B4-026 CBCL Pleural Effusion

Question 1

studies ordered to determine if effusion is transudate or exudate

Answer 1

• serum and pleural fluid protein
• LDH

Question 2

pleural fluid/serum fluid > 0.5
pleural fluid/serum LDH >0.6

Answer 2

exudate

Question 3

appropriate treatment of empyema

Answer 3

antibiotics and surgical intervention

Question 4

helps lungs expand and keeps them inflated

Answer 4

negative pressure in the pleural space

Question 5

complications of thoracentesis

Answer 5

• pneumothorax
• hemothorax
• infection
• chest wall bleeding
• cough
• vasovagal syncope

Question 6

low pleural pH
pleural glucose <60 mg/dl

Answer 6

exudate

Question 7

quick, inexpensive way to determine if effusion is free flowing following PA chest

Answer 7

lateral decubitus CXR

Question 8

extravascular in origin

Answer 8

chylothorax

Question 9

impaired lymphatic drainage

Answer 9

malignancy

Question 10

increased capillary permeability

Answer 10

parapneumonic effusions

Question 11

transdiaphragmatic movement of fluid from peritoneal cavity

Answer 11

ascites

Question 12

increased transplural pressure gradient

Answer 12

CHF

Question 13

tests necessary prior to diagnostic thoracentesis

Answer 13

• CXR or ultrasound
• platelet count
• PTT

Question 14

what should be the next step following recurrent pleural effusion with no known etiology?

Answer 14

thoroscopy or VATS

Question 15

what test is helpful in establishing transudate?

Answer 15

NT-proBNP

Question 16

what lab test would be helpful for establishing exudate?

Answer 16

• cultures
• CBC w/ diff
• glucose
• pH

Question 17

start antibiotics […] thoracentesis

Answer 17

after

Question 18

a lateral decubitus film can determine if the effusion is

Answer 18

free flowing

Question 19

following PA chest, get what view?

Answer 19

lateral decubitus

Question 20

pleural fluid glucose <60 is consistent with

Answer 20

exudate

Question 21

pleural fluid ADA level >40 is consistent with

Answer 21

TB

Question 22

if suspicion of PE is high but also exibiting pleural effusion what steps should be done first?

Answer 22

immediate anticoagulation, then CTA

Question 23

mechanism of hypoxemia during pleural effusion

Answer 23

increased right to left intrapulmonary shunt

Question 24

TG >110 mg/dl
chylomicrons present

Answer 24

chylothorax

Question 25

TG <110
chylomicrons absent

Answer 25

empyema

Question 26

complication of surgical repair of thoracic aortic aneurysm

Answer 26

post operative chylothorax

Question 27

associated with pus, but not an elevated TG level

Answer 27

empyema

Question 28

usual mechanism associated with malignancy

Answer 28

impaired lymphatic drainage

Question 29

mechanism associated with parapneumonic effusion

Answer 29

increased capillary pressure

Question 30

test best used to search for malignant cells

Answer 30

PF cytology

Question 31

NT-proBNP is helpful if you suspect

Answer 31

CHF

Question 32

most helpful test in establishing transudate vs exudate

Answer 32

pleural fluid protein:serum protein

ratio

Question 33

what is the most common cause of pleural effusion in the US?

Answer 33

CHF

Question 34

treatment for empyema

Answer 34

antibiotics
thoroscopy/VATS

Question 35

effusions associated with peritoneal dialysis are typically

Answer 35

transudate

Question 36

causes of transudate

3

Answer 36

CHF
cirrhosis
nephrotic syndrome

Question 37

causes of exudate

4

Answer 37

• infection
• malignancy
• chylothorax
• trauma

Question 38

pleural fluid protein: serum protein
is >0.5

Answer 38

exudate

Question 39

fluid LDH: serum LDH
is > 0.6

Answer 39

exudate

Question 40

pleural fluid LDH > 2/3 normal

Answer 40

exudate