Pleural Disease

Question 1

What is the effect of the following on pleural fluid analysis of pH:

• Lidocaine?
• Air?
• Time in tube?

Answer 1

• Lidocaine decreases pH
• Air increases pH
• Length of time in tube increases pH

Question 2

What pleural cholesterol value usually indicates exudate?

Answer 2

> 55

Question 3

What serum-pleural protein gradient value usually indicates transudate?

Answer 3

> 3.1

Question 4

What Albumin gradient value indicates transudate?

Answer 4

> 1.2

Question 5

Name the 3 most common transudates.

Now name 6 more.

Answer 5

• MC: HF, Hepatic hydrothorax, nephrotic syndrome.
• Urinothorax
• Peritoneal Dialysis
• Trapped lung
• CSF fistula
• Glycinothorax
• VP shunt

Question 6

What are the criteria for diagnosis spontaneous infection of hepatic hydrothorax?

Answer 6

Pleural fluid analysis either:

• PMNs > 250 + culture growth
• PMNs > 500 w/o culture growth

Question 7

Large unilateral pleural effusion should prompt workup for what other concurrent condition?

Answer 7

PE

Question 8

What lab value gives away the cause of a pleural effusion being due to peritoneal dialysis?

Answer 8

Pleural glucose > serum glucose

Question 9

What pleural fluid biomarker is indicative of tuberculoid effusion?

Answer 9

Adenosine deaminase

Question 10

What is the cause of a chylothroax?

Answer 10

Damage to the lymphatic duct.

-Runs with the abdominal aorta on the left, but is on the right above T5.

Question 11

What is the PFA of a chylothorax?

Answer 11

• TG > 110

- Chylomicrons present

Question 12

What is the cause of a pseudochylothorax?

Answer 12

Long-standing fluid in a fibrotic pleura.

Question 13

What is the PFA of a pseudochylothorax?

Answer 13

• Cholesterol level high.

- No TG or Chylomicrons

Question 14

Lymphangioleiomyomatosis is associated with what other disease?

Answer 14

Tuberous Sclerosis

Question 15

What is the most common thoracic manifestation of RA

Answer 15

Pleural effusion.

-Also nodules possible

Question 16

What is the PFA in a rheumatoid pleural effusion?

Answer 16

• Glucose very low, close to zero. pH also very low.
• LDH very high
• RF > 1:130

Question 17

What is the PFA in a pleural effusion due to a perforated esophagous?

Answer 17

Salivary amylase present.

• Left sided
• Low pH

Question 18

What is the PFA with complicated parapneumonic effusion or empyema regarding:

• pH
• Glucose
• LDH

Answer 18

• pH < 7.2
• Glucose < 60
• LDH > 1,000

Question 19

Score associated with mortality in empyema or complex parapneumonic effusion?

Answer 19

RAPID
Renal function
Age
Purulence
Infectious source (HAP?)
Dietary (Albumin)

Question 20

What is the definition of a “small” pneumothorax?

Answer 20

<3cm at apex

Question 21

What is the genetic mutation in Birt-Hogg-Dube syndrome?

Answer 21

Mutation of folliculin gene, localized on short arm of chromosome 17

Question 22

What are the clinical features of Birt-Hogg-Dube syndrome?

Answer 22

Benign skin tumors: fibrofolliculomas

• bilateral, multifocal kidney cancer
• Multiple pulmonary cysts; 25% lead to pneumothorax.

Question 23

What are the molecular markers for Lymphangioleiomamatosis?

Answer 23

-HMB-45 and VEG-F

Question 24

What are the two types of asbestos fibers? Which is worse?

Answer 24

Amphiboles are more carcinogenic than serpentines.