Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Respiratory > Pleural disease > Flashcards

Pleural disease Flashcards

1
Q

What is the pleura?

A

This is a protective layer of connective tissue that surrounds the chest wall and lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 types of pleura?

A

Parietal pleura (Chest wall)
Visceral pleura (Lungs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 4 regions of the parietal pleura?

A

Mediastinal
Diaphragmatic
Costal
Cervical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What forms the pulmonary ligament?

A

The 2 main layers of pleura combine around the hilla to form th pulmonary ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does the pulmonary ligament run?

A

It runs inferiorly and attaches the root of the lung to the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a pleural effusion?

A

This is an abnormal accumulation of fluid within the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 2 types of pleural effusion?

A

Exudative
Transudative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is meant by an exudate?

A

An effusion containing a large amount of protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is meant by a transudate?

A

An effusion containing a small amount of protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Light’s criteria for distinguishing between exudates and transudates?

A
  • Pleural fluid protein divided by serum protein is >0.5
  • Pleural lactate dehydrogenase (LDH) divided by serum LDH is >0.6
  • Pleural fluid LDH >2/3rd the upper limit of laboratory normal value for serum LDH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a general rule of thumb for protein levels in transudates and exudates?

A

Exudate has >30g / L protein
Transudate has <30g / L protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some conditions that can cause transudative pleural effusion (5)?

A

Heart failure
Liver cirrhosis
Hypoalbuninaemia
Atelectasis (Partial lung collapse)
Peritoneal dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some conditions that can cause exudative pleural effusion (4)?

A

Malignancy
Infection including TB
Pulmonary infarction
Asbestosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the usual cause of transudative effusions?

A

Changes in osmotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the usual cause of exudative effusions?

A

Inflammation or lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would a bilateral pleural effusion be suggestive of?

A

Drug use
Left ventricular failure
Pulmonary thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some symptoms of pleural effusion?

A

Chest pain
Dry cough
Dyspnoea
Difficulty taking deep breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some common clinical signs of pleural effusion?

A

Reduced chest expansion
Stony dull percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some tests required in pleural effusion?

A

Biochemistry
Aspiration
Cytology
Chest X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What biochemical tests are required in pleural effusion?

A

pH
LDH
Glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the normal pleural fluid pH?

A

~7.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are pH and LDH tests used for?

A

Determining the difference between simple and complicated parapneumonic effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is meant by a simple parapneumonic effusion?

A

pH > 7.2
LDH < 1000
High glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is meant by a complicated parapneumonic effusion?

