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A2. Respiratory System > Pleura > Flashcards

Pleura Flashcards

1
Q

What are the 2 layers of pleura?

A

Visceral pleura

Parietal Pleura

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2
Q

How much fluid is there inbetween the pleural layers?

A

2-3ml

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3
Q

Is the pressure in the pleura positive or negative?

A

Negative

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4
Q

Where does the pleura extend?

A

Above the first rib

Goes further down also

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5
Q

What is a pleural effusion?

A

This is an abnormal collection of fluid in the pleural space

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6
Q

What does the symptoms of pleural effusion depend on?

A

The cause of the effusion

And the volume of fluid that has accumulated

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7
Q

What are the symptoms of pleural effusion?

A 
Increasing breathlessness
Pleuritic chest pain 
Inflammation 
Dull ache 
Dry cough 
Weight loss 
Malaise
Fevers
Night Sweats
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8
Q

What is pleurisy?

A

The inflammation of the pleura

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9
Q

What are the signs of pleural effusion?

A 
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
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10
Q

What are the 2 types of pleural effusion?

A

Transudates

Exudates

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11
Q

What is a transudate effusion?

A

This is where there is an imbalance of pressures

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12
Q

Is transudate usually bilateral or unilateral?

A

Bilateral

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13
Q

What are the very common side effects of transudate effusion?

A

Left ventricular failure

Liver cirrhosis

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14
Q

What is a exudate effusion?

A

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

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15
Q

Is exudate usually bilateral or unilateral?

A

Usually but not always unilateral

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16
Q

What causes an exudate pleural effusion?

A

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

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17
Q

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

A

200ml of fluid

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18
Q

What is mesothelioma?

A

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

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19
Q

What is the peritoneum?

A

The membrane surrounding the heart

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20
Q

What is mesothelioma caused by?

A

Asbestos exposure

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21
Q

What is the prognosis of mesothelioma?

A

Less than 2 year survival rate

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22
Q

How does asbestos cause mesothelioma?

A

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

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23
Q

What are the treatment options for mesothelioma?

A

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

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24
Q

What is empyema?

A

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

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25
Q

What is pus composed of?

A

Filled with immune cells
Dead cells
Bacteria

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26
Q

Can pus in the lungs be coughed back up?

A

No

27
Q

How do you get rid of pus in the lungs?

A

Needs to be drained by a needle or surgery

28
Q

After what condition does empyema normally follow?

A

Pneumonia

29
Q

With empyema what will a CXR look like?

A

Pleural effusion

30
Q

When will a diagnosis for empyema be confirmed?

A

When the fluid drained from the lungs appears to be yellow

31
Q

What are the other names for empyema?

A

Pyothorax

Purulent Pleuritis

32
Q

What is pneumothorax?

A

Defined by the presence of air within the pleural cavity

33
Q

How does a pneumothorax occur?

A

Their a breach of the pleura which allows the entry of air

Due to the loss of relationship between the pleura

34
Q

When can a pneumothorax be asymptomatic?

A

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

35
Q

What are the symptoms of pneumothorax?

A

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

36
Q

What is a primary spontaneous pneumothorax?

A

No clinically apparent disease before hand

Completely random

37
Q

Is primary spontaneous pneumothorax more common in men or woman?

A

More common in men

38
Q

What is secondary spontaneous pneumothorax?

A

When there is pre-existing lung disease

39
Q

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

A

30-50%

40
Q

What % of asthmatics develop secondary spontaneous pneumothorax?

A

0.8% of asthmatics

41
Q

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

A 
COPD
Asthma
TB
Cystic Fibrosis 
Sarcoidosis 
Secondary pneumothorax can be brought on by almost any lung disease
42
Q

What is traumatic non-iatrogenic pneumothorax?

A

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

43
Q

What is a traumatic iatrogenic pneumothorax?

A

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

44
Q

What could cause a traumatic iatrogenic pneumothorax?

A

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

45
Q

What is classed as a small pneumothorax?

A

<2cm

46
Q

What is classed as a large pneumothorax?

A

> 2cm

47
Q

Where is a chest drain inserted?

A

4th intercostal space

48
Q

How is a small non-breathless pneumothorax treated?

A 
Observe overnight 
Repeat CXR
If no change hole has sealed 
Discharge 
Advise no vigorous movement
Return if it gets worse
49
Q

How is a small breathless pneumothorax treated?

A

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

50
Q

How is a secondary pneumothorax treated?

A

Insert a chest drain at intercostal space 4

51
Q

Where is the chest aspirated form anatomically?

A

2nd intercostal space

Mid-clavicular line

52
Q

When should a pneumothorax have ideally re-inflated by?

A

48 hours

53
Q

How is pneumothorax treated by surgery?

A

With the use of talcum powder

54
Q

What is asbestos?

A

Highly fibrous naturally occurring mineral

55
Q

What are the 3 types of asbestos?

A

White
Brown
Blue

56
Q

Which asbestos is most dangerous to human health?

A

Blue

57
Q

Give examples of occupations that involve asbestos exposure

A 
Boiler men 
Engineers
Electricians 
Plumbers 
Ship builders
58
Q

When does disease occur after asbestos exposure?

A

20-40 years

59
Q

What is mesothelioma?

A

A form of pleural malignancy

60
Q

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

A

80%

61
Q

What are the symptoms of mesothelioma?

A

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

62
Q

How is mesothelioma seen on a CXR?

A

Thickening of the pleura

63
Q

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

A

Send the patient for a CT scan

A2. Respiratory System (15 decks)

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