Term
| What is the most common cause of transudate pleural effusion? |
|
Definition
| transudates: increased production due to increased hydrostatic or decreased oncotic pressures |
|
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Term
| What type of plueral efusion is due to increased production due to increased hydrostatic or decreased oncotic pressures? |
|
Definition
|
|
Term
| What type of pleural effusion is due to increased production due to abnormal capilary permeability? |
|
Definition
|
|
Term
| What is the most common transudates due to pleural effusion? |
|
Definition
|
|
Term
| Besides lung ca which is 2nd most common, what is the most common cause of exudative pleural effusion? |
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Definition
|
|
Term
| What type of pleural effusion is due to decreased lymphatic clearance? |
|
Definition
|
|
Term
| What type of pleural effusion is due to infection in the pleural space? |
|
Definition
|
|
Term
| What type of pleural effusion is due to bleeding into pleural space? |
|
Definition
|
|
Term
| What are 5 types of pleural effusion? |
|
Definition
| transudates. exudates due to capillary permeability. exudates due to lymphatic clearance. empyema. hemothorax. |
|
|
Term
| What is an abnormal collection of fluid in the pleural space? |
|
Definition
|
|
Term
| What type of pressure is involved in the pulmonary system? |
|
Definition
|
|
Term
| Pt presents w/dyspnea, cough, respirophasic chest pain. pe reveals dullness to percussion, decreased breath sounds, egophony, and trachial shift. What is on top of your d/dx? |
|
Definition
|
|
Term
| How do small pleural effusions normally present? |
|
Definition
|
|
Term
| What are 3 s/s of pleural effusion? |
|
Definition
| dyspnea, cough, respirophasic chest pain |
|
|
Term
| What might a pe of a small pleural effusion reveal? |
|
Definition
| no characteristics on exam |
|
|
Term
| What might a pe of a larger pleural effusion reveal? |
|
Definition
| dullness to percussion, decreased or absent breath sounds, bronchial breath sounds (compressive atelectasis), egophony (just above the fluid), and massive effusion w/pressure may have trachial shift |
|
|
Term
| How might an exudative pleural fluid analysis appear? How might pleural fluid appear in transudates? |
|
Definition
| appearance (bloody, clear, turbid, serous, purulent). wbc and rbc counts. glucose. transudates have none of these characteristics and suggest that absense of local pleural disease. |
|
|
Term
| On cxr, which is more dense: fluid or lung tissue? |
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Definition
|
|
Term
| How many cc's do you need to visualize fluid on std upright cxr? |
|
Definition
|
|
Term
| What are 3 methods to image pleural effusion? |
|
Definition
|
|
Term
| How are transudate pleural effusions tx? |
|
Definition
| tx underlying cause. in some cases, therapeutic thoracentesis is needed |
|
|
Term
| What is the most common diagnostic imaging technique used to view pleural effusion? |
|
Definition
|
|
Term
| What is the most common cause of exudative pleural effusion? |
|
Definition
| pneumonia, lung ca-(40-80%) |
|
|
Term
| What is msed by the pleural effusion index? |
|
Definition
| the amt of fluid in pleural effusion. pei=a/b*100 |
|
|
Term
| Are most malignant effusions transudative or exudative? |
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Definition
|
|
Term
| What might be needed to tx exudative pleural effusion? |
|
Definition
|
|
Term
| What might be used to prevent further pleural effusions? |
|
Definition
| pleurodesis (used to be done w/talc now done w/sandpaper- rub it raw and then it sticks. also can be done w/chemicals) |
|
|
Term
| How do you tx hemothorax? |
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Definition
| tx underlying reason: bleeding to site, trauma |
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|
Term
| How should parapneumonic effusions be tx? |
|
Definition
| tx underlying infection (empyema- surgery) |
|
|
Term
| What are 2 ways pneumothorax can occur? |
|
Definition
| spnotaneous (primary or secondary) or traumatic |
|
|
Term
| What type of pneumothorax occurs where there is no underlying lung disease? |
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Definition
|
|
Term
