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Respiratory HQ > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

What type of cell make up the pleural membranes

A
  • single layer of mesothelial cells

- sub-pleural connective tissue

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2
Q

How is the pleural fluid maintained in the pleural space

A

inward pulmonary/systemic arterial pressure is greater than outward oncotic pressure

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3
Q

What is a pleural effusion

A

abnormal collection of fluid in the pleural cavity

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4
Q

What are the symptoms of pleural effusion

A
  • asymptomatic in small amounts
  • increasing breathlessness
  • pleuritic pain
  • dry cough
  • weight loss/malaise/night sweats
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5
Q

What are the clinical signs of pleural effusion

A
  • decreased chest expansion/breath sounds/vocal resonance
  • stony dullness on percussion
  • clubbing/cervical nodes/tracheal movement/peripheral oedema
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6
Q

What are transudates in pleural effusion

A
  • imbalance of hydrostatic forces influencing the formation/absorption of pleural fluid
  • bilateral
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7
Q

What are exudates in pleural effusion

A
  • increased permeability of pleural surface and local capillaries
  • unilateral
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8
Q

What is the pleural fluid protein content of transudates

A

less than 30g/L

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9
Q

What are the causes of transudates

A
  • left ventricular failure (increased pressure, pushing fluid out)
  • liver scarring
  • hypoalbuminaemia
  • hypothyroidism
  • PE
  • mitral stenosis
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10
Q

What is the pleural fluid protein content of exudates

A

greater than 30g/L

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11
Q

What are the causes of exudates

A
  • malignancy (lung/breast/metastatic)
  • pneumonia
  • PE
  • rheumatoid arthritis
  • autoimmune disease
  • pancreatitis
  • drugs
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12
Q

When should transudates be investigated

A
  • unusual features

- treatment failure

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13
Q

What are the two main investigations used to diagnose pleural effusion

A
  • CXR
  • contrast enhanced CT (to differentiate between benign and malignant disease)
  • pleural aspiration and biopsy
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14
Q

Name some complications arising form a pleural aspiration and biopsy

A
  • pneumothorax
  • pulmonary oedema
  • air embolism
  • haemothorax
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15
Q

What investigations should be carried out on the aspirated material

A
  • look and sniff
  • blood gas analysis
  • biochemistry
  • microbiology (suspected TB/infection)
  • cytology (for malignancy)
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16
Q

What investigation must be carried out if pleural effusion still cannot be diagnosed

A

thorascopy

17
Q

How is pleural effusion managed

A
  • treat underlying cause
  • give palliative treatment in malignancy
  • pleurodhesis
18
Q

What is pleurodhesis

A

removal of the pleural cavity by surgical/chemical meands

19
Q

What is the procedure of pleurodhesis

A

chest tube in 4th intercostal space, midaxillary line

20
Q

What is pneumothorax

A
  • presence of air in the pleural cavity leading to lung collapse
21
Q

What are the two main divisions of pneumothorax

A
  • spontaneous primary/secondary

- traumatic (iatrogenic/non-iatrogenic)

22
Q

What is the cause of primary spontaneous pneumothorax

A

the weight of the lung inducing development of blebs that may spontaneously rupture

23
Q

What is the cause of secondary spontaneous pneumothorax

A

any underlying lung disease

24
Q

What is the cause of non-iatrogenic pneumothorax

A
  • any penetrating/blunt lung injury
25
Q

What is the cause of iatrogenic pneumothorax

A
  • pleural aspiration and biopsy
  • subclavian vein cannulation
  • lung/liver/breast biopsy
26
Q

What are the symptoms of pneumothorax

A
  • asymptomatic if small breach
  • acute, worsening breathlessness
  • pleuritic pain
27
Q

What are the clinical signs of non-tension pneumothorax

A
  • surgical emphysema (bubble wrap)
  • tracheal deviation
  • decreased chest expansion/breath sounds
  • hyper resonance on percussion
28
Q

What are the additional clinical signs of tension pnemothorax

A

increased jugular venous pressure

29
Q

What is a tension pneumothorax

A

the breach is in the form of a flap, which forms a one way valve, allowing air into the pleural space but not back again

causes the lung to become smaller and smaller, and the pneumothorax to become larger and larger

30
Q

How can tension pneumothorax be managed

A

cannula in second intercostal space, midclavicular line followed by insertion of intercostal chest drain

31
Q

How is primary pneumothorax, no SOB managed

A
  • overnight
  • CXR
  • dishcharge
32
Q

How is primary pneumothorax, SOB managed

A

intercostal chest drain, midaxillary line

33
Q

What is asbestos

A

a highly fibrous naturally occurring material historically used in the building industry due to its commercially profitable properties that has been shown to give rise to mesothelioma

34
Q

What is mesothelioma

A

pleural malignancy caused by exposure to aspestos, usually presenting up to 40 years after first exposure

35
Q

What is the clinical presentation or mesothelioma

A
  • breathlessness

- chest wall pain

36
Q

What is the radiological presentation of mesothelioma

A
  • unilateral

- diffuse/localised pleural thickening

Respiratory HQ (26 decks)

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