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PANCE 2.0 > Pulmonology #8 (FBA, Effusion, Pneumothorax, Pulm HTN) > Flashcards

Pulmonology #8 (FBA, Effusion, Pneumothorax, Pulm HTN) Flashcards

1
Q

MC foreign body aspirated in children

A

Peanuts

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2
Q

Where is the MC location for a foreign body aspiration?

A

Right side (due to wider, more vertical, and shorter right main bronchus)

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3
Q

What is the mean age of a foreign body aspiration?

A

2 years old (absence of molars make it hard to grind food)

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4
Q

Symptoms of a foreign body aspiration

A

-Sudden onset of choking, cough, and dyspnea
-Wheezing or asymmetric breath sounds
-May be normal or asymptomatic

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5
Q

What is seen on CXR in a child with foreign body aspiration?

A

Air trapping

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6
Q

What should be ordered if a negative CXR in a symptomatic patient

A

CT chest

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7
Q

However, what is the definitive diagnostic for a foreign body aspiration?

A

Rigid bronchoscopy (also therapeutic because the object can be removed)

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8
Q

When should you use a flexible bronchoscopy vs a rigid?

A

Flexible used for diagnostic purposes when the diagnosis is not clear or the location is unclear

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9
Q

Treatment for FBA

A

Removal of object via rigid bronchoscopy

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10
Q

In acute choking, perform _________. If this does not work, _______

A

the Heimlich maneuver

Emergency tracheostomy

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11
Q

Although costochondritis is often idiopathic, what are some things that CAN cause it?

A

Physical strain, excessive coughing, etc.

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12
Q

Symptoms of costochondritis

A

-Pleuritic chest pain that is worse with inspiration or certain movements
-Point chest wall tenderness with palpation (MC involves the 3rd, 4th, and 5th ICS)
-Absence of palpable edema

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13
Q

Treatment for costochondritis

A

NSAIDs

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14
Q

What is the difference between costochondritis and Tietze Syndrome?

A

Costochondritis has the ABSENCE of palpable edema, whereas Tietze syndrome does have palpable edema

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15
Q

Treatment for Tietze Syndrome?

A

NSAIDs

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16
Q

What is a pleural effusion?

A

Abnormal accumulation of fluid in the pleural space

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17
Q

Explain the following terms:

-Empyema
-Hemothorax
-Chylothorax

A

Empyema: direct infection of the pleural space. Grossly purulent effusion

Hemothorax: gross blood

Chylothorax: increased lymph

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18
Q

What are the two etiologies of pleural effusion

A

Transudate

Exudate

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19
Q

MCC of Transudate pleural effusion

A

CHF

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20
Q

Other causes of Transudate pleural effusion

A

Nephrotic syndrome, cirrhosis

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21
Q

Causes of exudative pleural effusion

A

Any condition associated with infection or inflammation.

-Pulmonary embolism, malignancy.

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22
Q

Symptoms of pleural effusion

A

-Dullness to percussion
-Decreased fremitus
-Decreased breath sounds
-Pleural friction rub

23
Q

Initial test of choice for pleural effusion and what is normally seen

A

CXR
-Blunting of the costophrenic angles (meniscus sign)

24
Q

What are the BEST films to evaluate for a pleural effusion?

A

Lateral decubitus

25
Q

However, what is the GOLD standard diagnostic for pleural effusion?

A

Thoracocentesis

26
Q

A thoracocentesis can be diagnostic and therapeutic. It helps distinguish between transudate and exudate. What criteria is used and what are the three parts?

A

Light’s Criteria: an exudate is present if any of these three are present.

-Pleural fluid protein: >0.5
-Pleural fluid LDH: serum LDH >0.6
-Pleural fluid LDH >2/3 upper limit of normal

27
Q

How do you know if an empyema is present?

A

Pleural fluid pH < 7.2
Glucose < 40 mg
or Positive gram stain

28
Q

What should you do if an empyema is present?

