Pneunothorax

Question 1

Pneumothorax arises when

Answer 1

free air enters the potential space between the visceral and parietal lung pleura

Question 2

occur without clinically apparent lung disease, either spontaneously or from penetration of the intrapleural space by trauma

Answer 2

Primary pneumothoraces

Question 3

happen in patients with underlying lung disease.

Answer 3

Secondary pneumothoraces

Question 4

In secondary spontaneous pneumothorax, ______________________ is the most common cause

Answer 4

Chronic obstructive pulmonary disease

Question 5

True or false

Hemopneumothorax occurs in 2% to 7% of patients with secondary pneumothorax; if associated with a large amount of blood in the pleural cavity, this can be life threatening.

Answer 5

 True

Question 6

True or false

A primary spontaneous pneumothorax occurs when a subpleural bleb ruptures, disrupting pleural integrity and usually involving the lung apex

Answer 6

True

Question 7

True or false

In secondary spontaneous pneumothoraces, disruption of the visceral pleura occurs secondary to underlying pulmonary disease processes

Answer 7

 True

Question 8

develops as inhaled air accumulates in the pleural space but cannot exit due to a one-way valve system

Answer 8

Tension pneumothorax

Question 9

As intrathoracic pressure increases up to _____________, venous return and cardiac and lung function are severely restricted, resulting in hypoxemia and shock

Answer 9

(>15 to 20 mm Hg)

Question 10

clinical hallmarks of tension pneumothorax are

Answer 10

1. tracheal deviation away from the involved side
2. hyperresonance of the affected side
3. hypotension
4. dyspnea, profound

Question 11

Classic symptoms of primary spontaneous pneumothorax are ____1___, and ___2____.

Answer 11

1. sudden onset of dyspnea

and

2. ipsilateral, pleuritic chest pain

Question 12

is the most common physical finding in primary spontaneous pneumothorax

Answer 12

Sinus tachycardia

Question 13

Chest Radiograph in Pneumothorax

Answer 13

loss of lung markings in the periphery and a pleural line that runs parallel to the chest wall

Question 14

deep sulcus sign is

Answer 14

profound lateral costophrenic angle, on the affected side

To be seen in critically ill patients who cannot be moved to an erect position

Question 15

Pneumothorax vs bullae: differentiate.

Answer 15

Pneumothoraces usually cross more than one lung segment, whereas bullae follow a single lobe

a pneumothorax pleural line will run parallel with the chest wall, whereas bullae will have a medially concave appearance.

Question 16

British Thoracic Society defines a small pneumothorax as one with a ________ rim between the lung edge and chest wall; a large pneumothorax is defined as one with a ________rim

Answer 16

<2-cm

Large: ≥2-cm

Question 17

True or false

In a normal lung, there is a sonographic reverberation distal to the pleura that looks like a comet tail and a sliding sign of the movement of the visceral pleura along the parietal pleura

Answer 17

True

Question 18

Identify

Answer 18

Question 19

Criteria for Stable Patient With Pneumothorax

Answer 19

Question 20

Fill in the RED blanks

Answer 20

Question 21

Safe location of chest tube

Answer 21

Question 22

Complications of a pneumothorax

Answer 22

hypoxia, hypercapnia, and hypotension

Question 23

True or false

Reexpansion lung injury is UNCOMMON and seen more often when there is collapse of the lung for >72 hours, a large pneumothorax, rapid reexpansion, or negative pleural pressure suction of >20 cm.

Answer 23

 True

Question 24

True or false

Most patients need no treatment for reexpansion injury aside from observation or oxygen, with few adverse outcomes

Answer 24

 True

Question 25

 True or false Intervention complications

Answer 25

intercostal vessel hemorrhage, lung parenchymal injury, empyema, and tube malfunction (develop- ment of an air leak or tension pneumothorax)

Question 26

How much O2 is needed and MOA?

Answer 26

Oxygen administration (>28%) increases pleural air resorption three- to fourfold over the base 1.25% reabsorbed per day by creating a nitrogen gas pressure gradient between the alveolus and trapped air Recommended oxygen dosing ranges from 3 L/min by nasal cannula to 10 L/min by mask

Question 27

When is observation feasible? What to do during observation?

