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Respiratory System > Pleural disease > Flashcards

Pleural disease Flashcards

1
Q

Causes of pleural effusion

A 
Infection
Malignancy
Inflammation
Hydrothorax (transudate)
Chylothorax (lymph)
Haemothorax (blood)
Acute pancreatitis
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2
Q

Pleural effusions can be classified as

A

Large vs small
Unilateral vs bilateral
Exudate vs transudate

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3
Q

Unilateral effusion usually due to

A

Malignancy

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4
Q

Bilateral effusion usually due to

A

Cardiac/renal/hepatic impairment

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5
Q

Differential between exudate and transudate

A

Protein level

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6
Q

Exudate protein level

A

> 30g/L

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7
Q

Transudate protein level

A

<30g/L

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8
Q

Exudate

A

Fluid that leaks around the cells of the capillaries due to inflammation resulting in leaky vessels - reason for high protein

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9
Q

Transudate

A

Fluid pushed through the capillary due to high pressure within the capillary

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10
Q

Symptoms of pleural effusion

A

Shortness of breath
Cough
Pleuritic chest pain

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11
Q

Signs of pleural effusion

A 
Reduced chest expansion on affected side
Tracheal deviation
Stony dullness on percussion
Diminished/absent breath sounds
Loss of vocal resonance
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12
Q

Investigations of pleural effusion

A

Chest x-ray
Ultrasound
Thoracentesis and pleural fluid analysis

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13
Q

Thoracentesis

A

Insertion of needle into pleural space to remove fluid from pleural effusion

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14
Q

Investigations to determine cause of effusion

A

Bloods
CT
MRI
Thoracoscopy, bronchoscopy, pleural biopsy

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15
Q

Pleural effusion x-ray findings

A

Loss of costophrenic angles
White-out if effusion is large
Other abnormalities point to cause

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16
Q

Overall management of effusion encompasses

A

Management of underlying disease and management of effusion

17
Q

Management of effusion depends on

A

Size, cause and type

18
Q

Management of effusion

A 
Observation
Aspiration
Chest drain
Pleuroperitoneal shunts 
Pleurodesis (stick lung to chest wall)
Pleurectomy (removal of part of pleura)
19
Q

Differentials of pneumothorax

A

Pleaural effusion
Musculoskeletal cause
Pulmonary embolism

20
Q

Causes/risk factors of primary spontaneous pneumothorax

A

Smoking
Tall thin male
Family history (marfans habitus)

21
Q

Causes/risk factors of secondary pneumothorax

A

Associated with underlying lung disease - COPD, asthma

22
Q

Causes/ risk factors of tension pneumothorax

A

Usually traumatic

One way valve with air coming in but none going out

23
Q

Pneumothorax

A

A collapsed lung caused by air leaking into the intrapulmonary space

24
Q

Symptoms of pneumothorax

A

Chest pain - sudden onset
Shortness of breath
Asymptomatic

25
Q

Signs of pneumothorax

A 
Sweating
Tachycardia
Reduced chest expansion
Hyperresonance
Reduced/absent breath sounds
26
Q

Presentation of tension pneumothorax

A

HR > 135
Tracheal deviation
Raised JVP

27
Q

Pneumothorax investigations

A

Chest x-ray
Ultrasound
CT

28
Q

Pneumothorax x-ray findings

A

Visible visceral pleural edge very thing sharp white line
No lung markings peripheral to line
Peripheral space is radiolucent compared to adjacent lung
Mediastinum shifted away from affected side (tension)
Subcutaneous emphysema and pneumomediastinum may be present

29
Q

Management of primary spontaneous pneumothorax

A

<2cm - nothing

>2cm - chest drain

30
Q

Management of secondary pneumothorax

A

<1cm - admit and observe for 24 hours
1-2cm - aspiration, chest drain if fails
Over 50 yo, >2cm - chest drain

31
Q

Management of tension pneumothorax

A

Large bore cannula into second intercostal space in midclavicular line
Chest drain

32
Q

Management of recurring pneumothorax

A

Pleurodesis

Pleurectomy

33
Q

Pleural plaques

A

Localised fibrous deposits that thicken the lung lining

34
Q

Malignant mesothelioma

A

Cancer of mesothelium that lines the lungs, chest wall and abdomen

35
Q

Symptoms of malignant mesothelioma

A 
Chest pain
Breathlessness
Fever 
Weakness 
Cough 
Weight loss
36
Q

Management of malignant mesothelioma

A

Chemotherapy

Pleurodesis and long term drain

37
Q

Asbestos related diseases

A

Malignant mesothelioma
Benign asbestos effusion
Pleaural plaques

38
Q

Management of pleural plaque

A

No treatment

Respiratory System (20 decks)

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