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Foundations II- Pulmonary > Pleural Diseases > Flashcards

Pleural Diseases Flashcards

(56 cards)

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1
Q

What is the pleura?

A

serous membranes, consists of mesothelial cells, CT

Visceral-covers lungs and adjoining structures

Parietal- attached to CW, covers the diaphragm

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2
Q

What is pleuritis?

A

AKA pleurisy

inflammation or irritation of the pleura

the 2 layers rub together which produces pain with inhalation and exhalation

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3
Q

What are some causes of pleuritis?

A

Infection, autoimmune disorder, PE, pneumothorax, lung CA, rib , meds, sick cell disease, post op…

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4
Q

Sxs of pleuritis?

A

Sharp CP worse with breathing, coughing, sneezing. May radiate to shoulders/back

+ other signs and sxs depending on underlying cause: fever, chills, SOB, etc.

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5
Q

PE findings of pleuritis?

A

pleural friction rub

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6
Q

Can you see pleuritis on CXR?

A

NO, it is a clinical dx

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7
Q

Work up for pleuritis?

A

CXR- look for pna, pleural effuse, mass..

CTA chest- r/o PE

Serologic studies

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8
Q

Tx of pleuritis?

A

NSAIDS –> try for 2/3 wks and re-eval

Steroids for refractory pain

treat the underlying cause

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9
Q

Lupus Pleuritis

A

involvement of lung, pleura and pulmonary vasculature is common in SLE

pleurisy can be first sign of disease

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10
Q

Serological testing for SLE

A

ANA if +

anti-dsDNA, anti-Sm, etc.

r/o infection

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11
Q

Tx for lupus pleuritis?

A

NSAIDS

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12
Q

Common signs of rheumatoid pleuritis? tx?

A

pleuritic CP, fever, +/- dyspnea

NSAIDS

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13
Q

What is a pleural effusion?

A

Abnormal fluid collecting in the pleural space as a result of excess fluid production and/or decreased lymphatic absorption

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14
Q

How much fluid is normally contained in the pleural cavity?

A

5-15cc

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15
Q

Causes of pleural effusion?

A

can be caused by lots of disorders.

most caused by: CHF, pna, malignancy, pulmonary embolism

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16
Q

What are the 2 different categories of pleural effusions?

A
  1. Transudative effusions

2. Exudative effusions

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17
Q

sxs of pleural effusion?

A

dyspnea, cough, pleuritic CP

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18
Q

PE findings in pt with pleural effusion?

A

dullness to percussion, decrease/absent tactile fremitus, decreased BS, no voice transmission

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19
Q

How can you dx pleural effusion?

A

CXR-pleural fluid may blunt costophrenic angle and form a meniscus laterally (lat decubitus view is most sensitive)

CT chest/ US

Thoracentesis

Pleural biopsy

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20
Q

Indications for thoracentesis?

A
  • newly dx pleural effusion (for dx purposes)
  • Atypical feat. in CHF
  • therapeutic sxs relief
  • if imaging suggests complicated effusion: loculated, empyema
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21
Q

Contraindications for thoracentesis?

A

small volume of fluid (risk for pneumothorax), skin infx at needle site, mechanical ventilation, uncooperative pt

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22
Q

Potential complications of thoracentesis?

A

pain at puncture site, int. bleeding, pneumothorax, empyema

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23
Q

What is Light’s criteria used for?

Study These Flashcards
A

to differentiate transudate v. exudate

exudate if one of following:
-ratio of pleural fluid protein: serum protein >0.5

  • ratio of pleural fluid lactate dehydrogenase: serum LDH >0.6
  • pleural fluid LDH level > 2/3 of the upper limit of norm serum LDH
24
Q

What causes transudative effusions?

