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Pleural Disease Flashcards

1
Q

What are some clinical findings of pleural disease?

A

Reduced breath sounds

Stony dull on percusion

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2
Q

What are some possible chest X-ray findings for pleural disease?

A

Loss of costophrenic ange

At least 200ml of pleural fluid

Tracheal deviation

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3
Q

What are some possible CT findings of pleural disease?

A

Nodular thickening

Pleural fluid/air

Density of fluid

Localisation

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4
Q

When investigating pleural fluid, in terms of biochemistry, what are you looking for?

A

Protein

LDH

Glucose

Triglyceride

Cholesterol

Amylase

Rheumatoid factor

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5
Q

When investigating pleural fluid, in terms of microbiology, are you looking for?

A

Gram stain

AAFB

Culture

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6
Q

What are the 2 kinds of extracellular fluid?

A

Transudate

Exudate

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7
Q

What is tranudate?

A

Extracellular fluid with a low protein count, occurs due to increase hydrostatic pressure

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8
Q

What does transudate occur due to?

A

Increase hydrostatic pressure

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9
Q

What is exudate?

A

Extracellular fluid with a high protein count, occurs due to inflammation and increase capillary permeability

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10
Q

What does exudate occur due to?

A

Inflammation and increased capillary permeability

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11
Q

Which of tranudate and exudate has more protein?

A

Exudate

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12
Q

Which of transduate and exudate has more LDH?

A

Exudate

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13
Q

What is LDH?

A

Lactate dehydrogenase

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14
Q

What is exudate associated with?

A

Infection

Malignancy

Pulmonary embolism

Rheumatoid arthritis

Effusions

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15
Q

What is transudate associated with?

A

Cardiac failure

Liver failure

Renal failure

Hypoalbuminemia

Hypothyroidism

Pulmonary embolism

Malignancy

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16
Q

What are different kinds of biopsy that can be used to obtain a sample of pleural fluid?

A

Abrams pleural bipsy

Image guided biopsy

Medical thoracoscopy

VATS pleural biopsy

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17
Q

What does VATS stand up for?

A

Video assisted thoracoscopic surgery

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18
Q

What is a pleural effusion?

A

Build up of fluid between the layers of the pleura

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19
Q

What is a build up of fluid between the two layers of the pleura called?

A

Pleural effusion

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20
Q

When should a pleural effusion be drained?

A

Large

Breathless

Raised respiratory rate

Hypoxia

Tachycardia

Chest X-ray trachea deviated

Pus

Trauma

Parapneumonic

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21
Q

What is a parapneumonic effusion?

A

Type of effusion that arises as a result of a pneumonia, lung abscess or bronchiectasis

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22
Q

What is the prognosis of parapneumonic effusion?

A

Poor outcome

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23
Q

What percentage of pleural effusions are parapneumonic effusions?

A

33%

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24
Q

What is a type of effusion that arises as a result of a pneumonia, lung abscess or bronchiectasis called?

