Pulmonology from PANCE Pearls Flashcards
(45 cards)
What is Pneumothorax
Air within the pleural space
increasing positive pleural pressure causes collapse o the lung
What is a spontaneous pneumothorax
Primary vs. Secondary
Believed to be a ruptured bleb
Primary: No underlying lung disease without trauma (tall thin men, smokers)
Secondary: Underlying lung disease without trauma (COPD, Asthma)
What is a Traumatic Pneumothorax
Can be caused by iatrogenic causes such as CPR, thoracentesis, PEEP, sublcavian lines or other trauma (car accident)
What is a Tension Pneumothorax
Positive air pressure pushes the lungs, trachea and heart to the contralateral side
Life threatening
Sx of Pneumothorax
Chest pain
Pleuritic and unilateral, Dyspnea
Increased hyperresonnance, decreased fremitis, decreased breath sounds, unequal respiratory expansion
Sx of a Tension Pneumothorax
Increased JVP
Pulsus paradoxus
Dx of a Pneumothorax
CXR with expiratory view
See decreased lung markings, deep sulcus
Tx of Pneumothorax
Observation if small
Chest tube (thoracostomy) if large
Needle Aspiration if tension followed by chest tube placement
Where is the needle placed in a pneumothorax
2nd Intercostal Space at midclavicular line of the affected side
What is a Pleural Effusion
Abnormal accumulation of fluid in the pleural space
What is a Transudate in a pleural effusion
Circulatory system fluid due to either increasd hydrostatic or decreased oncotic pressure
What is the most common cause of a Transudative pleural effusion
CHF is 90%
Nephrotic Syndrome
Cirrhosis
What is an Exudate in a plural effusion
When local factors increase vascular permeability (infectious process)
See increase in plasma proteins in fluid, WBC, platelets
What is Light’s Criteria for Exudates in pleural effusions
Pleural fluid protein: serum protein >0.5
Pleural fluid LDH: Serum LDH>0.6 or Pleural Fluid LDH >2/3 upper limit of normal LDH
Sx of Pleural Effusion
Asymptomatic Dyspnea Pleuritic chest pain Cough Decreased fremitis, decreased breath sounds, dullness to percussion, audible pleural friiction rub
Dx of Pleural Effusion
CXR, Menisci (blunting of costophrenic angles with loculations)
CT needed to confirm empyema
What types of films are preferred for a pleural effusion
Lateral Decubitus
Detects smaller effusions
Differentiates loculations and empyema from new effusions or scarring
Tx of Pleural Effusion
Gold Standard
Tx underlying disease
Thoracentesis: Gold Standard
Pleural fluid MUST be drained if empyema
What pathogen is the most common cause of community acquired pneumonia and what does it look like under gram stain
Streptococcus Pneumoniae
Gram Positive Cocci
What pathogen is the second most common cause of CAP and who is most likely to get it. What does it look like under gram stain
H. Influenza
Underlying pulmonary disease like COPD, CF, Bronchiectasis
Gram Negative Rods (Bacilli)
What pathogen is related to a pneumonia that is associated with no person to person contact, cooling towers, and A/C contaminants
Legionella
What pneumonia pathogen is associated with alcoholics
Klebsiella
What are 8 pathogen examples of CAP
S. Pneumonia Mycoplasma, Chlamydia H. Influenza, M. Catarrhalis Legionella S. Auerues
What is an example of a pathogen associated with Hospital Acquired Pneumonia
Gram Negative Rods: Pseudomonas, Klebiella
