Pleural Disease

Question 1

what are the two types of pleural effusion?

Answer 1

transudates and exudates

Question 2

what is the difference between transudates and exudates? (by definition, not classification)

Answer 2

transudates: an imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid (normal capillary permeability), usually bilateral
exudates: increased permeability of pleural surface and / or local capillaries, usually unilateral

Question 3

what is the cut off for pleural fluid protein in order to classify a transudate pleural effusion?

Answer 3

< 30 g/L

Question 4

what is the cut off for pleural fluid protein in order to classify a exudate pleural effusion?

Answer 4

> 30 g/L

Question 5

what are the most common causes of transudate pleural effusion?

Answer 5

left ventricular failure
liver cirrhosis
hypoalbuminaemia
peritoneal dialysis

Question 6

what are the most common causes of exudate pleural effusion?

Answer 6

malignancy

parapneumonic (pneumonia etc)

Question 7

what investigations can be performed when pleural effusion is suspected?

Answer 7

chest xray
contrast enhanced thorax CT
pleural aspiration and biopsy

Question 8

if a pleural aspiration is performed and food particles are found, what does this suggest?

Answer 8

oesophageal rupture

Question 9

when performing pleural biopsies, do you biopsy immediately above or below a rib?

Answer 9

above

Question 10

how do you treat a tension pneumothorax?

Answer 10

chest drain in 2nd intercostal space mid clavicular line

Question 11

what is the main cause for mesothelioma?

Answer 11

asbestos poisoning