Study These Flashcards
A

systemic imbalances in hydrostatic and oncotic forces

i.e HF, atelectasis, nephrotic syndrome, hepatic hydrothorax

25
What causes exudative effusions?
occurs when local factors influencing accumulation of pleural fluid are altered increased pleural capillary permeability leads to elevated protein/cellular content i.e. malignancy, infection, PE, post cardiac injury
26
Long term management of pleural effusion?
- tx underlying illness - PRN thoracentesis - pleurX catheter (refractor effusions) - Pleurodesis (obliterates pleural space)
27
What is a pneumothorax?
presence of air/gas in the pleural cavity usually spontaneous
28
Primary spontaneous pneumothorax? Secondary spontaneous pneumothorax?
occurs w/o precipitating event in person w/o known lung disease occurs as comp. of an underlying lung disease
29
When does a pt have the highest risk for recurrent pneumothorax?
within the first 30 days
30
risk factors for pneumothorax?
smoking (91%) familial marfan syndrome
31
Presentation of spontaneous pneumothorax?
usually in 20s tall, thin, young men 20-40 sudden onset dyspnea and pleuritic CP pain is usually unilateral and can be sharp, agonizing and associated with considerable apprehension
32
PE findings in pt with spontaneous pneumothorax?
tachycardia, hypotension decreased chest expansion on one side diminished BS, hyperresoinant percussions, labored breathing, subcutaneous emphysema
33
How can you dx spontaneous pneumothorax?
1st line: CXR, CT chest
34
blebs and bullae can...
rupture and cause pneumothorax they are seen in COPD
35
What US finding would you seen in a pt with a pneumothorax?
absence of "sliding lung sign" used when dx needed emergently at bedside
36
Tx of spontaneous pneumothorax?
100% oxygen administration If small (<2-3cm) --> observe if clinically stable If large (>3cm)--> needle aspiration Recurrent --> chest tube insertion Unstable --> chest tube
37
When can you discharge a pt with a pneumothorax?
After observing for at least 6 hrs CXR must demonstrate NO progression of pneumothorax
38
How do you perform a needle aspiration?
1. needle inserted in 2nd intercostal space in midclavicular line 2. catheter left in place & attached to a 3 way stopcock and large syringe 3. air is aspirated until resistance is met of pt starts coughing 4. repeat CXR to document lung re-expansion
39
Indications for chest tube?
no response to needle aspiration, secondary spontaneous pneumothorax (SSP), recurrent pneumothorax, hemothorax
40
Clinical presentation of SSP?
generally more severe than PSP - have less reserve due to underlying lung disease
41
CXR in pt with SSP?
may be difficult to distinguish from underlying bleb, emphysematous changes
42
Tx for SSP?
admit almost all will require drainage tuve thoracostomy > needle aspiration
43
What is a tension pneumothorax?
medical emergency! occurs in 1-2% of PSP
44
Presentation of tension pneumothorax?
worsening dyspnea, hypotension, diminished BS on affected side, distended neck veins, tracheal deviated away from the affected side
45
Tx of tension pneumothorax?
immediate decompression needle decompression can be used temporarily until chest tube is placed
46
What is acute respiratory distress syndrome?
acute hypoxemic respiratory failure following a systemic or pulmonary insult w/o evidence of HF
47
Clinical findings in ARDS?
bilateral radiographic opacities and hypoxemia
48
Pathologic findings in ARDS?
diffuse alveolar damage
49
ARDS is a...
dx of exclusion
50
Berlin definition to dx ARDS?
- Acute onset w/in 1 week of a known clinical insult - B/L radiographic pulmonary infiltrates - Respiratory failure not fully explained by HF or volume overload - Moderate-severe oxygenation impairment
51
Pathophys of ARDS?
acute/diffuse inflammatory lung or systemic disease-> damage to pulmonary capillary endothelial cells and alveolar epithelial cells -> increased vascular permeability (and decreased surfactant) -> pulmonary edema and alveolar collapse --> hypoxemia
52
What are some systemic insults? pulmonary insults?
sepsis, shock, trauma, multiple blood transfusions, burns, etc. diffuse PNA, aspiration, lung contusion, etc.
53
clinical presentation of ARDS?
sig. SOB 6-62 hrs after inciting event, worsen quickly respiratory distress, accessory muscle use, tachypnea, tachycardia, diaphoresis hypoxemia that is unresponsive to O2 other signs of multiple organ failure
54
Dx tests for ARDS?
CXR, CT chest typically see: diffuse/patchy B/L infiltrates, usually spare the costophrenic angels - pleural effusions, enlarged heart ABGs: hypoxemia, acute respiratory alkalosis tests to r/o other conditions: BNP, echo, blood cultures
55
Tx for ARDS?
identify initial systemic/pulmonary insult and tx Intubation/mechanical ventilation Prone positioning (turn bed upside) nutrition support prompt tx VAP DVT/GI prophylaxis
56
ARDS prognosis?
high mortality hypoxemia and infiltrates takes wks-months survivors will likely be left with significant reduction in QOL

Foundations II- Pulmonary (2 decks)

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