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Block 9 Week 4 > Pleura and Smoking Effects- Parks and Baker > Flashcards

Pleura and Smoking Effects- Parks and Baker Flashcards

1
Q

What are the more common congential anomalies?

A
  • agenesis or hypoplasia of the lungs
  • foregut cysts
  • pulmonary sequestration
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2
Q

What causes agenesis or hypoplasia of the lungs (one lung or single lobes)?

A

caused by anything that impedes normal lung expansion in utero

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3
Q

What causes foregut cysts?

A

abnormal detachment of primitive foregut

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4
Q

What is pulmonary sequestration?

Where is it located?

A

lung tissue without connection to the airway system

-Can be internal to lung (intralobar) or external to lung (extralobar)

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5
Q

What is resorption atelectasis?

What is the most common cause of resorption atelectasis?

A

atelectasis that occurs when an obstruction prevents air from reaching distal airway. Get resorption of trapped O2 and then atelectasis
-obstruction of a bronchus by a mucous or mucopurulent plug. (typically occurs postoperatively)

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6
Q

What is ths:
airless pulmonary parenchyma?
How do get it?

A

atelectasis “collapsed lung”

  • neonatal, form incomplete expansion
  • aquired
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7
Q

What are the three ways to acquire atelectasis?

A

resportion
compression
contraction

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8
Q

What is resportion atelectasis?

A

airway obstruction leads to resoprtion of O2 within the alveoli

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9
Q

What are three ways you can get resportion atelectasis?

A 
Secretions 
-mucous plugs
-exudates
Aspiration of foreign body
Neoplasm
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10
Q

What diseases cause the secretions that cause resorption atelectasis?

A

astham, chronic bronchitis, bronchiectasis

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11
Q

What is compression atelectasis and what is it due to?

A

compression of pleural cavity (potential space between the visceral and parietal pleura of the lungs) due to fluid, tumor, blood, air (pneumothorax)

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12
Q

How do you get contraction atelectasis?

A

from pulmonary fibrosis

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13
Q

Does atelectasis cause post-op fever?

A

not really

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14
Q

What are the five 5 W’s of post op fever?

A
  • Wind (pneumonia…used to be that atelectasis was classic)
  • Water (UTI)
  • Wound (surgical site infection)
  • Walking (DVT/PE)
  • Wonder Drugs (Drug or other iatrogenic cause)
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15
Q

WHat is the pleura?

A

has a visceral and parietal surface that encloses each long.
It is a potential space with approx 15 mL of lubricating serous fluid.

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16
Q

Most pleura disease is (blank) to some other disease. What is the exception to this?

A

secondary

Mesothelioma

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17
Q

How do you get pleuritis from pneumonia?

A

you get serous fluid into pontential pleura space and then pleuritis

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18
Q

What is this:
any excess accumulation of pleural fluid
Is it symptomatic or asymptomatic?
What causes this?

A

pleural effusions
Can be both
Can be a variety of causes

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19
Q

Exudative effusions tend to be (blank)

And transudative effusions tend to be (blank)

A

inflammatory

non-inflammatory

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20
Q

What are transudative effusions associated with?

A 
"non inflammataory"
hydrostatic mechanism
-heart failure
-renal failure
-liver failure
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21
Q

What are exudative effusions associated with?

A

“Inflammatory”

  • Infections
  • Malignancies
  • Immune responses (Rheum)
  • Noninfectious inflammations
  • Trauma
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22
Q

What is the light’s criteria?

A

It determines whether a fluid is exudative or transudative

  • ProteinF/ProteinS > 0.5
  • LDHF/LDHS > 0.6
  • Serum LDH > 2/3 of the upper limit of normal for serum

Presence of any of these criteria is positive

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23
Q

What is the sensitivity/specificity of the light’s criteria for determining if a fluid is exudative?

A

Sensitive but not very specific

need to use clinical judgment to diagnose

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24
Q

What is this;
-inflammation of the pleura

What causes it?

A

Pleuritis

-infection (local or systemic), Rheumatologic, metastatic disase, radiation exposure

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25
Q

What are the inflammatory effusions?

A

pleuritis

empyema

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26
Q

What is a purulent pleural exudate?
How do you find it in the body?
What is the etiology?

A
  • empyema
  • loculated (formed in small pockets)
  • usually contiguous spread (pneumonia), but can come from a distant source
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27
Q

What are the dangers of empyema?

A

the purulence may resolve but can also organize and cause permanent respiratory restriction

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28
Q

What are the three non-inflammatory effusions?

A
  • hydrothorax
  • hemothorax
  • chylothorax
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29
Q

What does the fluid look like in a hydrothorax?
What is it associated with?
What is it usually caused by?

A

Clear/straw-colored fluid
pulmonary edema
cardiac failure

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30
Q

What is a hemothorax and what is it caused by?

A

frank blood in the pleural space

typically from trauma/vascular space

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31
Q

What is a chylothorax and what is it caused by?

A

milk, lymphatic fluid

thoracic duct trauma, obstruction (cancer?) with secondary lymph rupture

32
Q

Wht is a pneumothorax?
What is it most commonly associated with?
How else can you get it?

A

air in the pleural space

  • emphysema, asthma, TB
  • Trauma
  • Spontaneous Idiopathic Pneumothorax
33
Q

How can trauma cause a pneumothorax?

A

perforating injury to the chest wall

34
Q

How can a spontaneous idiopathic pneumothorax result?

Who does it occur in?

A
  • due to rupture of small peripheral blebs (often recurrent)

- relatively young people

35
Q

What is a tension pneumothorax?

A

progressive worsening of pneumothorax

36
Q

What is a tension pneumothorax associated with?

A

mechanica ventilation (positive pressure)

37
Q

How do you diagnose a tension pneumothorax?

