pleural

Question 1

visceral pleura lines the

Answer 1

lungs

Question 2

parietal pleura lines the

Answer 2

mediastinum, diapghragm and chest wall

Question 3

Costal & peripheral diaphragmatic pleura innervated by _______. Pain referred to __________

Answer 3

Costal & peripheral diaphragmatic pleura innervated by intercostal nerves. Pain referred to chest wall.

Question 4

Central diaphragmatic pleura: innervated by ________ Pain referred to ___________

Answer 4

Central diaphragmatic pleura: innervated by phrenic nerve. Pain referred to ipsilateral shoulder.

Question 5

how is the mechanical coupling of lungs against throacic wall maintaines?

Answer 5

by preventing gas and liquid accumulating

Question 6

transudate

Answer 6

plasma ultrafiltrate due to altered starling forces

Question 7

what sterling forces are altered in pleural effusions that cause transudate

Answer 7

• increase in hydrostatic pressure in the capillary - decrease in oncotic pressure in the capillary

Question 8

exudate

Answer 8

protein-rich fluid results from increased capillary leakage secondary to inflammation or disease of pleural surface

Question 9

major etiology of transudate (4)

Answer 9

• CHF - nephrotic syndrome - cirrhosis - atelectasis

Question 10

major etiology of exudate (5)

Answer 10

• tumor - pneumonia - TB - pulmonary embolism - collagen vascular disease

Question 11

do effusions cause pain? what is the pain?

Answer 11

effusions do not cause pain - it is a sign of parietal pleura irritation by the process causing the pleural effusion

Question 12

what are some of the physical signs of an effusion?

Answer 12

• decrease in chest excursion - decrease in tactile fremitus - decrease or absent sounds over the effusion

Question 13

loculated pleural effusion (3)

Answer 13

• empyema - hemothorax - malignancy

Question 14

what do you want to evaluate when considering pleural effusion?

Answer 14

• protein - LDH

Question 15

pleural fluid protein/ serum protein > 0.5

Answer 15

exudate

Question 16

pleural fluid LDH/serum LDH >0.6

Answer 16

exudate

Question 17

pleural fluid protein < 2.9

Answer 17

transudate

Question 18

leading cause of pleural effusion (2)

Answer 18

• CHF: transudate - pneumonia: exudate

Question 19

hepatic hydrothorax

Answer 19

caused by cirrhosis of the liver leading to transudative fluid moving to pleural space

Question 20

parapneumonic effusion

Answer 20

sterile exudate

Question 21

empyema

Answer 21

organisms or pus

Question 22

what does it mean when we see tumors in the pleural space?

Answer 22

poor prognosis

Question 23

chylothorax how does the exudate look like?

Answer 23

pleural effusion due to leakage of chyle due to lymphoma - exudate= milky and has high triglycerides

Question 24

how do you treat transudate? exudate?

Answer 24

• transudate- treat underlying cause - exudate- might require further intervention such as in the case of a hemothroax

Question 25

small pneumonia

Answer 25

effusion\<10 mm

Question 26

large effusion

Answer 26

\> 10mm and thoracentesis is indicated

Question 27

pneumothorax will present as _______ to percussion and the degree of collapse depends on

Answer 27

present as hyperresonance and the degree of collapse depends on size of PTX and elasticity of lung

Question 28

- trachea shifted to contralateral - compressed left lung - mediastinum shifted to contralateral side - diaphragm depressed and inverted contour

Answer 28

tension pneumothorax

Question 29

primary simple pneumothorax

Answer 29

spontaneous caused by small subpleural blebs that rupture

Question 30

secondary complicated pneumothorax

Answer 30

occurs in underlying disease like COPD

Question 31

iatrogenic pneumothorax

Answer 31

most common; puncture of the visceral pleura during invasive procedures

Question 32

Answer 32

loculated pleural effusion

Question 33

Answer 33

tuberculosis- exudate lymphocytic