FINAL: Pulmonary Embolism, Pneumothorax, Lung Cancer – Flashcards

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Pulmonary Embolism (PE)
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impaction of dislodged clot (embolus) or other particulate matter in pulmonary vascular bed
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3 main disposing factors of PE
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"Virchow's Triad" 1. venous stasis 2. endothelial injury 3. hyper-coagulability states
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Venous stasis
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slowed venous blood flow
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Causes of venous stasis
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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
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1. surgery (abdominal area) 2. trauma (fx of hip, femur) 3. burns 4. cancer
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Causes of Hypercoagulability States
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1. pregnancy 2. oral contraceptive use 3. hormone therapies
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PE is #___ of MC cardiovascular cause of death.
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3
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___% of PE deaths occur quickly, within an ____ of symptom onset.
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33%; hour
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PE Risk Factors
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>40yoa CHF prolonged immobilization or travel malignancy myocardial infarction obesity fractures in leg or pelvic bones
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MC origin of PE
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embolization of thrombi in deep leg or pelvic veins
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Small lung clot -->
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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 -->
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more sever symptoms: 1. pleural chest px 2. breathlessness 3. hemoptysis 4. syncope
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Massive or multiple clots -->
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1. syncope 2. coma 3. death
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MC Sign of PE
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tachypnea (92%)
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MC Symptom of PE
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pleuritic pain (74%)
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Chest X-ray is _______ in 90%.
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indefinite
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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
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Best screening test for PE
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V/Q scan
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V/Q Scan Method
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- 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
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0.8
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PE Tx - anticoagulant therapy
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1. IV heparin for 5-7 days 2. oral anticoagulants (Coumadin)
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___ must be monitored regularly to determine proper dose of Coumadin.
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INR
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Goal range for INR
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2-4
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IVC filter
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inserted to keep clots from reaching lungs
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PE Tx - Lysis of existing clots
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- using thrombolytic drugs - use of thrombolytics increases the risk of bleeding complications
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Absoute Contrainidcations to Throbolytic Use:
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1. previous intracranial hemorrhage 2. known structural intracranial cerebrovascular disease 3. CVA w/in 3 months 4. active bleeding 5. suspected aortic aneurysm
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#1 option for PE prevention of recurrence
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Anticoagulants - long term use, monitoring INR regularly
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Pneumothorax
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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
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perforation of parietal pleura by: bullets knives arrows broken ribs biopsy / acupuncture needles
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Spontaneous Pneumothorax
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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."
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apices
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Stresses on the lungs that may cause spontaneous pneumothorax:
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- pneumonia, asthma, COPD, cancer - mechanical ventilation (PEEP or CPAP)
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PEEP
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positive end expiratory pressure
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CPAP
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continuous positive air pressure
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weak areas of the lung wall that cause spontaneous pneumothorax
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blebs
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Most serious type of pneumothorax
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tension
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Tension Pneumothorax
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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
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true
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In tension pneumothorax, the trachea deviates to ______ side.
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unaffected
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Tension pneumothorax commonly presents in a ___, ___ male.
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tall, thin
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Iatrogenic Pneumothorax
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- diagnostic or therapeutic procedures (biopsy, tracheostomy, acupuncture) - barotrauma
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Consequences of Pneumothorax
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- 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.
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true
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Symptoms of Pneumothorax - Small, Mild, slowly progressive
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- vague chest or back pain - mild dyspnea - may experience palpitations
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Symptoms of Pneumothorax - large, severe, rapidly progressive
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- 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
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- ↓ chest wall motion during breathing - tympani on percussion - ↓ vocal fremitus & ↓ breath sounds - tracheal deviation (away)
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Chest X-ray Pneumothorax
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- air in chest cavity, but no lung tissue - sharp margin on lung - deviation of the heart to one side
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Tx of Small Pneumothorax
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- rest - air in pleural space gradually resorbed (days or weeks) - pleural wounds heal themselves
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Tx of Large Pneumothorax
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may require needle aspiration of air "chest tube"
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< 20% of lung collapsed
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small pneumothorax
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Tx of severe or recurrent spontaneous pneumothorax necessary when:
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- a lung fails to heal & re-inflate by itself - recurrent - occurence in both lungs
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Types of Treatment of Pneumothorax
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1. surgical stapling of blebs 2. pleurodesis 3. pleurectomy
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Pleurodesis
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fusion of parietal & visceral pleural layers to each other, eliminating the pleural space
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Pleurectomy
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surgical removal of parietal pleura, which then leads to pleurodesis
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T/F: patients who have undergone successful pleurodesis can usually resume normal, active lives
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true
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MCC of cancer deaths in both men & women
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lung cancer
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T/F: lung cancer is less common in developed countries
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false (more common)
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Epidemiology of Lung Cancer in U.S.
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180,000 new cases/year 160,000 deaths/year $10 billion / year
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Lung cancer is ______ in female population.
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increasing
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Lung Cancer Risk Factors
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- smoking cigarettes (~90%) - ↑age - (+) family history - M > F - history of lung disease - exposure to asbestos, radioactive dusts, gases, air pollution - chronic Vit. A deficiency
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Asbestos exposure & smoking increases risk of smoking ____ fold.
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10
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Cigarette smoke causes cancer by:
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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
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Smoke Carcinogens
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nitrosamines polycyclic aromatic HCs
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Symptoms of Lung Cancer
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- 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
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Signs of Lung Cancer
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- tracheal deviation - abnormal breath sounds - ↓ lung funciton - lymphadenopathy - Horner's syndrome - SVC syndrome - finger clubbing - Paraneoplastic syndrome
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Horner's syndrome
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droopy eyelid smaller pupil on same side
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SVC syndrome
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swollen face & neck veins
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What syndrome is MC in small-cell lung CA?
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Paraneoplastic syndrome
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Paraneoplastic syndrome
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sx due to hormones & toxins secreted by tumor - thigh & upper arm weakness - lethargy, weight loss, anorexia - dry mouth - hypercalcemia
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___% of patients have symptoms caused by cancer at the time of diagnosis.
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90%
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Most cased of lung cancer are _____ by time sx develop.
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untreatable
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Lung Cancer Dx Labs
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altered electrolytes Ca++ ALP ESR
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Lung Cancer definitive dx from:
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*biopsy* of lung tissue via *bronchoscopy* or *thoracotomy*
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NSCLC
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non small cell lung cancer
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Staging for NSCLC
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process used to determine what stage the cancer is at as well as tx & prognosis - cell type - size & spread via TNM
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TNM in staging
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T = tumor; how big? N = nodes; extent of spread M = metastasis; presence & extent
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Staging for Small Cell Lung Cancer (SCLC)
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- limited stage - extensive stage
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Lung Cancer Tx
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1. surgical excision 2. chemotherapy for mets 3. radiation therapy, shrink tumor & reduce pain 4. counseling, end-of-life-choices
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Experimental (off-label) Tx
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- Essiac - Green tea - Iscador - Vit. A, C, & E - 714-X
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Prevention of Lung CA
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- avoid smoking - smoking cessation
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