A

Chest tube fluid drainage

29
Q

What is a pneumothorax?

A

Air in the pleural space, leading to collapse of the lung from positive intrapleural air pressure

30
Q

What is a primary pneumothorax?

A

Atraumatic and idiopathic with no underlying lung disease. Mainly affects 20-40 thin men, smokers, with a family history of pneumothorax.

31
Q

What is a secondary pneumothorax

A

Secondary spontaneous - due to underlying lung disease (COPD, asthma, etc.)

32
Q

A tension pneumothorax occurs when

A

positive air pressure pushes the trachea, great vessels, and heart to the contralateral side

33
Q

What is a catamenial pneumothorax?

A

Occurs during menstruation

34
Q

When does a traumatic pneumothorax occur?

A

During CPR, thoracocentesis, subclavian line placement, car accident, etc.

35
Q

Exam findings of a patient with a pneumothorax

A

-Chest pain: pleuritic, unilateral, non-exertional, sudden. Dyspnea
-Hyperresonance to percussion
-Decreased fremitus
-Decreased breath sounds

36
Q

Also, what are the specific symptoms of a tension pneumothorax

A

-Increased JVP, hypotension, pulsus paradoxus

37
Q

What is the initial diagnostic done for pneumothorax?

A

CXR: expiratory upright view preferred
-Companion lines (visceral pleural line running parallel with the ribs)
-Decreased peripheral markings

38
Q

What is the management of a small (<3 cm) primary spontaneous pneumothorax

A

-Observation and supplemental oxygen
-Repeat films 6 hours to exclude progression

39
Q

What is the management of a large (>3 am) PSP?

A

Needle or catheter aspiration vs chest tube vs catheter thoracostomy

40
Q

What should you do for a tension pneumothorax

A

Needle aspiration followed by chest tube thoracostomy

41
Q

What should you advise the patient who has a pneumothorax?

A

Avoid pressure changes for a minimum of 2 weeks (high altitudes, smoking, scuba diving, etc.)

42
Q

What is pulmonary hypertension?

A

Elevated mean pulmonary arterial pressure > 20 mmHg

43
Q

What happens as a result of the increased pulmonary vascular resistance?

A

Leads to RVH, increased RV pressure, and eventually right-sided HF

44
Q

Primary pulmonary HTN, which is idiopathic in nature, MC occurs in

A

middle-aged or young women

45
Q

What gene defect is associated with primary pulmonary HTN

A

-BMPR2 gene defect

46
Q

Symptoms of pulmonary HTN

A

-Dyspnea
-Fatigue
-Chest pain
-Weakness
-Cyanosis
-Edema

47
Q

Other physical exam findings in pulmonary HTN

A

-Accentuated S2
-Signs of Right-heart failure: increased JVP, peripheral edema, ascites
-Pulmonary regurgitation, systolic ejection click

48
Q

Diagnostics for pulmonary hypertension

CXR: _______
ECG: _________
Echocardiogram: ________

A

-enlarged pulmonary arteries
-Cor pulmonale: RVH, right axis deviation, Right BBB
-large right ventricle, RVH

49
Q

What is the definitive diagnostic for pulmonary HTN?

A

Right heart catheterization

50
Q

What is seen on CBC in a patient with pulmonary HTN?

A

-polycythemia with increased hematocrit

51
Q

What is the first thing that should be done with the treatment in pulmonary HTN?

A

Vasoreactivity trial with IV Adenosine, CCB, or inhaled Nitric oxide.

52
Q

If vasoreactive, what is the treatment?

A

CCB are first line (Verapamil, Diltiazem, Nifedipine, Amlodipine)

53
Q

Other treatment options for pulmonary HTN

A

-PD5-inhibitors (Sildenafil, Tadalfil)
-Oxygen therapy
-Long term anticoagulation in some

54
Q

Definitive Treatment for pulmonary HTN

A

-Heart-lung transplant

PANCE 2.0 (62 decks)

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