preferred imaging for hemothorax

A

CT
*hard to differentiate between pleural effusion and hemothorax

33
Q

What is the treatment for a hemothorax

A

IV, O2, Monitor

if < 300mL and stable = observation

if unstable = decompression

34
Q

How often do you re-image a stable patient with a hemothorax

A

at 4-6 hours and again at 24 hours

35
Q

How do you decompress an unstable hemothorax

A

needle thoracostomy
chest tube
+/- thoracotomy

36
Q

Which patients require a thoracotomy

A

massive hemothorax (>1-1.5 L)

Continued bleeding
>300-500 in first hour
>200mL for first 3+ hours
>7mL/Kg/hr

Inability to ventilate
decompensation
worsening CXR

37
Q

What is a pneumothorax

A

Accumulation of air in the pleural space

38
Q

What are the pneumothorax classification

A

Primary (spontaneous)
Secondary (Spontaneous)
traumatic
iatrogenic
tension

39
Q

Who are at increased risk for a primary spontaneous pneumothorax

A

Tall, thin males (10-30y/o)

+FH and Smokers

40
Q

What causes secondary pneumothorax

A

underlying pulmonary disease (M>F)

41
Q

What occurs on inspiration with traumatic pneumothorax

A

Air goes into pleural space

42
Q

What occurs on expiration of traumatic pneumothorax

A

Air leaves pleural space

43
Q

What may be the cause of an iatrogenic pneumothorax

A

thoracentesis
lung biopsy
central lines

44
Q

What generally causes a tension pneumothorax

A

Penetrating trauma
mechanical ventilation
CPR
infection

45
Q

What is occuring with a tension pneumothorax

A

the pressure in the pleural space is greater than pressure within the lungs

this causes impaired expansion and ultimately collapse

*will ultimately cause mediastinal shift

46
Q

What is the presentation of a tension pneumothorax

A

Sudden, severe, pleuritic chest pain on effected side

47
Q

What will as patient have on exam with tension pneumo

A

Severe tachycardia
hypotension
reduced chest movement
JVD
respiratory distress

48
Q

How do you treat a tension pneumothorax

A

Immediate decompression, no imaging

49
Q

What will you see on Xray with a pneumothorax

A

Visible pleural edge
lung markings dont extend to chest wall
Increased radiolucency
deep sulcus sign when supine

50
Q

Which patients with a pneumothorax are stable

A

RR<24
Normal BP
SpO2>90%
HR 60-120
able to speak sentences
**need all these

51
Q

What is the. treatment for a pneumothorax

A

Bigger & stable = chest tube
Respiratory distress= chest tube & ventilation

52
Q

If a chest tube fails or patient is super high risk, how do you treat a pneumo

A

pleurodesis
-tacking up the lung, abrasion, doxy/minocycline

53
Q

What are the 3 main processes of mediastinal disease

A

mediastinal masses
pneumomediastinum
mediastinitis

54
Q

What assess may present in the anterior mediastinum

A

thymoma
lymphoma

55
Q

What massess may present in the middle mediastinum

A

Vascular
lymphadenopathy

56
Q

What masses may present in the posterior mediastinum

A

neurogenic
esophagus

57
Q

What mediastinal masses can kiddos have

A

neurogenic
cystic

58
Q

What symptoms may occur with mediastinal masses

A

obstructive respiratory symptoms
stridor
recurrent bronchitis / PNA
Chest pain, dysphagia

59
Q

How do you workup mediastinal masses

A

Chest CT (TOC)
bx for definitive dx

60
Q

What is a thymoma

A

tumor arising from thymus
# anterior mediastinal tumor

61
Q

What are thymomas associated with

A

autoimmune paraneoplastic syndromes
-myasthenia gravis
-hypogammaglobinemia
-red cell aplasia

62
Q

IF a patient has symptoms with a thymoma, what would they be

A

phrenic palsy
hoarsness
cough
SVC syndrome

63
Q

What is the mainstay treatment of thymomas

A

surgical resection for early disease

+/- chemo if more severe

64
Q

Who is at greatest risk for pneumomediastinum

A

Young males

65
Q

How does pneumomediastinum present

A

sudden, severe, retrosternal chest pain

increased work of breathing
voice changes

66
Q

How do you dx pneumomediastinum

A

CXR

*CT to confirm, assess extent, or look for cause

67
Q

What is the treatment for pneumomediastinum

A

Most resolve on own

**rarely decompress if causing tamponade

68
Q

What is medistinitis

A

inflammation of mediastinal space

69
Q

What is the cause of medistinitis

A

secondary to infection (m/c)

70
Q

How does medistinitis present

A

sudden or insidious onset severe chest pain, dyspnea, and fever

71
Q

How do you dx medistinitis

A

CXR or CT

72
Q

How do you treat medistinitis

A

abx (clinda + ceftriaxone)

*is pleural effusion or pneumothorax is also present… need surgery

clin med pulmonology (12 decks)

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