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ICC1 > pleura LGW > Flashcards

pleura LGW Flashcards

1
Q

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

A

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

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2
Q

what does a history of pleuritic chest pain suggest ?

A

eeither pulmmoonarry embolism or inflammatory pleural process

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3
Q

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

A

chest wall invasion by bronchogenic carcinoma or malignant mesothelioma

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4
Q

at what level of effusion does pleural effusion manifest ?

A

once it exceeds 300 ml

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5
Q

what are the signs associated with pleural effusion ?

A

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

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6
Q

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

A

clue to obstruction of a labor bronchus
malignancy or foreign body

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7
Q

what are the two main types of pleural effusion ?

A

transudate and exudate

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8
Q

what are the causes of transudate pleural effusion ?

A

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

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9
Q

what doees exudate arise from ?

A

asbestos exposure
raditation pleuritis
pulmonary embolism
TB
/
malignancy

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10
Q

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

A

radiology
pleural fluid analysis
pleural biopsy

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11
Q

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

A

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

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12
Q

what does hydropneumothorax look like on X-ray ?

A

air fluid level is seen

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13
Q

what is thoracocentesis ?

A

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

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14
Q

where is the tube placed for thoracocentesis ?

A

2 rib interspace below the level of stony dullness

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15
Q

what must be done after thoracentesis ?

A

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

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16
Q

what are the relative contraindications associated with thoracentesis ?

A

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

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17
Q

complications of thoraentesis ?

A

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

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18
Q

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

A

empyema
chylothorax
hemothorax

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19
Q

what is seen on X ray suggesting empyema ?

A

D shaped opacity

20
Q

at what level of protein is exudative effusion indicated ?

A

above 2.9 g/dl

21
Q

low pleural glucose vs very low pleural glucose ?

A

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

22
Q

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

A

chylothorax

23
Q

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

A

empyema

24
Q

what level of hematocrit suggests hemothorax ?

A

above 50%

25
Q

what is light’s criteria ?

A

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

26
Q

what are the differentials associated with pleural fluid lymphocytosis ?

A

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

27
Q

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

A

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

28
Q

what are the types of pleural effusion in lung cancers ?

A

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

29
Q

what are the characteristics of malignant pleural effusion ?

A

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

30
Q

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

A

then its transudate

31
Q

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

A

blunting of hemidiaphragm
progressive loss of basal lung field

32
Q

what is the management for hemothorax ?

A

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

33
Q

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

A

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

34
Q

what is seen on x ray of pneumothorax ?

A

abnormal collection of air on the pleural space

35
Q

what are thee three main causes of pneumothorax ?

A

spontaneous
trumatic
iatrrogenic

36
Q

what are the spontaneous causes of pneumothorax ?

A

1- primary - young , thin patient
associated with marfan’s and ehlers danlos

2- secondary - underlying lung disease
COPD
Asthma
CF

37
Q

what are the three types of pneumothorax ?

A

closed pneumothorax
open pneumothorax
tension pneumothorax

38
Q

what are the signs associated with pneumothorax ?

A

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

39
Q

what is thee management for recurrent pneumothorax ?

A

pleurodesis

40
Q

what is thee management of pneumothorax ?

A

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

41
Q

what are the high risk characteristics associated with pneumothorax ?

A

hypoxia
bilateral pneumothoraces
underlying lung disease
haemodynamic compromise

42
Q

what is the management for tension pneumothorax ?

A

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

43
Q

presentation of tension pneumothorax ?

A

cardiogenic shock and respiratory distress
tachycardia and hypotensive

44
Q

what tare the pleural fluid findings associated with empyema ?

A

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

45
Q

what are the differentials of pleural fluid esosinophilia?

A

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

46
Q

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

A

malignancy
bacterial infections
TB

47
Q

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

A

CT chest

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