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Respiratory > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

Why does a pleural effusion occur?

A

2y infection, inflammation, malignancy

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2
Q

What 2 types of PEf can there be?

A

Transudate (low protein) and exudate (high protein)

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3
Q

What is a PEf?

A

Fluid in the pleural space

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4
Q

What is the pathophysiology of PEf?

A

Transudate: fluid moving into pleural space (due to excess fluid in body)
Exudate: inc leakiness of pleural capillaries due to inflammatory response

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5
Q

What are the causes for transudate PEf?

A

heart failure, hypoproteinaemia, hypothyroidism, ovarian tumours

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6
Q

True/False:

Meig’s Syndrome causes PEf as a result of ovarian tumour formation

A

True

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7
Q

What are causes for exudate PEf?

A

bacterial pneumonia, carcinoma of bronchus, pulmonary infarction (due to PE), TB, Rheumatic disease

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8
Q

What are presenting symptoms of PEf?

A
  • SOB, pleuritic pain

- EXAM: deviated trachea away from PEf, percussion is dull, lack of chest expansion, absent chest sounds

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9
Q

Ix for PEf…

A

USS guided pleural tap (aspiration/thoracentesis)
pleural biopsy
CXR (transudate PEf usually bilateral)

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10
Q

True/False:

P.Tap would show exudate PEf is protein content <30g/l

A

False:
exudate= >30g/l
transudate= <30g/l

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11
Q

What does a PEf CXR show?

A

blunting of costophrenic angle, fluid in lung fissures, large effusions may have a meniscus, tracheal deviation

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12
Q

What is Light’s Criteria?

A

Used to assess if PEf is exudate..
Pleural Fluid Protein: serum protein >0.5
Pleural Fluid LDH: serum LDH >0.6
Pleural Fluid LDH > 2/3 upper limit of normal serum

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13
Q

Tx for PEf…

A

treat underlying cause and drain

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14
Q

What is parpneumonic effusion?

A

Effusion caused by pneumonia, lung abscess or bronchiectasis

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15
Q

What are the 2 types of Parapneumonic Effusion?

A

simple, complicated

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16
Q

How is parapneumonic effusion investigated and symptoms?

A

same as PEf ie. USS P.Tap etc.

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17
Q

Is Parapneumonic effusion common in patients with pneumonia?

A

Yes

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18
Q

What is empyema?

A

common complication of parapneumonic effusion- pus in the pleural space

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19
Q

What organism is present in an empyema and why?

A

Streptococcus as alpha- haemolytic streptococcus is present for strep pneumoniae

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20
Q

How can Empyema be diagnosed?

A
  • High levels of acute inflammatory cells, low pH, <2.2 glucose in bloods
  • slow resolve of pneumonia
  • imaging: CXR, USS p.tap, CT
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21
Q

why does empyema occur?

A

unresolved pneumonia/ not responding to treatment, diabetes mellitus, immunosuppression, GORD, drugs

22
Q

True/False:

Empyema is treated differently to PEf and if so, how?

A

True-

Antibiotics are given on top of drainage

23
Q

What antibiotics are given for Empyema?

A

Amoxicillin and Metronidazole (broad spectrum)

24
Q

What is a haemothorax?

A

blood in pleural space

25
Q

What is a pneumothorax?

A

air in pleural space due to tear in pleura

26
Q

What are the different classes of pneumothorax?

A

1y spontaneous, 2y spontaneous, iatrogenic/trauma

27
Q

How does a pneumothorax occur…

A

Small gap formed in pleural cavity so surface tension is lost between 2 pleural layers & -ve pressure is lost in pleural cavity as it comes into contact with atmospheric pressure so lung recoils.

28
Q

What causes a 1y spontaneous pneumothorax?

A

congenital defect in connective tissue of alveolar walls forming bull which rupture

29
Q

Who is more likely to have a 1y pneumothorax?

A

Tall, thin young men

30
Q

What causes a 2y spontaneous pneumothorax?

A

pre-existing lung disease
- underlying COPD, asthma, TB, CF, emphysema, chronic cough
usually occurs as a result of inflammation, 2y infection or neoplasms

31
Q

True/False:

Cannabis smokers are more likely to have a 1y spontaneous pneumothorax?

A

False

More likely to have a 2y spontaneous pneumothorax

32
Q

What can cause an iatrogenic pneumothorax?

A

ventilation, lung biopsy, central line

33
Q

what are the presenting symptoms of a pneumothorax?

A

Unilateral strong pleuritic pain, breathlessness, pallor, tachycardia

34
Q

What are the signs of a pneumothorax?

A

hyper resonance on percussion, reduced breath sounds, dec vocal resonance

35
Q

What is decreased vocal resonance sign called?

A

Hamman’s Sign

36
Q

Pneumothorax Ix…

A

CXR, CT (or none if Tension Pneumothorax)

37
Q

Tx for pneumothorax?

A

Drainage tube, surgery VATS (pleurectomy, tac pleurodesis)

38
Q

Where is the drainage use for a pneumothorax inserted?

A

Axillary triangle

39
Q

When is surgery the best way to proceed for pneumothorax Tx?

A

If drainage tube bubbles

40
Q

True/False:

large px <2cm, resolves spontaneously

A

False
small px: <2cm, resolves spontaneously
large px: >2cm, aspiration>chest drain>pleurectomy

41
Q

What is a tension pneumothorax (tpx)?

A

Medical Emergency !!!

42
Q

what may cause a tpx?

A

trauma, rupture of bulla, +ve pressure ventilation, misplaced drain

43
Q

What are the signs and symptoms of a tpx?

A

symptoms: severe breathlessness, severe unilateral chest pain
signs: mediastinal shift away from px side, hypotension, tachycardia

44
Q

Pathophysiology of a tpx…

A

air is sucked in on inspiration but is not expelled during expiration as pleural space fills with air

45
Q

Emergency tx for tpx?

A

needle decompression & drainage

46
Q

Where is needle decompression carried out in tpx?

A

2nd intercostal space, mid-clavicular line on tpx side

47
Q

What are complications of tpx?

A

Cardiorespiratory arrest, bronchopleural fistula (non closure of pleural tear)

48
Q

Give examples of chest wall disorders…

A

Trauma (rib fractures, rupture of trachea/ bronchus etc)
Kyphoscoliosis
Pectus excavatum/ carinatum

49
Q

What is the difference between a simple and a complicated parapneumonic effusion?

A

Complicated means that bacteria is present or other organisms are present in effusion.
simple effusion is sterile (no organisms)

50
Q

What is empyema a common complication of?

A

Complicated parapneumonic effusion

Respiratory (19 decks)

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