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Pulmonology > Pulm Pleural Disorders > Flashcards

Pulm Pleural Disorders Flashcards

1
Q

What is pleural effusion?

A

abnormal accumulation of fluid in the pleural space (more than 5ml)

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2
Q

What are the types of pleural fluid?

A

1) transudate
2) exudate
3) empyema
4) hemothorax

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3
Q

What is transudate?

A
  • there are normal capillaries (there is NO inflammation) but hydrostatic pressure is increased b/c pressure from the heart failure backs up into the lungs and the pressure cxs the fluid to leak out into the pleural space
  • also cxs decrease in oncotic pressure b/c there is pressure on the vessels
  • chemistries will show lower than 0.5
  • LDH will be lower than 0.6
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4
Q

What is exudate?

A
  • there is vasodialation b/c of inflammation so the vessels are bigger cxing BOTH fluid and proteins to get pushed out
  • there is decreased lympathic clearance b/c of lymphatic obstruction
  • chemistries will show higher than 0.5 b/c the cell contents are increased
  • LDH will be higher than 0.6
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5
Q

What is empyema?

A

infxn in the pleural space giving off PUS

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6
Q

What is hemothorax?

A

bleeding into the pleural space

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7
Q

What is Parapneumonic effusion?

A

exudates d/t bacterial pneumonia

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8
Q

Labs for Pleural effusion?

A
  • throacentesis (light’s criteral) to figure out if fluid is exudate or transudate
  • CXR: displaced diaphragm
  • US: lungs are “floating” b/c denser than water
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9
Q

Labs for transudate?

A

-clear

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10
Q

Labs for exudate?

A

-white

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11
Q

Labs for hemothorax?

A

-bloody

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12
Q

Tx for pleural effusion?

A
  • Malignancy (exudate): refer
  • Parapneumonic: supportive
  • Hemothorax: drain
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13
Q

What is pneumothorax?

A

accumulation of air in the pleural space

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14
Q

What are the types of pneumothorax?

A
  • spontaneous (primary and secondary)
  • traumatic
  • iatrogenic
  • tension
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15
Q

What is spontaneous primary pneumothorax?

A
  • no lung dz before
  • occurs in males 10-30 yo (d/t growth spurt / smoking)
  • may have family hx
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16
Q

What is spontaneous secondary pneumothorax?

A
  • lung dz
  • complication of COPD
  • asthma
  • P jiroveci
  • at higher risk of COPD/asthma
17
Q

What are sx/PE of pneumothorax?

A
  • chest pains
  • BIG: decrease tactile fremitus; decrease of chest movement; tachycardia; tracheal shift TOWARDS affected lung
  • TENSION: increase x2 in tachycardia, hypotension, tracheal shift AWAY from affect lung
18
Q

What is tension pneumothorax?

A

-air enters pleural space but cannot get out d/t (1) trauma (2) lung infxn

19
Q

CXR on pneumothorax?

A

pleural lines

20
Q

Complications on pneumothorax?

A
  • pneumomediastinum: ruptured esophagus/bronchus - able to FEEL crackles via subcutaneous emphysema
  • TENSION: can lead to death
21
Q

Tx of pneumothorax?

A
  • small: observe w/O2
  • large: small catheter aspiration w/ serial xrays q24 hrs
  • severe: thoracostomy
  • pt education: STOP SMOKING; avoid flying unpressurized aircraft, high latitudes, scuba diving
  • recurrent/failure of first tube: thorascoscopy/open thoractomy
22
Q

What is sleep apnea?

A

pause in breathing for more than 10 seconds with lower than 90% O2 stats

23
Q

What are the types of sleep apnea?

A
  • obstructive sleep apnea

- central sleep apnea

24
Q

What is obstructive sleep apnea?

A

PHYSICALLY obstruction of the airway

25
Q

What is central sleep apnea?

A

the DRIVE (mentally) is GONE

26
Q

Who does sleep apnea affect?

A
  • adults and children
  • M>F
  • smokers
27
Q

What are the RF sleep apnea?

A
  • hypothyroidism: the body is not able to respond to the changes d/t the lack of responsive thyroid –> it can also lead to chronic resp. failure
  • smoking
28
Q

What are sx/PE of sleep apnea?

A
  • chronic daytime drowsiness (MVA accident risk, impaired relationships)
  • cognitive impairment b/c body is not getting enough O2 at night
  • abnormal upper airways
  • Micrognathia (narrowed airways)
  • macroglossia
  • obesity
  • tonisllar hypertrophy
  • resistant HTN
  • displaced mandible
  • nasal polyps
  • thryomegaly d/t hypothyroidism
  • CHF
  • AMI
  • CVA
  • DM2
  • acromegaly
  • Nasal Twang
  • Bull neck
29
Q

What can make sleep apnea worse?

A
  • alcohol/sedatives

- nasal obstruction/CONGESTION

30
Q

Labs for sleep apnea?

A

GOLD STANDARD: POLYSOMNOGRAPHY (sleep study)

31
Q

What is important to rule out for sleep apnea?

A
  • seizure disorders
  • narcolepsy
  • depression
32
Q

What is the apnea cycle?

A

collapsed airway –> snoring –> occulusion –> apnea –> hypoxia & hypercapnia (incr of CO2 b/c body can’t get it out) –> arousal, waking, and incr in sympathetic tone –> disrupted sleep –> REPEAT

33
Q

What is mallampati score?

A
  • used for sleep apnea
  • entire tonsil is visible
  • 1/2 tonsil fossa visible
  • BOTH soft and hard palate visible
  • ONLY hard palate visible
34
Q

Tx sleep apnea?

A
  • don’t smoke
  • lose weight
  • avoid alcohol/sedatives
  • CPAP: best option
  • BIPAP

Pulmonology (7 decks)

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