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Systems 1 > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

Symptoms of pleural effusion

A

Worsening breathlessness
Pleuritic pain (progressive if malignant)
Dry cough

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2
Q

Signs of Pleural effusion

A 
Affected chest side:
Decreased expansion
Stony dullness
Decreased breath sounds
Decreased vocal resonance
Cervical lymph nodes
Increased JVP
Peripheral oedema
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3
Q

Why is the net movement of fluid from the pleura into the lung?

A

Systemic arterial pressure is greater than the pulmonary arterial pressure (4>1.5)

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4
Q

Transudates: protein content, usual presentation, common causes.

A 
<30g/L
Bilateral
LVF
Liver cirrhosis
Hypoalbuminaemia
Peritoneal dialysis
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5
Q

Exudates: protein content, usual presentation, common causes

A

> 30g/L
Unilateral
Malignancy
Parapneumic (inflammatory)

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6
Q

When to investigate pleural effusion further?

A

Unilateral

Fails to respond to treatment

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7
Q

Additional investigations for pleural effusion, what does each look for?

A

Pleural aspiration - content
Contrast CT - malignancy
CXR - pleural thickening

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8
Q

How is a pleural aspiration performed?

A

Patient bends over
Guide needle with ultrasound
Use antiseptic and lignocaine
Drain 50ml

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9
Q

Different tests performed on aspirated fluid?

A

Look and sniff
Blood gas analyser
Lab testing

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10
Q

What does a foul smelling pleural fluid suggest?

A

Anaerobic empyema

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11
Q

What does pus in the pleural fluid suggest?

A

Empyema

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12
Q

What does food in the pleural fluid suggest?

A

Oesophageal rupture

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13
Q

What does white/milky pleural fluid suggest?

A

Chylothorax - lymphoma

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14
Q

Difference between blood in pleural fluid vs blood stained fluid?

A

Blood stained - malignancy

Blood - haemothorax

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15
Q

What does a blood gas analyser result of pH <7.2 indicate?

A

Chest drain

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16
Q

What criteria is used to identify whether a pleural fluid is exudate?

A

Light’s Criteria (exudate if one of):
 Effusion : serum protein ratio >0.5
 Effusion : serum LDH ratio >0.6
 Effusion LDH is 0.6 x ULN

17
Q

Raised amylase in pleural fluid suggests what?

A

Pancreatitis

18
Q

Cytology will test the pleural fluid for what?

A

Malignant cells
Lymphocytes (TB, Lymphoma)
Eosinophils

19
Q

Low glucose in pleural fluid suggests what?

A 
Empyema
RA 
SLE
TB
Malignancy
20
Q

Which needle is used for biopsy?

A 
Abrams needle (Blind)
Tru-cut (US guided)
21
Q

How many samples are taken, and where are they sent?

A

3 - to histology

1 - to microbiology (esp. if suspected TB)

22
Q

If no diagnosis for PE, what is recommended?

A

Thorascopy

Pleuradhesis

23
Q

What increases the risk of primary pneumothorax?

A

Tall, thin (marfans like)

Apical blebs

24
Q

What is the cause of non-iatrogenic pneumothorax?

A

Blunt/penetrating chest trauma

25
Q

Largest causes of secondary pneumothorax?

A

COPD (30-50%)
TB, pneumonia, asthma
CF

26
Q

Symptoms of pneumothorax?

A

None
Pleuritic chest pain
Extreme acute dypnoea

27
Q

Signs of non-tension pneumothorax?

A

Decreased expansion
Hyper-resonance
Absent breath sounds

28
Q

Signs of tension pneumothorax?

A 
TRACHEAL DEVIATION 
Increased JVP/Haemodynamic compromise
Decreased expansion
Hyper-resonance
Absent breath sounds
29
Q

Treatment for tension pneumothorax

A

Cannula 2nd ICS MCL

Drain

30
Q

Treatment of a small (minor) primary pneumothorax

A

Observe, repeat CXR

No change? Hole has sealed

31
Q

Treatment of a large (breathless) primary or secondary pneumothorax

A

Aspirate with 3 way tap (underwater seal)

32
Q

If you drain >3L, what does it suggest?

A

Persistent fluid leak into the pleural cavity

33
Q

What is the treatment if the lung fails to reinflate?

A

Surgical thoroscopy

Pleuradhesis

34
Q

When is pleuradhesis indicated?

A

2nd ipsilateral pneumothorax
First contralateral pneumothorax
Bilateral
High risk profession

35
Q

Symptoms of mesothelioma?

A

Breathless
Pleuritic pain
(can also appear in the peritoneum)

36
Q

How late does mesothelioma occur post-exposure?

A

20-40y

37
Q

Expected radiological findings in mesothelioma?

A

Unilateral diffuse/local pleural thickening

38
Q

Three types of asbestos

A

Chrysotile (white asbestos)
Crocidolite (blue asbestos)
Amosite (brown or grey asbestos)

Systems 1 (25 decks)

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