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Respiratory System - exam style qs > Pleural disease - pleural effusion, pneumothorax, mesothelioma > Flashcards

Pleural disease - pleural effusion, pneumothorax, mesothelioma Flashcards

1
Q

Describe the pleura

A

Single layer of mesothelial cells with sub-pleural connective tissue
Two layers: visceral and parietal
Pleural cavity inbetween with negative pressure and 2-3ml pleural fluid

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2
Q

What is a pleural effusion?

A

abnormal collection of fluid in the pleural space

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3
Q

Symptoms of pleural effusion

A 
Asymptomatic
Breathlessness
Pleuritic chest pain
Dull ache
Dry cough
Weigh loss, malaise, fevers, night sweats
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4
Q

Signs of pleural effusion

A 
On affected side:
reduced expansion
stony dullness to percussion
reduced breath sounds
reduced vocal resonance
clubbing, tar staining
cervical lymphadenopathy
raised JVP
trachea away from large effusion
peripheral oedema
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5
Q

What are the two classifications of effusion?

A

transudates and exudates

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6
Q

Pathophysiology of transudate effusion

A

an imbalance of hydostatic forces influencing the formation and absorption of pleural fluid
usually bilateral

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7
Q

Pathophysiology of exudate effusion

A

increased permeability of pleural surface and/or local capillaries
usually unilateral

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8
Q

Protein content of transudates and exudates?

A

Transudate less than 30g/l

Exudate more than 30g/l

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9
Q

Very common causes for transudate effusions?

A

Left ventricular failure
Liver cirrhosis
Hypoalbuminaemia
Peritoneal disease

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10
Q

Less common causes for transudate effusion

A

Hypothyroidism
Nephrotic syndrome
Mitral stenosis
Pulmonary embolism

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11
Q

Very common causes for exudate effusions

A

Malignancy

Parapneumonic

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12
Q

Less common causes for exudate effusions

A 
Pulmonary embolism/infarction
Rheumatoid arthritis
Autoimmune diseases
Benign asbestos effusion
Pancreatitis
Post-myocardial infarction
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13
Q

Investigations (with exudates mainly)

A 
Chest x-ray
Contrast enhanced CT of thorax
Pleural aspiration
Pleural biopsy
Thoracopy/ video assisted thorascopy
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14
Q

How much fluid must be in a pleural effusion before it is detectable on a chest x-ray?

A

200ml

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15
Q

What might you find in a CT of the thorax?

A 
nodular pleural thickening
mediastinal pleural thickening
parietal pleural thickening > 1cm
Circumferential pleural thickening
other malignant manifestations in the lung/liver
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16
Q

When ‘looking and sniffing’ the sample from a pleural aspiration, what do the following results indicate?

  1. foul smelling
  2. pus
  3. food particles
  4. milky
  5. blood stained
  6. blood
A 
foul smelling - anaerobic empyema
pus - empyema
food particles - oesophageal rupture
milky - chylothorax (lymph)
blood stained - malignancy
blood - haemothorax, trauma
17
Q

Where/ how should a pleural biopsy be done?

A

Immediately above a rib to avoid neurovascular bundle
Cutting edge downwards
Abram’s needle or Tru-cut

18
Q

How many pleural biopsies should be taken?

A

At least 4
3 in formaldehyde for histology
1 in saline to microbiology if TB suspected

19
Q

Management of pleural effusion

A

Treatment directed at the cause: chemotherapy, anti TB drugs, corticosteroids
Pleural aspiration
Pleurodhesis
Surgical pleurodhesis

20
Q

What surface anatomy is used to locate position for a pleurodhesis?

A

4th intercostal space mid-axillary line

21
Q

What is a pneumothorax?

A

Presence of air within the pleural cavity, lung collapses

22
Q

Describe the 4 causes

A

Primary spontaneous - young, thin, tall male (apical blebs rupture)
Secondary spontaneous - underlying lung disease
Traumatic (non-iatrogenic) - car accident, stabbing
Traumatic (iatrogenic) - surgeon/physician makes cut

23
Q

What is it called when there is a progressive build up of air within the pleural space due to a one way valve which eventually pushes the lungs and mediastinum to one side?

A

Tension pneumothorax

24
Q

Symptoms of pneumothorax

A

asymptomatic
acute breathlessness
pleuritic chest pain

25
Q

Signs of non-tension pneumothorax

A 
surgical emphysema (bubble wrap feeling under skin)
trachea deviated to affected side
on affected side:
reduced expansion
hyper resonant
absent or reduced breath sounds
26
Q

Signs of tension pneumothorax

A

trachea deviated away from affected side
haemodynamic compromise
raised JVP

27
Q

Management of tension pneumothorax

A

cannula in 2nd intercostal space mid-clavicular line and chest drain

28
Q

management of small primary pneumothorax

A

observe overnight, repeat chest x-ray
discharge
review in chest clinic in 2 weeks and advise no vigorous activity

29
Q

management of breathless primary/ secondary pneumothorax and worsening

A

aspirate
intercostal chest drain
apply suction
thoracic surgeon at 3 days

30
Q

3 main types of asbestos

A

chrysotile (white)
amosite (brown)
crocidolite (blue)

31
Q

What is mesothelioma?

A

Pleural malignancy, normally due to asbestos

Respiratory System - exam style qs (13 decks)

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