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Clinical Medicine II > Disorders of the Pleura > Flashcards

Disorders of the Pleura Flashcards

1
Q

Abnormal accumulation of fluid in the pleural space. It is not a disease itself but a sign of a disease.

A

Pleural effusion

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2
Q

Direct infection of pleural space (grossly purulent/turbulent)

A

Empyema

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3
Q

Chest trauma with gross blood

A

Hemothorax

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4
Q

Due to high cholesterol

A

Chyloform

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5
Q

Circulatory system fluid due to either an increase in hydrostatic and/or oncotic pressure NOT by inflammation and not due to local pleural disease

A

Transudate

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6
Q

What is the most common cause of transudate?

A

CHF (>90%)

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7
Q

Other than CHF, what can cause transudate?

A

Nephrotic syndrome, cirrhosis, atelectasis

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8
Q

PE’s usually result in pleural effusions of ____

A

Exudate

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9
Q

Occurs when local factors increase vascular permeability (ex. infectious process)

A

Exudate

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10
Q

Any fluid that filters from circulatory system into areas of inflammation (contains an increase in plasma proteins, WBCs, platelets +/- RBCs)

A

Exudate

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11
Q

What is exclusive to exudates?

A

Lights criteria: To be considered an exudate it must have ONE of lights criteria

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12
Q

Pleural fluid protein:Serum protein ratio for exudate with light’s criteria

A

> 0.5

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13
Q

Pleural fluid LDH:Serum LDH ratio for exudate with light’s criteria

A

> 0.6

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14
Q

Pleural fluid LDH must be greater than _____ upper limit of normal LDH

A

2/3

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15
Q

Asymptomatic symptoms with dyspnea and “pleuritic” chest pain*** and cough

A

Pleural effusion

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16
Q

On PE, a pleural effusion will have _____ tactile fremitus, _____ breath sounds, and _____ to percussion

A

Decreased
Decreased
Dullness

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17
Q

In extreme cases, pleural effusions can cause lung collapse or mediastinal shift to _______ side

A

contralateral

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18
Q

How do you diagnose a pleural effusion?

A

CXR

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19
Q

How much fluid can be seen on a PA CXR?

A

> 175cm

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20
Q

Blunting of costophrenic angles with or without loculations

A

Menisci

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21
Q

Pleural effusions are _____ for menisci on x-rays

A

Positive

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22
Q

What film is the best type of film to check for a pleural effusion?

A

Lateral decubitus

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23
Q

Why is a lateral decubitus film best to diagnose a pleural effusion?

A

Detects smaller effusions, differentiates location and makes it so you can tell the difference between new effusions or scarring

24
Q

How do you confirm empyema?

A

CT scan

25
Q

What causes loculations?

A

pleural adhesions

26
Q

How do you manage a pulmonary effusion?

A

Treat underlying condition
Thoracentesis
Thoracentesis for pleural fluid drainage

27
Q

What is a pleurodesis?

A

Gets rid of pleural space to prevent chronic pleural effusions. Obliteration of pleural space with talc and bleomycin.

28
Q

What is the gold standard treatment for a pleural effusion?

A

Thoracentesis

29
Q

Do not remove more than ____L of fluid during a thoracentesis in one procedure

A

1.5L

30
Q

If the pleural fluid pH is less than 7.2

A

empyema

31
Q

____ are associated with leaky capillaries from infection, malignancy, and trauma

A

Exudates

32
Q

______ are associated with increased hydrostatic or decreased oncotic pressure; examples include CHF, atelectasis and renal or liver disease

A

Transudates

33
Q

An infection within the pleural space

A

Empyema

34
Q

Empyema requires a thoracentesis and ___?

A

Antibiotic therapy

35
Q

_____ Pleural effusions resolve when underlying causes are treated

A

Transudate

36
Q

Air within the pleural space

A

Pneumothorax

37
Q

What causes the lung to collapse in a pneumothorax?

A

Positive pleural pressure

38
Q

What are the three types of pneumothorax?

A

Spontaneous
Traumatic
Tension

39
Q

What are the two types of spontaneous pneumothorax?

A

Primary and secondary

atraumatic and idiopathic

40
Q

No underlying disease; mainly affects tall, thin men 20-40 (Max you’re screwed), smokers, and those with a family history

A

Primary spontaneous pneumothorax

41
Q

Underlying lung disease (COPD, asthma), occurs without trauma

A

Secondary spontaneous pneumothorax

42
Q

Can be caused by iatrogenic causes - CPR, thoracentesis, PEEP, subclavian lines or other trauma

A

Traumatic pneumothorax

43
Q

When + air pressure pushes lungs, trachea, and the heart to the contralateral side

A

Tension pneumothorax

44
Q

Which type of pneumothorax is immediately life threatening?

A

Tension pneumothorax

45
Q

How do you manage a tension pneumothorax?

A

Needle aspiration followed by chest tube thoracostomay

46
Q

What are the clinical manifestations of a pneumothorax?

A

Chest pain (usually pleuritic and unilateral)
Non exertional in onset
Dyspnea

47
Q

A pneumothorax shows ____ hyper-resonance, _____ fremitus, and ______ breath sounds

A

Increased hyper resonance
Decreased remits
Decreased breath sounds

48
Q

How do you diagnose a pneumothorax?

A

CXR with expiratory view

49
Q

What does a CXR of a pneumothorax show?

A

Companion lines*, decreased peripheral markings, and a deep sulcus

50
Q

How do you manage a pneumothorax?

A

Observation if small
Chest tube placement
Needle aspiration

51
Q

How small does a pneumothorax need to be for it to close spontaneously?

A

Less than 20%

52
Q

If its a tension pneumothorax, what do you do first?

A

Needle aspiration

53
Q

Where do you place the needle for a needle aspiration of a tension pneumothorax?

A

2nd intercostal space in the midclavicular line

54
Q

What do you do once you perform a needle aspiration on a patient with a tension pneumothorax?

A

Place a chest tube

55
Q

Why is a tension pneumothorax so dangerous?

A

It compromises the cardiovascular system

Clinical Medicine II (10 decks)

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