Brainscape's Knowledge GenomeTM

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


See full index

Respiratory AM > Pleural diseases > Flashcards

Pleural diseases Flashcards

1
Q

What is the pleura?

A

Single layer of mesothelial cells

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

What is the pressure inside the pleural cavity?

A

-0.66kPa

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

What is the turnover of pleural fluid?

A

30-75% an hour

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

What causes the dynamic turnover of pleural fluid?

A

Osmotic/oncotic pressure drawing fluid out

Pulmonary and systemic arterial pressure pushing fluid into intrapleural space

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

What is a pleural effusion?

A

Abnormal collection of fluid in the pleural space

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

What are the symptoms of a small pleural effusion?

A

Asymptomatic

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

What are the symptoms of a larger pleural effusion?

A 
Increasing breathlessness
Pleuritic chest pain
Dull ache
Dry cough
Weight loss, fever, malaise, night sweats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 types of pleuritic chest pain in pleural effusion?

A

Inflammatory- early, may improve as fluid accumulates

Malignancy- progressively worsens

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

What are the signs of pleural effusion?

A

Chest on affected side- reduced expansion, stony dullness to percussion, reduced breath sounds and vocal resonance
Other- clubbing/tar staining of fingers, cervical lymphadenopathy, increased jugular venous pressure, trachea being pushed away, peripheral oedema

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

What are the causes of pleural effusion?

A

Transudates- imbalance of hydrostatic forces influencing formation and absorption of pleural fluid
Exudates- increases permeability of pleural surface and/or capillaries

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

Are the 2 types of pleural effusion more common in one or both lungs?

A

Transudate- bilateral

Exudate- unilateral

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

How can transudate and exudate be distinguished in the lab?

A

Pleural fluid protein levels
Transudate= <30g/L
Exudate= >30g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are common causes of transudate pleural effusion?

A

Left ventricular failure
Liver cirrhosis
Hypoalbuminaemia
Peritoneal dialysis

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

What are less common and rare causes of transudate pleural effusion?

A 
Hypothyroidism
Nephrotic syndrome
Mitral stenosis
Pulmonary embolism
Constrictive pericarditis
Ovarian hyperstimulation syndrome
Meigs' syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the common causes of exudate pleural effusion?

A

Malignancy- lung, breast, mesothelioma, metastatic

Parapneumonic

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

What are the less common and rare causes of exudate pleural effusion?

A 
Pulmonary embolism/infarction
Rhematoid arthritis
Autoimmune disease
Benign asbestos effusion 
Pancreatitis
Past MI
Yellow nail syndrome
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What drugs can cause an exudate pleural effusion?

A 
Amidarone
Nitrofuratoin
Phenytoin
Methotrexate
Carbamazepine
Penicillamine
Bromocriptine
Pergolide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is investigation required for transudate pleural effusion?

A

Usually none required

Investigate if- unusual features, failure to respond to appropriate treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What investigations are done for pleural effusion?

A 
Chest xray
Contrast enhanced CT thorax
Pleural aspiration and biopsy
Pleural biopsy
Thorascopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a chest xray used for in pleural effusion and what are the limitations?

A

Detecting pleural effusion, but only if there if more than 200ml of fluid

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

What is the purpose of a CT thorax in pleural effusion and what does it detect?

A

Differentiates between benign and malignant

  • Nodular pleural thickening
  • Mediastinal pleural thickening
  • Parietal pleural thickening >1cm
  • Circumferenal pleural thickening
  • Malignant manifestations in lung/liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can a pleural aspiration be analysed in the ward?

A 
Foul smelling- anaerobic empyema
Pus- empyema
Food particles- oesophageal rupture
Milky- cyclothorax
Blood stained- possible malignancy
Blood- harm-thorax or trauma
23
Q

How can pleural aspiration be analysed in the lab?

A 
High amylase- pancreatitis
Glucose <3.3M- empyema, rheumatoid arthritis, TB, malignancy
Gram stain
Acid alcohol fast
Culture
24
Q

What are possible complications of lung aspiration?

A 
Pneumothorax
Pulmonary oedema 
Empyema
Vagal reflex
Air embolism
Tumour cell seeding
Haemothorax
25
Q

How much fluid is aspirated during a pleural aspiration?