| What type of pneumothorax occurs as a result of a complication of preexisting lung disease? |
|
Definition
|
|
Term
| What type of pneumothorax occurs from penetrating or blunt trauma? |
|
Definition
|
|
Term
| What type of pneumothorax occurs from penetrating or blunt trauma? |
|
Definition
|
|
Term
| Whaty type of pneumothorax is most likely to be caused from rupture of small blebs in a tall thin male age 10-30 (more specifically 18-25) with a hx of family hx and smoking? |
|
Definition
| pneumothorax: primary spontaneous |
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|
Term
| What type of pneumothorax occurs in the setting of copd, cf, tb, pcp, interstitial lung disease (sarcoidosis)? |
|
Definition
| pneumothorax: secondary spontaneous |
|
|
Term
| How can pneumothorax present? (3 signs and 3 symptoms) |
|
Definition
| signs: respiratory distress, tachycardia, tachypnea. symptoms: chest pain (mild to severe), dyspnea, palpitations |
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|
Term
| What is the test of choice for ptx? |
|
Definition
|
|
Term
| What diagonstic imaging technique might be needed to detect smaller ptx? |
|
Definition
|
|
Term
| When are abg's needed in ptx? |
|
Definition
|
|
Term
| What is the severity of tension ptx? |
|
Definition
| tension ptx is a life treatening illness! requires immediate evacuation of air |
|
|
Term
| What is the most serious type of ptx? |
|
Definition
|
|
Term
| Why might a young healthy individual w/ptx not seek medical tx? |
|
Definition
|
|
Term
| On what does tx of ptx depend? |
|
Definition
| on severity, size, sympoms and underlying disease. |
|
|
Term
| What might be required in larger ptx? |
|
Definition
| require chest tube insertion and placed under water seal vacuum |
|
|
Term
| How prevalent is tx of ptx w/thoracostomy or open thoracotomy? When this tx is instituted, how effective is it long term? |
|
Definition
| small population may require this. 30% of spontaneous may have recurrence. |
|
|
Term
| What is defined as pulmonary htn w/elevated pulmonary vascular resistance? |
|
Definition
|
|
Term
| What is the etiology of pulmonary htn? |
|
Definition
| etiology unknown, thought to be genetic |
|
|
Term
|
Definition
| chest tube hooked to water seal, into chamber that has a bit of fluid sease, so air comes in and every time you take a deep breath in, you reinflate lung, which is then resealed by water. (just writing what thibideau said sorry if it doesn't make sense w/o a diagram) |
|
|
Term
| What is a diffuse narrowing of the vessels w/mild sx that can mimic other disease processes, occurs mostly in women- younger populations and presents many times w/right sided heart failure and progressively worsens? |
|
Definition
|
|
Term
| The following disorders of the lung or hypoxemia can contribute to what pathology: copd, interstitial lung disease, sleep apnea, high altitude (chronic exposure), alveolar-capillary dysplasia? |
|
Definition
|
|
Term
| The following chronic thromboembolic diseases can contribute to what pathology: thrombotic obstruction (clot), pulmonary emboli (tumor, foreign material)? |
|
Definition
|
|
Term
| The following disorders of pulmonary vasculature can contribute to what pathology: schistosomiasis, sarcoidosis, histiocytosis X? |
|
Definition
|
|
Term
| What are 3 classes of disorders that cause pulmonary htn? |
|
Definition
| 1. disorders of lung or hypoxemia, chronic thromboembolic disease, and disorders of pulmonary vasculature |
|
|
Term
| How are most pulmonary htn cases tx? |
|
Definition
| most medically tx: anticoagulation, diuretics, supplemental o2, ca2+ channel blockers (may worsen rv), transplantation reserved (high mortality. 50% 2 yr survival) |
|
|
Term
| What pathology do the following tx: anticoagulation, diuretics, supplemental o2, ca2+ channel blockers (may worsen rv), transplantation reserved (high mortality. 50% 2 yr survival)? |
|
Definition
|
|
Term
| What involves right ventricular hypertrophy, failure from pulmonary disease, and depends on the underlying cause of disease? |
|
Definition
|
|
Term
| What is the most common cause of cor pulmonale? |
|
Definition
|
|
Term
| Pt presents w/chronic productive cough, exertional dyspnea, wheezing respirations, fatigability, and weakness. What might this indicate? |
|
Definition
