Pleural And Pericardial Diseases

Question 1

What is it the most common cause of pleural and pericardial diseases

Answer 1

Idiopathic due to cocksackie B virus

Question 2

What is the C/P of Dry Pleurisy ?

Answer 2

FAHM

Pleurodynia
“Localized stitching Chest pain radiating to shoulders (diaghramatic) or abdominal (peripheral)”

Question 3

What increases or decreases pleurodynia?

Answer 3

Increases: cough and inhalation
Decreases: lying of affected site

Question 4

Examination of dry pleurisy ?

Answer 4

I: symmetrical and unilaterally limited
Palp: palpable pleural rub
Percussion: tenderness
Ausculation: biphasic superficial scratches

Question 5

When to stop colchicine

Answer 5

Diarrhea

Question 6

How does colchicine work?

Answer 6

Inhibit microtubules and chemotaxis

Question 7

Ttt of dry pleurisy

Answer 7

NSAIDs
Then colchicine
Then steroids

Question 8

Normal amount of fluid in pleura and pericardium

Answer 8

Pleura 10ml
Pericardium 25ml

Question 9

What is pleural effusion or pericardial effusion:

Answer 9

Accumulation of fluid in pleural/ pericardial space

Question 10

When is pleural fluid present on xray and when does it appear clinically ?

Answer 10

CXR more than 300ml
Clinically more than 500ml

Question 11

What is the cause of transudate in lung?
And the mc

Answer 11

Heart failure mc
Liver disease
Nephrotic
Protein malnutrition
Myxodema

Question 12

What causes exudate in pleaura and mc?

Answer 12

Bacteria mc
Pulmonary embolism

Question 13

Causes of empyema?

Answer 13

Staph aerus

Question 14

Causes of hemorrhagic pleural effusion ?

Answer 14

TB
Malignancy

Question 15

Causes of chylothorax?

Answer 15

Thoracic duct obstruction.

Question 16

Examination of pleural effusion?

Answer 16

Inspection: asymmetrical bulge, decreased movement on affected side

-ve litten sign
+ve trill (same malignancy and opposite all)

Palp: unequal TVF and palpable pleural rub

Perc: stony dullness and tenderness

Aus: vesicular with decreased airway entry and biphasic superficial scratches

Question 17

If a lung is collapsed near effusion what would you hear ?

Answer 17

Bronchial
Bronchophony
Egophony
Whispering pectroliqy

Question 18

What is trill sign

Answer 18

Bulging of a clavicular head of sternomastoid

Question 19

Complication of pleural effusion

Answer 19

Lung collapse
Empyema
Fibrothorax

Question 20

Investigations of pleural effusion

Answer 20

U/s ( minimal effusion)
Thoracocentesis (diagnostic and therapeutic)

Question 21

Name of criteria of pleural effusion

Answer 21

Lights criteria

Question 22

Use of light criteria

Answer 22

Exudate

Question 23

Criteria of lights criteria

Answer 23

Pleural fluid protein to serum protein >0.5
Plural LDH to serum LDH > 0.6
Pleural fluid LDH > 2/3 of normal serum level

Question 24

Types of pneumothorax

Answer 24

Closed (spontaneous)

1ry tall thin male smoker
2ndry COPD with emphysematous Bullae

Open (traumatic)

Question 25

Treatment of 1ry closed pneumothorax

Answer 25

If either Dyspnea or >2cm

Aspiration then chest drain if failed

Else
High flow O2 and follow up

Question 26

Treatment of closed 2ndry pneumothorax

Answer 26

If
Less than 1cm high flow O2 and follow up
1cm to 2cm aspiration and if failed chest drain

More than 2cm or Dyspnea chest drain

Question 27

Ttt of open pneumothorax

Answer 27

Wound closure
High flow o2
Aspiration
Then chest drain

Question 28

Symptoms of pneumothorax

Answer 28

Sudden Dyspnea
Acute RVF up to shock
Acute chest pain up to cyanosis

Question 29

Signs of pneumothorax

Answer 29

Trill sign to opposite side
Amorphic breathing
Tympanic if tension pneumothorax