Trigger - pleural diseases

Question 1

which pleura contains pain fibers

Answer 1

the parietal pleura

Question 2

when would you see chest pain with radiation of pain to ipsilateral scapula

Answer 2

pleuritis affecting diaphragmatic pleura

Question 3

when would you see a pleural friction rub

Answer 3

pleuritis caused by PE

Question 4

when would you see peripheral edema and orthopnea

Answer 4

pleurisy caused by CHF

aso see paroxysmal nocturnal dyspnea

Question 5

when would you see paroxysmal nocturnal dyspnea

Answer 5

pleurisy cuased by CHF

also see orthopnea and peripheral edema

Question 6

what occurs when a patient no longer has chest pain but has now developed a worse cough and SOB

Answer 6

pleuritis that became a pleural effusion

apparently pleuritic chest pain can be present but it lessens a bit

Question 7

what absorbs pleural fluid to maintain homeostasis

Answer 7

the lymphatics of the PARIETAL pleura

Question 8

how much fluid is in the pleural space

Answer 8

5-15mL

Question 9

the term for fluid rich in cells and protein that goes through vessels during inflammation

Answer 9

exudates

Question 10

the term for watery solution with no protein or cells that passes through vessels due to pressure imbalance (natural)

Answer 10

transudate

Question 11

what would cause symptoms of hemoptysis, night sweats, fever and weight loss in presence of pleuritic CP, cough and dyspnea

Answer 11

pleural effusions caused by TB

pleural effusions with hemoptysis and weight loss can also be caused by malignancy!

Question 12

pt presents with pleuritic chest pain, cough, dyspnea, fever and purulent sputum

Answer 12

pleural effusion caused by pneumonia

Question 13

if the trachea is displaced to the right which side is the pleural effusion

Answer 13

left side

Question 14

a patient has S3 gallop and JVD with associated dullness to percussion and decreased lung sounds

Answer 14

pleural effusion d/t CHF

Question 15

a patient has ascites with associated tracheal deviation to the left side and dullness to percussion on the right side

Answer 15

pulmonary effusion d/t liver disease

may also present with jaundice

Question 16

a patient has LAD with associated decreased tactile fremitus and decreased chest expansion on the right side

Answer 16

right sided pleural effusion d/t malignancy

may also see a palpable mass with malignancy

Question 17

costophrenic blunting is seen with what

Answer 17

pleural effusions of >175ml or 6oz

Question 18

CXR shows deviation of bronchi, loculation along fissures and chest wall and costophrenic blunting

Answer 18

pleural effusion

may also see air bronchogram!!

Question 19

what imaging results suggests a need for thoracentesis in pleural effusion

Answer 19

loculation

Question 20

in a patient with recurrent effusions, what treatment is used

Answer 20

pleurodesis

Question 21

a patient who smokes and has no underlying lung disease has a pneumothorax. what type is this?

Answer 21

primary spontaneous pneumothorax

can be an early indicator of lung disease!

Question 22

affects mainly tall, thin males between 10-40 years old

Answer 22

primary spontaneous pneumothoraces

fam hx is a big risk factor!
(so is smoking)

Question 23

what type of pneumothorax is known to be associated with menstruation/endometriosis

Answer 23

secondary spontaneous pneumothoraces

(known as catamenial pneumothoraces, occurs 72 hours before or after menstruation)

Question 24

a patient with a known hx of COPD now has developed a pneumothorax. what type is this?

Answer 24

secondary spontaneous pneumothoraces.

(remember this is pneumothorax as a complication of a preexisting pulmonary disease)

Question 25

if a patient develops a pneumothorax secondary to a healthcare intervention such as biopsy, ventilation or thoracentesis, what type of pneumothorax is it

Answer 25

iatrogenic pneumothorax

Question 26

pneumothorax d/t CPR or positive pressure ventilation can be described as what type of pneumothorax

Answer 26

tension pneumothorax AND iatrogenic pneumothroax

Question 27

which category of pneumothoraces is life threatening

Answer 27

tension pneumothoraces

Question 28

tachypnea, brady/tachycardia, abnormal BP and o2 sat <90% are all vital signs associated with what diagnosis

Answer 28

pneomothoraces

Question 29

tachypnea is associated with which diagnosis

Answer 29

pneumothorax

aslo see:
dyspnea, SOB, pleuritic chest pain (mild/severe)

Question 30

with small pneumothoraces what may be the only PE finding

Answer 30

mild tachypnea!

Question 31

a patient presents with severe respiratory distress. They are unable to speak in full sentences and have marked tachycardia and hypotension. what is occuring?

Answer 31

tension pneumothorax

Question 32

presents with tracheal deviation, displacement of PMI and respiratory distress

Answer 32

tension pneumothorax

Question 33

what is the treatment for a person with no hx of pneumothorax currently presenting with small pneumothorax (<2cm) with no pleural effusion and stable vital signs

Answer 33

O2 at 6L with goal of SpO2 >96% and repeat CXR in 6 hours.

(must meet all these criteria for oxygenation:
- small pneumothorax (3cm or less at apex or 2cm or less at hilum)
- stable vital signs
- first PSP
- no pleural effusion)

Question 34

a patient with no previous hx of pneumothorax presents with a
large pneumothorax (4cm) and stable vital signs. what is the treatment

Answer 34

aspiration IF a provider with expertise is present.

all must be present for aspiration:
- large pneumothorax (3cm or greater at apex, 2cm or greater at hilum)
- stable vital signs
- first PSP
- provider with expertise in aspirations

Question 35

where is aspiration performed

Answer 35

2nd ICS in midclavicular line

Question 36

what is an indication for chest tube during aspiration?

Answer 36

lack of resistance to aspiration after 4L removed

Question 37

where is a thoracostomy placed?

Answer 37

4th or 5th ICS in anterior axillary or midaxillary line

Question 38

this type of pneumothorax is NEVER observed! always maintain airway and do thoracostomy

Answer 38

secondary spontaneous pneumothorax

Question 39

needle decompression is used in which pneumothorax

Answer 39

tension pneumothorax

Question 40

where is needle decompression done?

Answer 40

2nd anterior ICS between at midclavicular line

or

5th ICS anterior or midaxillary line