| cor pulmonale (sounds a lot like copd) |
|
|
Term
| What causes sx of cor pulmonale to increase? |
|
Definition
|
|
Term
| To what are sx of cor pulmonale related? |
|
Definition
|
|
Term
| Pt presents w/ cyanosis, clubbing, distended neck veins, rv heave or gallop, hepatomegaly w/tenderness, and dependent edema. What illness might these signs indicate? |
|
Definition
|
|
Term
| What pathology might be indicated by the following pathology: ekg: right axis deviation, peaked p waves, deep s waves, rv hypertrophy, supraventricular arrythmias are frequent? |
|
Definition
|
|
Term
| What tests might determine the underlying cause of cor pulmonale? What tests might be ordered to view rv funtion? |
|
Definition
|
|
Term
| At what is tx of cor pulmonale directed? |
|
Definition
| at underlying pulmonary cause |
|
|
Term
| How serious is pe? How many deaths each year are due to pe? How is it ranked in causing death in hopitalized pts. |
|
Definition
| very serious, life threatening illness- over 200,000 deaths in the us each year, third leading cause of death in hospitalized pts. |
|
|
Term
| The following etiologies cause what pathology: aire (from surgery or venous catheter), amniotic fluid, fat (from long bones), foreign bodies, renal cell tumor, septic emboli, parasite eggs, genetic- protein s, protein c, factor v leiden deficiency? |
|
Definition
|
|
Term
| What is the most common embolus? |
|
Definition
|
|
Term
|
Definition
| from anywhere in the venous vasculature |
|
|
Term
| How frequently is pe caused by thrombus in the leg? |
|
Definition
|
|
Term
| What can be caused by the following: pulmonary arterial htn. primary pulmonary htn. persistent pulmonary htn of newborn. secondary: connective tissue disease, eisenmenger's physoiology (congenital heart disease), portal htn, hiv, drugs/toxins (esp something hard to read), pulmonary venous htn. left sided heart disease. pulmonary venouse obstruction: veno-occlusive disease, and fibrosing mediastinitis (usually related to histo or xrt)? |
|
Definition
|
|
Term
| From where do 20% of pts get pe? |
|
Definition
| proximal popliteal or ileofemoral |
|
|
Term
| Over half pts w/pe will have what other pathology? |
|
Definition
| 50-60% of pts w/pe will have dvt |
|
|
Term
| On what are s/s of pe dependent? |
|
Definition
|
|
Term
| What is the most common s/s of pe? |
|
Definition
| tachypnea: over 50% of pts |
|
|
Term
| The following are s/s of what pathology: seizures, syncope, abdominal pain, fever, productive cough, wheezing, decreasing level of consciousness, new onset of atrial fibrillation? |
|
Definition
|
|
Term
| Most pts w/pe will have abnormality of what test? |
|
Definition
| ekg: 70% will have abnormality |
|
|
Term
| What is the most common abnormality on ekg in pts w/pe? |
|
Definition
| most common is sinus tachycardia and/or nonspecific st and t wave abnormalities |
|
|
Term
| How prevalent is the following abnormality in pts w/pe: p pulmonale, right axis deviation and right bundle branch block? |
|
Definition
|
|
Term
| What might abg's show in a pt w/pe? |
|
Definition
| acute respiratory alkalosis |
|
|
Term
| What might a profound hypoxia in the setting of normal cxr indicate? |
|
Definition
|
|
Term
| Can echos can be used in pulmonary htn? |
|
Definition
|
|
Term
| What do positive or negative d-dimers indicate in a pt who presents w/s/s of pe? |
|
Definition
| d-dimer: degredation product of fibrin is elevated in the presence of pe. a negative d-dimer bolsters a negative pe. however, a positive one does not confirm it. |
|
|
Term
| What does westermark sign indicate? |
|
Definition
| pe- prominant central pulmonary artery |
|
|
Term
| What might a prominant central pulmonary arter indicate? |
|
Definition
|
|
Term
| Would you order a cxr in a pt w/s/s of pe? Why or why not? |
|
Definition
| cxr needed to rule out other reasons for complaint. in cases of pe, most cxr's are normal. you may see: atelectasis, parenchymal infiltrates, pleural effusions. |
|
|
Term
| What might a hampton hump indicate? |
|
Definition
| pe. pleural base of incerased marking. respresents interparencymal hemorrhage. |
|
|
Term
| What are the various ways a lung scan (v/q scan) will be read in a pt w/pe? |
|
Definition
| negative. low probability. intermediate probability. high probability. |
|
|
Term
| What has rapidly become the initial test of choice for detecting pe? Why? |
|
Definition
| ct. very sensitive in the main pulmonary aa, less so in the subsegmental and segmental aa. |
|
|
Term
| What are 2 tests that are equal in dx pe? Each have advantages and disadvantages. |
|
Definition
|
|
Term
| The following tests may be ordered to dx what pathology: venous thrombosis studies, venous us, impedence plethysmography, contrast venography, and pulmonary arteriography? |
|
Definition
|
|
Term
| What dx tool for pe is readily available with good results in detecting proximal extremit thrombosis? |
|
Definition
|
|
Term
| What dx tool for pe ms impedence in flow over a v? |
|
Definition
| impedence plethysmography |
|
|
Term
| What dx tool for pe is still the gold std but not w/o several risks (invasive study)? |
|
Definition
|
|
Term
| *PANCE* What dx tool for pe still remains the reference std (gold std) test for detecting pulmonary embolism? |
|
Definition
|
|
Term
| What dx tool for pe includes intraluminal filling defect, abrupt cutoff of the arterial flow, and asymmmetry of flow? |
|
Definition
|
|
Term
| To what category do the following causes of pe belong: protein s, protein c, factor v leiden? |
|
Definition
|
|
Term
| What is the big reason why people get pe's? |
|
Definition
| increased immobility (bed rest-post operative, obesity, stroke) (this is a perfect set-up for a thrombus to occur and cause an embolus to develop) with prior episodes of thrombus and meds (ocp's hormone replacement tx) |
|
|
Term
| The following can cause what pathology: hyperviscosity (polycythemia) with orthopedic sx and disease (malignancy, sx)? |
|
Definition
|
|
Term
| The following are risk factors for what disease: increased venous pressures (low cardiac output, pregnancy), trauma, and gene defects? |
|
Definition
|
|
Term
| New onset of afib is a big risk factor for what pathology? |
|
Definition
|
|
Term
| "people who come in w/a big pe come in with this overwhelming sense of doom, and usually they're right." no question, just a quote from thibideau's old prof |
|
Definition
|
|
Term
| The following are tx for what pathology: anticoagulation therapy, heparin, maintain a pTT of 1.5-2.5 times nml, adjust dose based on repeat of aPTT values? |
|
Definition
|
|
Term
| How should aPTT be maintained in tx of pe? |
|
Definition
| 1.5-2.5x above nml. adjust dose based on repeat aPTT intervals |
|
|
Term
| When tx pe, how should heparin be dosed? |
|
Definition
| loading dose: 80units/kg iv, then maintenance infusion of 18 units/kg/hr |
|
|
Term
| What type of heparin is used to tx pe? Why? |
|
Definition
| low molecular weight heparin: have less binding to cells- greater availability. longer plasma half life. more predictable w/dose response administered sq- can continue tx at home. few side effects low risk of bleeding. |
|
|
Term
| How is warfarin (coumadin) used to tx pe: po, iv, or im? How long does tx continue? Where is tx started? How long does it take to get to therapeutic state? On what does maintenance dose vary? |
|
Definition
| oral tx continued for at least 3 mos after event. started in hospital along w/heparin. takes up to 7 days to get to therapeutic state. initial dose stated from 2.5-10 mg daily. maintenance dose varies depending on response. |
|
|
Term
| What is the target inr with warfarin tx for pe? What inr is too high? |
|
Definition
| target inr=2.5 with range from 2-3. inr above 4 give increase risk of bleeding. |
|
|
Term
|
Definition
| good or poor kidney function, anyone, really. preferred over cat in pregnant women, preferred over mri for pts w/kidney failure. |
|
|
Term
| What tx of pe is a pregnancy category x? |
|
Definition
| warfarin. use lmwh instead |
|
|
Term
| What must be considered in risks involved with indeinite tx for pe? |
|
Definition
| consider pts age, hemorrhage, pt's desire to cont tx |
|
|
Term
| What is the duration of pe tx? |
|
Definition
| unknown- most will continue w/tx indefinitely to reduce the risk of recurrent thrombus formation (both pe and dvt) |
|
|
Term
| How should thrombolytic tx be administered to tx pe: what is the purpose of the tx? when must it be administered? what is the success relative to heparin and warfarin? |
|
Definition
| thrombolytic tx: streptokinase, urokinase, recombinant tissue plasminogen activator (rTPA alteplase). increase plasmin levels- lyse thrombus. must use in 1st 24 hrs to be effective. no change in success of hx of 1 week and 1 mo when compared to heparin and warfarin |
|
|
Term
| What are disadvantages of thrombolytic tx for pe? What are contraindications |
|
Definition
| sig increase in risk for intracranial hemorrhage when compared to heparin (2.1% v. 0.2%). absolute contraindications- stroke in past 2 mos, active internal bleeding. major contraindications: uncontrolled htn, surgery or trauma in last 6 weeks. |
|
|
Term
| When is thrombolytic tx absolutely contraindications? |
|
Definition
| stroke in past 2 mos, active internal bleeding |
|
|
Term
| How does tx for pe tx thrombi? |
|
Definition
| prevents it from getting bigger; doesn't get rid of clots already there |
|
|
Term
| When is an inferior vena cava filter indicated for pe? It is indicated for pts w/ what major contraindication and what risks? |
|
Definition
| high risk pts. major contraindication to anticoagulation. high risk of recurrent dvt or pe |
|
|
Term
| If you don't get coag level back to normal in first 24 hrs, how is risk increased? |
|
Definition
|
|
Term
| With what pathology is warfaring contraindicated? |
|
Definition
|
|
Term
| What tx of pe isn't used much anymore, and is more of a last-ditch effort to tx pe? |
|
Definition
| thrombolytic tx. these try to lyse thrombus and in doing so these need to be used very quickly to be effective |
|
|
Term
| symptoms include: fever. sob. chills. chest pain. sore throat. malaise. body aches. rhinorrhea. |
|
Definition
|
|
Term
| dry cough, dyspnea, and constitutional symptoms for weeks to mos |
|
Definition
|
|
Term
| BQ: What is the most common cause of cor pulmonale? |
|
Definition
|
|
Term
| BQ: what is the most common cause of pleural transudates? |
|
Definition
|
|
Term
| BQ: What are the 2 most common causes of exudative pleural effusions? |
|
Definition
| bacterial pneumonia, cancer |
|
|
Term
| BQ: What is the most common cause of massive pleural effusion causing opacification of an entire hemithorax? |
|
Definition
| most common=cancer. may also be seen in tb/others |
|
|
Term
| BQ: Which 2 ca's most commonly cause pleural effusion? |
|
Definition
|
|
Term
| BQ: are most malignant pleural effusions exudative or transudative |
|
Definition
|
|
Term
| BQ: How/when do most pts w/malignant effusions present? |
|
Definition
| advanced disease and multiple symptoms. dyspnea occurs in over 1/2 pts w/malignant pleural effusion |
|
|
Term
| BQ: what is the most common pe? |
|
Definition
|
|
Term
| BQ: what is virchow's triad |
|
Definition
| stasis, hypercoag, vessel wall injury |
|
|
Term
| BQ: what is the most common inherited cause of hypercoaguability in white populations? |
|
Definition
| resistance to activated prot c, aka factor v leiden |
|
|
Term
| BQ: what is the most common sign and symptom in pts at risk for pulmonary thromboembolism? |
|
Definition
| symptom: dyspnea 67-85% (pain on inspiration 65-75%). sign: tachypnea- only reliable sign in more than 1/2 pts |
|
|
Term
| BQ: what do abg's usually reveal in pts w/pe? |
|
Definition
| alkalosis due to hyperventilation |
|
|
Term
| BQ: what is the initial dx study in us for suspected pe? what is teh reference std for dx of pe? in most centers what is the test of choice to detect proximal dvt? what is the reference std for dx of dvt? |
|
Definition
| helical ct pulmonary angiography has essentially supplanted v/q scanning. a nml helical ct alone does not exclude pe in high-risk pts. pulmonary angiography remains ref std for dx pe. in most centers, venous us is the test of choice to detect proximal dvt. contrast venography. |
|
|
Term
| BQ: what is characteristic of pulmonary htn in severe emphysema? |
|
Definition
| peripheral pruning" of lg pulmonary aa |
|
|
Term
| BQ: what is the most common sign of wegener granulomatosis lung disease? |
|
Definition
| nodular pulmonary infiltrates |
|
|
Term
| BQ: what is the rule for immune response detection in wegener's? |
|
Definition
| marked peripheral eosinophilia |
|
|
Term
| BQ: what is the most common prognosis for pts w/wegener granulomatosis? |
|
Definition
| complete remissions can be achieved in over 90% of pts w/wegener granulmatosis |
|
|
