Pleural Disease

Question 1

What is the turnover of pleural fluid?

Answer 1

30-75% per hour

Question 2

What is a pleural effusion?

Answer 2

The abnormal collection of fluid in the pleural space

Question 3

How can pleural effusion be asymptomatic?

Answer 3

If it is small and accumulates slowly

Question 4

What are the symptoms of a pleural effusion?

Answer 4

Increasingly breathless
Pleuritic chest pain 
Dull ache 
Dry cough 
Weight loss 
Malaise 
Fevers 
Night Sweats

Question 5

When is a dry cough most common?

Answer 5

During rapid accumulation

Question 6

What are the two causes of pleuritic chest pain and what are there outcomes?

Answer 6

Inflammatory - ear;y, may improve as fluid accumulates

Malignancy - progressively worsening

Question 7

What are the signs of pleural effusion?

Answer 7

Reduced chest expansion 
Stony dullness on percussion 
Low breath sounds 
Low vocal resonance
Clubbing 
Tar staining of fingers 
Cervical lymphadenopathy 
Increased jugular venous pressure 
Peripheral oedema 
Trachea moved away from large effusion

Question 8

What are the two types of fluid that makes up a pleural effusion?

Answer 8

Transudates

Exudates

Question 9

What is usually the cause of transudates pleural effusion?

Answer 9

An imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid

Question 10

What is usually the cause of an exudate pleural effusion?

Answer 10

Increased permeability of pleural surface and/or local capillaries

Question 11

What investigations can be done?

Answer 11

Chest radiograph
Contrast enhanced CT of the thorax
Pleural aspiration and biopsy
Thoracoscopy

Question 12

When should an investigation be carried out?

Answer 12

If there are unusual features

Failure to response to appropriate treatment

Question 13

How many biopsies should be done?

Answer 13

At least 4, 3 in formaldehyde and 1 in saline if TB suspected

Question 14

What are the possible treatments of pleural effusion?

Answer 14

Chemotherapy 
Antituberculous chemotherapy 
Corticosteroids 
Pleurodhesis 
Surgical pleurodhesis

Question 15

What is a pneumothorax?

Answer 15

Presence of air within the pleural cavity

Question 16

What are the 4 types of pneumothorax?

Answer 16

Primary spontaneous
Secondary spontaneous
Non-iatrogenic
Iatrogenic

Question 17

What are the symptoms of a pneumothorax?

Answer 17

Acute breathlessness
Worsening breathlessness
Pleuritic chest pain
Extreme dyspnoea

Question 18

What are the signs of a non tension pneumothorax?

Answer 18

Trachea diverted to affected side
Less expansion
Hyper resonant
Absent or low breath sounds

Question 19

What are the signs of a tension pneumothorax?

Answer 19

Trachea deviated away from affected side
Haemodynamic compromise
Increased jugular venous pressure

Question 20

When are there no signs or symptoms of a pneumothorax?

Answer 20

when it is small and there is still good ventilation

Question 21

What is the management of a tension pneumothorax?

Answer 21

An intercostal chest drain

Question 22

Where in an intercostal chest drain placed?

Answer 22

2nd intercostal space at the mid-clavicular line

Question 23

What is the management of a small primary pneumothorax where the patient is not breathless?

Answer 23

Observe overnight
Repeat CXR
If there is no change the whole has sealed so discharge and advice against vigorous activity and review in 2 weeks

Question 24

What is the management of a breathless primary pneumothorax?

Answer 24

Aspirate pneumothorax

If unsuccessful chest drain

Question 25

What is the management of breathless secondary pneumothorax?

Answer 25

Try to aspirate but most likely chest drain

Question 26

What is asbestos?

Answer 26

Highly fibrous naturally occurring mineral

Question 27

What can asbestos cause?

Answer 27

Mesothelioma

Question 28

What is mesothelioma?

Answer 28

Pleural malignancy that can also occur in the peritoneum

Question 29

what type of asbestos is most dangerous to health?

Answer 29

Crocidolite