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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
Most common type of effusion in children
ParaPneumonic effusion *can be a complication of Mycoplasma and viral
26
Stages of parapneumonic effusion
Exudative (simple, low WBC) Fibrinopurulent stage (fibrin, septations, loculations, increase in WBC, pus) Organizational (fibroblast, tight fibrous membranes)
27
Most common cause of parapneumonic and empyema
Bacterial
28
Empyema mechanism
Inc vascular permeability secondary to mesothelial cell cytokines (IL-1, IL-6, IL 8, TNF alpha, PAF)
29
Empyema in healthy children
Genetics Virulence and load Delayed antibiotic
30
Primary causative organism of empyema
S pneumoniae
31
How does empyema px minimize pleuritic pain
SHALLOW breaths Refuse to move/change position Lie on the affected side
32
What causes strep Toxic shock syndrome
Group A streptococcus
33
risk factors for Strep TSS caused by GAS
Varicella infection Steroid use
34
If px does not responds clinically to antibiotics for 48 hrs, consider
EMPYEMA
35
What view can be requested to appreciate meniscus sign and loss of costophrenic angle
Erect or lateral decubitus in EMPYEMA
36
Elevated lateral hemidiaphragm
InfraPULMONARY effusion
37
Causes of empyema
38
EMPYEMA GRADING With septations and more complex
Grade 3 and 4
39
Grade 1 vs Grade 2
Grade 1 - ANechoic Grade 2 - echoic fluid WITHOUT septations
40
Grade 3 vs Grade 4 empyema
grade 3 THICK septations Grade 4 - had >1/3 of the effusion is solid
41
Blood cultures in empyeme is positive in ___ %
22%
42
Secondary hypoalbuminemia in empyema maybe secondary to
Malnutrition Loss of protein
43
May guide in rationalizing antibiotics in empyema
ASO
44
Continue IV antibiotics in empyema
Afebrile for 24 hours Until removal of drainage
45
Oral antibiotics for empyema
Minimum 1 week up to 6 weeks
46
In empyema, O2 support if less than
<93 %
47
Urokinase dosing (fibrinolytics)
BID for 3 days
48
When lung becomes trapped
Empyema necessitans
49
FOLLOW UP Cxr of empyema
6 weeks after the event *near Normal by 6 months *nearly ALL by 12 months
50
Spirometry of empyema
Usually normal
51
Treatment of parapneumonic effusion
52
Physical and chemical character of chyle
53
Drains RIGHT upper limb, head and neck, THORAX And LIVER SURFACE
RIGHT lymphatic duct
54
Side of chylothorax if damage is ABOVE 5th thoracic vertebra
Left
55
Most common cause of pleural effusion in neonates
Chylothorax (Trauma or congenital malformations)
56
SYndromes associated with chylothorax
Noonan and Down syndrome Turner
57
Classic manifestations of chylothorax
Cough Dyspnea
58
Confirmatory of chylomicrons
Presence of chylomicrons using SUDAN III Stain
59
Other measurements
Immunoglobulins HIGH T-lymphocytes Triglycerides >1.1 mmol/L
60
How to identify sites of defect
LymphOscintigraphy LymphANGIOgraphy CT SCAN
61
CHYLOTHORAX DIAGNOSIS Ph color Triglycerides Protein, Absolute cell count, lymphocyte count
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
When to do surgical intervention in chylothorax
After 4 weeks of medical treatment failed If progressing If with nutritional decline
63
AIM of chylothorax management
Decrease the flow through the thoracic duct Switching off the chylous leak
64
How long is the response of medical management
3 weeks 80% will respond
65
It is a synthetic analogue of somatostatin Vasoconstriction of splanchnic circulation Decrease intestinal blood flow Decrease GI secretions Diminisihing lymph production
OCREOTIDE

Kendigs (24 decks)

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