Goroll Chapter 43- Pleural Effusion

Question 1

What is the most common cause of effusion with transudate?

Answer 1

CHF (increases pulmonary capillary pressure causing excess fluid to go into interstitial; usually bilateral effusions)

Question 2

When is an effusion considered transudative?

Answer 2

1. ratio of pleural fluid protein to serum protein is <0.6
2. pleural fluid LDH concentration is less thatn 2/3 of the upper limit of normal for the serum LDH concentration

IF THESE RATIOS ARE EXCEEDED, THE EFFUSION IS EXUDATIVE

Question 3

What produces transudates?

Answer 3

increased hydrostatic pressure in the pulmonary interstitium and decreased colloid oncotic pressure

Question 4

Are transudates accompanied by pleural pain?

Answer 4

no, but can lead to SOB if large enough

Question 5

What are PE of transudative PE?

Answer 5

dullness and diminished breath sounds

Question 6

What do exudates result from?

Answer 6

inflammatory or infiltrative disease of the pleura and its adjacent structures; damage occurs to capillary membranes and protein-rich material accumulates in the pleural space

Question 7

What is the tumor most associated with pleural effusion?

Answer 7

bronchogenic carcinoma

Question 8

What are the S/S associated with bronchogenic carcinoma that caused PE?

Answer 8

dyspnea if PE is large; pleuritic CP; clear or straw-colored fluid

Question 9

What is the leading metastatic tumor leading to PE?

Answer 9

carcinoma of the breast

Question 10

Is metastatic carcinoma more likely bilateral or unilateral?

Answer 10

Bilateral b/c its a consequence of lymphatic obstruction or diffuse seeding of the pleura

Question 11

What is empyema?

Answer 11

When organisms are found in the pleural effusion fluid; cough, sputum production, fever, chills, pleuritis pain

Question 12

What symptoms are assoc. with postprimary TB that causes PE?

Answer 12

lethargy, fever, weight loss; possible acute onset of pleuritic pain and fever

Question 13

What is assoc. with intraabdominal pathology causing exudative PE?

Answer 13

Seen with recent abd surgery, intestinal perf, or hepatobiliary disease

GI symptoms, pleuritic pain, fever, weight loss, malaise, elevated diaphragm on involved side, possible air fluid level

Question 14

What are drugs that cause PE?

Answer 14

nitrafuratoin
Phenytoin
amiodarone
methotraxate

Question 15

What are 9 causes of transudative PE?

Answer 15

CHF
hypoalbuminemia
salt-retention syndromes
ascites secondary to cirrhosis
early phases of sympathetic effusion
neoplasm
peritoneal dialysis
postpartum
cardiac bypass graft surgery

Question 16

What are 16 causes of exudative PE?

Answer 16

Bronchogenic carcinoma
Breast cancer
Lymphoma
Mesothelioma
Meigs' syndrome
TB
Bacterial pneumonia (including empyema)
Viral pneumonitis
Mycoplasmal pneumonia
Pneumocystis pneumonia
Pulmonary embolization
RA
Systemic lupus erythematosus
Subphrenic abscess
Pancreatitis
Idiopathic

Question 17

What are physical findings of PE?

Answer 17

incidental finding on chest x-ray

dullness and diminished breath sounds confirmed by x-ray