A

clinically (not radiographic)

38
Q

How do you clinically diagnose a tension pneumothorax?

A

-no breath sounds, hyper-resonance to percussion, contralateral deviation of the trachea/mediastinum

39
Q

What happens to cardiac ouput with tension pneumothorax?

A

reduced CO -> medical emergency

40
Q

Where do you do a needle thoracostomy to remedy a tension pneumothorax?

A

anterior 2nd intercostal, mid-clavicular line

41
Q

Which pleural tumors are more common, primary or secondary?

A

secondary tumors (metastatic) MUCH MORE COMMON

42
Q

What are the most common causes of secondary pleural tumors?

A

Lung and breast tumors (but could be any)

43
Q

If you have a met to your lung how can you tell?

A

A met will cause a pleural effusion with positive cytology

44
Q

Is malignant mesothelioma common?
What is related in 90% of cases?
What is the lifetime risk of getting malignant mesothelioma in patients who are heavily exposed to asbestos?
Is risk worsened with smoking?

A

no it is uncommon
Asbestos-related
7-10%
No

45
Q

How long is the latent period of malignant mesotheliom?

A

25-45 years long latent period

46
Q

What is the presentation of malignant mesothelioma?

A

chest pain, dyspnea, recurrent pleural effusions

-20% have asbestosis also

47
Q

What will malignant mesothelioma present as?

What is the death rate?

A

mets to the liver and other distant organs

-50% death rate in 12 months, rare survival after 2 years

48
Q

Is malignant mesothelioma exclusive to pulmonary pleura?

A

NO! it can affect the peritoneum, pericardium as well as the pulmonary pleura

49
Q

If you have a peritoneal mesothelioma, what does this indicate?

A

a particularly heavy exposure to asbestos (50% have coexisting asbestosis)

50
Q

How do you check for malignancy?

A

order a cytology

51
Q

CF is a disorder of ion transport in epithelial cells that affects fluid secretion in exocrine glands and the epithelial lining of the (blank X 3)
Caused by a mutation in what gene?
How common is it?

A

Respiratory
GI
Reproductive tracts

CFTR, 1 in 2500 live births

52
Q

Explain why your salty in CF?

A

NaCl channels are blocked so you sodium can leave the sweat duct lumen

53
Q

Explain why your mucus is sticky and dry in cystic fibrosis?

A

your chloride channel is broken so you cant get chloride into the mucus thus your chloridestays in the epithelium creating a negative charge inside of it and thus sodium has to leave the mucus to neutralize the charge and brings water with it thus causing the dry mucus

54
Q

How do you do a sweat chloride test?

A

a mild electrical current pushes medicine into skin to cause sweating. Sweat is collected and salt content is measured.
(chloride and sodium is measured)

55
Q

What is the most serious complication of CF?

A

pulmonary diseases such as bronchiectasis and colonization by resistant organisms (staph aureus/ pseudomonas)

56
Q

What can the viscous mucus of CF cause?

A

bronchiectasis

57
Q

What age group smokes the most? what gender?
What education level?
What race?

A

18-44 yrs
men
GED
Native Am/Ala

58
Q

What is the trend of tobacco use?

A

less people are smoking but the ones who are smoking are smoking more cigarettes than before

59
Q

How many cigarettes are there in a pack?

A

20

60
Q

What is the tobacco trend in males?

What is the tobacco trend in the femles?

A

males-> decreasing use with sharp decline

females-> leveled use with very slight decline

61
Q

What is the leading cause of preventable death in the US?

A

smoking

62
Q

Cigarettes are responsible for (blank) deaths annually

A

438,000

more than HIV, illegal drug use, alcohol use, MVI, murders combined

63
Q

Smoking accounts for (blank) percent of cancer cases.

How many cancer deaths does it cause?

A

25-30%

170,000

64
Q 
Smoking causes (blank) percent of cases of lung cancer in men.
Smoking causes (blank) percent of cases of lung cancer in females
A

90%

78% (600% increase deaths in women since 1950)

65
Q

What are the vascular affects of smoking?

A
  • CAD (20% of all deaths from heart disease)
  • Cerebrovascular disease
  • Peripheral vascular disease
  • Abdominal aortic aneurysm
66
Q

Who should you screen for abdominal aortic aneurysm?

A

men aged 65-75

who have smoked >100 cigarettes in their life

67
Q

Tobacco + OCP =?

A

MI, Stroke, Venous thromboembolism

especially greater than 35 yrs

68
Q

What can smoking in pregnancy lead to?

A

low birthweight and prematurity

69
Q

What are the benefits of quitting smoking?

A
  • circ and lung function improves
  • 2.5 yrs cardiac events decreases to that of non smokers.
  • other cancer risks go fown
  • 15 yrs without smoking =risk for stroke approaches that of never smokers
70
Q

After you quit smoking the chronic cough resolves or markedly improves in (blank)% of patients. (blank) patients experience resoltion in the first few weeks.
SOB improves within (blank to blank) months

A

94-100%
1/2
1 to 9 months

71
Q

When office staff asks about and documents smoking status…

(blank) more likely that a physician will intervene.
(blank) more likely that the patient will quit.

A

3x

2x

72
Q

What are the 5 A’s?

A 
ASK – about tobacco use
ADVISE – to quit
ASSESS – willingness to quit
ASSIST – in quit attempt
ARRANGE – follow-up
73
Q

What are the 5 R’s?

A 
Relavance
Risks
Rewards
Roadblocks
Repeat
74
Q

Physicians advice alone – increases rates of smoking cessation by (blank)

A

30%

75
Q

Dont give (Blank) to a patient with kidney failure

A

IV contrast

76
Q

Whats the trend of cigarette prices and sales?

A

increased prices and decreased sales

Block 9 Week 4 (9 decks)

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