pleural disease

Question 1

where does pleural fluid normally come from and go out

Answer 1

• comes in from intercostal and bronchial vessel system
• goes out the lymphatic drainage system
• most action on the parietal side

Question 2

what happens in CHF

Answer 2

transudate

• high pressure in blood vessels pushes fluid in
• high pressure blocks lymphatic drainage
• get more in than out

Question 3

what happens in inflammation

Answer 3

exudate

• high pressure from blood vessels
• cells wall separate and let proteins into the pleural space

Question 4

what happens in CA

Answer 4

exudate

• high pressure in vessels
• tumors can block lymphatics
• cytokines can cause walls to separate

Question 5

3 cauese of transudate

Answer 5

1. CHF
2. hepatic hydrothorax
3. nephrotic syndrome

Question 6

4 general cause of exudate

Answer 6

1. infection
2. malig
3. inflammatory
4. other

Question 7

CXR signs of effusion

Answer 7

• blunting of costophrenic angle
• meniscus
• increased opacity
• pleural fluid layering out

Question 8

what is thoracentesis

Answer 8

• sampling of fluid

- can be done with local

Question 9

light’s crit. for exudate

Answer 9

it is exudate if any one of:

1. pleural prot:serum protein >0.5
2. pleural LDH:serum LDH >0.6
3. LDH > 200

Question 10

what is high LDH sign of

Answer 10

1. empyema
2. RA
3. malig

Question 11

what is high protein sign of

Answer 11

1. TB

2. myeloma

Question 12

what is low pH sign of

Answer 12

1. empymena
2. TB
3. RA
4. malig.
5. eso rupture

Question 13

what is low glucose sign of

Answer 13

1. epymnema
2. TB
3. RA
4. malig
5. eso rupture

Question 14

what are 3 cell counts to look and and what do they tell us

Answer 14

Neutrophil
- bacterial
Lymphocyte
- malig, TB
Eosinophil
- pneumo, hemothorax, drugs, parasites

Question 15

what is MGMT of transudate

Answer 15

TREAT underlying problem

- can also help reduce the afterload

Question 16

4 possible Tx of malig. effusion

Answer 16

1. repeated thoracentesis
2. pigtail cath.
3. pleurodesis - more definitive
4. indwelling pleural cath - tunneled under skin

Question 17

2 types of spont. pneumothoraxes

Answer 17

1. primary

2. secondary

Question 18

4 risks for primary

Answer 18

1. smkoer
2. male
3. fam Hx
4. marfans

Question 19

4 risks for secondary

Answer 19

1. COPD
2. CF
3. pneumocystits
4. TB

Question 20

mgmt of stable pneumothorax

Answer 20

1. small

Question 21

mgmt of unstable pneumo

Answer 21

1. chest tube
2. if can do tube or emergency - needle decompression
3. if all else - VATS