Pleural Disease

Question 1

what is a pleural effusion?

Answer 1

an abnormal collection of fluid in the pleural space

Question 2

what does straw coloured pleural effusion suggest?

Answer 2

cardiac failure

hypoalbuminaemia

Question 3

what does blood pleural effusion suggest?

Answer 3

trauma
malignancy
infection
infarction

Question 4

what does a milky pleural effusion suggest?

Answer 4

empyema

Question 5

what does a foul smelling pleural effusion suggest?

Answer 5

anaerobic empyema

Question 6

what does the presence of food particles in a pleural effusion suggest?

Answer 6

oesophageal rupture

Question 7

what are the two main types of pleural effusion?

Answer 7

transudate

exudate

Question 8

what protein level is present in a transudate pleural effusion?

Answer 8

<30

Question 9

name some causes of a transudate pleural effusion

Answer 9

heart failure
cirrhosis 
hypoalbuminaemia 
atelectasis
peritoneal dialysis

Question 10

what protein level is present in an exudate pleural effusion?

Answer 10

> 30

Question 11

name some possible causes of an exudate pleural effusion

Answer 11

malignancy
infection
pulmonary infarction
asbestos

Question 12

which type of pleural effusion suggests a more serious pathology?

Answer 12

exudate

Question 13

what is the normal pH of a pleural effusion?

Answer 13

7.6

Question 14

what is mesothelioma?

Answer 14

rare malignant tumour of the lining of the lung

Question 15

what increases the risk of developing mesothelioma?

Answer 15

exposure to asbestos

Question 16

how can mesothelioma present?

Answer 16

breathlessness
chest pain
weight loss
fever
sweating
cough

Question 17

when does mesothelioma usually present?

Answer 17

30-40 years after asbestos exposure

Question 18

how does mesothelioma present on CXR?

Answer 18

pleural thickening - makes the lungs look smaller

Question 19

what are the three types of asbestos and which is most common?

Answer 19

chrysolite - common
amosite
crocidolite

Question 20

what is the most dangerous type of asbestos?

Answer 20

crocidolite

Question 21

how can mesothelioma be managed?

Answer 21

pleuodeses effusions 
radiotherapy 
surgery 
chemotherapy 
palliative care

Question 22

what cancers can metastasise to the pleura?

Answer 22

lung
breast
upper GI
lymphoma
melanoma
ovary

Question 23

what is the median survival in pleural malignancy?

Answer 23

3-12 months

Question 24

what score is used to predict survival in pleural malignancy?

Answer 24

LENT score

• LDH
• ECOG PS
• neutrophil/lymphocyte ratio
• tumour type

Question 25

what is a small pneumothorax?

Answer 25

<2cm rim of air

Question 26

what is a large pneumothorax?

Answer 26

> 2cm rim of airr

Question 27

what is the management of a tension pneumothorax/

Answer 27

needle decompression in the second ICS, mid clavicular line