pleural disease

Question 1

what is pleural effusion?

Answer 1

abnormal collection of fluid in the pleural space

- do a pleural tap

Question 2

what does straw coloured fluid mean?

Answer 2

cardiac failure

hypoalbuminaemia

Question 3

what does bloody coloured fluid mean?

Answer 3

trauma
malignancy
infection
infarction

Question 4

what does turbid/milky ocloured fluid mean?

Answer 4

empyema

chylothorax

Question 5

what does foul smelling fluid mean?

Answer 5

anaerobic empyema

Question 6

what do food particles in the fluid mean?

Answer 6

oesophageal rupture

Question 7

transudates?

Answer 7

proteins < 30 g/L
heart failure
liver cirrhosis

Question 8

exudates?

Answer 8

proteins > 30 g/L
malignancy
infection inc TB

Question 9

fluid pH

Answer 9

normal = 7.6
< 7.3 = pleural inflammatoin
< 7.2 = requires drainage in the setting of infection

Question 10

when is gluocse low?

Answer 10

in infection
TB
rheumatoid arthirisis 
malignancy
oesophagela rupture
SLE

Question 11

when is amylase raised?

Answer 11

in pancreatitis and oesophageal rupture

Question 12

when is creatine raised?

Answer 12

in urinothroax

Question 13

when is adenosine deaminase raised?

Answer 13

in TB

Question 14

what are the effects of systematic tumours?

Answer 14

embolism

hypoalbuminaemia

Question 15

what are the effects of local tumours?

Answer 15

post obstructive infection
lymphatic obstruction
atelectasis

Question 16

what is mesothelioma?

Answer 16

uncommon malignant tumour in the lining of the lung or very occasionally in the lining of the abdominal cavity

• as a result of asbestos
• may causes breathlessness, chest pain, weight loss, fever, sweating and coughing

Question 17

what is asbestos?

Answer 17

• chrysotile = white = most common
• amosite = brown
• crocidolite = most dangerous

Question 18

what is the treatment for mesothelioma?

Answer 18

• pleurodese effusion
• radiotherapy
• surgery
• chemotherapy
• paliative care

Question 19

what is a long term pleural catheter?

Answer 19

• designed to allow patients to control their effusion and symptoms
• designed to remain in place for life
• complications: incorrect placement, bleeding, infection

Question 20

how do you treat effusions?

Answer 20

• LVF = diuretics
• infection = drian, antibiotics, may require surgery
• malignancy = drain, pleurodesis, long term pleural catheter

Question 21

what is the presentation of pneumothorax?

Answer 21

• tachycardia
• hyper-resonant pecussion note
• reduced expansion
• quiet breath sounds on auscultation

Question 22

how do you manage pneumothorax?

Answer 22

<2cm = oxygen
>2cm = high flow O2, aspirate via 16-18g cannula

Question 23

do you give gentimycin for pleural infections?

Answer 23

no, avoid intra-pleural antibiotics

Question 24

what do you give for pleural infection?

Answer 24

6 week course of co-amoxiclav