A

Parapneumonic effusion

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25
Where should the needle go (in regards to the rib) when obtaining a sample of pleural fluid?
Above the rib to avoid the nerve bundle
26
What is a pneumothorax?
Collapsed lung, occurs when air leaks into the pleura
27
What is a collapsed lung, occuring due to air leaking into the pleura called?
Pneumothorax
28
What are the 2 ways that a pneumothorax can occur?
Spontaneous Traumatic
29
What are different kinds of traumatic pneumothorax?
Non-iatrogenic Iatrogenic
30
What does iatrogenic mean?
Illness caused by medical examination or treatment
31
What is an illness caused by medical examination or treatment called?
Iatrogenic
32
What does management of a pneumothorax include?
Nothing Aspiration Oxygen and chest drain insertion
33
What does long term management of a pneumothorax include?
Home with chest drain Medical pleurodeisis Cardiothoracic referral
34
What is a pleurodeisis?
Procedure that uses medicine to adhere your lung to your chest wall
35
What is a procedure that uses medicine to adhere your lung to your chest wall called?
Pleurodeisis
36
What is a tension pneumothorax?
Progressive build up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not return
37
What is the progressive build up of air within the pleural spaced called?
Tension pneumothorax
38
What is a laceration?
Deep cut or tear
39
What is a deep cut or tear called?
Laceration
40
What perentage of the time that a tension pneumothorax requires ventilation?
50%
41
What are the signs of a tension pneumothorax?
Distressed Trachea deviation Reduced chest expansion Hyper resonance Hypoxia Tachycardia Hypotension Cardiac arrest
42
What do you aspirate for a tension pneumothorax?
2nd anterior intercostal space in the midclavicular line
43
What advice should you speak about with a patient you are discharging?
Advice about recurrence Smoking cessation Flying Return to work Any follow up
44
What is a well known chemical that can cause pleural disease?
Asbestos
45
What are the 3 main highly fibrous materials that cause pleural disease?
Chrysotile (white) Amosite (brown) Crocidolite (blue)
46
What colour is chrysotile?
White
47
What colour is amosite?
Brown
48
What colour is crocidolite?
Blue
49
What is the most dangerous asbestos to health?
Crocidolite
50
What is asbestos?
Group of minerals made of microscopic fibres, where if you breath in these fibres they can damage your lungs
51
What are the group of materials made of microscopic fibres called?
Asbestos
52
What is asbestos related pleural disease usually due to?
Occupation
53
How long is the latent period?
20-40 years
54
What are examples of occupations that might lead to asbestos related pleural disease?
Marine engineer Ship building Docks Construction sites Joiners Plumbers Engine rooms Boilers
55
What are examples of diseases caused by asbestos?
Pleural plaques Benign asbestos effusion Malignant mesothelioma Diffuse pleural thickening
56
What are pleural plaques?
Due to exposure to asbestos areas of the pleural membrane become thickened and accumulates a chalky material
57
What is it called when due to asbestos areas of the pleural membrane become thickened and accumulates a chalky material?
Pleural plaques
58
What may people who have pleural disease due to asbestos be entitled to?
Compensation
59
Are pleural plaques benign or malignant?
Benign
60
What is a benign asbestos effusion?
Non-malignant pleural disease
61
What is benign asbestos effusion associated with?
Pleural thickening
62
What is a malignant mesothelioma?
Cancer of the thin tissue (mesothelium) that lines the lung, chest wall and abdomen
63
What is cancer of the thin tissue (mesothelium) that lines the lung, chest wall and abdomen called?
Malignant mesothelioma
64
What are symptoms of malignant mesothelioma?
Chest pain Breathlessness Fever Weakness Cough Weight loss
65
What does the diagnosis of malignant mesothelioma use?
Chest X-ray CT Aspirate Tissue required to confirm diagnosis
66
What does a chest X-ray show for malignant mesothelioma?
Pleural effusion Pleural based opacity/mass
67
What is used to obtain tissue to confirm the diagnosis of malignant mesothelioma?
Image guided biopsy Thoracoscopy Lobectomy
68
What is the median survival time for malignant mesothelioma?
Less than 1 year
69
What is the treatment for malignant mesothelioma?
Limited role for surgery Chemotherapy Palliation
70
What is diffuse pleural thickening?
Extension, often smooth scarring thickens the pleural membrane
71
What is it called when smooth scarring thickens the pleural membrane?
Diffuse pleural thickening
72
What is pleural fibrosis?
Thickening and stiffening of the pleural that occurs due to pleural inflammation or exposure to asbestos
73
What is thickening and stiffening of the pleura that occurs due to pleural inflammation or exposure to asbestos called?
Pleural fibrosis
74
What is empyema?
Collection of pus in the pleural cavity caused by microorganisms
75
What is a collection of pus in the pleural cavity caused by microorganisms called?
Empyema

Respiratory System (37 decks)

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