Category II - Pleural Effusion

Question 1

Type of effusion due to alteration of SYSTEMIC factors that influence formation and absorption of pleural fluid.
A. Transudative
B. Exudative

Answer 1

A. Transudative
Leading causes: LV failure, cirrhosis

EXUDATIVE: alteration of LOCAL factors
Leading causes: bacterial pneumonia, malignancy, viral infection, pulmonary embolism

Question 2

In the Light’s criteria, how many of the criteria should be fulfilled to denote an exudative effusion?

Answer 2

ANY!! Or only ONE.

Question 3

What is the correct pairing
A. PF/serum protein >0.6
B. PF/serum LDH >0.5
C. PF LDH >2/3 upper normal serum limit
D. None of the above
E. All of the above

Answer 3

C. PF LDH >2/3 upper normal serum limit

Question 4

An increase in pleural fluid amylase level can denote what disease entities?

Answer 4

Esophageal rupture
Pancreatic pleural effusion
Malignancy

Question 5

If despite meeting criteria for exudative effusion BUT clinical consideration is transudative, a serum-PF protein gradient of ____ g/L can denote that a patient likely has a TRANSUDATIVE pleural effusion.

Answer 5

> 31 g/L

Question 6

The most common cause of pleural effusion

Answer 6

LV failure

PF pro-BNP level >1500 pg/mL is virtually diagnostic of CHF as a cause of effusion.

Question 7

The most common cause of exudative pleural effusion.

Answer 7

Parapneumonic effusion

Question 8

Give at least 2 factors indicating need for tube thoracostomy

Answer 8

(In increasing order of importance)

1. Loculated PF
2. PF pH <7.20
3. PH glucose <60 mg/dL
4. Positive gram stain or culture of PF
5. Presence of gross pus in the pleural space

Question 9

The 2nd most common type of exudative pleural effusion

Answer 9

Malignant pleural effusions from metastatic disease

Approx 75% of malignant pleural effusions are caused by the 3 tumors: lung CA, breast CA, lymphoma

Question 10

Sclerosing agents that can be used for pelurodesis

Answer 10

Talc

Doxycycline

Question 11

TB markers in pleural fluid (2)

Answer 11

1. Adenosine deaminase >40 IU/L

2. Gamma interferon >140 pg/ml

Question 12

Treatment of choice for chylothorax

Answer 12

Chest tube insertion + octreotide

PF: milky, triglyceride level >110 mg/dL

Question 13

Diagnosis of hemothorax involves the finding of PF hematocrit level _____% of peripheral blood hematocrit

Answer 13

50%