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Kendigs > Air & Fluid In Pleural Space > Flashcards

Air & Fluid In Pleural Space Flashcards

1
Q

Newborn
Risk factor: oligohydramnios
presenting with unexplained pneumothorax should be investigated further for

A

OBSTRUCTIVE renal abnormalities

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2
Q

These are developmentally abnormal enlarged airspaces

A

Pulmonary “blebs’ or “bullae”

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3
Q

Common among neonates
Also in tall, thin boys

After Valsalva meneuver
Increases intrathoracic pressure

A

Spontaneous pneumothorax

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4
Q

Character of chest pain in pneumothorax

A

Initially pleuritic
Becomes dull/Constant ache

May resolve without intervention

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5
Q

PE in pneumothorax

A

Hyperresonant on percussion
Decreased air entry on side of pneumothorax

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6
Q

Result of abnormal capillary permeability
Malingnancy, infarction

A

Exudate

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7
Q

Variation in osmotic, systemic, pulmonary HYDROSTATIC pressure

A

Transudate

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8
Q

Collins method fo pneumothorax

A

% = 4.2 + [4.7(A+B+C)]

Distance at apex = A
Midpoint of upper half = B
Midpoint of lower half = C

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9
Q

Rhea method

A

Average of all 3 interpleural distances (in CM)

Use nomogram converting it to volume

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10
Q

Light method

A

1-(average diameter lung)^3)/(average diameter hemithorax^3) x100]

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11
Q

By estimate, how many cms is considered large pneumothorax

A

> 3 cm from apex
2 cm from lateral edge

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12
Q

High flow o2 in pneumothorax
Hastens re expansion of the lung tup to ___ times in case of larger pneumothorax by ______ partial pressure of nitrogen in pleural space

A

4 times
Decreasing

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13
Q

Insertion of drain

A

Axillary (safe triangle) - avoiding Internal mammary ARTERY

Or

Above 2nd rib (anterior)

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14
Q

Reason why immediate suction is not advised after tube drain

A

Risk of persistent air leak
Re expansion pulmonary edema

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15
Q

HIGH VOLUME, Low pressure suction indication

A

If minimal improvement
-10 to -20 cmH2O

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16
Q

Risk or recurrence of pneumothorax

A

50-60%

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17
Q

Definitive treatment of spontaneous pneumothorax

A

Bullectomy with Pleurodesis

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18
Q

tx If with recurrent pneumothorax
High treatment failure

A

VATS

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19
Q

Scuba diver with recurrent pneumothorax should be cautious UNLESS

A

Definitive surgical procedure done
Normal lung function
Chest CT Scan normal

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20
Q

Flight after pneumothorax resolution should be delayed

A

7 days to 6 weeks - LOW CABIN atm pressure

*no risk of recurrence if confirmed radiologically (PSP)

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21
Q

LOW glucose
LOW ph (acidic)

High WBC
High LDH
High protein

Change in vascular permeability or IMPAIRED lymphatic drainage

A

Exudative

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22
Q

Hepatic cirrhosis
Superior vena cava obstruction

A

Transudate

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23
Q

Churg strauss
Sarcoidosis
Viral hepatitis
HYPOthyroidism

A

Exudative

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24
Q

LIGHTS criteria

A

EXUDATIVE

> 0.5 Protein PF luid: Serum protein
0.6 LDH PF fluid: serum LDH
Upper 2/3 of the upper limit serum LDH

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25
Q

Most common type of effusion in children

A

ParaPneumonic effusion

*can be a complication of Mycoplasma and viral

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26
Q

Stages of parapneumonic effusion

A

Exudative (simple, low WBC)
Fibrinopurulent stage (fibrin, septations, loculations, increase in WBC, pus)
Organizational (fibroblast, tight fibrous membranes)

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27
Q

Most common cause of parapneumonic and empyema

A

Bacterial

28
Q

Empyema mechanism

A

Inc vascular permeability secondary to mesothelial cell cytokines
(IL-1, IL-6, IL 8,
TNF alpha, PAF)

