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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
What is a pneumothorax?
air in pleural space due to tear in pleura
26
What are the different classes of pneumothorax?
1y spontaneous, 2y spontaneous, iatrogenic/trauma
27
How does a pneumothorax occur...
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
What causes a 1y spontaneous pneumothorax?
congenital defect in connective tissue of alveolar walls forming bull which rupture
29
Who is more likely to have a 1y pneumothorax?
Tall, thin young men
30
What causes a 2y spontaneous pneumothorax?
pre-existing lung disease - underlying COPD, asthma, TB, CF, emphysema, chronic cough usually occurs as a result of inflammation, 2y infection or neoplasms
31
True/False: | Cannabis smokers are more likely to have a 1y spontaneous pneumothorax?
False | More likely to have a 2y spontaneous pneumothorax
32
What can cause an iatrogenic pneumothorax?
ventilation, lung biopsy, central line
33
what are the presenting symptoms of a pneumothorax?
Unilateral strong pleuritic pain, breathlessness, pallor, tachycardia
34
What are the signs of a pneumothorax?
hyper resonance on percussion, reduced breath sounds, dec vocal resonance
35
What is decreased vocal resonance sign called?
Hamman's Sign
36
Pneumothorax Ix...
CXR, CT (or none if Tension Pneumothorax)
37
Tx for pneumothorax?
Drainage tube, surgery VATS (pleurectomy, tac pleurodesis)
38
Where is the drainage use for a pneumothorax inserted?
Axillary triangle
39
When is surgery the best way to proceed for pneumothorax Tx?
If drainage tube bubbles
40
True/False: | large px <2cm, resolves spontaneously
False small px: <2cm, resolves spontaneously large px: >2cm, aspiration>chest drain>pleurectomy
41
What is a tension pneumothorax (tpx)?
Medical Emergency !!!
42
what may cause a tpx?
trauma, rupture of bulla, +ve pressure ventilation, misplaced drain
43
What are the signs and symptoms of a tpx?
symptoms: severe breathlessness, severe unilateral chest pain signs: mediastinal shift away from px side, hypotension, tachycardia
44
Pathophysiology of a tpx...
air is sucked in on inspiration but is not expelled during expiration as pleural space fills with air
45
Emergency tx for tpx?
needle decompression & drainage
46
Where is needle decompression carried out in tpx?
2nd intercostal space, mid-clavicular line on tpx side
47
What are complications of tpx?
Cardiorespiratory arrest, bronchopleural fistula (non closure of pleural tear)
48
Give examples of chest wall disorders...
Trauma (rib fractures, rupture of trachea/ bronchus etc) Kyphoscoliosis Pectus excavatum/ carinatum
49
What is the difference between a simple and a complicated parapneumonic effusion?
Complicated means that bacteria is present or other organisms are present in effusion. simple effusion is sterile (no organisms)
50
What is empyema a common complication of?
Complicated parapneumonic effusion

Respiratory (19 decks)

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