Ch 316: Disorders of the Pleura

Question 1

Normally, fluid enters the pleural space from the ___________ __ ___ ________ ______ and is removed via the lymphatics in the parietal pleura.

Answer 1

capillaries in the parietal pleura

Question 2

The lymphatics have the capacity to absorb __ times more fluid than is formed normally.

Answer 2

20

Question 3

A transudative pleural effusion occurs when ________ _______ that influence the formation and absorption of pleural fluid are altered.

Answer 3

systemic factors

Question 4

The leading causes of transudative pleural effusions in the United States are…

Answer 4

…left ventricular failure and cirrhosis.

Question 5

An exudative pleural effusion occurs when _____ _______ that influence the formation and absorption of pleural fluid are altered.

Answer 5

local factors

Question 6

The 4 leading causes of exudative pleural effusions are…

Answer 6

…bacterial pneumonia, malignancy, viral infection, and pulmonary embolism.

Question 7

Exudative pleural effusions meet at least one of the following criteria, whereas transudative pleural effusions meet none:

Pleural fluid protein/serum protein > 0.5

Pleural fluid LDH/serum LDH > 0.6

Pleural fluid LDH more than two-thirds the normal upper limit for serum.

These criteria misidentify __% of transudates as exudates.

Answer 7

~ 25%

Question 8

If one or more of the exudative criteria are met and the patient is clinically thought to have a condition producing a transudative effusion, the difference between the protein levels in the serum and the pleural fluid should be measured. If this gradient is > _____, the exudative categorization by these criteria can be _______ because almost all such patients have a transudative pleural effusion.

Answer 8

31 g/L (3.1 g/dL)

ignored

Question 9

The effusion caused by left ventricular failure occurs because the increased amounts of fluid in the ____ ____________ ______ exit in part across the visceral pleura; this overwhelms the capacity of the lymphatics in the parietal pleura to remove fluid.

Answer 9

lung interstitial spaces

Question 10

A pleural fluid N-terminal pro-brain natriuretic peptide (NT-proBNP) > ____ ____is virtually diagnostic that the effusion is secondary to congestive heart failure.

Answer 10

1500 pg/mL

Question 11

Pleural effusions occur in ~5% of patients with cirrhosis and ascites. The predominant mechanism is the direct movement of __________ _____ through small openings in the _________ into the pleural space.

Answer 11

peritoneal fluid

diaphragm

Question 12

The three tumors that cause ~75% of all malignant pleural effusions are…

Answer 12

…lung carcinoma, breast carcinoma, and lymphoma.