Pulmonology from PANCE Pearls Flashcards
What is Pneumothorax
Air within the pleural space
increasing positive pleural pressure causes collapse o the lung
What is a spontaneous pneumothorax
Primary vs. Secondary
Believed to be a ruptured bleb
Primary: No underlying lung disease without trauma (tall thin men, smokers)
Secondary: Underlying lung disease without trauma (COPD, Asthma)
What is a Traumatic Pneumothorax
Can be caused by iatrogenic causes such as CPR, thoracentesis, PEEP, sublcavian lines or other trauma (car accident)
What is a Tension Pneumothorax
Positive air pressure pushes the lungs, trachea and heart to the contralateral side
Life threatening
Sx of Pneumothorax
Chest pain
Pleuritic and unilateral, Dyspnea
Increased hyperresonnance, decreased fremitis, decreased breath sounds, unequal respiratory expansion
Sx of a Tension Pneumothorax
Increased JVP
Pulsus paradoxus
Dx of a Pneumothorax
CXR with expiratory view
See decreased lung markings, deep sulcus
Tx of Pneumothorax
Observation if small
Chest tube (thoracostomy) if large
Needle Aspiration if tension followed by chest tube placement
Where is the needle placed in a pneumothorax
2nd Intercostal Space at midclavicular line of the affected side
What is a Pleural Effusion
Abnormal accumulation of fluid in the pleural space
What is a Transudate in a pleural effusion
Circulatory system fluid due to either increasd hydrostatic or decreased oncotic pressure
What is the most common cause of a Transudative pleural effusion
CHF is 90%
Nephrotic Syndrome
Cirrhosis
What is an Exudate in a plural effusion
When local factors increase vascular permeability (infectious process)
See increase in plasma proteins in fluid, WBC, platelets
What is Light’s Criteria for Exudates in pleural effusions
Pleural fluid protein: serum protein >0.5
Pleural fluid LDH: Serum LDH>0.6 or Pleural Fluid LDH >2/3 upper limit of normal LDH
Sx of Pleural Effusion
Asymptomatic Dyspnea Pleuritic chest pain Cough Decreased fremitis, decreased breath sounds, dullness to percussion, audible pleural friiction rub
Dx of Pleural Effusion
CXR, Menisci (blunting of costophrenic angles with loculations)
CT needed to confirm empyema
What types of films are preferred for a pleural effusion
Lateral Decubitus
Detects smaller effusions
Differentiates loculations and empyema from new effusions or scarring
Tx of Pleural Effusion
Gold Standard
Tx underlying disease
Thoracentesis: Gold Standard
Pleural fluid MUST be drained if empyema
What pathogen is the most common cause of community acquired pneumonia and what does it look like under gram stain
Streptococcus Pneumoniae
Gram Positive Cocci
What pathogen is the second most common cause of CAP and who is most likely to get it. What does it look like under gram stain
H. Influenza
Underlying pulmonary disease like COPD, CF, Bronchiectasis
Gram Negative Rods (Bacilli)
What pathogen is related to a pneumonia that is associated with no person to person contact, cooling towers, and A/C contaminants
Legionella
What pneumonia pathogen is associated with alcoholics
Klebsiella
What are 8 pathogen examples of CAP
S. Pneumonia Mycoplasma, Chlamydia H. Influenza, M. Catarrhalis Legionella S. Auerues
What is an example of a pathogen associated with Hospital Acquired Pneumonia
Gram Negative Rods: Pseudomonas, Klebiella
Define a Hospital Acquired Pneumonia
Pneumonia occuring >48 hours after hospital admission
Think pathogens associated with hospitalslike Pseudomonas
What are examples of typical pneumonia pathogens
S. Pneumonia
H. Influenza
Klebsiella
S. Auerues
What are examples of atypical pneumonia pathogens
Mycoplasma
Chlamydia
Legionella
Viruses
What will you see on CXR with a typical pneumonia vs. atypical
Typical: Lobar
Atypical: Diffuse, patchy infiltrates
Sx of Typical Pneumonia
Sudden onset of fever Productive cough with purulent sputum Pleuritic chest pain Tachycardia, Tachypnea Dullness to percussion, increased tactile fremitis, egophony, Crackles
Sx of Atypical Pneumonia
Low grade fever
Dry, nonproductive cough
Extrapulmonary sx: myalgias, malaise, sore throat, headache
What does sputum tell you about the pathogen with pneumonia Blood-Tinged Currant Jelly Green Foul Smelling
Blood-Tinged: S. Pneumonia
Currant Jelly: Klebsiella
Green: H.Flu, Pseudomonas
Foul Smelling: Anaerobes
Tx of CAP outpatient
Macrolide or Doxy
Macrolides: Clarithromycin, Azithromycin
Tx of CAP Inpatient
Beta-Lactam + Macrolide
Beta-Lactam: Ceftriaxone, Cefotaxime, Ampicillin
Macrolides: Clarithromycin, Azithromycin
Tx of Hospital Acquired Pneumonia
An Anti-Pseudomonal beta-lactam + Anti-Pseudomonal Fluoroquinolone
Anti-Pseudomonal beeta-lactam: Cefepime, Imipenem, Meropenem, Piperacillin-tazobactam, Piperacillin
Anti-Pseudomonal FQ: Levafloxacin, Gatifloxacin, Moxifloxacin, Gemifloxacin
What is the most common cause of cancer deaths in men and women
Lung Cancer
Where does lung cancer metastasize to
Brain, Bone, Liver, Lymph Nodes, and Adrenals
How is lung cancer classified
Non-Small Cell Carcinoma: Adenocarcinoma, Squamous Cell, Large Cell, Bronchoalveolar
Small Cell Carcinoma
What is the most common form of lung cancer in smokers vs. non-smokers
Smokers: Adenocarcinoma
Non-Smokers: Adenocarcinoma
Which type of lung cancer tends to metastasize early and therefore the most deadly type
Small Cell
Which lung cancer is associated with paraneoplastic syndromes and what are some examples of those sx
Small Cell
Cushing Syndrom
SIADH/Hyponatremia
Where is Adenocarcinoma lung cancer typically seen
Peripherally
Where is Squamous Cell lung cancer typically seen
Central
Where is Large cell lung cancer typically seen
Peripheral and aggressive
What pattern is seen with Bronchoalveolar lung cancer
Interstitial lung pattern
Which lung cancer is associated with Hypercalcemia and Pancoast Syndrome and Cavitary Lesions
What is Pancoast Syndrome
Squamous Cell
Pancoast: Shoulder pain, Horner’s Syndrome, Atrophy of hand/arm muscles
