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Surgery > Pulmonology from PANCE Pearls > Flashcards

Pulmonology from PANCE Pearls Flashcards

1
Q

What is Pneumothorax

A

Air within the pleural space

increasing positive pleural pressure causes collapse o the lung

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2
Q

What is a spontaneous pneumothorax

Primary vs. Secondary

A

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)

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3
Q

What is a Traumatic Pneumothorax

A

Can be caused by iatrogenic causes such as CPR, thoracentesis, PEEP, sublcavian lines or other trauma (car accident)

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4
Q

What is a Tension Pneumothorax

A

Positive air pressure pushes the lungs, trachea and heart to the contralateral side
Life threatening

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5
Q

Sx of Pneumothorax

A

Chest pain
Pleuritic and unilateral, Dyspnea
Increased hyperresonnance, decreased fremitis, decreased breath sounds, unequal respiratory expansion

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6
Q

Sx of a Tension Pneumothorax

A

Increased JVP

Pulsus paradoxus

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7
Q

Dx of a Pneumothorax

A

CXR with expiratory view

See decreased lung markings, deep sulcus

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8
Q

Tx of Pneumothorax

A

Observation if small
Chest tube (thoracostomy) if large
Needle Aspiration if tension followed by chest tube placement

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9
Q

Where is the needle placed in a pneumothorax

A

2nd Intercostal Space at midclavicular line of the affected side

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10
Q

What is a Pleural Effusion

A

Abnormal accumulation of fluid in the pleural space

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11
Q

What is a Transudate in a pleural effusion

A

Circulatory system fluid due to either increasd hydrostatic or decreased oncotic pressure

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12
Q

What is the most common cause of a Transudative pleural effusion

A

CHF is 90%
Nephrotic Syndrome
Cirrhosis

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13
Q

What is an Exudate in a plural effusion

A

When local factors increase vascular permeability (infectious process)
See increase in plasma proteins in fluid, WBC, platelets

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14
Q

What is Light’s Criteria for Exudates in pleural effusions

A

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

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15
Q

Sx of Pleural Effusion

A 
Asymptomatic
Dyspnea
Pleuritic chest pain
Cough
Decreased fremitis, decreased breath sounds, dullness to percussion, audible pleural friiction rub
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16
Q

Dx of Pleural Effusion

A

CXR, Menisci (blunting of costophrenic angles with loculations)
CT needed to confirm empyema

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17
Q

What types of films are preferred for a pleural effusion

A

Lateral Decubitus
Detects smaller effusions
Differentiates loculations and empyema from new effusions or scarring

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18
Q

Tx of Pleural Effusion

Gold Standard

A

Tx underlying disease
Thoracentesis: Gold Standard
Pleural fluid MUST be drained if empyema

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19
Q

What pathogen is the most common cause of community acquired pneumonia and what does it look like under gram stain

A

Streptococcus Pneumoniae

Gram Positive Cocci

20
Q

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

A

H. Influenza
Underlying pulmonary disease like COPD, CF, Bronchiectasis
Gram Negative Rods (Bacilli)

21
Q

What pathogen is related to a pneumonia that is associated with no person to person contact, cooling towers, and A/C contaminants

A

Legionella

22
Q

What pneumonia pathogen is associated with alcoholics

A

Klebsiella

23
Q

What are 8 pathogen examples of CAP

A 
S. Pneumonia
Mycoplasma, Chlamydia
H. Influenza, M. Catarrhalis
Legionella
S. Auerues
24
Q

What is an example of a pathogen associated with Hospital Acquired Pneumonia

A

Gram Negative Rods: Pseudomonas, Klebiella

25
Q

Define a Hospital Acquired Pneumonia

A

Pneumonia occuring >48 hours after hospital admission

Think pathogens associated with hospitalslike Pseudomonas

26
Q

What are examples of typical pneumonia pathogens

A

S. Pneumonia
H. Influenza
Klebsiella
S. Auerues

27
Q

What are examples of atypical pneumonia pathogens

A

Mycoplasma
Chlamydia
Legionella
Viruses

28
Q

What will you see on CXR with a typical pneumonia vs. atypical

A

Typical: Lobar
Atypical: Diffuse, patchy infiltrates

29
Q

Sx of Typical Pneumonia

A 
Sudden onset of fever
Productive cough with purulent sputum
Pleuritic chest pain
Tachycardia, Tachypnea
Dullness to percussion, increased tactile fremitis, egophony, Crackles
30
Q

Sx of Atypical Pneumonia

A

Low grade fever
Dry, nonproductive cough
Extrapulmonary sx: myalgias, malaise, sore throat, headache

31
Q 
What does sputum tell you about the pathogen with pneumonia
Blood-Tinged
Currant Jelly
Green
Foul Smelling
A

Blood-Tinged: S. Pneumonia
Currant Jelly: Klebsiella
Green: H.Flu, Pseudomonas
Foul Smelling: Anaerobes

32
Q

Tx of CAP outpatient

A

Macrolide or Doxy

Macrolides: Clarithromycin, Azithromycin

33
Q

Tx of CAP Inpatient

A

Beta-Lactam + Macrolide
Beta-Lactam: Ceftriaxone, Cefotaxime, Ampicillin
Macrolides: Clarithromycin, Azithromycin

34
Q

Tx of Hospital Acquired Pneumonia

A

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

35
Q

What is the most common cause of cancer deaths in men and women

A

Lung Cancer

36
Q

Where does lung cancer metastasize to

A

Brain, Bone, Liver, Lymph Nodes, and Adrenals

37
Q

How is lung cancer classified

A

Non-Small Cell Carcinoma: Adenocarcinoma, Squamous Cell, Large Cell, Bronchoalveolar
Small Cell Carcinoma

38
Q

What is the most common form of lung cancer in smokers vs. non-smokers

A

Smokers: Adenocarcinoma

Non-Smokers: Adenocarcinoma

39
Q

Which type of lung cancer tends to metastasize early and therefore the most deadly type

A

Small Cell

40
Q

Which lung cancer is associated with paraneoplastic syndromes and what are some examples of those sx

A

Small Cell
Cushing Syndrom
SIADH/Hyponatremia

41
Q

Where is Adenocarcinoma lung cancer typically seen

A

Peripherally

42
Q

Where is Squamous Cell lung cancer typically seen

A

Central

43
Q

Where is Large cell lung cancer typically seen

A

Peripheral and aggressive

44
Q

What pattern is seen with Bronchoalveolar lung cancer

A

Interstitial lung pattern

45
Q

Which lung cancer is associated with Hypercalcemia and Pancoast Syndrome and Cavitary Lesions
What is Pancoast Syndrome

A

Squamous Cell

Pancoast: Shoulder pain, Horner’s Syndrome, Atrophy of hand/arm muscles

Surgery (12 decks)

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