Pleural Diseases

Question 1

What is pleura

Answer 1

It’s a serous membrane that covers the lung parenchyma, mediastinum, and diaphragm

Question 2

What are the parts of the pleura

Answer 2

-cervical
-costal part
-mediastinal
-diaphragm

Question 3

What is pneumothorax

Answer 3

-collection of air inside the plural cavity

Question 4

What are the types of pneumothorax

Answer 4

-spontaneous
-acquired

Question 5

What is the classification of spontaneous pneumothorax

Answer 5

-primary
-secondary

Question 6

What is the cause of primary spontaneous pneumothorax

Answer 6

-rupture of the bleb in thin, tall, young patient

Question 7

What is the cause of secondary spontaneous pneumothorax

Answer 7

-underlying pulmonary causes (COPD, asthma and cystic fibrosis)
-immunocompromised patients

Question 8

What is the classification of acquired pneumothorax

Answer 8

-traumatic penetration
-iatrogenic (biopsy, CV catheter, thoracentesis)
-barotrauma

Question 9

What are the risk factors of primary spontaneous pneumothorax

Answer 9

-male
-young age (15-30)
-tall and thin
-smoking

Question 10

What is the side of rupture of bleb in primary spontaneous pneumothorax

Answer 10

-apex of upper lobe
-superior segment of lower lobe

Question 11

What are the symptoms of primary spontaneous pneumothorax

Answer 11

-sudden onset of dyspnea
-pleuritic chest pain

Question 12

What are the signs of primary spontaneous pneumothorax

Answer 12

-inspection: decrease of the chest movement
-palpation: <TVF
-percussion: hyperressorance
-auscultation: diminished breath sound

Question 13

What is the indications of tube thoracotomy

Answer 13

-symptomatic PSP
-SSP
-tension pneumothorax

Question 14

What is the indications of surgical in PSP

Answer 14

-recurrent pneumothorax
-massive air leak
-decrease lung expansion after tube thoracotomy

Question 15

What is the definition of haemothorax

Answer 15

-blood in the plural cavity

Question 16

What is the cause of haemothorax

Answer 16

-traumatic penetration
-iatrogenic (biopsy, CV catheter, thoracentesis)

Question 17

What is the symptoms of haemothorax

Answer 17

-cough
-chest pain
-dyspnea

Question 18

What is the signs of haemothorax in small amount

Answer 18

-normal physical examination

Question 19

What is the signs of haemothorax in large amount

Answer 19

-inspection: decrease of the chest movement
-palpation: <TVF
-percussion: dullness
-auscultation: diminished breath sound

Question 20

What is the X-ray findings of haemothorax in small amount

Answer 20

-obliteration of the costophrenic angle

Question 21

What is the X-ray findings of haemothorax in large amount

Answer 21

-homogeneous opacity in obliteration of the costophrenic angel rising to the axilla

Question 22

What is the X-ray findings of haemothorax if air fluid level is presence

Answer 22

-haemopneumothorax

Question 23

What is the management of haemothorax

Answer 23

-restoration of blood volume
-decompression of the lungs by tube thoracotomy

Question 24

What is the indication of tube thoracotomy in haemothorax

Answer 24

-persistent haemothorax (3-5)
-massive haemothorax (15)
-clotted pneumothorax

Question 25

What is thoracic empyema

Answer 25

-pus in the pleural cavity

Question 26

What is chronic empyema

Answer 26

-failure of chest expansion after drainage of the lung

Question 27

What is the causative agents in empyema

Answer 27

-specific: TB -non specific: anaerobes

Question 28

What is the most common source of empyema in children

Answer 28

-pnemonia

Question 29

What are the stages of parapneumonic plueral effusion

Answer 29

-exudative -fibropurulent -organising

Question 30

What is character of exudative stage in parapneumonic plueral effusion

Answer 30

-increase fluid due to inflammation

Question 31

What is character of fibropurulent stage in parapneumonic plueral effusion

Answer 31

-fibrin deposition leads to loculations -infected fluid becomes thick and purulent

Question 32

What is character of organising stage in parapneumonic plueral effusion

Answer 32

-firm granuloma formation

Question 33

Rest for Question; Take note that the diagnosis of haemothorax is the same with empyema in case of symptoms, signs and x-ray but it has extra which is

Answer 33

Thoracentesis

Question 34

During thoracentesis, foul smelling indicates

Answer 34

anaerobic

Question 35

What are the criteria of thoracic empyema

Answer 35

-pus frank -based on light criteria

Question 36

List of light criteria based on: -ph -glucose -ldh -protein level -WBC

Answer 36

-ph<7.2 -glucose<40 -ldh>1000 -protein level>3 -WBC>15000

Question 37

What are the management of the empyema

Answer 37

-antibiotic therapy -chest tube -thoracoscopy -rib resection -decortication -pulmonary resection -thoracoplasty

Question 38

What is given during the antibiotic therapy of empyema

Answer 38

-broad spectrum antibiotic

Question 39

When is the early insertion of the chest tube in empyema

Answer 39

-before loculation of pleural effusion

Question 40

When is the position of the chest tube in empyema

Answer 40

-based on the affected site

Question 41

When is the recommended size of bore of the chest tube in empyema

Answer 41

large (34-40F)

Question 42

What is the indication of thoracoscopy

Answer 42

-multiloculated empyema

Question 43

What is the indication of rib resection

Answer 43

-ill patient that cannot tolerate to décortication

Question 44

What are done during decortication of empyema

Answer 44

-removal of fibrous peels in visceral pluera -opening fissures -removal of thickened parietal pluera

Question 45

what is the indication of pulmonary resection

Answer 45

-destruction of the lobes or the whole lungs

Question 46

Combination of thoracoplasty and pedicle flap is used in case of what condition and why

Answer 46

-chronic empyema -due bronchopleural fistula

Question 47

What is pleural mesothelioma

Answer 47

-it’s cancer caused by prolonged exposure of asbestos

Question 48

What is the most common type of mesethelioma

Answer 48

-pleural mesothelioma

Question 49

What is the histological type of pleural mesothelioma

Answer 49

-epithelial -sarcomatous -mixed

Question 50

What is the median survival rate of pleural mesothelioma

Answer 50

12-18

Question 51

What is the treatment pleural mesothelioma

Answer 51

-surgical, chemotherapy, radiotherapy -pleurodesis (gives relief)

Question 52

What is chylothorax

Answer 52

-lymph in the pleura cavity

Question 53

What is the cause of chylothorax

Answer 53

-congenital -neoplasm as lymphoma

Question 54

What is the investigation of chylothorax

Answer 54

-same with haemothorax -aspiration; TGA:Cholesterol>1

Question 55

What is the treatment of chylothorax

Answer 55

-chest tube -right thoracotomy (ligation of thoracic duct) -video surgery

Question 56

What is the indication of right thoracotomy (ligation of thoracic duct) in chylothorax

Answer 56

-drainage >1500 per 5 days