Pleural disease

Question 1

What is the most common chest pain?

Answer 1

pleurisy

Question 2

What does pleurisy feel like?

Answer 2

sharp, stabbing pain

worsens with inspiration

Question 3

What causes pleurisy?

Answer 3

Mostly viral infection

inflammatory processes, so responds well to NSAIDs

Question 4

What is pleural effusion?

Answer 4

the accumulation of fluid in pleural space

**Not a disease but a sign of disease**

Question 5

What causes pleural effusion?

Answer 5

a) increased production of fluid
b) decreased lymph drainage (e.g. CA)

Can be filled with pus (empyema), blood (hemothorax)

Question 6

How are most small effusions discovered?

Answer 6

Routine radiography

usually asymptomatic

Question 7

What disease is about a quarter of effusions associated with?

Answer 7

malignancy

Question 8

What is a transudate pleural effusion?

Answer 8

“intact capillaries”

associated w/ inc hydrostatic or decreased oncotic pressure but NOT inflammation or pleural disease

seen in CHF, renal dz, cirrhosis

Question 9

What is an exudate pleural effusion?

Answer 9

“leaky capillaries”

local factors inc permeability, allowing more fluid in

due to inflammation (e.g. infection)

Question 10

How does one determine if an effusion is exudative?

Answer 10

Light’s Criteria

Question 11

What is lights criteria?

Answer 11

used to determine if pleural effusion is exudative process

1) Pleural fluid protein : serum protein >0.5
2) Pleural fluid LDH : serum LDH >0.6

or 2/3 upper limit of normal

Question 12

What are the sx of a large or bilat effusion?

Answer 12

dyspnea, cough

pleuritic chest pain

(no orthopnea unless CHF)

Question 13

What will you see on PE of someone with large pleural effusion?

Answer 13

dull percussion over fluid area

reduced or absent breath sounds

decreased fremitus

audible rub

mediastinum shifted away from the side of the effusion

Question 14

How will you dx a pleural effusion?

Answer 14

thoracentesis of pleural fluid (compare serum and LDH levels)

CXR: diaphragm menisci

Question 15

How do you treat a pleural effusion?

Answer 15

Treat underlying condition

Therapeutic thoracentesis*

Question 16

What type of pleural effusion is a pulmonary embolism?

Answer 16

exudate

Question 17

What is a pneumothorax?

Answer 17

Air within the pleural space

Can be spontaneous, traumatic, or caused by tension

Question 18

What’s a primary spontaneous pneumothorax, and who gets it?

Answer 18

A ruptured bleb

No trauma, no real known cause, no underlying lung disease

common in 20-40y tall, thin, male, smokers, fam hx

Question 19

What’s a secondary spontaneous pneumothorax, and who gets it?

Answer 19

occurs w/ other lung disease

still atraumatic

Question 20

What is a tension pneumothorax?

Answer 20

air pressure pushes lungs and heart to contralateral side

MC with trauma, mechanical ventilation, CPR

also caused by TB

Question 21

Which type of pneumothorax is life threatening?

What do you do?

Answer 21

tension pneumothorax

do needle aspiration, then chest tube thoracostomy

Question 22

What are the sx of pneumothorax?

Answer 22

unilateral, pleuritic chest pain

dyspnea

Question 23

What will you find on PE with a pneumothorax?

Answer 23

hyperresonance, dec fremitus, dec breath sounds

unequal resp expansion

tachycardia/pnea, inc JVP, pulsus paradoxus

Question 24

How do you dx pneumothorax?

Answer 24

CXR - can see lung outline and companion lines

loss of lung markings

Question 25

How do you tx a pneumothorax?

(small v large)

Answer 25

Small: watch it, usually self-resolves

Large: needle aspiration, chest tube

avoid high altitudes, smoking, flying, scuba diving