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IM Pulmo > Pleural Diseases > Flashcards

Pleural Diseases Flashcards

1
Q

What are the two layers of the pleura?

A

Visceral pleura and Parietal pleura.

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2
Q

What is the primary blood supply for the visceral pleura?

A

Bronchial circulation.

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3
Q

Which nerves supply the parietal pleura?

A

Intercostal nerve and phrenic nerve.

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4
Q

What is the main function of serous fluid in the pleural cavity?

A

To lubricate the pleural surfaces and generate surface tension for thoracic cavity expansion during inspiration.

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5
Q

What regulates pleural fluid formation?

A

The balance of hydrostatic and oncotic pressures between the parietal and visceral pleura, and lymphatic drainage.

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6
Q

What is pleural effusion?

A

An excess quantity of fluid in the pleural space due to increased fluid formation or decreased fluid removal.

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7
Q

What are the classifications of pleural effusion based on Light’s criteria?

A

Transudate and Exudate.

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8
Q

What is the most common cause of transudative pleural effusion?

A

Congestive heart failure.

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9
Q

What are the diagnostic imaging options for pleural effusion?

A

Chest radiograph, ultrasound, and CT scan.

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10
Q

What is the first-line treatment for primary spontaneous pneumothorax?

A

Simple aspiration.

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11
Q

What is the hallmark of tension pneumothorax?

A

Positive pressure in the pleural space throughout the respiratory cycle.

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12
Q

What structures are located in the superior mediastinum?

A

Thymus, trachea, esophagus, aortic arch, brachiocephalic trunk, superior vena cava, and vagus nerve.

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13
Q

What is the most common cause of acute mediastinitis?

A

Direct invasion following surgical interventions.

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14
Q

What imaging modality is diagnostic of choice for acute mediastinitis?

A

CT scan.

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15
Q

What is the treatment for fibrosing mediastinitis?

A

Supportive treatment targeting underlying causes, often requiring biopsy for diagnosis.

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16
Q

What is Light’s diagnostic criterion for exudative pleural effusion?

A

Pleural fluid protein/serum protein ratio >0.5, Pleural fluid LDH/serum LDH ratio >0.6, or Pleural fluid LDH >2/3 the upper limit of normal for serum.

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17
Q

What is the most common cause of exudative pleural effusion in the US?

A

Parapneumonic effusion.

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18
Q

What is empyema?

A

A grossly purulent effusion associated with bacterial infections.

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19
Q

What are the symptoms of pleural effusion?

A

Chest pain, shortness of breath, dry cough, orthopnea, and lightheadedness if fluid volume is large.

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20
Q

What is a subpulmonic effusion?

A

A pleural effusion located beneath the lungs, often elevating the diaphragm.

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21
Q

How does malignancy cause pleural effusion?

A

By increasing vascular permeability or obstructing lymphatic drainage.

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22
Q

What is the most common malignancy causing pleural effusion?

A

Lung cancer.

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23
Q

What is pleurodesis?

A

A procedure to obliterate the pleural space by inducing inflammation and fibrosis with a sclerosing agent.

24
Q

What is the main nerve supplying the diaphragm?

A

Phrenic nerve.

25
Q

What is pneumothorax?

A

Air in the pleural space, causing partial or complete lung collapse.

26
Q

What is the primary cause of primary spontaneous pneumothorax?

A

Rupture of apical pleural blebs.

27
Q

What are the types of pneumothorax?

A

Spontaneous (primary and secondary), Traumatic, and Tension pneumothorax.

28
Q

What imaging finding is typical in tension pneumothorax?

A

Mediastinal shift to the unaffected side.

29
Q

What are the subdivisions of the inferior mediastinum?

A

Anterior, middle, and posterior portions.

30
Q

What is Hamman’s sign in pneumomediastinum?

A

A crunching or clicking noise synchronous with the heartbeat.

31
Q

What is the diagnostic hallmark of chylothorax?

A

Milky pleural fluid with triglyceride levels >110 mg/dL.

32
Q

What is a bronchogenic cyst?

A

A congenital anomaly commonly found in the middle mediastinum.

33
Q

What is the treatment for acute mediastinitis?

A

Mediastinal exploration, drainage, and broad-spectrum antibiotics.

34
Q

What is the most common cause of transudative pleural effusion?

A

Congestive heart failure.

35
Q

What imaging modality guides thoracocentesis?

A

Ultrasound.

36
Q

What are the signs of pleural effusion on percussion?

A

Dullness on the affected side.

37
Q

What are common symptoms of pleural effusion?

A

Chest pain, shortness of breath, dry cough, and orthopnea.

38
Q

What is the treatment for a parapneumonic effusion with pH <7.20?

A

Chest tube thoracostomy (CTT).

39
Q

Which cancers commonly cause malignant pleural effusion?

A

Lung cancer, breast cancer, and lymphoma.

40
Q

What is pleurodesis used for?

A

To obliterate the pleural space by inducing pleural adhesion and fibrosis.

41
Q

What causes chylothorax?

A

Disruption of the thoracic duct due to trauma or tumors.

42
Q

What is the primary imaging finding in tension pneumothorax?

A

Mediastinal shift to the unaffected side.

43
Q

What are the symptoms of primary spontaneous pneumothorax?

A

Sudden chest pain and shortness of breath.

44
Q

What is pneumomediastinum?

A

Gas in the mediastinum.

45
Q

What is the most common cause of acute mediastinitis?

A

Postoperative deep sternal infections.

46
Q

What structures are in the superior mediastinum?

A

Thymus, trachea, esophagus, aortic arch, superior vena cava, and vagus nerve.

47
Q

What are the regions of the mediastinum?

A

Superior, anterior, middle, and posterior.

48
Q

What is the hallmark clinical sign of pneumomediastinum?

A

Hamman’s sign (a crunching noise synchronous with the heartbeat).

49
Q

What is fibrosing mediastinitis?

A

Abnormal proliferation of collagen and fibrous tissue within the mediastinum.

50
Q

What causes tuberculous pleuritis?

A

A hypersensitivity reaction to tuberculous protein.

51
Q

What are the main findings of malignant mesothelioma on imaging?

A

Pleural thickening and a shrunken hemithorax.

52
Q

What diagnostic test confirms malignant mesothelioma?

A

Image-guided needle biopsy or thoracoscopy.

53
Q

What is the treatment for tension pneumothorax?

A

Immediate needle decompression followed by chest tube placement.

54
Q

What is Meigs syndrome?

A

Pleural effusion and ascites associated with ovarian cancer.

55
Q

What is the function of the phrenic nerve?

A

It supplies motor innervation to the diaphragm.

IM Pulmo (5 decks)

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