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Foundations-Pulmonary > Pleural Dz > Flashcards

Pleural Dz Flashcards

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1
Q

Pleura

A

Serous membrane

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2
Q

Viscerla pleura

A

covers the lungs and adjoining structures (blood vessels, bronchi, nerves)

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3
Q

Parietal Pleura

A
  • attached to the chest wall

- covers the diaphragm

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4
Q

Pleural cavity

A
  • Potential space between the two pleurae

- Allows smooth inhalation and exhalation, the fluid prevents friction

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5
Q

Costal pleura

A

Lines inner ribs

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6
Q

Diaphragmatic Pleura

A

lines diaphragm

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7
Q

Costodiaphragmatic Recesses

A

-Spaces between costal and diaphragmatic pleura

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8
Q

Pleuritis causes

A

Infection:

  1. Viral*
  2. Bacterial
  3. Fungal
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9
Q

Pleuritis clinical presentation

A
  1. SHARP CP- Aggravated by breathing, coughing, sneezing
  2. Fever, chills
  3. Cough
  4. SOB
    * depends on underlying cause
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10
Q

Pleuritis PEx

A

Pleural friction rub

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11
Q

Pleuritis Treatment

A
  1. NSAIDS: Naproxen
  2. Steroids: Prednison-For refractory pain
  3. Proton Pump Inhibitor: Omeprazole- prophylactic tx of GI upset due to NSAIDS
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12
Q

What is often the presenting sx in Lupus pleuritis

A

Pleurisy!

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13
Q

Lupus pleuritis diagnostics

A
  1. Serologic testing for SLE: ANA, anti-dsDNA
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14
Q

Lupus pleuritis Tx

A

NSAIDS

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15
Q

Rheumatoid pleuritic common signs

A
  1. Pleuritic CP
  2. Fever
  3. +/- Dyspnea
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16
Q

Rheumatoid pleuritic causes

A
  1. Exudative “rheumatoid” effusion
  2. Drug-induced pleuritis: methotrexate, infliximab
  3. Empyema
  4. Bronchopleural fistula
  5. Hemopneumothorax
  6. Pyopneumothorax
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17
Q

What is the most common pleural dz?

A

Pleural effusion

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18
Q

What is pleural effusion a result of?

A
  1. Excess fluid production AND/OR

2. Decreased lymphatic absorption

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19
Q

What are the 4 major causes of pleural effusions

A
  1. Congestive heart failure
  2. Pneumonia
  3. Malignancy
  4. Pulmonary embolism
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20
Q

What are the two distinct categories of pleural effusions?

A
  1. Transudative effusions

2. Exudative effusions

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21
Q

Pleural effusion clinical presentation

A
  1. Dyspnea
  2. Cough
  3. Pleuritic chest pain
    * Variability depending on underlying disease
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22
Q

Pleural effusion PEx

A
  1. Dullness to percussion
  2. Decreased or absent tactile
    fremitus
  3. Decreased breath sounds
  4. No voice transmission
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23
Q

What is the best CXR view for pleural effusion?

A

CXR in lateral decubitus view

  • can detect as little as 50cc of fluid
  • more sensitive
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24
Q

CXR findings

Study These Flashcards
A
  1. Blunt costophrenic angle

2. Meniscus laterally

25
What is more sensitive than CXR in diagnosing a pleural effusion?
CT chest - Detect as little as 2-10cc fluid - Distinguish pleural thickening from fluid
26
When would you consider a CT angiogram?
Rule out PE
27
What do we use Lights criteria for?
differentiate between transudative fluid vs. exudative fluid
28
How sensitive is cytology analysis of pleural fluid?
60% | Look for malignancy this way
29
Indications for thoracentesis
1. Newly detected pleural effusion- for diagnostic purposes 2. Therapeutic sx relief 3. Imaging suggest complicated effusion (located) 4. Empyema 5. Atypical features of CHF
30
When is a thoracentesis contraindicated?
Small volume fluids= <1 cm thickness on a lateral decubitus film
31
What is one of the main complication of a thoracentesis?
Pneumothorax
32
Transudative effusions
Result from systemic imbalances in hydrostatic | and oncotic forces
33
Causes for Transudative effusions
1. Heart Failure 2. Nephrotic syndrome 3. Hepatic hydrothorax
34
Exudative effusions
Pleural capillary permeability ↑ leading to elevated protein/cellular content
35
Causes for Exudative effusions
1. Malignancy 2. Infectious 3. PE 4. Postcardiac injury
36
Chylothorax
Build up up cholesterol
37
long term management of pleural effusion
1. PRN thoracentesis 2. PleurX catheter- Refactory effusions 3. Pleurodesis: Surgical and Chemical (Talc, Bleomycin)
38
Pneumothorax
- Presence of air or gas in the pleural cavity | - Usually spontaneous
39
Primary Spontaneous Pneumothorax (PSP)
Occurs without a precipitating event in a person without known lung disease
40
Secondary Spontaneous Pneumothorax (SSP)
Occurs as complication of an underlying lung disease
41
What is the #1 cause for Pneumothorax?
Smoking= 91%
42
What is the most common population of a spontaneous Pneumothorax?
Tall, thin, young men from age 20-40
43
Spontaneous Pneumothorax clinical presentation
Sudden onset of dyspnea (80%) and pleuritic CP (90%)***
44
Indication for CT chest in a Spontaneous Pneumothorax
1. Differentiate pneumothorax from large subpleural bullae 2. Evaluate for underlying lung pathology 3.
45
What indicates a Spontaneous Pneumothorax on an US?
Absence of “sliding lung sign”
46
Define what a small pneumothorax is and treatment
< or equal to 2-3 cm= Observe
47
Define what a large pneumothorax is and treatment?
>3 cm | Needle aspiration
48
Indication for chest tube
1. No response to needle aspiration 2. Secondary spontaneous pneumothorax (SSP) 3. Recurrent PSP 4. Hemothorax
49
What is a Video Assisted Thoracoscopy? (VATS)
Pleurodesis by: 1. Pleural abrasion 2. Partial pleurectomy
50
Indications for VATS
1. Persistent air leakr 2. Recurrence 3. Chest tube required on first occurrence 3. Job where recurrence could be harmful to others (ie. Pilot), 4. bleb/bullae resection (COPD pt)
51
Secondary Spontaneous Pneumothorax treatment
1. Hospitalized | 2. Chest tube> Thoracentesis
52
Tension Pneumothorax clinical presentation
1. Worsening dyspnea 2. Hypotension 3. Diminished BS 4. Distended neck veins 5. Tracheal deviation
53
Tension Pneumothorax Treatment
IMMEDIATE decompression | Chest tube
54
Tension Pneumothorax CXR findings
1. Mediastinal shift and tracheal deviation to contralateral side 2. Ipsilateral flattening or inversion of diaphragm
55
Hallmark clinical presentation of acute respiratory distress
1. Bilateral radiographic opacities 2. Hypoxemia 3. Significant SOB 6-72 hrs after inciting event
56
Hallmark pathologic findings acute respiratory distress
Diffuse alveolar damage
57
CXR findings in acute respiratory distress
1. Diffuse or patchy B/L infiltrates | 2. Usu. spare the costophrenic angles
58
Acute respiratory distress diagnostics
ABG: - Hypoxemia - acute respiratory alkalosis - PaO2/FiO2 < 300 mm Hg - Increased alveolar-arterial oxygen (A-a) gradient
59
Acute respiratory distress treatment
1. Intubation 2. Mechanical ventilation 3. Prone positioning in bed 4. DVT and GI prophylaxis * HIGH MORTALITY

Foundations-Pulmonary (9 decks)

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