Question 1

What is a pleural effusion?

Accepted Answer

This is a collection of fluid in the plerual space

Question 2

What are the different types of pleural effusion?

Accepted Answer

Transudate - due to pressure differences Exudate - due to inflammatory process

Question 3

What are the symptoms of a pleural effusion?

Accepted Answer

Asymptomatic Dyspnoea Pleuritic chest pain

Question 4

What are clinical signs of a pleural effusion?

Accepted Answer

Generally only in effusions \> 500ml Decreased expansion Stony dull percussion note Diminished breath sounds Decreased tactile vocal fremitus Decreased vocal resonance Bronchial breathing - above where lung is compressed by effusion Tracheal deviation - very large effusions

Question 5

Why do you get reduced breath sounds in a pleural effusion?

Accepted Answer

Breath sounds are related to the intensity of flow (sound energy) as well as the transmission of the sounds through the lungs and chest wall. Abnormalities of either element will diminish breath sounds. Pleural fluid between the airways and stethoscope reduces transmission

Question 6

Why do you get stony dull percussion in a pleural effusion?

Accepted Answer

Pleural fluid dampens the normal resonance of the lung fields, creating the characteristic ‘stony’ dullness.

Question 7

What else would you look for if you suspected a pleural effusion?

Accepted Answer

Signs of a cause Malignancy - cachexia, clubbing, lymphadenopathy Chronic liver disease Cardiac failure Hypothyroidism RA SLE signs

Question 8

How would you investigate a pleural effusion?

Accepted Answer

CXR CT Aspiration Biopsy

Question 9

What complications can occur from aspirating a pleural effusion?

Accepted Answer

Pneumothorax Empyema Pulmonary oedema Vagal reflex Air embolism Tumour cell seeding Haemothorax

Question 10

If, when aspirating a pleural effusion, a foul smelling fluid was aspirated, what might you suspect to be the cause?

Accepted Answer

Anaerobic empyema

Question 11

If, when aspirating a pleural effusion, you aspirated food particles in pleural fluid, what might suspect?

Accepted Answer

Oesophageal rupture

Question 12

If, when aspirating a pleural effusion, you obtained a milky coloured fluid, what might you suspect?

Accepted Answer

Chylothorax

Question 13

What investigations might you want to get done on a pleural fluid sample?

Accepted Answer

Depends on clinical picture Gross analysis Cytology Clinical chemistry Immunology Microbiology

Question 14

What might a bloody pleural effusion indicate?

Accepted Answer

Trauma Malignancy Pulmonary infarction

Question 15

If, on biochemical analysis of a pleural fluid sample, the protein level was found to be \< 25g/L, what type of effusion would this be?

Accepted Answer

Transudate

Question 16

If, on biochemical analysis of a pleural fluid sample, the protein level was found to be \> 35g/L, what type of effusion would this be?

Accepted Answer

Exudate

Question 17

What could cause a glucose of \<3.3 mmol/L in a pleural fluid sample?

Accepted Answer

Empyema Malignancy TB RA SLE

Question 18

What could cayse a pH of \< 7.2 in a pleural fluid sample?

Accepted Answer

Empyema Malignancy RA SLE TB

Question 19

What could cause a raised LDH in a pleural fluid sample?

Accepted Answer

Empyema Malignancy TB RA SLE

Question 20

How would you manage a pleural effusion?

Accepted Answer

Treat the cause Drainage Pleurodesis Surgery

Question 21

When would you drain a pleural effusion?

Accepted Answer

If it was symptomatic

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Pleural disease Flashcards

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