Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Hospital Based Medicine And Surgery > L04: Effusions > Flashcards

L04: Effusions Flashcards

1
Q

What is the pleural space

A

The space betwwen the viscera and the parietal plerua

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the visceral pleura cover

A

The lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the parietal pleura cover

A

The chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is in the pleural space

A

Pleural fluid

Low protein content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 2 types of pleural disease

A

Pleural effusion

Pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is pleural effusion

A

Build up of fluid in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is pneumothorax

A

Build up of air in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the types of pleural effusion according to the fluid

A

Transudate

Exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is transudate

A

Fluid that appears clear and protein content is low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is exudate pleural effusion

A

Due to an inflammatory process, fluid is cloudy and fluid content is high protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the causes of transudate fluid

A

Failures: heart failure, liver failure, renal failure

Hypoabuminaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the causes for exudate fluid

A

Infections
Malignancy
PE
Inflammation; pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the presentations/symptoms for pleural effusion

A

Short of breath
Pleuritic chest pain
Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If the effusion is more than 300ml what are the physical examination findings that you may find

A

Dullness to percusion
Decreased tactile fremitus
Decreased breath sounds
Decreased focal resonance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the gold standard diagnostic investigation for pleural effusion

A

Cxr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

After confirming that there is a pleural effusion what is the next step

A

To determine the fluid and take the fluid out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do we take the fluid out in a pleural effusion

A

By aspiration (thoracentesis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When the fluid is taken out by aspiration what happnes to the fluid

A

Is taken to :
Biochemistry: protein, LDH, protein
Microbiology: for infection, gram stain, microbiology, culture, tb
Cytology: for maligant cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

After sending the pleural effusion sample what is the next question we need to determine

A

Is the effusion exudate or transudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do we tell the difference between exudate and transudate fluid

A

Exudate: pleural fluid is more than 35
Transudate: pleural fluid is less than 25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What happens if the fluid has a protein content between 25-35, how do we determine what fluid it is

A

We use the LIGHTS criteria to differentiate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If the fluid is transudate what is the next step

A

Confirm the cuase by taking a history and examiantion
Lft, renal function and serum protein
Echo or liver ultrasound to exclude heart failure or cirrhosis

23
Q

What is the management of transudate pleural effusion

A

Treat the cause

24
Q

What is the next step if the fluid is exudate

A 
Check:
Fluid ph
Fluid mcs and afb
Fluid cytology
Infection markers: crp,esr
25
Q

What are the types of exudative fluid

A

Para-pneumonic

Empyema

26
Q

What are the deatures of parapneumonic

A

Ph more than 7.2
Fluid cytology: no malignant cells
Fluid mcs and tb negative
Infection markers raised

27
Q

What are the features of empyema

A

Fluid ph less tha 7.2
Fluid cytology: no malignant cells
Fluid mcs and tb: negaitve for tb
Infection markers rasied

28
Q

What is the management of parapneumonic effusion

A

Antibiotics

Therapeutic drainage- if large and symptomatic

29
Q

What is the management of empyema effusion

A

Prolonged antibiotics
Urgent chest drain to drain the fluid
Consider surgical referral to remove the pleural fluid

30
Q

What is the presentation of tb effusion

A 
General fatigue
Night sweats
Shortness of breath 
Unexplained weightloss
Fever
31
Q

What type of fluid will tb effusion have

A

Exudate

32
Q

What can malignancy causing pleural effusion be

A

Primary: mesothelioma
Secondary: cancer

33
Q

To confirm the diagnosis of pleural effusion what will the fluid be

A

Exudate

Show malignant cells in cytology

34
Q

If the is a primary pleural malignancy what is the next step

A

Pleural biopsy

35
Q

What is the treatment for malignant effusion

A

Treat the underlyling malignancy

Treat the symptoms with aspiration or chest drain

36
Q

If there is recurrence of pleural effusion due to the malignacy what is the management

A

permanent chest drain
Pleurodesis: chest drain over 24-48 hours and insertion of talc that causes an inflammatory reaction between parietal and visceral pleura so they stick together

37
Q

What are the types of pneumothorax

A

Spontaneous pneumothorax
Traumatic pneumothorax
Tension pneumothorax

38
Q

What is spontaneous pneumothorax

A

Pneumothorax that occurs without trauma

39
Q

What is traumatic pneumothorax

A

Results from penetration or non penetrating chest injury

40
Q

What is spontaneous pneumothorax due to

A

Primary: occurs in young tall slim males
Secondary: to an underlying disease e.g copd, asthma, intersitial lung disease

41
Q

What is the presentation of spontanous pneumthorax

A

Suddent onset of pleuritic chest pain

Shortness of breath

42
Q

On examination what would a pneumothorax show

A 
Tachycardia
Hyper-resonance to percussion
Decreased chest expainsion
Decreased breath sounds
Decreased focal resonance on the side of pneumothorax
43
Q

What is the main investigation for pneumothorax

A

Chest-xray

44
Q

What is the treatment of primary spontaneous pneumothorax

A

If patient is asymptomatic and pneumothorax is less than 2cm then dishcarge and outpatient follow up in 2-4 weeks

45
Q

What is the treatmetn for someone who is symptomatic and has a depth more than 2cm

A

Aspirate using 12-18 canula if it improves discharge

46
Q

If the patient remain symptomatic after a pneumothorax what is the treatmetn

A

Chest drain

47
Q

What is the treatment for spontaneou secondary pneumothorax

A

If symptomatic and more than 2cm: chest drain
If depth is between 1-2cm: aspiration
If depth is less than 2cm: observe for 24 hours then discharge

48
Q

What is tension pneumothorax

A

When air enters into the the pleural space with each inspiration and is unable to escape on expiration, so pressure build up and compresses the lung and mediastinum

49
Q

What does the pressure on the mediastinum lead to

A

Heart becoming comresses which compresses the venous return to the heart leadinf to hypotension and potential cardiac arrest

50
Q

What is the presentation of tension pneumothorax

A 
Acute respiratory distress
Hypotension
Raised jvp
Tracheal deviation away from the pneumothorax side
Reduced air entry on affected side
51
Q

What is the management of tension pneumothorax

A
  1. High flow oxygen
  2. Insert large bore canulla into the 2nd intercostal space mid clavicular line on side of pneumothorax
  3. Air will hiss to confirm the diagnosis
52
Q

When the patient with tension pneumothorax is stable what is the next step

A

Carry out a chest x-ray

Insert a chest drain

53
Q

Where is a chest drain inserted

A

Triangle of safety:
5th ICS
Mid axillary line
Anterior axillary line

54
Q

When is needle aspiration contraindicated in spontaneous pneumothorax

A

Tension pneumothorax
Recurrent
Underlying lung disease

Hospital Based Medicine And Surgery (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions