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Respirology RC > Pleural disease > Flashcards

Pleural disease Flashcards

1
Q

Besides medications/drugs, list 4 causes of an eosinophilic pleural effusion

A 
Infection (parasites)
Inflammatory (AEP, EGPA, RA)
Malignancy (mesothelioma)
PE
Benign Asbestos Pleural Effusion
Hemothorax, pneumothorax
Cardiac surgery
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2
Q

3 Medication/ Drug causes of Eosinophilic pleural effusion

A

Warfarin
sulfasalazine
PTU

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3
Q

4 causes of non-traumatic chylothorax

A 
Malignant (
Lymphoma, mediastinal tumor, lung cancer, SVC syndrome secondary to a malignancy)
LAM
Non-malignant
Yellow nail
Infection: TB, mediastinitis
Chyloperitoneum
Sarcoid, amyloid
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4
Q

Trapped lung vs entrapped lung

A

trapped = no active inflammatory process ( may be remote)
- can be differentiated by pleural elastance ( will be rapidly decline in trapped; entrapped starts positive and decreasing slowly)

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5
Q

name 2 risk factors for re-expansion pulmonary edema

A
  • Lung is collapsed for greater than 3 days
  • Age between 20-40 years
  • Application of high negative pressures (>20cmH20)
  • Diabetes
    If secondary to pneumothorax, the size of pneumothorax
  • Presence of pleural effusion
  • Removal of large volumes of pleural fluid (>1.5L)
  • Removal of an obstructing endobronchial tumor
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6
Q

List 6 causes of a pleural effusion with a pH < 7.3

A 
Malignant
Complicated pleural infection
CTD (particularly RA)
TB pleural effusions
Esophageal rupture
Exposure to air and lidocaine will also decrease your pH
Paragonamiasis
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7
Q

List 2 predictors of prognosis for mesothelioma

A
  • Stage (t3 vs t4 -non resectable)
  • Histology (non-epitheliod)
  • ECOG
  • Age >75
  • Elevated LDH
  • Hematologic abnormalities
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8
Q

List two treatment modalities for mesothelioma

A

Debulking surgery
Systemic chemotherapy (pemitrexed + cisplatin)
Immunotherapy

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9
Q

List the principles of management of secondary pneumothorax

A
  • admit to hospital

- aspirate if >2cm or symptommatic

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10
Q

When to refer to thoracic surgery for PTX? (BTS 2010

A

Second ipsilateral pneumothorax
First contralateral pneumothorax
Synchronous bilateral spontaneous pneumothorax
Persistent air leak (despite 5-7 days of drainage)
Spontaneous haemothorax
Professions at risk (pilots, divers)
Pregnancy

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11
Q

What is the role of surgical pleurodesis in LAM (2017 LAM guideline)?

A

Consider after FIRST PTX if diagnosis of LAM is certain
Do NOT wait for recurrence
Does NOT exclude patient to transplant

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12
Q

Name 6 causes of cystic lung disease

A 
Infection
PJP
Inflammatory
LIP, LAM, PLCH
Malignant
Cystic metastasis
Lymphoma/Castleman’s 
Rare
Birg-Hogg-Dube, amyloid, respiratory papillomatosis, hyperIgE
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13
Q

List 3 therapies that are NOT effective in LAM

A 
Hormone therapy (progesterone, GnRH analogues)
Bilateral-salpingo-oophorectomy
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14
Q

What are two effective therapeutic interventions in LAM

A

1st line- Sirolimus (MILES trial)

2nd line- Lung transplant has GOOD outcome

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15
Q

What are the benefits of sirolimus in LAM

A

BENEFITS of SIROLIMUS

  • Improved FEV1 and FVC
  • Improved QoL
  • reduced cyst size
  • Reduced AML and chylous effusions

MILES trial (n=111)
Sirolimus 2mg/day v Placebo; 12 months ON + 12 months OFF
Mean difference of ~150 mL (11%) between treatment v placebo
MCID in COPD is 100-140 mL

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16
Q

What are the complications of an intrapleural catheter (pleurex?)

A

Infection

Loculations

Catheter Fracture, Rare complication (<1 percent)

Bleeding and pneumothorax.

17
Q

List two causes of effusion in SVC obstruction

A
  • increase in pressure

- decrease in clearance

18
Q

3 causes of pleural fluid amylase

A

acute pancreatitis
esophageal perforation
pleural malignancy

19
Q

list 4 types of pleural disease related to asbestos

A 
pleural plaques
diffuse pleural thickening
Benign Asbestos Pleural Effusion
Mesothelioma
Rounded atelectasis
20
Q

List 4 characteristics of a tuberculous pleural effusion

A 
Protein high >40g/L
LDH high
Ph low <7.4
glucose low <3 (7-20% suggests chronic)
lymphocytic
21
Q

list 6 causes of secondary pneumothorax in a young nonsmoking female

A 
Necrotising infection
CF
Birt hogg dube
hyper IgE 
PJP
Ehlers-danlos, marfans
LAM
A1AT
paragonamiasis
hypersenstivity pneumonitis
syndrome
22
Q

What are two benefits of fibrinolytic therapy (as reported in MIST2 nejm)

A
  1. improved drainage

2. reduction in need for surgical intervention

23
Q

List 4 features of a complicated parapneumonic effusion

A 
PH <7.2
Glucose < 3.4 mmol/L 
LDH > 1000
Presence of separations or loculation 
Positive gm stain or culture

BTS 2010 mgmt of pleural space infection

Respirology RC (11 decks)

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