pleura LGW

Question 1

what is pleural effusion and what is the normal pleural space fluid?

Answer 1

accumulation of fluid in the pleural space
normal fluid 1-15 ml

Question 2

what does a history of pleuritic chest pain suggest ?

Answer 2

eeither pulmmoonarry embolism or inflammatory pleural process

Question 3

what does a history of constant dull-aching pain suggest ?

Answer 3

chest wall invasion by bronchogenic carcinoma or malignant mesothelioma

Question 4

at what level of effusion does pleural effusion manifest ?

Answer 4

once it exceeds 300 ml

Question 5

what are the signs associated with pleural effusion ?

Answer 5

stony dullness
decreased breath sounds
decreased vocal resonance
mediastinal shift away from the effusion if it is above 1000 ml

Question 6

if there is displacement of the trachea towards the effusion what may this denote ?

Answer 6

clue to obstruction of a labor bronchus
malignancy or foreign body

Question 7

what are the two main types of pleural effusion ?

Answer 7

transudate and exudate

Question 8

what are the causes of transudate pleural effusion ?

Answer 8

compression of the SVC
congestive HF
constrictive pericarditis
hypoalbuminemia
nephrotic syndrome
cirrohsis

Question 9

what doees exudate arise from ?

Answer 9

asbestos exposure
raditation pleuritis
pulmonary embolism
TB
/
malignancy

Question 10

what are the three main investigations when it comes to pleural effusion ?

Answer 10

radiology
pleural fluid analysis
pleural biopsy

Question 11

what arre the findings in chest x ray for pleural effusion ?

Answer 11

P-A view upright film
small effusion - blunting of the costophrenic angle
large effusion - mediastinal shift away from the. effusion

Question 12

what does hydropneumothorax look like on X-ray ?

Answer 12

air fluid level is seen

Question 13

what is thoracocentesis ?

Answer 13

method to remove fluid from the fluid or air from the thoracic cavity
either therapeutic or diagnostic

Question 14

where is the tube placed for thoracocentesis ?

Answer 14

2 rib interspace below the level of stony dullness

Question 15

what must be done after thoracentesis ?

Answer 15

1- inspiratory chest X-ray to establish a new baseline for patients likely to have recurrent effusions
2- expiratory chest x ray to exclude pneumothorax

Question 16

what are the relative contraindications associated with thoracentesis ?

Answer 16

1- small volume of fluid
2- bleeding disorder orr systemic anticoagulant
3- mechanical ventilation
4- cutaneous disease over the proposed puncture area

Question 17

complications of thoraentesis ?

Answer 17

1- pain at the puncture site
2 - cutaneous or internal bleeding
3- pneumothorax
4- empyema
5- spleen or liver puncture

Question 18

on gross examination what do each of these descriptions indicate ?
frankly, purulent fluid -
milky fluid -
bloody fluid -

Answer 18

empyema
chylothorax
hemothorax

Question 19

what is seen on X ray suggesting empyema ?

Answer 19

D shaped opacity

Question 20

at what level of protein is exudative effusion indicated ?

Answer 20

above 2.9 g/dl

Question 21

low pleural glucose vs very low pleural glucose ?

Answer 21

low pleural glucose - malignant effusion , TB
very low pleural glucose - suggest empyema

Question 22

what does a high triglyceride level in the pleural fluid suggest ?

Answer 22

chylothorax

Question 23

what does a pleural fluid ph of less than 7.2 suggest?

Answer 23

empyema

Question 24

what level of hematocrit suggests hemothorax ?

Answer 24

above 50%

Question 25

what is light's criteria ?

Answer 25

fluid is considered an exudate if any of the following apply : 1- ratio of pleural fluid to serum protein is more than 0.5 2- ratio of pleural fluid to serum LDH is more than 0.6 3- pleural fluid LDH is more than 2/3 of the upper limits of normal serum value need to measure pleural fluid and serum protein and LDH

Question 26

what are the differentials associated with pleural fluid lymphocytosis ?

