Diseases of the pleura

Question 1

What is the pleura?

Answer 1

A single layer of mesothelial cells and sub pleural connective tissue

Question 2

Why is there a negative pressure in the pleura?

Answer 2

Due to the elastic recoil of the lungs

Question 3

About how much pleural fluid lubricates the pleura?

Answer 3

2-3ml

Question 4

What is the dynamic turnover of pleural fluid?

Answer 4

30-75%/hour

Question 5

What is the net flow between pleura?

Answer 5

systemic to pulmonary

parietal to visceral

Question 6

What is the driving pressure in the pleura?

Answer 6

plasma oncotic pressure

Question 7

Name some features the pleura covers

Answer 7

spleen
liver
above first rib
kidneys

Question 8

What is pleural effusion?

Answer 8

Collection of fluid in the pleural space

Question 9

What do the symptoms of pneumothorax depend on?

Answer 9

the cause and the volume of fluid

Question 10

List some of the symptoms of pneumothorax

Answer 10

increasing breathlessness
pleuritic chest pain
gradually worsening if malignant
dull ache
dry cough

Question 11

In a pneumothorax what other things do you need to enquire about?

Answer 11

Peripheral oedema
liver disease
orthopnoea
PND

Question 12

What is orthopnoea?

Answer 12

dyspnoea whilst lying down

Question 13

Name the 4 signs of pneumothorax

Answer 13

reduced expansion
stony dullness on percussion
bronchial breathing
vocal resonance

Question 14

Name some other non respiratory signs of pneumothorax

Answer 14

clubbing
tar staining
lymph nodes
deviated trachea

Question 15

What is a transudate?

Answer 15

absorption of pleural fluid due to high pressure and is usually bilateral

Question 16

What is an exudate?

Answer 16

fluid leaking around cells of capillaries caused by inflammation and is usually unilateral

Question 17

State the values for pleural fluid protein for transudate and exudates

Answer 17

transudate is <30g/l

exudate is >30g/l

Question 18

List some causes of transudates

Answer 18

liver cirrhosis
left ventricular failure 
hypothyroidism
hypoalbuminaemia
ovarian problems

Question 19

List some causes of exudates

Answer 19

malignancy
pulmonary embolism
rheumatoid arthritis

Question 20

How much fluid is required for it to be picked up in a CXR?

Answer 20

20ml

Question 21

What can a CT look for in pneumothorax?

Answer 21

pleural thickening

determine if it is malignant

Question 22

List some complications of aspiration

Answer 22

pneumothorax
empyema
oedema
air embolism

Question 23

If the pH of the fluid is less than 7.2 what does this mean?

Answer 23

there is an infection

Question 24

What can the look and smell of fluid tell you?

Answer 24

pus = empyema and if it smells bad is anaerobic
milky = lymphoma
blood stained = cancer
food particles = oesophageal rupture

Question 25

What things are looked for in the lab in the fluid?

Answer 25

glucose and protein | stain to see the cells => cancer

Question 26

What needle is used in blind biopsies?

Answer 26

Abrams needle

Question 27

How many biopsies samples should you take?

Answer 27

4

Question 28

What should 3 of the biopsy samples be treated with and why?

Answer 28

formaldehyde to kill off TB

Question 29

Where should you biopsy in respect to a rib?

Answer 29

immediately above with cutting edge upwards to avoid hitting the vascular bundle

Question 30

What investigation is done to directly look at the pleura?

Answer 30

(video assisted) thoracoscopy

Question 31

Briefly explain pleurodhesis

Answer 31

patient lies on bed at 45 degree angle with arm above their head and insert thoracostomy tube in 4th intercostal space

Question 32

Why is the thoracostomy tube attached to an underwater seal?

Answer 32

To create a one way system - like a valve

Question 33

What volume should you not drain the pleurodhesis no more than/

Answer 33

500ml/hour

Question 34

What is a pneumothorax?

Answer 34

presence of air within the pleural cavity due to the breach of pleura leading to a collapsed lung

Question 35

Name the 2 broad categories of pneumothorax

Answer 35

spontaneous and traumatic

Question 36

give an example of when a primary spontaneous pneumothorax would occur

Answer 36

in young 20-30 year olds due to a ruptured bleb

Question 37

Give an example when a secondary spontaneous pneumothorax would occur

Answer 37

underlying disease including COPD, CF or asthma

Question 38

What is a tension pneumothorax?

Answer 38

When the trachea is deviated to the side away from the pneumothorax

Question 39

What is the size threshold for small and large rim of air in a pneumothorax?

Answer 39

2cm

Question 40

What is asbestos/

Answer 40

A highly fibrous naturally occurring mineral

Question 41

What colour of asbestos is the worst?

Answer 41

blue

Question 42

With asbestos how long after exposure does the disease occur?

Answer 42

20-40 years

Question 43

What is mesothelioma?

Answer 43

Pleural malignancy

Question 44

What percentage of mesothelioma is related to asbestos?

Answer 44

80%+

Question 45

Is mesothelioma usually unilateral or bilateral?

Answer 45

unilateral