Pleural Disease

Question 1

cell lining of visceral and parietal pleura

Answer 1

lined by mesothelial cells, overly vessels and lymphatics

Question 2

features found only in parietal pleura

Answer 2

stoma b/w mesothelial cells leading to lymphatics, sensory pain nerves (pleuritic chest pain)

responsible for normal clearance of fluid in pleural space

Question 3

describe the composition of pleural fluid (normally)

Answer 3

75% macros, 23 lymphs, 2 other

alkolotic pH over 7.5

low protein

Question 4

2 categories of pleural effusions

Answer 4

transudate: non inflammatory fluid w/ low protein- from increase in hydrostatic pressure or loss of oncotic pressure
exudate: inflammatory proteinaceous fluid, from icreased capillary permeability or lymphatic obstruction

Question 5

physical exam findings for pleural effusion

Answer 5

dullness to percussion, reduced breath sounds

Question 6

radiology of pleural effusion

Answer 6

flattened diaphragm, blunted CP angles

meniscus sign (b/c its a liquid)

mediastinal shift if large

will shift due to gravity in decubitus position (unless it has organized)

Question 7

usual appearance of transudate fluid

Answer 7

clear, straw colored, non visous, odorless (not always true)

Question 8

orange or milky pleural fluid

Answer 8

chylothorax- thoracic duct injury

Question 9

gross pus in pleural fluid

Answer 9

empyema

Question 10

causes of bloody pleural fluid

Answer 10

cancer, pulmonary infarct, trauma

true hemothorax when has over half the hematocrit level of blood

Question 11

factors used in light’s criteria to determine exudate

Answer 11

high protein or LDH compared to normal serum ratio

Question 12

4 common transudative cuases

Answer 12

CHF, PE, cirrhosis, nephrotic syndrome

Question 13

4 common exudative casues

Answer 13

pneumonia, malignancy, PE, GI disease

Question 14

high PMNs in exudate indicates

Answer 14

acute inflammatory process

Question 15

high eosinophils in exudate indicates

Answer 15

likely air or blood etiology

Question 16

high lymphs in exudate inidicates

Answer 16

malignancy or TB

Question 17

what can a low glucose level in pleural fluid mean (4)

Answer 17

parapneumonic or empyema, rheumatoid disease, malignancy (lower glucose= worse tumor), TB

Question 18

high LDH indicates

Answer 18

complicated parapneumonic effusions or malignancy

Question 19

high triglycerides in pleural fluid

Answer 19

chylothorax- disruption of thoracic duct from tumor or trauma

Question 20

amylase in fluid

Answer 20

pancreatitis (will be higher than serum) or esophageal rupture

Question 21

4 Tx for pleural effusion

Answer 21

thoracentesis, chest tube drainage, pleurodesis, small bore catheter

Question 22

define pleuritis

Answer 22

inflammatory process involving pareital pleura, has many pain fibers= pleurisy

Question 23

two types of pneumothorax causes

Answer 23

tear in lungs- blebs, mechanical ventilation, spontaneous, bronchoscopy

chest wall compromise- trauma, central line, lung biopsy

Question 24

radiology of pneumothroax

Answer 24

depends on severity!

can see edge of lung parenchyma w/ more lucent area alongside peripherally

tracheal deviation away from lesion

deep sulcus sign (deeper than usual CP angle)

when very severe, full mediastinal shift moving cardiac silouhette away from lesion

Question 25

4 Tx options for pneumothorax

Answer 25

observe- often self resolve 100% O2- increases pO2 in pleural gas and accelerates reabsorption into blood needle decompression chest tube

Question 26

define tension pneumo

Answer 26

one way valve for air into pleural space, can occur w/ mechanical ventilation w/ air buildup

Question 27

consequences and Tx of tension pneumo

Answer 27

can compromise venous return and cause shock requires needle decompression or chest tube