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Pulmonary By DP > Pneunothorax > Flashcards

Pneunothorax Flashcards

1
Q

Pneumothorax arises when

A

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

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2
Q

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

A

Primary pneumothoraces

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3
Q

happen in patients with underlying lung disease.

A

Secondary pneumothoraces

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4
Q

In secondary spontaneous pneumothorax, ______________________ is the most common cause

A

Chronic obstructive pulmonary disease

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5
Q

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.

A

 True

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6
Q

True or false

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

A

True

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7
Q

True or false

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

A

 True

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8
Q

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

A

Tension pneumothorax

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9
Q

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

A

(>15 to 20 mm Hg)

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10
Q

clinical hallmarks of tension pneumothorax are

A
  1. tracheal deviation away from the involved side
  2. hyperresonance of the affected side
  3. hypotension
  4. dyspnea, profound
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11
Q

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

A
  1. sudden onset of dyspnea

and

  1. ipsilateral, pleuritic chest pain
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12
Q

is the most common physical finding in primary spontaneous pneumothorax

A

Sinus tachycardia

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13
Q

Chest Radiograph in Pneumothorax

A

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

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14
Q

deep sulcus sign is

A

profound lateral costophrenic angle, on the affected side

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

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15
Q

Pneumothorax vs bullae: differentiate.

A

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.

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16
Q

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

A

<2-cm

Large: ≥2-cm

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17
Q

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

A

True

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18
Q

Identify

A
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19
Q

Criteria for Stable Patient With Pneumothorax

A
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20
Q

Fill in the RED blanks

A
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21
Q

Safe location of chest tube

A
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22
Q

Complications of a pneumothorax

A

hypoxia, hypercapnia, and hypotension

23
Q

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.

A

 True

24
Q

True or false

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

A

 True

25
Q

 True or false

Intervention complications

A

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

26
Q

How much O2 is needed and MOA?

A

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

27
Q

When is observation feasible?
What to do during observation?

A

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

28
Q

≥5-mm induration is positive in:

A

• 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

29
Q

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

A

• 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

30
Q

True or false

A positive reaction does not necessarily indicate disease.

A

 True

31
Q

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

A

 True

32
Q

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.

A

Interferon-γ release assays (IGRAs)

33
Q

True or false

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

A

True

34
Q

True or false

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

A

True

35
Q

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

A

True

36
Q

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

A

Ziehl-Neelsen stain or a fluorochrome

37
Q

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

A

Sputum or other tissue cultures for M. tuberculosis

38
Q

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.

A

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

39
Q

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

A

paradoxical reaction or immune reconstitution syndrome

40
Q

Isoniazid

Potential Side Effects and Comments

A

Hepatitis, peripheral neuropathy, drug interactions.

41
Q

No side effect of hepatitis

A

Ethambutol

42
Q

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

A

Rifapentine

43
Q

Thrombocytopenia

A

Rifa

44
Q

used for patients who cannot tolerate RIF.

A

Rifabutin

45
Q

exacerbation of porphyria

A

Rifapentine

46
Q

_______________ is a unique finding in paradoxical reactions.

A

Hypercalcemia

47
Q

Athralgia

A

Pyrazinamide

48
Q

Retrobulbar neuritis

A

Ethambutol

49
Q

not approved in children <12 y old

A

Rifapentine

50
Q

Engineering Controls to Reduce the Transmission of Tuberculosis

A
51
Q

Define Extensive drug-resistant tuberculosis

A

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

52
Q

Define Multidrug-resistant tuberculosis

A

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

53
Q

In children, the most common extrapulmonary presentation is

A

Cervical lymphadenitis

Pulmonary By DP (9 decks)

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