Lecture 8 Pleural Effusion (missed lecture)

Question 1

Normal pleural fluid: 
 pH is (acidic or alkaline); most cells are \_\_\_\_\_, there are no \_\_\_\_ typically

Answer 1

alkaline (7.6); MQ, no PMNs

Question 2

pleural fluid is produced by the ____ pleura and absorbed by the ___ pleura. the pleural space should be virtually ____ free

Answer 2

parietal, visceral;

fluid

Question 3

fluid accumulates in the pleural space by 3 mechanisms:
increased ____ of fluid into the space, increased production of fluid by ____ in the space, decreased ____ of fluid from the space

Answer 3

drainage, cells; drainage

Question 4

at FRC, the intrapleural pressure is ____, preventing _____

Answer 4

negative, pneumothorax

Question 5

development of pleural effusion:
____ pulmonary capillary pressure such as CHF;
increased capillary permeability such as in ____;
____ intrapleural pressure such as in atelectasis

Answer 5

increased,
pneumonia,
increased

Question 6

development of pleural effusion:

____ plasma oncotic pressure such as nephrotic syndrome,

Answer 6

decreased

Question 7

a chylothorax is due to ____ injury from trauma or malignancy. there is a large amount of _____. a pseudochylothorax has a high amount of ___

Answer 7

throacic duct; triglycerides (ie greater than 110); cholesterol (ie greater than 250)

Question 8

transudate vs exudate:
which has a high protein count? 
which is cloudy?
which us usually bilateral?
which occurs in states of increased vascular perm?

Answer 8

exudate, exudate, transudate, exudate

Question 9

malignancy, pneumonia, collagen vascular disease, pancreatitis, and trauma all cause an ____ effusion

Answer 9

exudate

Question 10

causes of transudative effusion: hepatic ____, _____, ____ syndrome

Answer 10

cirhossis, CHF, nephrotic

Question 11

with pleural effusion, there is restricted lung ____ during ____. On physical exam, there is ____ to percussion, ____ tactile fremitus, ____ breath sounds, and _____.

Answer 11

expansion, inspiration;

dullness, decreased, decreasedd egophony

Question 12

CXR shows blunted _____ angles. what position is most sensitive for CXR?

Answer 12

costophrenic;

lateral decubitus

Question 13

fluid in CXR is seen as a dense ___ shadow with a ____ upper edge

Answer 13

white; concave

Question 14

in atelectasis, the heart and mediastinum are shifted ____ the whited out hemithorax. in a massive pleural effusion, the heart and mediastinum are shifted ____ the whited out hemithorax

Answer 14

toward; away from

Question 15

in thoracentesis, the needle should be inserted through the ____ border of the ____ rib

Answer 15

upper, lower

Question 16

pleural fluid lactate dehydrogenase: serum LDH ratio:

in ____ it is less than 0.6. in ____, it is greater than 0.6

Answer 16

transudate; exudate;

ie exudate has increased LDH.

Question 17

in an empeyema pleural effusion, pH is ____ and gluocse concentration is ____

Answer 17

reduced (ie acidic), reduced

Question 18

What other condition usually causes a low gluocse concentration in the pleural fluid?

Answer 18

rheumatoid pleurisy

also malignancy, Tb

Question 19

lactate levels are significantly higher in ____ and ____ pleural effusions than in other pleural effusions

Answer 19

bacteria, Tb

Question 20

pleural effusions with elevated amylase typically indicate ____, ____ rupture, or malignancy

Answer 20

pancreatitis, esophageal

Question 21

pleural effusions:
high Adenosine deaminase usually indicates ____;
high interferon gamma usually indicates ____

Answer 21

Tb, Tb pleuritis

Question 22

markedly increased numbers of mesothelial cells + blood or eiosinophillic effusions suggests _____ as the cause of effusion

Answer 22

pulmonary embolism

Question 23

a pleural biospy is most helpful in evaluating for ____.

Answer 23

Tb;

also maybe sarcoid, fungal

Question 24

3 stages of empyema:

Answer 24

exudative (1-3 days), fibrinopurulent (4-14 days), organizational (after 14 days)