29
Q

Empyema in healthy children

A

Genetics
Virulence and load
Delayed antibiotic

30
Q

Primary causative organism of empyema

A

S pneumoniae

31
Q

How does empyema px minimize pleuritic pain

A

SHALLOW breaths
Refuse to move/change position
Lie on the affected side

32
Q

What causes strep Toxic shock syndrome

A

Group A streptococcus

33
Q

risk factors for Strep TSS caused by GAS

A

Varicella infection
Steroid use

34
Q

If px does not responds clinically to antibiotics for 48 hrs, consider

A

EMPYEMA

35
Q

What view can be requested to appreciate meniscus sign and loss of costophrenic angle

A

Erect or lateral decubitus in EMPYEMA

36
Q

Elevated lateral hemidiaphragm

A

InfraPULMONARY effusion

37
Q

Causes of empyema

A
38
Q

EMPYEMA GRADING
With septations and more complex

A

Grade 3 and 4

39
Q

Grade 1 vs Grade 2

A

Grade 1 - ANechoic

Grade 2 - echoic fluid WITHOUT septations

40
Q

Grade 3 vs Grade 4 empyema

A

grade 3 THICK septations

Grade 4 - had >1/3 of the effusion is solid

41
Q

Blood cultures in empyeme is positive in ___ %

A

22%

42
Q

Secondary hypoalbuminemia in empyema maybe secondary to

A

Malnutrition
Loss of protein

43
Q

May guide in rationalizing antibiotics in empyema

A

ASO

44
Q

Continue IV antibiotics in empyema

A

Afebrile for 24 hours
Until removal of drainage

45
Q

Oral antibiotics for empyema

A

Minimum 1 week up to 6 weeks

46
Q

In empyema, O2 support if less than

A

<93 %

47
Q

Urokinase dosing (fibrinolytics)

A

BID for 3 days

48
Q

When lung becomes trapped

A

Empyema necessitans

49
Q

FOLLOW UP Cxr of empyema

A

6 weeks after the event

*near Normal by 6 months
*nearly ALL by 12 months

50
Q

Spirometry of empyema

A

Usually normal

51
Q

Treatment of parapneumonic effusion

A
52
Q

Physical and chemical character of chyle

A
53
Q

Drains RIGHT upper limb, head and neck, THORAX
And LIVER SURFACE

A

RIGHT lymphatic duct

54
Q

Side of chylothorax if damage is ABOVE 5th thoracic vertebra

A

Left

55
Q

Most common cause of pleural effusion in neonates

A

Chylothorax
(Trauma or congenital malformations)

56
Q

SYndromes associated with chylothorax

A

Noonan and Down syndrome
Turner

57
Q

Classic manifestations of chylothorax

A

Cough
Dyspnea

58
Q

Confirmatory of chylomicrons

A

Presence of chylomicrons using SUDAN III Stain

59
Q

Other measurements

A

Immunoglobulins
HIGH T-lymphocytes
Triglycerides >1.1 mmol/L

60
Q

How to identify sites of defect

A

LymphOscintigraphy
LymphANGIOgraphy
CT SCAN

61
Q

CHYLOTHORAX DIAGNOSIS
Ph
color
Triglycerides

Protein, Absolute cell count, lymphocyte count

A

7.4 to 7.8 (alkaline)
milky (clear if starving)
>1.1 mmol/l Trigly

2-6g/dL proteins,
Absolute cell count >1,000 cell/L
Lymphocyte count >80%

Chylomicrons or (+)sudan III test

62
Q

When to do surgical intervention in chylothorax

A

After 4 weeks of medical treatment failed
If progressing
If with nutritional decline

63
Q

AIM of chylothorax management

A

Decrease the flow through the thoracic duct
Switching off the chylous leak

64
Q

How long is the response of medical management

A

3 weeks
80% will respond

65
Q

It is a synthetic analogue of somatostatin
Vasoconstriction of splanchnic circulation

Decrease intestinal blood flow
Decrease GI secretions
Diminisihing lymph production

A

OCREOTIDE

Kendigs (24 decks)

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