A

pH < 7.2
LDH > 1000
Low glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
In what conditions will glucose levels in pleural effusion be low? (4)
Infection including TB Rheumatoid arthritis Malignancy SLE
26
What conditions can cause a straw coloured effusion?
Cardiac failure Hypoalbuminaemia
27
What conditions can cause a blood effusion?
Trauma Malignancy Infection Infarction
28
What conditions can cause a turbid/milky effusion?
Empyema Chylothorax
29
What is meant by a chylothorax?
Lymphatic drainage into the pleural cavity
30
What would a could smelling effusion be suggestive of?
Anaerobic empyema
31
What would food particles within an effusion be suggestive of?
Oesophageal rupture
32
What would cytology be used for in pleural effusion?
Malignant cells - Cancer Lymphocytes - Malignancy or TB Neutrophils - Acute illness
33
What microbiological testing can be performed in pleural effusion?
Gram staining Cultures PCR AFB staining
34
What will most bacteria in complicated parapneumonic effusions stain?
Gram positive
35
What will most bacteria in simple parapneumonic effusions stain?
Gram negative
36
What levels of effusion are required for a pleural effusion to be visible on CXR?
200ml on plain x-ray 500ml will show a clear fluid level
37
What conditions will cause raised amylase in pleural effusion?
Pancreatitis Oesophageal rupture
38
What conditions will cause the presence of triglycerides in the pleural effusion?
Chylothorax caused by trauma, malignancy or LAM (Lymphangioleiomyomatosis)
39
What conditions will cause cholesterol crystals to form in pleural effusion?
Pseudochylothorax, caused by TB or rheumatoid arthritis
40
What will cause raised creatinine levels within a pleural effusion?
Urinothorax (Urine leakage into pleural cavity)
41
What condition will cause a raised adenosine deaminase in pleural effusion?
TB
42
What test will be performed if there is no clear diagnosis from fluid sampling?
CT guided thoracoscopy
43
How are simple parapneumonic effusions usually treated?
Antibiotics only
44
How are complicated parapneumonic effusions usually treated?
Chest drain (Thoracentesis) and antibiotics
45
What are the most common cancers that metastasise to the pleura?
Lung cancer Breast cancer
46
What is the median survival time of pleura malignancy?
3-12 months
47
How are frequent pleural effusions in pleural malignancy usually treated?
Palliation using chemotherapy and radiotherapy Permanent chest drain Talc slurry (Pleurodesis)
48
What are some possible complications of talc slurry (Pleurodesis)?
Minor pleuritic pain Fever Pneumonia Respiratory failure Talc pneumonitis Secondary empyema
49
What is a pneumothorax?
This is an abnormal collection of air in the pleural space
50
What are the 3 main types of pneumothorax?
Primary spontaneous pneumothorax Secondary spontaneous pneumothorax Traumatic or iatrogenic pneumothorax
51
What is meant by primary pneumothorax?
This occurs with no underlying lung disease, often as a result of a bulla rupture
52
Who is most at risk of a primary spontaneous pneumothorax?
Tall Thin Male Cannabis smoker
53
What is meant by a secondary spontaneous pneumothorax?
This occurs due to an underlying lung disease
54
What are some possible presentations of pneumothorax?
Asymptomatic - If small enough Acute onset pleuritic chest pain Dyspnoea
55
How does pneumothorax cause breathlessness?
Pneumothorax abolishes the transmural pressure gradient and so expansion of the chest wall cannot properly inflate the lungs
56
What are some possible clinical signs of pneumothorax?
Hypoxia Tachycardia Hyper-resonant percussion note Reduced chest expansion Quiet breath sounds on auscultation Hamman's sign (Clock on auscultation of left side)
57
What investigations are required in pneumothorax?
Chest X-ray CT scan
58
What will be seen on CXR in pneumothorax?
A small rim of air around the lungs
59
How can CXR differentiate between a small and large pneumothorax?
<2cm wide rim = small >2cm wide rim = large
60
What is the use of CT scanning in pneumothorax?
It is important in differentiating between bullous lung disease and small pneumothorax
61
What is the management for a large primary pneumothorax with symptoms?
High flow oxygen Aspirate via 16-18G cannula
62
Where is a needle aspiration performed?
IN the Safe triangle in he 4-5th intercostal space on the mid-axillary line
63
What makes up the safe triangle for needle aspiration?
Anterior border of latissimus doors Posterior border of pectorals major Anterior axial line, superior to the nipple
64
Where in the intercostal space should needle aspiration be performed?
Through the centre, in order to avoid the neuromuscular bundles at the top and bottom of the intercostal space
65
What are some management options in small primary pneumothorax with no symptoms?
High flow oxygen Discharge early
66
What is the limit for the amount of fluid that can be drained at once in pneumothorax?
2.5L aspirate, as any more than this can cause a rapid expansion oedema
67
What is used in pneumothorax >2.5 L?
Suction can be performed over 48 hours
68
What is a tension pneumothorax?
This is a life threatening variant of pneumothorax in which a one way valve causes progressively increasing pressure in the pleural space leading to mediastinal shift and cardiorespiratory compromise
69
How will tension pneumothorax usually present?
Hypertension Tachycardia Tachypnoea Tracheal deviation Elevated JVP
70
How is tension pneumothorax treated?
Needle decompression, in which a large gauge cannula is inserted into the 2nd or 3rd intercostal space in the midclavicular line
71
What is mesothelioma?
This is an aggressive malignant tumour of the mesothelium, mostly arising from the pleura
72
What is the most common cause of mesothelioma?
20-40 years post exposure to asbestos, mostly chrysotile asbestos fibres
73
How does mesothelioma usually present?
Pleural effusion Progressive dyspnoea Stony dull percussion Chest pain Weight loss
74
What are some investigations that can be performed in mesothelioma?
Chest X-ray CT scan Thoracoscopy Aspiration of pleural fluid
75
What will be seen on CXR in mesothelioma?
Pleural effusion Pleural mass with a lobulated margin Possible pleural thickening
76
What is an empyema?
This is the presence of purulent fluid in the pleural space, most commonly caused by pneumonia
77
What are some risk factors for empyema?
Immunodeficiency Immunosuppression Abnormal innate immunological defence Repeated insult e.g. aspiration
78
How will empyema usually present?
Slow to resolve pneumonia The patient will usually get better and then will develop a spike in temperature Possible signs of pleural effusion
79
What are some investigations that can be performed in empyema?
CXR - Fluid level USS CT (Not routinely)
80
What is the management for empyema?
IV amoxicillin and IV metronidazole Cultures taken Oral antibiotics to culture Chest tube drain in safe triangle
81
What are the 3 basic types of asbestos?
Chrysotile - White asbestos Amosite - Brown asbestos Crocidolite - Most dangerous

Respiratory (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions