Pleural diseases

Question 1

Indications for pleural fluid drainage

Answer 1

– Large free flowing pleural effusion more than 50% hemithorax OR
– Positive culture OR
– Positive gram stain OR
– pH of <7.2 suggesting the presence of Pus.

Question 2

RAPID score - risk of poor outcome following a pleural infection

Answer 2

Renal, age, purulence, infection source, and dietary factors
The clinical predictors measured were:
Age, urea,albumin, source of infection,purulence.

Question 3

Factors causing shift of oxygen dissociation curve to left

Answer 3

Shift Left: Lower oxygen delivery to tissues: 
 Lower H+  ie Alkaline
 Lower temperature
 Lower 2,3-DPG
 HbF
 Carboxy/methaemoglobin

Shifts Right- Raised oxygen delivery to tissues:
Raised H+(acidic)
Raised temperature
Raised 2,3 DPG

Question 4

Which condition would the LENT score be applicable

Answer 4

Malignant pleural effusion:
LENT prognostic score (pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group (ECOG) performance score (PS), neutrophil-to-lymphocyte ratio and tumour type)

Question 5

Which intervention is most helpful in reducing the need for surgical drainage of loculated effusion?

Answer 5

Alteplase and Dornase

Question 6

Markers of malignant mesothelioma

Answer 6

Serum mesothelin(superior diagnostic marker) and fibulin 3 (better prognostic marker)

Question 7

Intervention that reduced need for surgical drainage in empyema

Answer 7

Alteplase and dornase

Question 8

Causes of primary and secondary pneumothorax

Answer 8

Primary -Smoking, family history,Marfans, homocytinuria

Secondary-COPD, PCP, HIV,CF, TB