Answer 27

Observation is appropriate for small, stable pneumothoraces. > at least 4 hours on supplemental oxygen > repeat the chest radiograph > If symptoms and chest radiograph improve, discharge > return in 1 to 2 weeks for repeat examination

Question 28

≥5-mm induration is positive in:

Answer 28

• HIV • Close contact • Healed PTB with abnormal chest radiograph • IMMUNOCOMPROMISED: organ transplants and receiving the equivalent of prednisone >15 milligrams per day for >1 month

Question 29

≥10-mm induration is positive in patients not meeting the above criteria but who have other risks:

Answer 29

• Injection drug users • High-prevalence groups (immigrants, long-term care facility residents, persons in local high-risk areas) • Patients with conditions that increase the risk of progression to active disease (silicosis; diabetes; carcinoma of the head, neck, or lung) • Children <4 y of age

Question 30

True or false A positive reaction does not necessarily indicate disease.

Answer 30

 True

Question 31

True or false Detection of newly infected persons in a screening program: • ≥10-mm induration increase within any 2-y period is positive if <35 y • ≥15-mm induration increase within any 2-y period is positive if >35 y

Answer 31

 True

Question 32

indirectly assess for tuberculosis. The test seeks the response to peptides present in all M. tuberculosis proteins, which trigger the release of interferon-γ by the infected host.

Answer 32

Interferon-γ release assays (IGRAs)

Question 33

True or false the most common finding is a normal chest radiograph, especially in immunocompromised patients

Answer 33

True

Question 34

True or false Isolated ipsilateral hilar or mediastinal adenopathy is sometimes the only finding.

Answer 34

True

Question 35

True or false The radiographic appearance of tuberculosis is often dependent on the integrity of the immune system rather than the stage of tuberculous disease

Answer 35

True

Question 36

Sputum Samples are stained using either a _____________stain or __________ procedure followed by exposure to an acidic agent.

Answer 36

Ziehl-Neelsen stain or a fluorochrome

Question 37

_______________________ are the best method of confirming diagnosis and the most specific test for the disease, detecting as few as 10 bacteria/mL.

Answer 37

Sputum or other tissue cultures for M. tuberculosis

Question 38

can yield results within 1 day and detect as few as 1 to 10 organisms/mL sample. The WHO endorses this for diagnosis of pulmonary and extrapulmonary tuberculosis.

Answer 38

Probe-based tests, or the nucleic acid amplification test (NAAT)

Question 39

portion of patients treated for tuberculosis worsen after the initiation of antituberculous medications

Answer 39

paradoxical reaction or immune reconstitution syndrome

Question 40

Isoniazid Potential Side Effects and Comments

Answer 40

Hepatitis, peripheral neuropathy, drug interactions.

Question 41

No side effect of hepatitis

Answer 41

Ethambutol

Question 42

Recommended by Centers for Disease Control and Prevention for continuation therapy only for human immunodeficiency virus–negative patients.

Answer 42

Rifapentine

Question 43

Thrombocytopenia

Answer 43

Rifa

Question 44

used for patients who cannot tolerate RIF.

Answer 44

Rifabutin

Question 45

exacerbation of porphyria

Answer 45

Rifapentine

Question 46

_______________ is a unique finding in paradoxical reactions.

Answer 46

Hypercalcemia

Question 47

Athralgia

Answer 47

Pyrazinamide

Question 48

Retrobulbar neuritis

Answer 48

Ethambutol

Question 49

not approved in children <12 y old

Answer 49

Rifapentine

Question 50

Engineering Controls to Reduce the Transmission of Tuberculosis

Answer 50

Question 51

Define Extensive drug-resistant tuberculosis

Answer 51

occurs when resistance to INH, RIF, any fluoroquinolone, and at least one injectable second-line medication exists

Question 52

Define Multidrug-resistant tuberculosis

Answer 52

is tuberculosis with isolates that demonstrate resistance to at least INH and RIF

Question 53

In children, the most common extrapulmonary presentation is

Answer 53

Cervical lymphadenitis