Diseases of the pleura

Question 1

The pleura

Answer 1

single layer of mesothelial cells

sub-pleural connective tissue

Question 2

…….ml of fluid between visceral and parietal pleura

Answer 2

2-3ml

Question 3

Pleura lies…

Answer 3

above the first rib

over the liver, spleen and kidney

Question 4

Symptoms of pleural effusion

Answer 4

increasing SOB

Pleuritic chest pain

Dull ache

Dry cough

(weight loss, malaise, fevers, night sweats)

Question 5

Signs of pleural effusion

Answer 5

Chest on the effected side will be:

reduced expansion

stony dullness to percussion

reduced breath sounds

reduced vocal resonance

Question 6

Pleural effusion causes

Answer 6

an imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid (transudate)

increased permeability of pleural surface and/or local capillaries (exudate)

Question 7

Pleural effusion

pleural fluid protein is less than (exudate)

Answer 7

35g/l

Question 8

At least …..ml is required before a pleural effusion can be seen on a chest radiograph

Answer 8

200ml

Question 9

Investigation of pleural effusion

Answer 9

CXR

CT of thorax (differentiates between malignant and benign disease)

pleural aspiration or biopsy (taken from immediately above a rib)

(if still no diagnosis - thoracoscopy)

Question 10

Pleural effusion

pleural fluid protein is less than (transudate)

Answer 10

> 25g/l

Question 11

Management of Pleural Effusion

treatment directed at cause

Answer 11

chemotherapy

anti-tuberculosis chemotherapy

cortico steroids

pleurodhesis (fluid drained form pleural cavity)

Question 12

Management of Pleural Effusion

Palliative

Answer 12

repeated pleural aspiration

Question 13

Management of Pleural Effusion

Clinically

Answer 13

Pleurodhesis (patient lies at 45 degree arm above head - fluid is drained no faster than 500ml/hour)

Question 14

Pneumothorax

Answer 14

Presence of air within the pleural cavity

Question 15

Iatrogenic

Answer 15

illness relating to medical treatment

Question 16

Spontaneous pneumothorax

PRIMARY

Answer 16

believed to be due to the weight of the lung - inducing development of radical blebs that eventually rupture

Question 17

spontaneous pneumothorax

SECONDARY

Answer 17

pre-existing lung disease (COPD, asthma, pneumonia, cystic fibrosis, TB etc)

Question 18

Traumatic pneumothorax

non-iatrogenic

Answer 18

stab wound/ gunshot

rib fracture

Question 19

Traumatic pneumothorax

iatrogenic

Answer 19

pleural aspiration/biopsy

lung, liver, breast biopsy

acupuncture

Question 20

Pneumothorax Symptoms

Answer 20

Asymptomatic (if small good respiratory reserve)

Acute SOB

Worsening SOB

Question 21

Pneumothorax signs

Answer 21

emphysema (if extreme leak)

trachea deviation

increased JVP

Question 22

Small pneumothorax (cm)

Answer 22

<2cm

Question 23

Large pneumothorax (cm)

Answer 23

> 2cm

Question 24

Management of small primary pneumothorax

Answer 24

observe overnight (repeat CXR)

discharge (it will resolve itself at 1.25% her day)

return for CXR after 2 weeks

Question 25

Management of breathless primary pneumothorax

Answer 25

aspirate pneumothorax

patient at 45 degrees

Lignocaine (numbing) into second intercostal space - mid clavicular line then 50ml syringe

Question 26

Management of breathless secondary pneumothorax

Answer 26

insert intercostal chest drain (4th intercostal space, mid-axillary line)]

using small bore not syringe

Question 27

intercostal chest drain for pneumothorax

Answer 27

ideally - lung inflates in 1-2 days

Drain stops bubbling

CXR confrims lung inflated

(if lungs do not re-inflate - you apply suction to the drain)

Question 28

There is a high risk of subsequent pneumothorax - therefore the patient can undergo surgical

Answer 28

pleurodesis

Question 29

Pleurodesis

Answer 29

surgery where the pleural space is artificially obliterated