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Clinical Medicine II > Pneumothorax + effusion > Flashcards

Pneumothorax + effusion Flashcards

1
Q

What is:
Sharp, localized, fleeting pain exacerbated by coughing, deep breathing, movement, sneezing

Radiation to ipsilateral shoulder

A

pleuritis

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2
Q

What does this cause:
Acute inflammation of parietal pleura: bacterial, viral, or fungal infection/pneumonia
PE/ lung cancer
Lupus, metastatic cancer, mesothelioma

A

pleuritis

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3
Q

How do you Dx pleuritis?

A

CXR - rule out other causes

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4
Q

How do you treat pleuritis?

A

NSAIDs, codeine, other opioids

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5
Q

Sudden onset of chest pain, dyspnea, cough, life-threatening or respiratory failure

A

pneumothorax

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6
Q

What are risk factors for pneumothorax?

A

Drug use, increased pressure (diving, flying), airway disease, infection, lung disease

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7
Q

What does this PE indicate:
Decreased breath sounds
Hyperresonance
Decreased or absent tactile fremitus
Mediastinal or tracheal deviation = tension
Increased JVP, pulsus paradoxus, HOTN

A

pneumothorax

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8
Q

What type of pneumothorax: : no pre-existing lung disease
tall, thin boys + men 10 - 30 years w/ smoking + family hx

A

primary spontaneous pneumothorax

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9
Q

What type of pneumothorax: pre-existing lung disease
more life-threatening, COPD, asthma, interstitial lung disease, TB, pneumocystis pneumonia

A

secondary spontaneous pneumothorax

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10
Q

What type of pneumothorax: penetrating trauma, lung infections, CPR, + pressure mechanical ventilation
life-threatening, organs pushed to contralateral side

A

tension pneumothorax

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11
Q

For unstable patients what imaging do you pick for a pneumothorax?

A

rapid bedside imaging w/ US: lung point, absence of lung sliding

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12
Q

For stable patients what imaging do you pick for a pneumothorax?

A

CXR (TOC), showing visceral pleural line (companion lines), deep sulcus sign
CT, if dx is uncertain, loculated pneumothorax, or further trauma

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13
Q

A small pneumothorax is <_

A

2 cm

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14
Q

A large pneumothorax is _

A

> / 2 cm

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15
Q

What values of the average intrapleural distance dictate a small or large pneumothorax?

A

<15% small, 50% large

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16
Q

What’s the first step for pneumothorax?

A

stabilize patient
- RR <24
- HR>60 but <120
- normal BP
- O2>90%
- ability to speak in whole sentences

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17
Q

What is treatment for a small primary pneumothorax?

A

6 hour observation
Repeat CXR to confirm no progression
Follow up in 24 hours

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18
Q

What’s treatment for a large primary pneumothorax?

A

Needle aspiration followed by chest tube (second intercostal space at midclavicular line of the affected side) if fails
Attach to heimlich valve to prevent tension

19
Q

What’s treatment for a secondary pneumothorax?

A

Chest tube placement (large, severe, or from mechanical ventilation) + hospitalization
Thoracostomy (recurrence, bilateral, failure)

20
Q

How do you treat a tension pneumothorax?

A

Medical emergency → emergent chest decompression with a large-bore needle followed by immediate chest tube placement

21
Q

What can be seen as asymptomatic or pain referring to shoulder from pleural inflammation and dyspnea, cough?

A

pleural effusion

22
Q

What does this PE indicate:
absent or diminished movements on affected side
Fullness of chest w/ bulging intercostal spaces
Diminished breath sounds
decreased/absent tactile fremitus
Dullness to percussion
Absence of breath sounds
Absent vocal resonance
Pneumonia-like findings (crackles)

A

pleural effusion

23
Q

associated w/ bacterial pneumonia, bronchiectasis, or lung abscess

A

parapneumonic

24
Q

anatomically confined within a sac

A

loculated effusion

25
Q

accumulation of fluid between lung and diaphragm

A

subpulmonic effusion

26
Q

increased hydrostatic or decreased oncotic pressures (CHF, atelectasis, renal/liver disease)

A

transudative pleural effusion

27
Q

leaky capillaries from infection, malignancy, trauma

A

exudative pleural effusion

28
Q

A pleural effusion is classified by:

A

1) site
2) type
3) mechanism

29
Q

Protein <.5
LDH <.6
LDH <⅔ upper limit of normal for serum LDH

A

transudative pleural effusion

30
Q

Protein >.5
LDH >.6
LDH > ⅔ upper limit of normal for serum LDH

A

exudative pleural effusion

31
Q

Increased WBC count pleural effusion

A

empyema

32
Q

Pleural fluid: blood ratio >.5

A

hemothorax

33
Q

Light’s criteria purpose

A

If any are true, pleural effusion is EXUDATIVE

34
Q

protein >.5
serum LDH >.6
pleural LDH > 2/3

A

light’s criteria – exudative

35
Q

elevated amylase in pleural effusion

A

pancreatic disease, malignancy, esophageal rupture

36
Q

elevated triglycerides in pleural effusion

A

chylothorax from thoracic duct disruption

37
Q

How do you diagnose pleural effusion?

A

CBC - leukocyte counts
CXR: initial TOC
PA: need fluid to diagnose, blunting of costophrenic angle (meniscus sign), diaphragm + heart poorly demarcated, shifts to uninvolved side
Lateral decubitus: smaller effusions, free flowing vs. loculated - best

CT scan: if minimal or loculated, US or CT for loculated or empyema

38
Q

pleural effusion TOC

A

chest xray

39
Q

What’s the gold standard for diagnosis of pleural effusion

A

thoracentesis

40
Q

For all acute effusions + differentiation –

A

Analyze protein, LDH, pH, WBC, glucose, cytology, Gram stain
Glucose <60 =
TB, malignancy, rheumatoid arthritis, parapneumonic effusion

Thoracentesis

41
Q

How do you treat a transudative pleural effusion?

A

treat underlying cause, diuretics + sodium restriction

42
Q

How do you treat an exudative pleural effusion?

A

drainage w/ consideration for placement of indwelling pleural catheter
(pleurodesis for refractory >2 or 3)

43
Q

How do you treat an empyema?

A

antibiotics + drainage

44
Q

How do you treat a hemothorax?

A

drainage

Clinical Medicine II (15 decks)

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