Pleural Disease

Question 1

what is a pleural effusion

Answer 1

Abnormal collection of fluid in the pleural space

Question 2

what are symptoms of pleural effusion

Answer 2

increasing breathlessness
pleuritic chest pain 
dull ache 
dry cough
weight loss
malaise 
fevers
night sweats

Question 3

what do you need to enquire about when taking symptoms from a patient with pleural effusion

Answer 3

have they had:
peripheral oedema
liver disease
orthopnoea
PND

Question 4

what are clinical signs of pleural effusion

Answer 4

affected side will have:
decrease in expansion
stony dullness to percuss
decreases breath sounds
decrease vocal resonance

Question 5

what are common transudate causes of plueral effusion

Answer 5

LV failure
liver cirrhosis
hypoalbuminaemia
peritoneal dialysis

Question 6

what are less common transudate causes of pleural effusion

Answer 6

hypothyroidism
nephrotic syndrome
mitral stenosis
pulmonary embolism

Question 7

what are common exudate causes of pleural effusion

Answer 7

malignacy

parapneumonic

Question 8

what are less common exudate causes of pleural effusion

Answer 8

PE
post-MI
rheumatoid arthritis

Question 9

what investigations would you do for pleural effusion

Answer 9

CXR
contrast enhanced CT of thorax
pleural aspiration and biopsy

Question 10

what can be complications of pleural aspiration and biopsy

Answer 10

Pneumothorax
Empyema
Pulmonary oedema
Vagal reflex
Air embolism

Question 11

after pleural aspiration the fluid can be analysed on the ward by looking at it and smelling. what might you see/smell in the fluid aspirated

Answer 11

foul smelling-anaerobic empyema
pus-empyema 
food particles-oesophageal rupture
milky-chylothorax 
blood stained- malignacy?
blood-haemothrax,trauma

Question 12

after a pleural aspiration the fluid can be analysed to tell wether it is transudate or exudate, how would this be done

Answer 12

exudate if it had 30g/L of protein or more

Question 13

where in relation to the rib would you take a biopsy

Answer 13

immediately above a rib, do not biopsy with cutting edge upwards

Question 14

how many biopsies should be taken

Answer 14

at least 4

Question 15

what do you have to do with 3 of the biopsies

Answer 15

at least 3 put into formaldehyde for histology

Question 16

what do you have to do with 1 of the biopsies and why

Answer 16

at least 1 in saline to send to microbiology, this is done if TB is suspected

Question 17

if you have investigated a pleural effusion with the normal set of tests but have no diagnosis what other investigation could be carried out

Answer 17

thoracoscopy as it gives direct inspection of the pleura

Question 18

what is the management of pleural effusion

Answer 18

Treatment directed at the cause: 
chemotherapy 
antituberculous chemotherapy
corticosteroids
repeated drainage 
Pleurodhesis

Question 19

what is a pneumothorax

Answer 19

Presence of air within the pleural cavity

Question 20

what are the types of pneumothorax

Answer 20

primary spontaneous
secondary spontaneous
non-iatrogenic
iatrogenic

Question 21

who gets primary spontaneous pneumothroax and why is it believed to happen

Answer 21

more men than wome
young peak incidence 20-30y
happens to tall thin people

believed to be due to weight of the lung inducing development of apical blebs

Question 22

when can spontaneous pneumothorax happen

Answer 22

in almost any lung disease:
asthma 
COPD
pneumonia 
TB
cystic fibrosis
sarcoidosis

Question 23

what can cause traumatic non-intragenic pneumothorax

Answer 23

penetrating chest injury-stab

blunt injury-rib fracture

Question 24

what can cause traumatic intragenic pneumothorax

Answer 24

pleural aspiration
acupuncture
pleural aspiration/biopsy

Question 25

what are the clinical features of pneumothorax

Answer 25

abrupt 
pleuritic chest pain 
reduced breath sounds
reduced chest expansion
hyper-resonant 
tachycardic 
tachypnoea