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Year 1- Respiratory > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

Describe the structure of the pleura.

A

Glistening, smooth, thin membrane which covers the thoracic cavity and the lung

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2
Q

RECAP- name the pleura on the outside of the lung

A

Parietal

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3
Q

RECAP- name the pleura on the inside of the lung.

A

Visceral

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4
Q

What is found between the parietal and visceral pleura?

A

Plural fluid

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5
Q

What process produces pleural fluid?

A

Filtration

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6
Q

Name some of the cells found in pleural fluid.

A

Macrophages, lymphocytes, mesothelial cells

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7
Q

What type of pressure does the pleura have?

A

Subatmospheric pressure

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8
Q

What part of the lung has the most negative pressure?

A

Apex

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9
Q

RECAP- what is the collection of fluid in the pleural cavity called?

A

Pleural effusion

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10
Q

RECAP- what is a collection of air in the pleural cavity known as?

A

Pneumothorax

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11
Q

What is the term for pleural malignancy?

A

Mesothelioma

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12
Q

What is a combination of water and air in the parietal cavity known as?

A

Hydropneumothorax

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13
Q

Why does pleural effusion occur?

A

Imbalance between production and absorption

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14
Q

Name the two types of pleural effusion.

A

Transudate
Exudate

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15
Q

Is transudate non-inflammatory or inflammatory?

A

Non-inflammatory

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16
Q

Is exudate inflammatory or non-inflammatory?

A

Inflammatory

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17
Q

Which type of pleural effusion has a high protein content?

A

Exudate

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18
Q

What is the protein content of exudate?

A

3g/dl or more

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19
Q

Which criteria can determine if pleural effusion is exudate/

A

Light’s criteria

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20
Q

Name two very common causes of transudates.

A

Left ventricular failure
Liver cirrhosis

(she said we need to know three so one less common cause is Nephrotic syndrome)

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21
Q

Name some common causes of exudates.

A

Malignancy ( Pulmonary and non pulmonary)
Parapneumonic effusions, empyema
Tuberculosis

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22
Q

What tests can be used to diagnose pleural effusion?

A

Ultrasound
Chest x-ray
CT thorax

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23
Q

List the advantages of using an ultrasound.

A

More sensitive than CXR , mark site for aspiration, assess pleura, bedside

24
Q

List the advantages of using a chest x-ray

A

Accessible , easy to interpret

25
Q

List the advantages of using a CT of the thorax.

A

Allows better look at complex effusions , visualising the pleura , vascular and mediastinal structures

26
Q

Discuss the process of pleural fluid analysis.

A

Collect a sample via aspiration

Inspect the fluid-> pus, blood etc.

Check pH on bedside ABG machine

27
Q

What do you do if the pH of the sample is <7.2?

A

May need chest drain

28
Q

What is a primary spontaneous pneumothorax?

A

Spontaneous rupture in normal lungs

29
Q

What is a secondary spontaneous pneumothorax?

A

Rupture occurs in someone with a pre-existing condition

30
Q

Which pre-existing lung diseases may lead to a secondary spontaneous pneumothorax?

A

Interstitial lung disease
COPD
Asthma
Cystic fibrosis

31
Q

What is a traumatic pneomothorax?

A

Pneumothorax as a result to injury

32
Q

What is an iatrogenic pneumothorax?

A

As a result to a procedure like lung biopsies.

33
Q

What is a tension pnuemothorax?

A

Air builds up and pushes structures, like the trachea, and squashes the other lung and puts pressure on the heart.

34
Q

Which type of pneumothorax can be very dangerous?

A

Tension pneumothorax

35
Q

Who usually gets a primary spontaneous pneumothorax?

A

Tall, thin, young men.

uh oh good luck jmatt

36
Q

What are the presenting symptoms of a spontaneous pneumothorax?

A

Chest pain or breathlessness

37
Q

What would you commonly see during examination in someone with a pneumthorax?

A

Breathing fast : tachypneic

Hypoxic

Reduced chest wall movement and reduced or no breath sounds

Not uncommonly examination may be normal

38
Q

When would you choose to observe a patient w a pneumothorax?

A

If they are well and the size of the pneumothorax is small

39
Q

When would you choose to collect a sample (aspiration) from a patient with pneumothorax?

A

Pneumothorax over 2 cm in size , patient well

40
Q

When would a patient be given surgery for pneumothorax?

A

Recurrent events, unresolving

41
Q

What is a management option for those in hospital and requires anaesthetic?

A

Chest drain insertion

42
Q

Where is it safe to do a pleural aspiration/ drain?

A

2nd intercostal space, midclavicular line

43
Q

Are most pleural tumours benign or maligant?

A

Malignant

44
Q

What is meant by secondary pleural malignancy?

A

Malignancy has developed as a result of cancer elsewhere in the body.

45
Q

What is the most common primary malignant tumour?

A

Mesothelioma

46
Q

Why may mesothelioma arise?

A

In some cases, by a mutation.
More commonly, due to the inhalation of asbestos dust and fibres.

47
Q

How does asbestos cause the formation of tumours?

A

Inhaled fibres reach the pleura and cause inflammation hence causing a tumour to form

48
Q

How long after inhaling asbestos can mesothelioma develop?

A

20-40 years

49
Q

Name some symptoms that suggest a mesothelioma has developed.

A

Breathlessness
Weight loss
Chest pain
Clubbing, sign of pleural effusion

50
Q

What could you do for the diagnosis of a mesothelioma?

A

Biopsy
CT Thorax
Thoracoscopy

51
Q

Discuss management options for mesothelioma.

A

Incurable
Treating the effusion
Chemo
Palliative surgery for some
Recruitment to trials

52
Q

What is the only imaging modality that allows a site for drainage of a pleural effusion to be marked?

A

Ultrasound

53
Q

What are pleural plaques?

A

Benign areas of thickened tissue in the pleura

54
Q

When may a person develop pleural plaques?

A

20-40 years after exposure to asbestos

55
Q

What is the treatment for pleural plaques?

A

No treatment unless very large.

56
Q

List some more general causes of transudates.

A

Heart failure
Nephrotic syndrome
Constrictive pericarditis
Cirrhosis

57
Q

List some more general causes of exudates.

A

Lung malignancy
Pneumonia
Mesothelioma
Rheumatoid arthritis.

Year 1- Respiratory (36 decks)

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