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Pulmonary Review > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

Normal amt of pleural fluid in an individual?

A

7-14 ml

Make about 0.15ml/kg/hr

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2
Q

Treatment of re-expansion pulmonary edema?

A

Supportive

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3
Q

When should you consider
terminating fluid removal
during thoracentesis?

A

When a patient complains
of chest discomfort or
when 1.5L has been
removed

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4
Q 
Which organism is
associated with a
complicated
parapneumonic pleural
effusion that has an
elevated pH?
A

Proteus. In general, all
other complicated
parapneumonic effusions
will have a low pH.

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5
Q

Tell me the different meanings of pleural albumin gradients (albumin gradient = serum albumin - PF albumin).

A

Gradient > 1.2 g/dL = transudate

Gradient <1.2 g/dL = exudate

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6
Q

Tuberculous pleuritis, post CABG, RA, yellow nail syndrome, and chylothorax all cause what cell prodominence on effusions?

A

Lymphocytic effusions

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7
Q

Trauma (PTX, hemothorax, surgery), malignancy, asbestos effusions, parasitic, fungal, and drug induced effusions have what cell predominance?

A

Eosinophilic

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8
Q 
Which pleural effusion
most commonly presents
with dyspnea out of
proportion to pleural
effusion size?
A

Pleural effusion secondary

to CHF

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9
Q 
A patient with CHF being
diuresed has an exudative
pleural effusion. What is
the best way to evaluate
whether this is a false
exudate in the setting of
diuresis?
A

Check PF albumin (or

protein) gradient

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10
Q

What % of CHF effusions are unilateral?

A

30%

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11
Q

What % of hepatic hydrothorax effusions are unilateral?

A

80%

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12
Q

What do you see on cell count to diagnose spontaneous bacterial pleuritis (aka the other SBP)?

A

Same criteria as the other SBP!

Neutrophil count > 250 cells/mm3 with positive culture
OR
>500 cells/mm3 with negative culture

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13
Q

Treatment of spontaneous bacterial pleuritis?

A

Antibiotics alone - chest tube is seldom required

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14
Q

Case:

45 y/o gets started on peritoneal dialysis due to SLE. 16 days after starting PD she develops worsening dyspnea and CXR reveals large right sided effusion. What is the best initial treatment?

A

Stop PD for 2-6 weeks, 50% are able to resume PD without recurrence

Consider VATS to correct diaphragmatic defects

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15
Q 
A patient with nephrotic
syndrome presents with an
exudative pleural effusion.
What diagnosis should you
suspect?
A

Pulmonary embolus

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16
Q

When to consider surgery for trapped lung?

A

When dyspnea is clearly due to trapped lung, otherwise thoracic interventions rarely help.

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17
Q

Case:

Patient develops dyspnea 3 days post-op from ex lap due to trauma. Right pleural effusion noted. Thoracentesis fluid reveals pleural creatinine:serum Cr >1. Diagnosis?

A

Urinothorax

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18
Q

Case:

Patient develops dyspnea 3 days post-op from ex lap due to trauma. Right pleural effusion noted. Thoracentesis fluid reveals protein <1 and positive beta-2 transferrin. Diagnosis?

A

Duropleural fistula/subarachnoid pleural fistula

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19
Q

Tell me the stage of parapneumonic effusion (simple vs complicated) given the following fluid characteristics:

Appears clear or slightly turbid

A

Simple

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20
Q

Tell me the stage of parapneumonic effusion (simple vs complicated) given the following fluid characteristics:

pH < 7.20

A

Complicated

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21
Q

Tell me the stage of parapneumonic effusion (simple vs complicated) given the following fluid characteristics:

Glucose < 60 mg/dL

A

Complicated

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22
Q

Tell me the stage of parapneumonic effusion (simple vs complicated) given the following fluid characteristics:

LDH <1000

A

Simple

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23
Q

Tell me the stage of parapneumonic effusion (simple vs complicated) given the following fluid characteristics:

Gram stain may be positive

A

Complicated

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24
Q

Most common pathogens that cause empyema?

A

Strep (50%)
Anaerobes (20%)
Staph (10%)

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25
Q

This study found that intrapleural tPA + DNase is superior to either agents alone in the treatment of empyema in terms of improved fluid drainage, reduced frequency of surgical referral, and reduced duration of hospital stay

A

MIST-2

26
Q

What are the indications for
chest-tube drainage of a
parapneumonic effusion?

A

Frankly purulent or
turbid/cloudy PF, pH < 7.2,
positive Gram stain or
culture

27
Q

When to consider IPC in malignant effusions?

A

Effusions that are

  1. Symptomatic
  2. Prognosis >1 month
  3. No trapped lung
28
Q

This study was for malignant effusions where there was IPC vs chest tube pleurodesis in management in pleural effusions, showing no difference in dyspnea at 6 weeks but shorter length of initial hopsitalization and less dyspnea at 6 months in IPC group

A

Therapeutic Intervention in Malignant Effusion (TIME)

29
Q

What % of patient with acute PE have pleural effusions from increased pulmonary capillary permeability?

