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Respiratory Medicine > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

What colour is normal pleural fluid?

A

Straw coloured

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2
Q

How much pleural fluid is contained within the average person?

A

0.26ml/kg/cavity.

Around 3ml total in the pleural cavity

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3
Q

What process produces pleural fluid?

A

Filtration

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4
Q

Which pleura produces most of the pleural fluid?

A

The parietal pleura

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5
Q

How much protein is found in normal pleura?

A

1.5-2g/dl

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6
Q

Name the cells which can be found in pleural fluid

A

macrophages, lymphocytes & mesothelial cells

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7
Q

Is pleural pressure positive or negative?

A

Negative

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8
Q

Where in the thorax is pleural pressure the most and least negative?

A

most negative at the apex and becomes less negative as you move down towards the lung base.

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9
Q

What is a pleural effusion?

A

A collection of fluid in the pleural space

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10
Q

What causes a pleural effusion?

A

an imbalance between production and absorption of pleural fluid

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11
Q

What is pleural fluid normally drained by?

A

pleural lymphatics in the parietal pleura

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12
Q

Name the two different types of pleural effusion

A
  1. transudate

2. Exudate

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13
Q

What is the difference between a transudate and an exudate effusion?

A

Transudate= non-inflammatory effusion

Exudate= Inflammatory effusion with a protein content of >3g/dl

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14
Q

What is the name of the criteria used to differentiate between a transudate and an exudate?

A

Lights Criteria

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15
Q

Which three things does lights criteria compare?

A
  1. serum protein to pleural fluid protein and serum lactate dehydrogenase (an enzyme found in blood and bodily fluids).
  2. Pleural fluid to serum fluid levels.
  3. The level of pleural fluid LDH as a percentage of the upper limit of normal
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16
Q

What are the values of the following in a pleural effusion according to Lights criteria

pleural fluid protein /serum fluid protein ratio

Pleural fluid LDH/ serum fluid LDH ratio

pleural fluid LDH

A

Pleural fluid /serum fluid ratio > 0.5

Pleural fluid /serum fluid ratio > 0.6

> 2/3 rd ULN serum LDH

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17
Q

What are the two very common causes of transudates?

A
  • Left ventricular failure
  • Liver cirrhosis
  • Hypoalbuminaemia
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18
Q

What are the three very common causes of exudates?

A
  • Malignancy ( Pulmonary and non-pulmonary)
  • Parapneumonic effusions empyema
  • Tuberculosis
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19
Q

What is the most useful diagnostic tool in pleural effusion?

A

Ultrasound

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20
Q

Other than ultrasound, what other imaging modalities can be used in pleural effusion

A

CXR

CT thorax

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21
Q

How should pleural effusion be managed?

A
  1. Aspirate the fluid and inspect it for blood and pus

2. Test the pH, biochem, microbiology and cytology of the fluid

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22
Q

if the pH of the pleural effusion is <7.2, what is required and why?

A

chest drain because there is a high likelihood that the fluid will become exudate (if it hasn’t already).

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23
Q

How is a transudate managed?

A

Treat the underlying cause

24
Q

What is a pneumothorax?

A

a collection of air in the pleural space

25
Q

Name the 5 different types of pneumothorax

A
  1. primary spontaneous
  2. Secondary spontaneous
  3. Traumatic
  4. Iatrogenic
  5. Tension
26
Q

What is the difference between a primary and a secondary spontaneous pneumothorax?

A

Primary spontaneous occurs in an individual with normal healthy lungs whereas a secondary spontaneous occurs in an individual with a preexisiting lung condition

27
Q

What is an iatrogenic pneumothorax?

A

occur as a result of a medical procedure such as lung biopsies or ventilation

28
Q

What is a tension pneumothorax?

A

air in the pleural cavity following a pneumothorax builds up to the point where it is causing pressure and it pushes the central structures of the chest and squashes the opposite lung which can cause blood oxygen levels to drop. This also prevents proper heart filling due to pressure and causes blood pressure to drop. These factors together can escalate quickly and become life threatening

29
Q

How does a spontaneous pneumothorax present?

A
  • Sudden event

- Chest pain or breathlessness

30
Q

Which demographic is most commonly affected by a spontaneous pneumothorax?

A

Tall thin young men

31
Q

List the examination findings that point towards a pneumothorax

A
  • Breathing fast (tachypneic)
  • Hypoxic
  • Reduced chest wall movement and reduced or no breath sounds
  • Not uncommonly examination may be normal
32
Q

What is the first line investigation into pneumothorax?

A

CXR

33
Q

Why are small pneumothaxes difficult to spot?

A

because the air rises to the apices which are occluded from view by bony structures

34
Q

A patient comes in with a pneumothorax. In which scenario would you simply observe?

A

if the pneumothorax is <2cm and the patient is <50 years old and well

35
Q

A patient comes in with a pneumothorax. In which scenario would you aspirate?

A

if the pneumothorax is over 2cm in size and the patient is well

36
Q

A patient comes in with a pneumothorax. In which scenario would you insert a chest drain??

A

If the patient is unwell & the pneumothorax is >2cm

37
Q

In which cases of pneumothorax would surgery be recommended?

A

Reoccurring or unresolving pneumothorax

38
Q

What advice should you give to patients after they have suffered a pneumothorax?

A

not to lift any heavy weights or fly for 7 days after pneumothorax has been resolved

39
Q

Where should the needle be inserted for aspiration and decompression?

A

the 2nd intercostal space (in line with sternal angle) on the midclavicular line

40
Q

Where should a chest drain be inserted?

A

5th intercostal space on the mid-to-anterior axillary line within the safe triangle

41
Q

What is the most common pleural tumour?

A

Mesothelioma

42
Q

What are the two main causes of mesothelioma?

A
  1. Asbestos exposure

2. Genetic mutation

43
Q

What is the average time between exposure to asbestos and tumour formation?

A

20-40 years

44
Q

Briefly explain the pathophysiology behind mesothelioma formation s a result of asbestos exposure

A

Inhaled asbestos fibres reach the pleura and cause inflammation which triggers repair mechanisms. There is then a repeated cycle of inflammation and repair which can provokes tumour formation.

45
Q

List the 4 most significant clinical signs of mesothelioma

A
  • Breathlessness
  • Chest Pain
  • Weight loss
  • Clubbed (signs of a pleural effusion)
46
Q

Which two imaging modalities are used to diagnose mesothelioma?

A

CXR and CT

47
Q

Which two diagnostic processes are required in order to make a definitive diagnosis of mesothelioma?

A

CT thorax and biopsy

48
Q

List the three ways in which a biopsy can be obtained

A
  1. blind pleural biopsy using Abram’s pleural needle
  2. CT or ultrasound guided biopsy
  3. thoracotomy
49
Q

What is pleurodesis and what is its purpose?

A

Pleurodesis= spraying the lung with sterile talcum powder to stop fluid from reaccumulating

50
Q

What is the most significant effect of mesothelioma, clinically?

A

Pleural effusion

51
Q

What is the main focus of mesothelioma treatment?

A

Manage and treat the pleural effusion

52
Q

Chemotherapy is rarely useful in mesothelioma patients. why?

A

Mesothelioma is usually diagnosed at such a late stage that chemotherapy is rarely useful

53
Q

What are the palliative surgical treatments available to mesothelioma patients?

A
  1. Pleurodesis

2. Decortication

54
Q

What is decortication?

A

peeling the layers of thickened pleura off in order to allow the underlying lung to re-expand and to relieve breathlessness

55
Q

Is a mesothelioma patient entitled to compensation?

A

yes as it is an occupational lung disease

Respiratory Medicine (27 decks)

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