Pleura

Question 1

What are the 2 layers of pleura?

Answer 1

Visceral pleura

Parietal Pleura

Question 2

How much fluid is there inbetween the pleural layers?

Answer 2

2-3ml

Question 3

Is the pressure in the pleura positive or negative?

Answer 3

Negative

Question 4

Where does the pleura extend?

Answer 4

Above the first rib

Goes further down also

Question 5

What is a pleural effusion?

Answer 5

This is an abnormal collection of fluid in the pleural space

Question 6

What does the symptoms of pleural effusion depend on?

Answer 6

The cause of the effusion

And the volume of fluid that has accumulated

Question 7

What are the symptoms of pleural effusion?

Answer 7

Increasing breathlessness
Pleuritic chest pain 
Inflammation 
Dull ache 
Dry cough 
Weight loss 
Malaise
Fevers
Night Sweats

Question 8

What is pleurisy?

Answer 8

The inflammation of the pleura

Question 9

What are the signs of pleural effusion?

Answer 9

Chest pain on affected side
Less expansion 
Stony dullness to percussion 
Vocal resonance 
Finger clubbing 
Cervical lymph node swelling 
Trachea has been shifted (especially if there is  large effusion) 
Peripheral oedema

Question 10

What are the 2 types of pleural effusion?

Answer 10

Transudates

Exudates

Question 11

What is a transudate effusion?

Answer 11

This is where there is an imbalance of pressures

Question 12

Is transudate usually bilateral or unilateral?

Answer 12

Bilateral

Question 13

What are the very common side effects of transudate effusion?

Answer 13

Left ventricular failure

Liver cirrhosis

Question 14

What is a exudate effusion?

Answer 14

This is when there is an increased permeability of the pleura or capillaries

Question 15

Is exudate usually bilateral or unilateral?

Answer 15

Usually but not always unilateral

Question 16

What causes an exudate pleural effusion?

Answer 16

There is an inflammatory reaction in the lung causing vasodilation so fluid and proteins can leak through into the pleural cavity

Question 17

How much fluid is required in the pleura before it can be detected on a CXR?

Answer 17

200ml of fluid

Question 18

What is mesothelioma?

Answer 18

A disease in which malignant cells are found in the pleura or the peritoneum

Question 19

What is the peritoneum?

Answer 19

The membrane surrounding the heart

Question 20

What is mesothelioma caused by?

Answer 20

Asbestos exposure

Question 21

What is the prognosis of mesothelioma?

Answer 21

Less than 2 year survival rate

Question 22

How does asbestos cause mesothelioma?

Answer 22

The fibers in asbestos can cause inflammation and scarring which can lead to the development of cancer cells

Question 23

What are the treatment options for mesothelioma?

Answer 23

Surgery - involves the removal of all or part of the pleura
Chemotherapy
Radiotherapy

Question 24

What is empyema?

Answer 24

Condition in which pus accumulates in the area between the lungs and the inner surface of the chest wal

Question 25

What is pus composed of?

Answer 25

Filled with immune cells Dead cells Bacteria

Question 26

Can pus in the lungs be coughed back up?

Answer 26

No

Question 27

How do you get rid of pus in the lungs?

Answer 27

Needs to be drained by a needle or surgery

Question 28

After what condition does empyema normally follow?

Answer 28

Pneumonia

Question 29

With empyema what will a CXR look like?

Answer 29

Pleural effusion

Question 30

When will a diagnosis for empyema be confirmed?

Answer 30

When the fluid drained from the lungs appears to be yellow

Question 31

What are the other names for empyema?

Answer 31

Pyothorax | Purulent Pleuritis

Question 32

What is pneumothorax?

Answer 32

Defined by the presence of air within the pleural cavity

Question 33

How does a pneumothorax occur?

Answer 33

Their a breach of the pleura which allows the entry of air | Due to the loss of relationship between the pleura

Question 34

When can a pneumothorax be asymptomatic?

Answer 34

If the patient is young and fit and the pneumothorax is small

Question 35

What are the symptoms of pneumothorax?

Answer 35

Pleuritic chest pain Breathlessness Sudden deterioration Decreased chest expansion on examination The trachea can be deviated away from the midline

Question 36

What is a primary spontaneous pneumothorax?

Answer 36

No clinically apparent disease before hand | Completely random

Question 37

Is primary spontaneous pneumothorax more common in men or woman?

Answer 37

More common in men

Question 38

What is secondary spontaneous pneumothorax?

Answer 38

When there is pre-existing lung disease

Question 39

In what % of patients if COPD present in secondary spontaneous pneumothorax?

Answer 39

30-50%

Question 40

What % of asthmatics develop secondary spontaneous pneumothorax?

Answer 40

0.8% of asthmatics

Question 41

What conditions are present in patients before they develop secondary spontaneous pneumothorax?

Answer 41

``` COPD Asthma TB Cystic Fibrosis Sarcoidosis Secondary pneumothorax can be brought on by almost any lung disease ```

Question 42

What is traumatic non-iatrogenic pneumothorax?

Answer 42

Caused by a penetrating chest injury e.g stabbing or gun wound Blunt chest injury (rib fractures, bronchial rupture) I.e was a complete accident

Question 43

What is a traumatic iatrogenic pneumothorax?

Answer 43

When the penumothorax is caused by something that could have been completely avoided

Question 44

What could cause a traumatic iatrogenic pneumothorax?

Answer 44

Pleural aspiration Sub-clavian vein cannulation Lung, liver, breast, renal biopsy Acupuncture

Question 45

What is classed as a small pneumothorax?

Answer 45

<2cm

Question 46

What is classed as a large pneumothorax?

Answer 46

>2cm

Question 47

Where is a chest drain inserted?

Answer 47

4th intercostal space

Question 48

How is a small non-breathless pneumothorax treated?

Answer 48

``` Observe overnight Repeat CXR If no change hole has sealed Discharge Advise no vigorous movement Return if it gets worse ```

Question 49

How is a small breathless pneumothorax treated?

Answer 49

Second intercostal space drain - suck out the air to re-inflate the lung Aspirate until can feel the surface of the lung beneath the chest wall

Question 50

How is a secondary pneumothorax treated?

Answer 50

Insert a chest drain at intercostal space 4

Question 51

Where is the chest aspirated form anatomically?

Answer 51

2nd intercostal space | Mid-clavicular line

Question 52

When should a pneumothorax have ideally re-inflated by?

Answer 52

48 hours

Question 53

How is pneumothorax treated by surgery?

Answer 53

With the use of talcum powder

Question 54

What is asbestos?

Answer 54

Highly fibrous naturally occurring mineral

Question 55

What are the 3 types of asbestos?

Answer 55

White Brown Blue

Question 56

Which asbestos is most dangerous to human health?

Answer 56

Blue

Question 57

Give examples of occupations that involve asbestos exposure

Answer 57

``` Boiler men Engineers Electricians Plumbers Ship builders ```

Question 58

When does disease occur after asbestos exposure?

Answer 58

20-40 years

Question 59

What is mesothelioma?

Answer 59

A form of pleural malignancy

Question 60

What % of cases of mesothelioma are due to asbestos exposure?

Answer 60

80%

Question 61

What are the symptoms of mesothelioma?

Answer 61

Chest pain Weight loss - associated with cancer in general Breathlessness Usually unilateral

Question 62

How is mesothelioma seen on a CXR?

Answer 62

Thickening of the pleura

Question 63

If a mesothelioma is suspected on CXR what is the next step?

Answer 63

Send the patient for a CT scan