Pleural diseases

Question 1

Pleuritis presentation

Answer 1

SHARP pain
Worse with breathing, coughing, sneezing
Signs depend on underlying cause

Question 2

Pleuritis PE

Answer 2

Pleural friction rub

Question 3

Pleuritis workup

Answer 3

CXR: CANT see it

CTA chest, Serologic studies for immune cause

Question 4

Pleuritis Tx

Answer 4

1. NSAIDS: Naproxen with food/PPI
2. Steroids for refractory pain
3. D/C if medication induced
4. Tx underlying cause: ABX pneumonia, Thoracentesis for pleural effusion, Chest tube for pneumothorax

Question 5

Lupus pleuritis

Answer 5

SLE, commonly involves lung + pleura + vasculature
Typically: CP +/- exudative pleural effusion
Workup: ANA then Anti-dsDNA, anti-Sm & -RNP & -RO/SSA & La/SSB if still suspicious
MUST r/o infection
Tx: NSAIDS

Question 6

Rheumatoid pleuritis

Answer 6

Less common than in SLE
Signs: pleuritic CP + fever +/- dyspnea
Exudative effusion, may be drug induced, hemo, empyema
Tx: NSAIDs

Question 7

Pleural effusion epidemiology

Answer 7

MC manifestation of pleural disease

1.5 a year in US

Question 8

Pl effusion patho

Answer 8

ABNORMAL fluid collection in space (greater than 15 cc)

1. Excess production
2. Decreased lymphatic absorption

Question 9

Pleural effusion XR

Answer 9

1. Whited out

2. Meniscus seen

Question 10

Pleural cavity importance

Answer 10

Vacuum keeps visceral and parietal pleurae close