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Pulmonology > Clin Med: Disorders of the Pleural Space, mediastinum and chest wall > Flashcards

Clin Med: Disorders of the Pleural Space, mediastinum and chest wall Flashcards

1
Q

A pleural effusion is

A

accumulation of fluid in the pleural space
between the visceral and parietal pleura

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2
Q

Pleural effusions 2 types

A

transudative
exudative

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3
Q

Transudative Pleural Effusion is

A

decreased oncotic or increased hydrostatic pressure
(too much fluid or too few proteins in fluid - fluid overload)

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4
Q

Exudative Pleural Effusion is

A

inflammation –> increased capillary permeability
“leaky capillaries”, primarily infectious agents or malignancy

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5
Q

Pleural effusion presentation

A

SOB
orthopnea
PND
CP
Cough - usually dry

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6
Q

PE of pleural effusion

A

dullness to percussion
diminished breath sounds
decreased tactile fremitus
E –> A on egophony
+/- pleural friction rub

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7
Q

Work up of pleural effusion

A

CXR (meniscus sign)
ultrasound (more sensitive)
+/- CT
thoracentesis (dx and therapeutic)

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8
Q

Helpful clues for Pleural effusions:
if lots of fluid think…

A

malignancy, CHF, ascites, TB

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9
Q

Helpful clues for Pleural effusions:
if bilateral think…

A

CHF or malignancy

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10
Q

Helpful clues for Pleural effusions:
if right sided think…

A

CHF

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11
Q

Helpful clues for Pleural effusions:
if left sided think…

A

esophageal rupture, pancreatic, post-CABG

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12
Q

Contraindications to a thoracentesis

A

overlying skin infection/ wound
small fluid accumulation
bleeding disorders

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13
Q

Pleural effusion treatment

A

treat underlying cause
therapeutic thoracentesis
+/- chest tube
+/- surgical management

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14
Q

Hemothorax is when

A

there is pooling of blood in the pleural space
(bloody pleural effusion)

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15
Q

Hemothorax is most commonly secondary to

A

trauma

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16
Q

Presentation of a Hemothorax

A

more rapid development
may not be able to provide sx/hx
may present hemodynamically unstable
if AAO - chest pain, dyspnea

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17
Q

Clues from MOI for Hemothorax

A

MCA > 35 mph
fall > 15 ft
ejection > 10 ft
LOC

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18
Q

work up Hemothorax

A

CT preferred

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19
Q

treatment of Hemothorax

A

IV, O2, monitor
less than 300mL and stable –> obs.
if unstable –> emergent decompression (usually chest tube)

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20
Q

Who do we open for a Hemothorax

A

massive - >1-1.5 L
continued bleeding - >300-500mL in first hour
worsening on CXR
persistent despite treatment

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21
Q

Pneumothorax is

A

accumulation of air in the pleural space

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22
Q

Pneumothorax classifications

A

primary
secondary
traumatic
iatrogenic
tension

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23
Q

Primary Pneumothorax is

A

spontaneous
no underlying pulm disease
usually tall, think males often with +FH and smokers, secondary to ruptured pleural blebs

24
Q

Secondary Pneumothorax is

A

Spontaneous
underlying pulmonary disease
injury to lung parenchyma – air out of lung

25
Q

Traumatic Pneumothorax is

A

blunt or penetrating trauma
injury to chest wall/ lungs — air in pleural space
open (chest wall injury) or closed (lung injury)

26
Q

Pneumothorax: inspiration and expiration (what occurs during each)

A

inspiration - air into pleural space
expiration - air leaves pleural space

27
Q

Iatrogenic Pneumothorax is

A

secondary to procedure or mechanical ventilation

28
Q

Tension Pneumothorax is

A

usually penetrating trauma, mechanical vent, CPR, infection
pleural space pressure > lung pressures –> impaired expansion –> collapse

29
Q

Pneumothorax presentation

A

sudden, severe, pleuritic CP on affected side
dyspnea at rest –> respiratory distress

30
Q

if tension Pneumothorax treatment is ______, ______ imaging

A

immediately, no

31
Q

workup of Pneumothorax

A

hypoxia (pulse ox)
chest XR

32
Q

CXR on a Pneumothorax will show

A

lung markings don’t extend to chest wall
visible pleural edge
increased radiolucency (darker) on chest wall periphery

33
Q

Tension Pneumothorax CXR will show a shift of

A

contralateral mediastinal shift

34
Q

Pneumothorax treatment:
small (>15%) and stable –>
bigger and stable –>
resp distress –>
tension pneumo –>

A

supportive treatment - upright positioning, analgesia, O2 as needed
small and stable –> obs
bigger and stable –> chest tube
resp distress –> mechanical vent and chest tube
tension pneumo –> immediate needle thoracostomy

35
Q

Mediastinal disease 3 main processes

A

mediastinal masses
pneumomediastinum
Mediastinitis

36
Q

treatment of pneumothorax if recurent

A

consider pleurodesis
(taking up the lung)

37
Q

mediastinum is the area

A

between the lungs

38
Q

Anterior mediastinum can present with

A

thymoma, lymphoma

39
Q

Middle mediastinum can present with

A

vascular, lymphadenopathy

40
Q

Posterior mediastinum can present with

A

neurogenic, esophagus

41
Q

Mediastinum masses:
Peds usually present
adults mostly present

A

symptomatic
asymptomatic

42
Q

Mediastinum masses workup

A

mostly found incidentally on CXR
CT chest is test of choice

43
Q

What condition is linked with mediastinal tumors

A

myasthenia gravis

44
Q

Definitive dx of mediastinum masses

A

bx

45
Q

Mediastinum masses treatment

A

treat underlying cause

46
Q

Treatment of a thymoma

A

surgical resection
+/- chemo and radiation

47
Q

Thymoma sx

A

phrenic nerve palsy
cough
dyspnea
CP
hoarseness
SVC syndrome

48
Q

Pneumomediastinum is

A

air in the mediastinal space
rare - young adults, M

49
Q

Pneumomediastinum presentation

A

sudden severe retrosternal CP
chest pain radiating to back/ neck
cough
dyspnea
increased work of breathing
voice changes

50
Q

dx Pneumomediastinum

A

CXR
CT to confirm

51
Q

Pneumomediastinum treatment

A

most resolve on its own - air reabsorbs
treat underlying disorder
sx treatment

52
Q

Mediastinitis is

A

inflammation of the mediastinal space

53
Q

Mediastinitis is m/c secondary to

A

infection
esophageal rupture or chest surgery

54
Q

Mediastinitis presentation

A

sudden or insidious onset severe CP, dyspnea and fever

55
Q

Mediastinitis dx

A

CXR or chest CT

56
Q

Mediastinitis treatment

A

abx - clindamycin and ceftriaxone

Pulmonology (18 decks)

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