Pleural Disease

Question 1

What are the SYMPTOMS of PLEURAL EFFUSION?

Answer 1

1) Asymptomatic - if small and slow to accumulate
2) > Dyspnoea
3) Pleuritic Chest Pain
4) Dry Cough
5) Fever
6) Malaise
7) Weight Loss
8) Night Sweats

Question 2

What are the MAIN SIGNS of PLEURAL EFFUSION?

Answer 2

1) < Chest Expansion (Affected Side)
2) Stony Dullness to Percussion
3) Bronchial Breathing
4) < Vocal Resonance

Question 3

What are the MAIN CAUSES of PLEURAL EFFUSION?

Answer 3

Transudates

Exudates

Question 4

What is a TRANSUDATE?

Answer 4

An Imbalance of Hydrostatic Forces Influencing the Formation and Absorption of Pleural Fluid

Normal Capillary Permeability

Can be Bilateral

Question 5

What is an EXUDATE?

Answer 5

> Permeability of Pleural Surface and or Local Capillaries

Usually Unilateral

Question 6

Following pleural aspiration, what is the cut-off measurement for pleural protein in a TRANSUDATE?

Answer 6

< 30 g/l

Question 7

Following pleural aspiration, what is the cut-off measurement for pleural protein in an EXUDATE?

Answer 7

> 30 g/l

Question 8

What are the COMMON CAUSES of a TRANSUDATE PLEURAL EFFUSION?

Answer 8

Left Ventricular Failure
Liver Cirrhosis
Hypoalbuminaemia
Peritoneal Dialysis

Question 9

What are the COMMON CAUSES of an EXUDATE PLEURAL EFFUSION?

Answer 9

Malignancy, i.e. Breast Cancer, Mesothelioma or Metastases

Question 10

What INVESTIGATIONS would be used to diagnose a PLEURAL EFFUSION?

Answer 10

1) CXR - 200ml of Fluid must be Present to be Detectable
2) CT Thorax - Differentiates between Malignant and Benign Disease
3) Pleural Aspiration
4) Pleural Biopsy - at Least 4
5) FBC and Serum Biochemistry
6) Video Assisted Thoracoscopy, if necessary

Question 11

What CRITERIA would be used to differentiate a TRANSUDATE from an EXUDATE?

Answer 11

Light’s Criteria

Question 12

How would a pleural effusion be MANAGED?

Answer 12

Treatment Aimed at the Cause, i.e. Chemo (Malignancy) or Anti-TB Chemo (TB)

Palliative Care (Malignancy)

Pleurodesis - Obliteration of the Pleural Space; Adhesion of the Pleurae with Talc

Question 13

Where on the thorax would a CHEST DRAIN be INSERTED for the purposes of PLEURODESIS?

Answer 13

4th Intercostal Space, Mid-Axillary Line

Question 14

What are the SYMPTOMS of a PNEUMOTHORAX?

Answer 14

Acute Dyspnoea and/or Worsening Dyspnoea

Pleuritic Chest Pain

Question 15

What are the SYMPTOMS of a TENSION PNEUMOTHORAX?

Answer 15

Extreme Dyspnoea

Diaphoretic

Question 16

What are the SIGNS of a PNEUMOTHORAX?

Answer 16

Can be Negligible Signs

Tracheal Shift TOWARDS the Affected Side
< Expansion
Hyper Resonance
Absent/ < Breath Sounds

Question 17

What are the SIGNS of a TENSION PNEUMOTHORAX?

Answer 17

Tracheal Shift AWAY from the Affected Side
Raised JVP
Haemodynamic Compromise

Question 18

How would a PNEUMOTHORAX be MANAGED?

Answer 18

Intercostal Chest Drain
CXR
Surgical Pleurodesis, if Required
Pleurectomy, if Required

Question 19

Where would a CHEST DRAIN be INSERTED to treat a TENSION PNEUMOTHORAX?

Answer 19

2nd Intercostal Space, Mid-Clavicular Line

Question 20

Describe the TYPES of PNEUMOTHORAX:

Answer 20

1) Spontaneous:

Primary - Idiopathic

Secondary - Complication of Other Lung Disease

2) Traumatic:

Non-Iatrogenic - Penetrating and Blunt Chest Injury

Iatrogenic - Medical Negligence

Question 21

What is MESOTHELIOMA?

Answer 21

Pleural Malignancy, Largely, due to Asbestos Exposure

Question 22

What are the SYMPTOMS of MESOTHELIOMA?

Answer 22

Dyspnoea

Pleuritic Chest Pain

Question 23

What is a SIGN of MESOTHELIOMA?

Answer 23

Weight Loss - Due to Malignancy

Question 24

How can MESOTHELIOMA be INVESTIGATED?

Answer 24

CXR
CT Thorax
Pleural Aspiration and Biopsy

Question 25

How would MESOTHELIOMA be MANAGED?

Answer 25

Radiotherapy

Palliative Care

Question 26

What LEGAL REQUIREMENT must be adhered to following mortality from MESOTHELIOMA?

Answer 26

All Cases of Occupational-Related Death Must be Referred to the Procurator Fiscal

The Relatives of the Deceased may be Entitled to Compensation