Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory System DO > Pleural Disease - Pleural Effusion > Flashcards

Pleural Disease - Pleural Effusion Flashcards

1
Q

What is the pleura

A

A single layer of mesothelial cells with sub-pleural connective tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the layers of pleura

A

Visceral

Parietal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the space between the two pleura lubricated by

A

2-3ml of pleural fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the dynamic turnover of pleural fluid per hour

A

30-75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is pleura present above the first rib

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is there pleura present over the liver, spleen and kidney

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is pleural effusion

A

The abnormal collection of fluid in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of plerual effusion dependent on

A

The cause and volume of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the symptoms of a pleural effusion

A

Asymptomatic - when there is a small amount which accumulates slowly
Increasing breathlessness (over days, weeks or months)
Pleuritic chest pain (due to inflammation or malignancy)
Dull ache
Dry cough
Weigh loss
MAlaise
Fever
Night sweats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should be enquired about in pleural effusion

A

Peripheral oedema
Liver disease
Orthopnoea
PND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What signs will be present on the affected side

A

Decreased expansion
Stony dullness to percussion Decreased breath sounds (band of bronchial breathing)
Decreased vocal resonance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What other signs will there be

A 
Clubbing, tar staining of fingers
Cervical lymphadenopathy
Increased JVP
Trachea away from large effusion
Peripheral oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can the causes be classified into

A

Transudates

Exudates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

State the features of transudates

A

An imbalance of hydostatic forces influencing the formation and absorption of pleural fluid
Normal capillary permeability
Usually (not always) bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

State the features of exudates

A

Increased permeability of pleural surface and/or local capillaries
Usually unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name 4 very common causes of transudates

A

Left ventricular failure
Liver cirrhosis
Hypoalbuminaemia
Peritoneal dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name 4 less common causes of transudates

A

Hypothyroidism
Nephrotic syndrome
Mitral stenosis
Pulmonary embolism (2/3rds exudates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name 3 rare causes of transudates

A 
Constrictive pericarditis (previous TB, connective tissue diseases)
Ovarian hyperstimulation syndrome
Meigs’ Syndrome (benign ovarian fibroma, ascites, R sided effusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What must the pleural fluid level be for it to be considered a transudate

A

Below 30g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What must the pleural fluid level be for it to be considered a exudate

A

Over 30g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name 2 very common causes of exudates

A

Malignancy (lung, breast, mesothelioma, metastatic)

Parapneumonic (consider sub-phrenic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name 6 less common causes of exudates

A 
Pulmonary embolism/infarction			
Rheumatoid arthritis
Autoimmune diseases (SLE, polyarteritis)
Benign asbestos effusion
Pancreatitis
Post-myocardial infarction/cardiotomy syndrome
23
Q

Name 2 rare causes of exudates

A

Yellow nail syndrome

Drugs: amiodarone, nitrofurantoin, phenytoin, methotrexate, carbamazapine, penicillamine, bromocriptine, pergolide

24
Q

Do transudates normally require investigation

A

No

25
Q

When should transudates be investigated

A

If there are unusual features present

There is a failure to respond to the appropriate treatment

26
Q

How can the presence of effusion be confirmed

A

Through a chest radiograph (at least 200ml is required before being detectable on a chest X-Ray)

27
Q

What can a contrast enhanced CT of the thorax differentiate between

A

Malignant and benign disease

28
Q

What equipment is required for a pleural aspiration and biopsy

A

50ml syringe 21G needle (green)
Lignocaine anaesthesia
Sterile universal containers
Blood culture bottles

29
Q

What are the complications of a pleural aspiration and biopsy

A 
Pneumothorax
Empyema
Pulmonary oedema
Vagal reflex
Air embolism
Tumour cell seeding
Haemothorax
30
Q

What can looking and sniffing of a pleural aspiration identify

A 
Foul smelling – anaerobic empyema
Pus - empyema
Food particles – oesophageal rupture
Milky – chylothorax (usually lymphoma)
Blood stained -? malignancy
Blood – haemothorax, trauma
31
Q

What can a blood gas analyser show

A

If the patient is infected and has a pH below 7.2 they require a chest drain

32
Q

What should be used if the protein is between 25-35g/L

A

Lights criteria

33
Q

How can you determine that the protein is an exudate using light’s criteria

A

If one or more of the below is met:
Pleural / serum protein >0.5
Pleural / serum LDH >0.6
Pleural LDH >0.66 of upper limit of serum LDH

34
Q

Where is a pleural biopsy taken from

A

Immediately above a rib

35
Q

What type of needles can be used for a pleural biopsy

A

Abram’s needle

Tru-cut

36
Q

When conducting a pleural biopsy how many biopsies are required

A

4
3 sent sent in formaldehyde for histology
1 in saline sent to microbiology for suspected TB

37
Q

What other methods can be used if there is no diagnosis after previous more common investigations

A

Thorascopy

Video assisted thorascopy

38
Q

What does a thorascopy involve

A

Direct inspection of the pleura
Direct biopsies
Can be therapeutic

39
Q

What is the treatment administered directed at

A

The cause of pleural effusion

40
Q

What type of treatments are available

A 
Chemotherapy
Antituberculous chemotherapy
Corticosteroids
Palliative
Pleurohesis
41
Q

When is palliative treatment normally used

A

For malignancy

42
Q

What does palliative treatment involve

A

Repeated plerual aspiration of 1-1.5L at any one time

43
Q

What is the life expectancy for patients requiring palliative treatment

A

Very limited life expectancy (tend to be hospitalised)

44
Q

What is pleurohesis

A

Procedure which helps to stick the 2 pleural surfaces together so there is no space present for fluid

45
Q

How is pleurohesis conducted

A

With the patient lying at 45˚ with there arm above their head
The thoracostomy is conducted in the 4th intercostal space mid-axillary line and attached to an underwater seal

46
Q

What is the maximum amount that can be drained per hour using pleurohesis

A

500ml/hr

47
Q

How long does pleurohesis drain for

A

Until dry which is checked with a chest X-Ray

48
Q

What happens if the lung has not re-expanded after pleurohesis

A

Suction will be applied for 24 hours

49
Q

What happens if the lung still has not expanded 24 hours suction has been applied

A

Drain should be removed to prevent infection

50
Q

What should be done if the lung has re-expanded after pleurohesis

A

Chemical pleurodhesis should be conducted

51
Q

What does a chemical pleurodhesis involve

A

Instilling 3mg/kg of lignocaine
2-5g of talc slurry
Drain should be clamped for 1 hour

52
Q

When should the drain be removed if the lung has re-expanded

A

12-72 hours if the lung remains expanded

53
Q

When is a surgical pleurodhesis normally preformed

A

At the time of diagnostic thorascospy

Respiratory System DO (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions