question

Pulmonary Embolism (PE)

answer

impaction of dislodged clot (embolus) or other particulate matter in pulmonary vascular bed

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3 main disposing factors of PE

answer

"Virchow's Triad" 1. venous stasis 2. endothelial injury 3. hyper-coagulability states

question

Venous stasis

answer

slowed venous blood flow

question

Causes of venous stasis

answer

1. immobilization 2. obesity 3. varicose veins 4. congestive heart failure (CHF) 5. pregnancy 6. cerebrovascular accident (CVA)

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Causes of Endothelial Injury

answer

1. surgery (abdominal area) 2. trauma (fx of hip, femur) 3. burns 4. cancer

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Causes of Hypercoagulability States

answer

1. pregnancy 2. oral contraceptive use 3. hormone therapies

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PE is #___ of MC cardiovascular cause of death.

answer

3

question

___% of PE deaths occur quickly, within an ____ of symptom onset.

answer

33%; hour

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PE Risk Factors

answer

>40yoa CHF prolonged immobilization or travel malignancy myocardial infarction obesity fractures in leg or pelvic bones

question

MC origin of PE

answer

embolization of thrombi in deep leg or pelvic veins

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Small lung clot -->

answer

mild symptoms: 1. unexplained dyspnea, tachypnea, SOB 2. anxiety, "something is wrong in my chest" 3. vague substernal pressure 4. occasionally, syncope

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Larger clot -->

answer

more sever symptoms: 1. pleural chest px 2. breathlessness 3. hemoptysis 4. syncope

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Massive or multiple clots -->

answer

1. syncope 2. coma 3. death

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MC Sign of PE

answer

tachypnea (92%)

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MC Symptom of PE

answer

pleuritic pain (74%)

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Chest X-ray is _______ in 90%.

answer

indefinite

question

Dx of PE

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- based on suspicious SSx in at risk patient - ECG to rule out MI - V/Q scan of lungs - spiral CT to confirm

question

Best screening test for PE

answer

V/Q scan

question

V/Q Scan Method

answer

- introduce contrast medium - take x-ray - look for unventilated & unperfused areas in lung fields => ventilation or perfusion defects

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Normal V/Q ratio

answer

0.8

question

PE Tx - anticoagulant therapy

answer

1. IV heparin for 5-7 days 2. oral anticoagulants (Coumadin)

question

___ must be monitored regularly to determine proper dose of Coumadin.

answer

INR

question

Goal range for INR

answer

2-4

question

IVC filter

answer

inserted to keep clots from reaching lungs

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PE Tx - Lysis of existing clots

answer

- using thrombolytic drugs - use of thrombolytics increases the risk of bleeding complications

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Absoute Contrainidcations to Throbolytic Use:

answer

1. previous intracranial hemorrhage 2. known structural intracranial cerebrovascular disease 3. CVA w/in 3 months 4. active bleeding 5. suspected aortic aneurysm

question

#1 option for PE prevention of recurrence

answer

Anticoagulants - long term use, monitoring INR regularly

question

Pneumothorax

answer

when air gets into the pleural space between the outside of the lungs & the inside of the chest (lung cannot expand during inspiration)

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Traumatic Pneumothorax

answer

perforation of parietal pleura by: bullets knives arrows broken ribs biopsy / acupuncture needles

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Spontaneous Pneumothorax

answer

perforation of visceral pleura due to weakness or disease of lung, or to overinflation stresses - blebs - at apices - stresses on lung wall

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Blebs are often at the lung _____, where they spontaneously "pop."

answer

apices

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Stresses on the lungs that may cause spontaneous pneumothorax:

answer

- pneumonia, asthma, COPD, cancer - mechanical ventilation (PEEP or CPAP)

question

PEEP

answer

positive end expiratory pressure

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CPAP

answer

continuous positive air pressure

question

weak areas of the lung wall that cause spontaneous pneumothorax

answer

blebs

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Most serious type of pneumothorax

answer

tension

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Tension Pneumothorax

answer

air enters the pleural space during *inspiration*, but can't get out during expiration, causing lung to *slowly collapse*

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T/F: both pulmonary & cardiac function can become severely compromised in Tension Pneumothorax

answer

true

question

In tension pneumothorax, the trachea deviates to ______ side.

answer

unaffected

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Tension pneumothorax commonly presents in a ___, ___ male.

answer

tall, thin

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Iatrogenic Pneumothorax

answer

- diagnostic or therapeutic procedures (biopsy, tracheostomy, acupuncture) - barotrauma

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Consequences of Pneumothorax

answer

- lung collapses inward - V/Q ↓ - IVC & SVC can become compressed --> ↓ return to R. heart - chest wall appear expanded

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T/F: Decrease in V/Q ratio can be life-threatening.

answer

true

question

Symptoms of Pneumothorax - Small, Mild, slowly progressive

answer

- vague chest or back pain - mild dyspnea - may experience palpitations

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Symptoms of Pneumothorax - large, severe, rapidly progressive

answer

- chest px, radiate to corresponding shoulder, across chest, over abdomen - severe dyspnea - life-threatening respiratory failure - severe anxiety

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Signs of Pneumothorax

answer

- ↓ chest wall motion during breathing - tympani on percussion - ↓ vocal fremitus & ↓ breath sounds - tracheal deviation (away)

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Chest X-ray Pneumothorax

answer

- air in chest cavity, but no lung tissue - sharp margin on lung - deviation of the heart to one side

question

Tx of Small Pneumothorax

answer

- rest - air in pleural space gradually resorbed (days or weeks) - pleural wounds heal themselves

question

Tx of Large Pneumothorax

answer

may require needle aspiration of air "chest tube"

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< 20% of lung collapsed

answer

small pneumothorax

question

Tx of severe or recurrent spontaneous pneumothorax necessary when:

answer

- a lung fails to heal & re-inflate by itself - recurrent - occurence in both lungs

question

Types of Treatment of Pneumothorax

answer

1. surgical stapling of blebs 2. pleurodesis 3. pleurectomy

question

Pleurodesis

answer

fusion of parietal & visceral pleural layers to each other, eliminating the pleural space

question

Pleurectomy

answer

surgical removal of parietal pleura, which then leads to pleurodesis

question

T/F: patients who have undergone successful pleurodesis can usually resume normal, active lives

answer

true

question

MCC of cancer deaths in both men & women

answer

lung cancer

question

T/F: lung cancer is less common in developed countries

answer

false (more common)

question

Epidemiology of Lung Cancer in U.S.

answer

180,000 new cases/year 160,000 deaths/year $10 billion / year

question

Lung cancer is ______ in female population.

answer

increasing

question

Lung Cancer Risk Factors

answer

- smoking cigarettes (~90%) - ↑age - (+) family history - M > F - history of lung disease - exposure to asbestos, radioactive dusts, gases, air pollution - chronic Vit. A deficiency

question

Asbestos exposure & smoking increases risk of smoking ____ fold.

answer

10

question

Cigarette smoke causes cancer by:

answer

1. irritation of airways → *rapid cell turnover* 2. carcinogens in smoke → *mutations* in cells lining airways 3. interference with action of *A-1 anti-trypsin*, an enzyme that protects the lungs

question

Smoke Carcinogens

answer

nitrosamines polycyclic aromatic HCs

question

Symptoms of Lung Cancer

answer

- cough or change - bloody sputum - SOB - recurring bronchitis or pneumonia - chest, shoulder or arm pain - weight loss - px - hoarseness - HA or seizures - unusual tenderness over bones of chest, spine, pelvis, tibia

question

Signs of Lung Cancer

answer

- tracheal deviation - abnormal breath sounds - ↓ lung funciton - lymphadenopathy - Horner's syndrome - SVC syndrome - finger clubbing - Paraneoplastic syndrome

question

Horner's syndrome

answer

droopy eyelid smaller pupil on same side

question

SVC syndrome

answer

swollen face & neck veins

question

What syndrome is MC in small-cell lung CA?

answer

Paraneoplastic syndrome

question

Paraneoplastic syndrome

answer

sx due to hormones & toxins secreted by tumor - thigh & upper arm weakness - lethargy, weight loss, anorexia - dry mouth - hypercalcemia

question

___% of patients have symptoms caused by cancer at the time of diagnosis.

answer

90%

question

Most cased of lung cancer are _____ by time sx develop.

answer

untreatable

question

Lung Cancer Dx Labs

answer

altered electrolytes Ca++ ALP ESR

question

Lung Cancer definitive dx from:

answer

*biopsy* of lung tissue via *bronchoscopy* or *thoracotomy*

question

NSCLC

answer

non small cell lung cancer

question

Staging for NSCLC

answer

process used to determine what stage the cancer is at as well as tx & prognosis - cell type - size & spread via TNM

question

TNM in staging

answer

T = tumor; how big? N = nodes; extent of spread M = metastasis; presence & extent

question

Staging for Small Cell Lung Cancer (SCLC)

answer

- limited stage - extensive stage

question

Lung Cancer Tx

answer

1. surgical excision 2. chemotherapy for mets 3. radiation therapy, shrink tumor & reduce pain 4. counseling, end-of-life-choices

question

Experimental (off-label) Tx

answer

- Essiac - Green tea - Iscador - Vit. A, C, & E - 714-X

question

Prevention of Lung CA

answer

- avoid smoking - smoking cessation

FINAL: Pulmonary Embolism, Pneumothorax, Lung Cancer – Flashcards

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