Pleural disease highlights Flashcards
PTX is one of the _______________ causes of chronic cough in adults
least common
When is ROS important?
If underlying cause not apparent
What can needle thoracentesis be used to get sample for?
Lab analysis
Key to determining etiology of effusion is what?
Characterize effusion as transudate vs. exudate via thoracentesis and lab
List Light’s criteria (3 things)
1) Effusion protein:serum protein > 0.5
2) Effusion LDH:serum LDH > 0.6
3) Effusion LDH > 2/3 upper limit of lab’s normal for serum LDH
BLUF: Increased protein & LDH = exudate
List the Light criteria for transudate pleural effusion:
1) Pleural:serum protein ratio
2) Pleural:serum LDH ratio
3) Pleural fluid LDH
4) Primary causes
need to know
1) 0.5 or less
2) 0.6 or less
3) <2/3 upper limit of normal serum LDH (may vary w each lab)
4) HF, cirrhosis, nephrotic syndrome, PE
List the Light criteria for exudate pleural effusion:
1) Pleural:serum protein ratio
2) Pleural:serum LDH ratio
3) Pleural fluid LDH
4) Primary causes
need to know
1) >0.5
2) >0.6
3) >2/3 ULN serum LDH
4) Malignancy, CAP (parapneumonic), MTB, PE, pancreatitis, esophageal rupture, collagen vascular disease (RA, Lupus, etc.), chylothorax/hemothorax
What makes fluid exudate vs transudate?
Light’s Criteria: if at least 1 of 3 criteria met = exudate
BLUF: Increased protein & LDH = exudate
Other pleural effusion exam findings:
1) What other fluid buildup can be present with pleural effusion?
2) Define Meigs syndrome
3) What is the cardinal sign that should cause you to consider DVT with pulmonary emboli?
1) + Ascites
2) Triad of benign ovarian tumor with ascites and pleural effusion (ovarian fibroma usually)
3) Unilateral lower leg swelling
Pleural effusion: imaging
1) On upright CXR, how much fluid?
2) How much on US?
1) ~ 75 ml of pleural fluid
2) 5-50ml
Apneumothoraxoccurs when _______ leaks into the pleural space and _____________ the lung.
air; collapses
What are the 2 kinds of Spontaneous pneumothorax? Differentiate between them
1) Primary: spontaneous rupture of apical bleb
2) Secondary: to underlying pulmonary disease
Give 3 examples of pneumothorax etiologies
1) Traumatic PTX (rib fracture, CPR)
2) Iatrogenic PTX
3) Tension PTX
Mediastinal structures may shift into the “empty” space created by the collapsed lung (shifts toward the PTX) during what type of pneumothorax?
Simple or non-tension pneumothorax
(spontaneous primary or secondary, traumatic, or iatrogenic)
What type of pneumothorax may shift the mediastinum away from affected side?
Tension pneumothorax
(this is just something Mac said in class)
Say a tall guy with Marfans says he was SOB and it went away. What was that?
A random bleb that just spontaneously ruptured
1) List 3 primary risk factors for spontaneous pneumothorax
2) List 1 secondary risk factor
1) Tall thin young male; Marfan syndrome; Smoking
2) COPD
Describe Marfan syndrome
1) Autosomal dominant d/o affecting genes that make fibrillin
2) Tall, thin with long arms, legs, fingers, toes
3) Exceptionally flexible joints
4) Scoliosis
5) Cardiovascular disease – Mitral valve prolapse and aortic aneurysm
-Diagnosed clinically and confirmed with genetic testing
Describe CF (cystic fibrosis):
1) What type of inheritance is it and what genes does it affect?
2) What glands does it affect?
3) What does it do to the lungs?
4) How is it diagnosed?
(don’t think he’ll test all tiny details here)
1) Autosomal recessive d/o affecting the genes producing the cystic fibrosis transmembrane conductance regulator protein (CFTR)
2) Affects most exocrine glands resulting in thick mucoid secretions
3) Thick bronchial secretions leading to dyspnea, cough, airway plugging and secondary RTI
4) Diagnosed with sweat chloride test and confirmed with genetic testing
Marfan is autosomal _____________, whereas CF is autosomal ______________.
dominant; recessive
Pneumothorax exam findings:
1) What would you hear on auscultation?
2) What abt on percussion?
3) Palpation?
4) How may mediastinal shift be noted?
1) Unilateral (usually) diminished breath sounds over involved area
2) Hyperresonance over involved area
(think percussing over a barrel of air)
3) Deceased tactile fremitus over involved area
4) By tracheal deviation
Pneumothorax exam findings:
1) What will the VS be like?
2) What may tension pneumothorax progress to?
3) What may be noted during PE? How does this help differentiate the two types?
1) Depend on severity; can incl. labored breathing, tachypnea, tachycardia, JVD
2) Cardiopulmonary collapse (hypoxia, and hypotension), AMS changes
3) Tracheal deviation
Simple = toward PTX [or no deviation as well I believe]
Tension = away from PTX
True or false: CT is the gold standard of imaging pneumothorax
True
For a differential of dyspnea and chest pain what 6 things do you need to rule out? How do you rule out each?
1) Pneumothorax – chest imaging
2) CAP
3) PE – well’s score, d-dimer, compressive U/S LE, CTA
4) ACS – EKG, cardiac enzymes (troponins)
5) Aortic dissection – CXR, U/S, aortogram
6) Pleural effusion – more insidious onset, CXR, US