A

50ml

26
Q

When are exudative pleural effusions investigated?

A

Pleural/serum protein>0.5
Pleural/serum LDH>0.6
Pleural LDH>66% upper limit of serum LDH

27
Q

Where would a pleural biopsy needle be inserted?

A

Immediately above a rib

28
Q

How many samples are taken during a pleural biopsy?

A

4

  • 3 in formaldehyde for histology
  • 1 in saline for microbiology
29
Q

What is a thorascopy?

A

Direct inspection of the pleura

30
Q

What are the treatments of pleural effusion?

A

Treatments directed at cause

  • Chemo
  • anti TB chemo
  • corticosteroids
  • palliative care
    • repeated pleural aspirations of 1-1.5 litres at a time
31
Q

What is pneumothorax?

A

Presence of air in the pleural cavity

32
Q

What happens to the lung during a pneumothorax?

A

Visceral/parietal pleura is breached and with entry of air into the pleural cavity, the lung collapses because o the elastic recoil

33
Q

What are the 2 general causes of pneumothorax?

A

Spontaneous

Trauma

34
Q

What are the types of spontaneous pneumothorax?

A

Primary

Secondary

35
Q

What are the features of a primary spontaneous pneumothorax?

A

No clinically apparent disease
Peak in 20-30 year olds
Believed to be due to weight of lung inducing development of apical blebs that rupture

36
Q

What are the features of a secondary spontaneous pneumothorax?

A

Preexisting lung disease

  • COPD
  • asthma
  • pneumonia
  • TB
  • cystic fibrosis
37
Q

What are the types of trauma pneumothorax?

A

Non-iatrogenic

Iatrogenic

38
Q

What is a non-iatrogenic trauma pneumothorax?

A

Penetrating or blunt chest injury causes pneumothorax

39
Q

What is an iatrogenic trauma pneumothorax?

A

Caused by medical procedure

40
Q

What can cause iatrogenic pneumothorax?

A

Pleural aspiration/biopsy
Subclavian vein cannulation
Lung, liver, renal or breast biopsy
Acupuncture

41
Q

What are the symptoms of pneumothorax?

A

Asymptomatic if small with good inspiratory reserve
Acute and worsening dyspnoea
Pleuritic chest pain

42
Q

What are the signs of pneumothorax?

A 
May be none if small
Tension
-trachea deviated to affected side
-reduced expansion
-hyper resonant
-absent/reduced breath sounds
Non tension
- trachea deviated away from affected side
-haemodynamic compromise
-increased jugular venous pressure
43
Q

How do you manage a tension pneumothorax?

A

Chest drain in 2nd intercostal space

44
Q

How do you manage a small, primary pneumothorax?

A

Observe overnight and repeat chest xray

If no change, discharge and review after 2 weeks

45
Q

How do you manage a primary, breathless pneumothorax?

A

Aspirate until can feel lung surface

If unsuccessful, chest drain

46
Q

How do you manage a secondary breathless pneumothorax?

A

Aspirate if small
Chest drain
-Ideally, lung inflates in 1-2 days, drain stops bubbling, xray confirms lungs inflated
-Less ideally, apply suction to drain and contact surgeons at day 3

47
Q

When should pneumothoracies be referred to surgery?

A 
2nd ipsilateral pneumothorax
1st contralateral pneumothorax
Bilateral spontaneous pneumothorax
1st pneumothorax in high risk professions
-pilots, divers
48
Q

What are treatments of recurrent pneumothoracies?

A

Talc poudrage

Pleurectomy

49
Q

What are the 3 types of asbestos?

A

Chrysotile
Amosite
Crocidolite- most dangerous to health

50
Q

When does disease normally occur after asbestos exposure?

A

20-30 years

51
Q

What is mesothelioma?

A

Pleural malignancy, mainly caused by exposure to asbestos

52
Q

What is the presentation of mesothelioma?

A

Dyspnoea

Pleuritic chest pain

53
Q

How does mesothelioma appear on chest xray?

A

Usually unilateral

Diffuse or localised pleural thickening

Respiratory AM (10 decks)

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