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ABIM Pulmonary Boards - Jackie > Pleural disease > Flashcards

Pleural disease Flashcards

1
Q

Black pleural fluid

A

Aspergillus niger

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2
Q

Milky pleural fluid

A

Chylothorax/pseudochylothorax

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3
Q

Yellow-green pleural fluid

A

Rheumatoid pleuritis

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4
Q

Anchovy paste pleural fluid

A

amebic liver abscess

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5
Q

Bloody pleural fluid

A

Hemothorax
Cancer
PE
Trauma
iatrogenic

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6
Q

Ammonia odor in pleural fluid

A

Urinothorax

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7
Q

Brown pleural fluid

A

Hemothorax (old)
Amebic liver abscess

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8
Q

Green pleural fluid

A

Cholothorax (biliary fistula)

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9
Q

Water like pleural fluid

A

Duro-pleural fistula

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10
Q

LDH >1000 pleural fluid

A

Empyema
complicated parapneumonic effusion
Cholesterol effusion
rheumatoid pleurisy
primary pleural lymphoma
paragonimiasis

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11
Q

Low glucose in pleural fluid

A

Empyema
Chronic rheumatic pleurisy
esophageal rupture
malignancy
paragonimiasis
acute lupus pleuritis
TB

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12
Q

High amylase in pleural fluid

A

Acute pancreatitis
esophageal rupture
malignancy

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13
Q

Total protein >7-8 in pleural fluid

A

Multiple myeloma
Rheumatoid pleurisy
Waldenstrom’s macroglobulinemia

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14
Q

Total protein >4 in pleural fluid

A

Cholesterol effusion
TB

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15
Q

Total protein <1in pleural fluid

A

Duropleural fistula
Urinothorax
peritoneal dialysis

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16
Q

Drugs that can lead to high eos in pleural fluid

A

Dantrolene, bromocriptine, nitrofurantoin, valproic acid

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17
Q

pleural fluid with lymphocytosis predominance

A

Malignancy
Chronic rheumatoid pleurisy
chylothorax
Post CABG
Sarcoid
TB
uremic effusion
yellow nail syndrome

if PH <7.3
-malignancy
- Chronic rhem
- TB

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18
Q

pleural fluid with eos (>10%) predominance

A

PTX (w/in hrs)
Hemothorax (after 10-14d)
pulm infarct
parasitic or fungal dz (histo, crypto)
Drug induced
lymphoma, carcinoma

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19
Q

pleural fluid with neutrophil predominance

A

Acute pleural injury
infection
inflammation

20
Q

pleural fluid with >10% eos and pH <7.3

A

Paragonimiasis

21
Q

pleural fluid with predominant neutrophils and pH <7.3

A

Empyema
acute esophageal rupture
acute lupus pleurisy
cholesterol effusion

22
Q

Causes of Low ph (<7.3) in pleural fluid

A

Empyema
esophageal rupture
chronic rheum pleursy
Cholesterol effu
Malignacy
TB
Acute lupus pleuritis
Paragonamiasis

23
Q

3 test rule for exudate

A

PF protein >/= 3
PF Cholesterol >45
PF LDH > 45% upper limit nl S LDH

24
Q

Serum measures to help make sure it is exudate vs transudate

A

Transudate if:
- Albumin gradient (S-PF) >1.2
- Total protein gradient >3.1
- PF/S albumin <0.6
- S or PF BNP >1500

Helps to confirm if HF or hepatic hydrothorax

25
Q

Dressler’s syndrome pleural fluid characteristics

A

Post-cardiac injury syndrome

Small effusion, unilateral or bilateral
Bloody or serosang
PMN or monos
High BNP

Treat with NSAIDs or steroids
Colchicine for ppx

26
Q

Characteristics of pleural fluid in PE

A

Exudate
Can be uni or bilateral
Neutrophil, bloody

27
Q

Characteristics of pleural fluid in pancreatitis

A

Exudate
elevated amylase

DDX esophageal rupture and malign
Check isoenzymes

28
Q

Characteristics of pleural fluid in RA

A

Exudate
painless
low pH and glucose

29
Q

Characteristics of pleural fluid in Lupus

A

Exudate
Higher glucose compared to RA
Painful
LE cells are highly specific

30
Q

Causes of pseudochylous pleural fluid

A

TB
Rheum
Helminth infxn

31
Q

Yellow nail syndrome pulm characteristics

A

Exudative pleural effusion
Bronchiectasis
Sinusitis

32
Q

Conditions that can present with PTX initially

A

Catamenial (endometrial implants)
Cystic lung dz
infections (HIV, PJP, TB, necrotizing)

33
Q

When to do definitive procedure for primary spontaneous PTX?

A
  • Recurrent PTX
  • Large size or high severity needing CT
  • High risk profession
  • High burden of cysts
  • Pt wants intervention
  • Persistent air leak (5-7d)
  • Need for lung biopsy
34
Q

Mesothelial markers

A

Calretinin
CK 5/6
D2-40
WT-1

35
Q

Adenocarcinoma markers

A

CEA
B27.3
Bg8
BerEP4
MOC-31

36
Q

Squamous cell carcinoma markers

A

P40
P63
CK5/6

37
Q

Lung cancer marker in Pleural fluid

A

TTF-1
Napsin A

38
Q

GI cancer marker in Pleural fluid

A

CDX-2
CK20

39
Q

Kidney cancer marker in Pleural fluid

A

PAX-2, PAX-8, RCC, CAIX

40
Q

GYN cancer marker in Pleural fluid

A

PAX-8, WT1

41
Q

Breast cancer marker in Pleural fluid

A

ER/PR
GATA 3
Mammaglobin
GCDFP-15

42
Q

Sensitivity of pleural fluid cytology?

A

Depends on tumor type
40-87%

good for lung adeno, breast and ovarian

BAD - mesothelioma and squamous cell of lung

43
Q

Most common chemos to cause pleural eff

A

Dasatinib
Gemcitabine

44
Q

Prognostic scores in malignant pleural effusion?

A

LENT- PF LDH, ECOG, neutrophil to lymph ratio and tumor type

PROMISE - estimates 3 mo mortality

Neither have been shown to assess improved outcomes

45
Q
A

ABIM Pulmonary Boards - Jackie (11 decks)

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