Bronchogenic Carcinoma, Trauma, Other Pulm Conditions

Question 1

Small cell carcinoma

Answer 1

Oat cell

Question 2

Non-small cell carcinoma

Answer 2

Squamous cell, adenocarcinoma, large cell undifferentiated

Question 3

Local mets of carcinoma found in

Answer 3

Pleura, chest wall, mediastinal structures

Question 4

Distant mets of carcinoma found in

Answer 4

Lymph nodes, liver, bone, brain, adrenals

Question 5

Bronchogenic carcinoma findings with pulmonary involvement:

1. Unexplained __ __
2. Hemoptysis
3. Dyspnea
4. Weakness
5. Fatigue
6. What kind of breath sounds?
7. PNA with ___ ___ due to A/W compression
8. Hoarseness with compression of ___ nerve
9. ___ or ___ PNA w/ non-reductive cough due to A/W obstruction

Answer 5

1. Weight loss
2. Wheezing
3. Productive cough
4. Laryngeal N.
5. Atelectasis, bacterial PNA

Question 6

Bronchogenic Carcinoma: hold PT until ____ and relieves bronchial obstruction

Answer 6

Palliative therapy reduces tumor size

Question 7

What can happen as effect of bronchogenic carcinoma? (Spine)

Answer 7

Possible fractures from thoracic bone mets with chest compressive maneuvers and coughing

Question 8

What is flail chest?

Answer 8

Fx of ribs, usually due to blunt trauma — 2+ fractures in 2+ adjacent ribs

Question 9

What are physical findings with rib fx/flail chest?

Answer 9

1. Shallow breathing
2. Splinting due to pain
3. Crepitation during ventilation over fx site
4. Paradoxical movement of fluid section during ventilation cycle
5. Confirmation by CXR

Question 10

Air in pleural space, usually through lacerated visceral pleura from rib fx or ruptured bullae

Answer 10

Pneumothorax

Question 11

What side do the trachea and mediastinum shift with pneumothorax/hemothorax?

Answer 11

AWAY from injured side

Question 12

What kind of breath sounds with pneumothorax/hemothorax?

Answer 12

Decreased or absent

Question 13

increased or decreased tympany with mediate percussion with pneumothorax?

Answer 13

Increased tympany

Question 14

Blood in pleural space, usually from laceration of parietal pleura

Answer 14

Hemothorax

Question 15

Blood and edema within alveoli and interstitial space due to blunt chest trauma with or without fx

Answer 15

Lung contusion

Question 16

What kind of breath sounds heard with lung contusion?

Answer 16

Decreased or crackles

Question 17

Excessive seepage of fluid from pulmonary vascular system into interstitial space, may eventually cause alveolar edema

Answer 17

Pulmonary edema

Question 18

Cardiogenic pulmonary edema: results from increased pressure in ____ associated with ___ ventricular failure, ____ valvular disease, ___ valvular disease

Answer 18

Pulmonary capillaries
L
Aortic
Mitral

Question 19

Non-cardiogenic pulmonary edema: results from increased permeability of ___ membranes, due to ____, hyper____, _____, or ____

Answer 19

Alveolar capillary
Inhalation of toxic fumes
Volemia
Narcotic OD
ARDS

Question 20

What kind of breath sounds with pulmonary edema?

Answer 20

Crackles

Question 21

What kind of edema seen if cardiogenic?

Answer 21

Peripheral

Question 22

What does cough produce with pulmonary edema?

Answer 22

Pink frothy sputum

Question 23

What pattern does pulmonary edema resemble on CXR? What is seen?

Answer 23

Increased vascular markings, butterfly pattern

- atelectasis possible if surfactant lining removed by alveolar edema

Question 24

Thrombus from peripheral venous circulation becomes embolitic and lodges in pulm circulation

Answer 24

Pulmonary emboli

Question 25

What is history consistent with PE?

Answer 25

DVT, real contraceptives, recent abdominal or hip surgery, polycythemia, prolonged bed rest

Question 26

What test is used to determine PE

Answer 26

V/Q scan

Question 27

1. Sudden onset of dyspnea
2. Tachycardia
3. Hypoxemia
4. Cyanosis

Answer 27

PE WITHOUT infarction

Question 28

What additional findings are consistent with PE WITH infarction?

Answer 28

Chest pain, hemoptysis

Question 29

What does CXR show for PE with infarction?

Answer 29

Decreased vascular markings
High diaphragm
Pulm infiltrate
Pleural effusion

Question 30

Excess fluid between visceral and parietal pleura, caused mainly by increased permeability to proteins from inflammatory diseases, neoplasticism disease, increased hydrostatic pressure within pleural space, decreased osmotic pressure, peritoneal fluid within pleural space, or interference of pleural reabsorption from tumor invading pleural lymphatics

Answer 30

Pleural effusion

Question 31

Pleural effusion:
Decreased breath sounds where?
What else is heard?

Answer 31

Around perimeter

Pleural friction rub if inflammatory process

Question 32

Pleural effusion: mediastinal shift ___ from effusion

Answer 32

away

Question 33

Pleural effusion: pain and fever only if pleural fluid is infected — aka

Answer 33

Empyema

Question 34

Collapsed or airless alveolar unit, caused by hypoventilation secondary to pain during ventilatory cycle, internal bronchial obstruction, external bronchial compression, low TV, neurological insult

Answer 34

Atelectasis

Question 35

Atelectasis from pain during ventilatory cycle from:

Answer 35

Pleuritis
Post-op
Rib fx

Question 36

Atelectasis from internal bronchial obstruction from:

Answer 36

Aspiration, mucus plugging

Question 37

Atelectasis from external bronchial compression from:

Answer 37

Tumor, enlarged lymph nodes

Question 38

Atelectasis from low TV from:

Answer 38

Narcotic OD, inappropriately low ventilator settings