disorders of pleura and mediastinum

Question 1

Pleural fluid should be sent to check for what sort of things:

Answer 1

– Protein
– Glucose
– Lactate dehydrogenase (LD)
– Cell count
– Gram stain
– Culture

Question 2

Pleural effusion is considered an exudate if the lab findings show?

Answer 2

EXUDATE: Protein >0.5 and LD >0.6

Question 3

Pleural effusion is considered an transudate if the lab findings show?

Answer 3

TRANSUDATE–> Glucose in pleural fluid = Glucose in serum & if pH is slightly elevated at 7.4-7.55

Question 4

If there is increase fluid due to ABNORMAL CAPILLARY PERMEABILITY, this is most likely due to what kind of pleural effusion?

Answer 4

Exudate

Question 5

If there is increase fluid due to INCREASED HYDROSTATIC PRESSURE, this is most likely due to what kind of pleural effusion?

Answer 5

Transudate

Question 6

What is the common causes for EXUDATE pleural effusions?

Answer 6

CA or Pneumonia

Question 7

What is the common cause for TRANSUDATE pleural effusions?

Answer 7

Heart Failure!

Can also be caused by cirrhosis, atelectasis

Question 8

What is pus in the pleura called?

Answer 8

empyema

Question 9

Typical patient where pleuritis is seen in?

Answer 9

Young patient who just had a Viral URI or Pneumonia

Question 10

A 25 year old male patient comes in with localized, sharp fleeting CP. He says that it worsens with coughing or sneezing and sometimes it radiates to his shoulder. On Xray, you see consolidation of fluid… Most likely diagnosis? TX?

Answer 10

DX: Pleuritis or Pleurisy

Tx: Treat underlying cause + Sx relief with analgesics or NSAIDS

Question 11

Pt X comes in after falling a terrible traumatic fall. He is completes short of breath, RR>30 and he looks blue. On PE, you hear diminished breath sounds but only on one side. XR: shows fluid Thoracentesis shows blood… Primary DX? TX? most common complication you worry about?

Answer 11

DX: Hemothorax

TX: Large bore thoracostomy tube to drain out

C: Bronchopleural fistula

Question 12

What is a common cause for pleurisy?

Answer 12

Rib fx

Question 13

A 55 yo male comes in today with dilated veins and swelling around his face and neck. He says that the swelling is heightened in the morning and subsides throughout the day. He complains of HA and dizziness. Both of which is worse when he says supine. Dx? Most common cause for DX? Tx?

Answer 13

Dx: SVC Syndrome - probably caused by a neoplasm

Tx: well you would refer… but they would treat the neoplasm (chemo, rad) and maybe do a balloon stent for the SVC

Question 14

What is the most common complication you worry about with mediastinal tumors?

Answer 14

Mediastinal tumors= HIGH RATE OF RECURRENCY

Question 15

What can you do to treat mediastinal tumors?

Answer 15

Nothing really, just SYMPTOM TX

Question 16

A 30 yo scuba instructor, thin M comes in with unilateral CP. On PE, you find diminished tactile fremitus and hyperressonance. Over the day, patient notices that the CP resolved within 24 hours. On XR you see a “ Visceral Pleural line”… DX? and Pt Ed for this patient?

Answer 16

Pneumothorax

Pt Ed: Sir, you need to not scuba due to increased pressures that could worsen the pneumothorax and you’ll regret it

Question 17

TX for Pneumothorax

Answer 17

if its small= observe

Large= tube thoracostomy

Question 18

Most common cause for parapneumonic effusion?

Answer 18

Strep pneumonia

Question 19

Is paraneumonic effusion an transudate or exudate?

Answer 19

EXUDATE because remember the earlier card said that exudates are commonly caused by CA or pneumonia, hence paraPNEUMONic

Question 20

Spontaneous pneumothorax is usually accompanied by chest pain and occurs most often in:

Answer 20

thin, young males, or in those with underlying lung disease

Question 21

Pulmonary embolism should always be suspected when a patient with NEW DYSPNEA reports a recent history of:

Answer 21

prolonged IMMOBILIZATION or HOSPITALIZATION, estrogen therapy, or DVT risk factors.

Question 22

Most patients with PLEURITIC CHEST pain in outpatient clinic have:

Answer 22

PLEURISY due to acute viral respiratory tract infection

Question 23

Absent breath sounds suggest:

Answer 23

PNEUMOTHORAX

Question 24

If someone has SOB, the most appropriate test is:

Answer 24

Chest XR. Even a normal CXR has substantial diagnostic value.

Question 25

Patient has dyspnea but no physical exam findings of COPD or HF, and CXR is normal. The remaining cause of dyspnea include:

Answer 25

PULMONARY EMBOLISM, upper airway obstruction, foreign body, anemia, metabolic acidosis

Question 26

Persistent uncertainty following clinical examination and routine diagnostic test ins (CXR), warrants:

Answer 26

ABG measurement