Pulmonary- Restrictive (pleura and mediastinum)

Question 1

What are the different types of pneumothorax?

Answer 1

• open pneumothorax
• tension pneumothorax
• spontaneous pneumothorax
• secondary pneumothorax

Question 2

What is an idiopathic pneumothorac?

Answer 2

Gas in the pleural space secondary to a defect in the parietal or visceral pleura

Question 3

What is a tension pneumothorax?

Answer 3

• A medical emergency!
• When air enters the pleural space during inspiration and is not allowed to exit on expiration
  
  • common after rib fracture or barotrauma
  • symptoms are sudden and severe

Question 4

What are the signs and symptoms of a pneumothorax?

Answer 4

• acute dyspnea
• ipsilateral chest pain
• decreased PaO2, increased PaCO2
• hypotension and tachycardia
• decreased chest wall movement
• decreased/absent breath sounds
• hyperresonant percussion
  
  • sounds like an empty drum

Question 5

How do you treat an idiopathic pneumothorax?

tension PTX?

Answer 5

• Idiopathic- evacuate aire via catheter aspiration or chest tube
• tension- small bore plastic catheter into second anterior intercostal space
• Both- increased FiO2 will improve the rate of air resorption by pleura x4

Question 6

What are other disorders of the pleuroa and mediastinum?

(6)

Answer 6

• Pleural fibrosis
• pleural effusion
• mediastinal tumors
• acute mediastinitis
• pneumomediastinum
• bronchogenic cysts

Question 7

How do the flow volume loops differentiate between normal, an asthmatic, and someone with emphysema?

Answer 7

• Asthma has a downward curve because not all the alveoli exhale at the same rate and might have different amounts of air

Question 8

What is a pulmonary embolism?

What is the Virchow triad?

Answer 8

• Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble
  
  • ortho surgeries can dislodge tissue fragments
  • pulmonary emboli often come from the deep veins in the theigh
• Virchow triad:
  
  • venous stasis
  • hypercoagulability
  • injuries to the endothelial cells that line the vessels

Question 9

What is the pathophysiology of a pulmonary embolism?

(chart)

Answer 9

Question 10

What is considered pulmonary hypertension?

What are the classifications?

Answer 10

• Mean pulm artery pressure 5-10 mmHg above normal or above 20 mmHg
• Classifications:
  
  • pulmonary arterial hypertension
  • pulmonary venous HTN
  • pulm HTN due to a respiratory disease or hypoxemia
  • Pulm HTN due to thromboti or embolic disease
  • Pulm HTN due to diseases of the pulmonary vasculature

Question 11

What role does endothelial dysfunction play in pulmonary HTN?

Answer 11

• Overproduction of vasoconstrictors
  
  • thromboxane
  • endothelin
• Underproduction of dilators
  
  • prostacyclin
  • NO

Question 12

What is the most common cause of lung cancer?

Answer 12

• cigarette smoking
  
  • heavy smokers are 20x more likely to develop lung cancer than nonsmokers
  • smoking related cancers can also be of the larynx, oral cavity, esophagus, and urinary bladder
• Environmental or occupational risk also present

Question 13

What are the different types of lung cancer?

Answer 13

• Squamous cell carcinoma
  
  • slow growing
  • near hilus
  • obstructuve; causes cough with hemoptysis
• Small cell carcinoma
  
  • very rapid
  • most correlated with smoking
  • very high mortality
  • hormone production (ACTH and cortisol)
• Adenocarcinoma
  
  • moderate rate or growth
  • least correlated with smoking
  • usually on the periphery
• Large cell carcinoma
  
  • rapid growth

Question 14

Lung cancer chart…..ugh

Answer 14