0203 Pleural Effusion

Question 1

When does pleural effusion happen

Answer 1

when fluid buildup exceeds fluid emptying

Question 2

leading cause of trasudative leural effusions in US?

Answer 2

LVHF Cirrhosis

Question 3

leading cause of trasudative leural effusions in US?

Answer 3

bacterial pneumonia
Malignancy
viral infections
PE

Question 4

what should be done If one
or more of the exudative criteria are met and the patient is clinically
thought to have a condition producing a transudative effusion

Answer 4

the pleural fluid should be measured for protein level and compared to the serum if the gardent is larger than 3.1 g/dL then it is trasudative ddepite the fact that the above criteria a(or some of them are met)

Question 5

what should be done if the patient does have an exudative fluid

Answer 5

Discrrption of the fluid
Glucose level
differential cell count
Microbiology
Cytology

Question 6

what are the three tumors responible for 75% of pleural effusions

Answer 6

lung cancer breast cancer

lymphoma

Question 7

In malignant patients with pleural effusion what is the main symptom? how can it be treated

Answer 7

dyspnea that affects cancer patient as a result of pleural effusion can be treated by
insertion of a small indwelling catheter or (2) tube thoracostomy
with the instillation of a sclerosing agent such as doxycycline (500 mg).

Question 8

most common cause of chylothorax is ____

Answer 8

trauma

Question 9

cyhylothorax: what do we see in Thoracentesis

Answer 9

milky fluid

TG levels >1.2 mmol/L (110 mg/dL

Question 10

Patients with chylothorax and no obvious trauma

Answer 10

should have a lymphangiogram and a mediastinal CT scan to assess the mediastinum for lymph nodes.

Question 11

When does chylothorax occur

Answer 11

Traumatic: after surgery (Iatrogenic)

Non-Traumatic: Malignancies

Question 12

Chylothorax: Treatment

Answer 12

1) Chest tube the Octirotide
2) Percutaneous transabdominal thoracic duct blockage
3) Ligation of thoracic duct

Question 13

Patients with chylothoraxes should undergo prolonged tube thoracostomy with chest tube drainage (T/F)

Answer 13

False

because this will lead to malnutrition and immunologic incompetence.

Question 14

what happens if If the pleural hemorrhage

exceeds 200 mL/h?

Answer 14

consideration should be given to angiographic coil

embolization, thoracoscopy or thoracotomy.

Question 15

match the following cases to the most possible disease:

1) High amylase levels
2) Febrile + polymorphonuclear cells high + no pulmonary parenchymal abnormalities
3) eoisinophilic pleural effusion

Answer 15

1) pancreatitis and___
2) Intra abdominal abcess
3)drugs
4)

Question 16

Meg’s Syndrome

Answer 16

pleural effusion cause by ovarian hyperstimulation

Triad of ascots pleural effusion and beginning ovarian tumor

Question 17

Causes of Transudative Pleural Effusion

Answer 17

CHF
Cirrhosis
Nephrotic syndrome 
peritoneal dialysis
SVC syndrome
Myexedema 
Urinothorax
PE (25% of effusion cases = transudate; mostly exudate though)

Question 18

Diagnostic Algorithm for pleural effsusion

Answer 18

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