Diseases of the Pleura

Question 1

What is the pleural

Answer 1

Single layer of mesothelial cells and the space between the parietal and visceral layers

Question 2

What type of pressure is between the parietal and visceral

Answer 2

Negative pressure

Question 3

How much pleural fluid is the lungs lubricated by

Answer 3

2-3ml

Question 4

What is the dynamic turnover of pleural fluid

Answer 4

30-75% per hour

Question 5

Straw coloured pleural effusion

Answer 5

Normal

Question 6

Cloudy pleural effusion

Answer 6

Exudate

Infection

Question 7

Milky pleural effusion

Answer 7

Chylothorax from lymph formed in the digestive system called chyle accumulating and disrupting the thoracic duct

Question 8

Blood in pleural effusion

Answer 8

Malignancy
TB
Trauma
Infarct

Question 9

Pus in pleural effusion

Answer 9

Empyema

Question 10

Diagnostic tests

Answer 10

Biochemistry: protein, LDH, glucose, triglyceride, cholesterol,amylase, rheumatoid factor
Microbiology: Gram stain, ZN stain and culture
Cytology

Question 11

What is transudate

Answer 11

fluid pushed through the capillary due to high pressure within the capillaries (high vascular hydrostatic or oncotic pressure)

Question 12

Protein content with transudate

Answer 12

<2.5

Question 13

What is exudate

Answer 13

fluid that leaks around cells of the capillaries caused by inflammation

Question 14

Protein content in exudate

Answer 14

> 3.5

Question 15

What is Dressler syndrome

Answer 15

pericarditis — inflammation of the sac surrounding the heart (pericardium). Believed to be an immune system response after damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury

Question 16

Features of Abrams pleural biopsy (4)

Answer 16

Beside
Local anaethesia
Blind
Diagnostic

Question 17

Features of Image guided biopsy (4)

Answer 17

Day case
Local anaesthesia
Image guided
Diagnostic

Question 18

Features of Medical thoracoscopy (4)

Answer 18

Sterile procedure room
Local and sedation
Direct visualisation
Pleurodesis

Question 19

What is a Pleurodesis

Answer 19

Pleurodesis is a procedure that uses medicine to adhere your lung to your chest wall. It seals up the space between the outer lining of your lung and chest wall (pleural cavity) to prevent fluid or air from continually building up around your lungs

Question 20

Features of a Vats pleural biopsy (4)

Answer 20

Theatre
General anaesthesia
Direct visualisation
Pleurodesis

Question 21

When should you drain an effusion (7)

Answer 21

Breathlessness
Raised RR
Hypoxia
Tachycardic
CXR shows deviated trachea 
Pus
Trauma/post operative

Question 22

Where should the chest tube be placed

Answer 22

Above the rib to avoid the neural vascular bundle

Question 23

What pH should you carry out a drain and why

Answer 23

<7.2

This shows high infection as bacteria are producing lactic acid and causing the pH to decrease

Question 24

Management for pleural effusion

Answer 24

Do nothing (be careful of bullous lung disease)
Aspiration
Oxygen and chest drain insertion

Question 25

Long term treatment for pleural effusion

Answer 25

Home with chest drain Medical pleurodesis using sclerosing agents Cardiothoracic referral -VAT

Question 26

What is a tension pneumothorax

Answer 26

A large pneumothorax causing cardiorespiratory compromise

Question 27

Complications of tension pneumothorax

Answer 27

``` Trachea deviated Subcutaneous emphysema Reduced chest excursion Hyperresonance Hypoxia Tachycardia Hypotension Cardiac arrest ```

Question 28

Treatment for tension pneuothorax (3)

Answer 28

Oxygen Aspirate in the 2nd anterior intercostal space in the midclavicular line CXR and US to confirm

Question 29

Features of Asbestos related pleural disease

Answer 29

``` Occupation Latent period (20-40 years) ```

Question 30

Features of Pleural plaques (4)

Answer 30

Incidental findings Benign Marker of previous asbestos exposure May be entitled to compensation

Question 31

Features of benign asbestos effusion (6)

Answer 31

``` Diagnosis of exclusion Exudate Lymphocytic May be blood stained Can resolve spontaneously Associated with pleural thickening ```

Question 32

Features of malignant mesothelioma

Answer 32

``` Chest pain SOB Fever Weakness Cough Weight loss Blood stained effusion RNS ROS ```