DISORDERS OF THE PLEURA

Question 1

Pleural effusion occurs when systemic factors that
influence the formation and absorption of pleural fluid are altered. The leading causes are left ventricular failure and cirrhosis.

Answer 1

transudative pleural effusion

Question 2

Pleural effusion occurs when local factors that influence the formation and absorption of pleural fluid are altered. Causes are bacterial pneumonia, malignancy, viral infection, and pulmonary embolism.

Answer 2

exudative pleural effusion

Question 3

there is an excess quantity of fluid in the pleural space.

Answer 3

pleural effusion

Question 4

Diagnosis of px suspected of having a pleural effusion.

Answer 4

Chest Imaging

Question 5

Exudative pleural effusions meet at least one of the following criteria:

1. Pleural fluid protein/serum protein
2. Pleural fluid LDH/serum LDH
3. Pleural fluid LDH

Answer 5

1. Pleural fluid protein/serum protein >0.5
2. Pleural fluid LDH/serum LDH >0.6
3. Pleural fluid LDH more than two-thirds the normal upper limit for serum

Question 6

Transudate pleural effusions meet at least one of the following criteria:

1. Pleural fluid protein/serum protein
2. Pleural fluid LDH/serum LDH
3. Pleural fluid LDH

Answer 6

NONE

Question 7

The most common cause of pleural effusion is

Answer 7

left ventricular failure

Question 8

refers to a grossly purulent effusion.

Answer 8

Empyema

Question 9

Patients with _______ and pleural effusion present with an acute febrile illness consisting of chest pain, sputum
production, and leukocytosis.

Answer 9

aerobic bacterial pneumonia

Question 10

Patients with _____ present with a subacute illness with weight loss, a brisk leukocytosis, mild anemia, and a history of some factor that predisposes them to aspiration.

Answer 10

anaerobic infections

Question 11

Factors indicating the likely need for a procedure more invasive than a thoracentesis (in increasing order of importance):

1. pleural fluid
2. Pleural fluid pH
3. Pleural fluid glucose
4. Gram stain or culture of the pleural space
5. Presence of _____ in the pleural space

Answer 11

1. Loculated pleural fluid
2. Pleural fluid pH <7.20
3. Pleural fluid glucose <3.3 mmol/L (<60 mg/dL)
4. Positive Gram stain or culture of the pleural space
5. Presence of gross pus in the pleural space

Question 12

occurs when the thoracic duct is disrupted and chyle accumulates in the pleural space.

Answer 12

Chylothorax

Question 13

The most common cause of chylothorax is

Answer 13

trauma

Question 14

If the hematocrit is more than one-half of that in the peripheral blood, the patient is considered to have a

Answer 14

hemothorax

Question 15

Transudate Pleural Effusion

Answer 15

1. Congestive heart Failure
2. Cirrhosis
3. Nephrotic syndrome
4. Peritoneal dialysis
5. Superior vena cava syndrome
6. Myxedema
7. Urinothorax

Question 16

is the presence of gas in the pleural space.

Answer 16

Pneumothorax

Question 17

is one that occurs without antecedent trauma to the thorax.

Answer 17

spontaneous pneumothorax

Question 18

occurs in the absence of underlying lung disease in spontaneous pneumothorax

Answer 18

primary spontaneous pneumothorax

Question 19

results from penetrating or nonpenetrating chest injuries.

Answer 19

traumatic pneumothorax

Question 20

is a pneumothorax in which the pressure in the pleural space is positive throughout the respiratory cycle.

Answer 20

tension pneumothorax

Question 21

The initial recommended treatment for primary spontaneous pneumothorax is

Answer 21

simple aspiration

Question 22

Nearly all patients with secondary pneumothorax should be

treated with

Answer 22

tube thoracostomy

Question 23

Most secondary pneumothoraces are due to

Answer 23

obstructive pulmonary disease

Question 24

If the patient is not a good operative candidate or refuses

surgery, _____ should be attempted by the intrapleural injection of a sclerosing agent such as doxycycline.

Answer 24

pleurodesis