Answer 26

more than 85 suggests TB or lymphoma betweeen 50 to 70 suggests malignancy

Question 27

how can WBC be used to differentiate between exudate and transudate ?

Answer 27

transudate is less than 1000 mm exudate is more than 1000 mm

Question 28

what are the types of pleural effusion in lung cancers ?

Answer 28

1- transudate - compression of the SVC 2- exudate - infection distal to obstruction or malignant cells in pleural fluid 3- hemorrhagic - pleural invasion by the tumor 4- chylothorax - metastasis compressing on thee thoracic duct 5- pyothorax- pyogenic infection on top

Question 29

what are the characteristics of malignant pleural effusion ?

Answer 29

1-haemorrhagic 2- massive 3- rapidly accumulating 4- mediastinum may be shifted to the same side

Question 30

what does it mean if light's criteria is not met ?

Answer 30

then its transudate

Question 31

what is seen on erect CT in a patient with hemothorax ?

Answer 31

blunting of hemidiaphragm progressive loss of basal lung field

Question 32

what is the management for hemothorax ?

Answer 32

crossmatch blood for urgent transfusion correct coagulopathy with fresh frozen plasma or platelets small hemothorax - observe with serrial x-ray and mmoniitorr for signs of deterioration significant hemothorax - insert a large borre chest drain

Question 33

when should a thoracic surgeon be contacted in a patient with hemothorax ?

Answer 33

if drainage exceeds 1000ml or more than 200ml for 3 hours despite correcting coagulopathy

Question 34

what is seen on x ray of pneumothorax ?

Answer 34

abnormal collection of air on the pleural space

Question 35

what are thee three main causes of pneumothorax ?

Answer 35

spontaneous trumatic iatrrogenic

Question 36

what are the spontaneous causes of pneumothorax ?

Answer 36

1- primary - young , thin patient associated with marfan's and ehlers danlos 2- secondary - underlying lung disease COPD Asthma CF

Question 37

what are the three types of pneumothorax ?

Answer 37

closed pneumothorax open pneumothorax tension pneumothorax

Question 38

what are the signs associated with pneumothorax ?

Answer 38

1- asymmetric chest expansion 2- hyperresonance on the affected side 3- absent or decreased breath sounds on the affected side

Question 39

what is thee management for recurrent pneumothorax ?

Answer 39

pleurodesis

Question 40

what is thee management of pneumothorax ?

Answer 40

depends if the patient is symptomatic or asymptomatic 1- asymptomatic and no high risk features - thee patient can be discharged 2- symptomatic patients can undergo either : needle aspiration , intercostal chest drain or the insertion of an ambulatory device

Question 41

what are the high risk characteristics associated with pneumothorax ?

Answer 41

hypoxia bilateral pneumothoraces underlying lung disease haemodynamic compromise

Question 42

what is the management for tension pneumothorax ?

Answer 42

ABCDE high flow oxygen immediate needle decompression inn the 2nd intercostal space, midclavicular line so that it is converted from tension pneumothorax to simple pneumothorax

Question 43

presentation of tension pneumothorax ?

Answer 43

cardiogenic shock and respiratory distress tachycardia and hypotensive

Question 44

what tare the pleural fluid findings associated with empyema ?

Answer 44

LDH above 1000 very low glucose levels ( below 30) pH below 7.2

Question 45

what are the differentials of pleural fluid esosinophilia?

Answer 45

eosinophils above 10% are often caused by air or blood in the pleural space ass with 1- pulmonary embolism with infarction 2- parasitic disease (paragonimiasis) 3- medication

Question 46

i the pleural fluid turns out to be exudate with a low glucose level what are the differentials ?

Answer 46

malignancy bacterial infections TB

Question 47

what is the most sensitive radiological option for the diagnosis of pneumothorax ?

Answer 47

CT chest