A

20-50%

30
Q

Given the following effusion characteristics, tell me if this is more post-CABG related or more post-cardiac injury syndrome (PCIS) related:

Fever, pleuritic chest pain, pericardial rub

A

PCIS

31
Q

Given the following effusion characteristics, tell me if this is more post-CABG related or more post-cardiac injury syndrome (PCIS) related:

Occurs due to myocardial or pericardial injury

A

PCIS

32
Q

Given the following effusion characteristics, tell me if this is more post-CABG related or more post-cardiac injury syndrome (PCIS) related:

Mostly small unilateral left-sided pleural effusions, but 10% can be larger

A

Post-CABG

33
Q

Given the following effusion characteristics, tell me if this is more post-CABG related or more post-cardiac injury syndrome (PCIS) related:

Appearance can be bloody early but clear-yellow late

A

Post CABG

PCIS has bloody or serosanguenous throughout

34
Q

True/False: bloody pleural effusion in the setting of a PE is a contraindication to anticoagulation/lytics.

A

FALSE

35
Q

True/False: pleural fluid from patients with TB pleuritis typically contains >5% mesothelial cells

A

FALSE

If >5% mesothelial cells, would argue against TB pleuritis

36
Q

Typical fluid analysis of pleural fluid from TB pleuritis?

A

Exudative
Low glucose
Lymphocytic
Mesothelial cells <5%

37
Q

What % of pleural fluid cultures are positive in TB pleuritis?

A

40%

38
Q

What pleural fluid test has a sensitivity and specificity of 90% in diagnosing TB pleuritis?

A

ADA

39
Q

What other condition can create a high pleural fluid ADA?

A

RA

40
Q

What procedure can get 90-100% diagnostic yield to diagnose TB pleuritis?

A

Thoracoscopy

41
Q

Based on the following characteristics, tell me if this is more consistent with RA or SLE pleuritis:

Older male with subQ nodules, arthritis preceeding

A

RA

42
Q

Based on the following characteristics, tell me if this is more consistent with RA or SLE pleuritis:

Pleural fluid has glucose <40, pH<7.2, high LDH (>700)

A

RA

43
Q

Based on the following characteristics, tell me if this is more consistent with RA or SLE pleuritis:

50% have bilateral effusions

A

SLE

44
Q

Based on the following characteristics, tell me if this is more consistent with RA or SLE pleuritis:

Treatment is NSAIDs and steroids

A

SLE

45
Q

What hct is consistent with hemothorax?

A

at least 50%

46
Q

Based on the following characteristics, tell me if this more consistent with chylothorax or cholesterol effusion/pseudochylothorax:

Milky or opalescent

A

both

Ha! got ya

47
Q

Based on the following characteristics, tell me if this more consistent with chylothorax or cholesterol effusion/pseudochylothorax:

Chylomicron +

A

Chylothorax

48
Q

Based on the following characteristics, tell me if this more consistent with chylothorax or cholesterol effusion/pseudochylothorax:

Triglyceride > 100

A

Chylothorax

49
Q

Based on the following characteristics, tell me if this more consistent with chylothorax or cholesterol effusion/pseudochylothorax:

Most common cause are TB effusion and RA pleural effusion

A

Cholesterol effusion

50
Q

Based on the following characteristics, tell me if this more consistent with chylothorax or cholesterol effusion/pseudochylothorax:

Treatment is dietary measures, possible high-protein, low-fat diet supplemented with medium-chain triglycerides

A

Chylothorax

51
Q

Give me 4 causes of elevated amylase in effusions

A

Acute pancreatitis
Chronic pancreatitis
Esophageal rupture
Malignancy

52
Q

Effusions secondary to pancreatitis are usually left or right sided?

A

Left

53
Q

This is the triad of lymphedema, yellow and thickened nails, and pleural effusion.

A

Yellow nail syndrome

54
Q

This is the development of pleural effusions with the use of hCG for fertility purposes

A

Ovarian hyperstimulation syndrome

55
Q

Average time from asbestos exposure to the development of benign asbestos pleural effusion (BAPE)?

A

15-20 years

56
Q

Typical pleural fluid charactersistics on BAPE?

A

Unilateral
Exudative
1/3 eosinophilic
>50% bloody

57
Q

True/False: BAPE has prognostic implications for the development of plaques or malignancy.

A

FALSE

58
Q

Average time from asbestos exposure to the development of pleural plaques?

A

> 20 years

59
Q

This is the comet-tail sign pointing toward the hilum, associated with asbestos history, can trap underlying lung, and stable of 2-3 year time span

A

Rounded atelectasis

60
Q

What are the signs of a
pneumothorax on
ultrasound?

A

Absence of lung sliding on
2-D mode and presence of
stratosphere or barcode
sign on M-mode

61
Q

When should recurrence
prevention be offered for
spontaneous
pneumothorax?

A

At the time of the second
occurrence of a PSP or the
first occurrence of a SSP

62
Q

As they say at the end of French movies

A

Fin

Pulmonary Review (14 decks)

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