Brainscape's Knowledge GenomeTM

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


See full index

CR3 > Pleural Diseases > Flashcards

Pleural Diseases Flashcards

1
Q

Pleural space

A

Small amount of fluid in it normally
Between visceral and parietal
Pressure in the space allows lung inflation

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

What lines the pleural space?

A

Mesothelial cells

Lymphatic openings in between allowing fluid to leave pleural space

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

Pleural fluid pressure

A
  • hydrostatic pressure and oncotic pressure between parietal and visceral
  • hydrostatic pressure > in parietal than visceral
  • oncotic the same
  • fluid into pleural space mostly from parietal through lymphatic channels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What mechanisms cause excess fluid in pleural space?

A
  • problem with drainage of fluid via lymphatic channels
  • excess production of fluid from parietal moving to space

= PLEURAL EFFUSION

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

What are exudates?

A
  • local factors

- suggest protein levels are greater in fluid

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

What are transudates?

A
  • systemic factors

- indicate protein levels in fluid are low

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

Exudate examples?

A
  • permeable capillaries
  • pleural permeability
  • lymphatic drainage reduced
  • increase in negative pleural pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What causes permeable capillaries?

A
  • trauma
  • malignancy
  • inflammation
  • infection
  • pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes pleural permeability?

A
  • malignancy
  • inflammation
  • PE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes reduced lymphatic drainage?

A
  • malignancy

- trauma

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

What causes increase in negative pleural pressure?

A
  • atelectasis

- mesothelioma

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

Examples of transudates?

A
  • increase in capillary hydrostatic pressure
  • increase in pulmonary interstitial fluid
  • reduced intravascular oncotic pressure
  • increase in flow of fluid from other cavities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes increase in capillary hydrostatic pressure?

A

HF

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

What causes increase in pulmonary interstitial fluid?

A

HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What causes intravascular oncotic pressure reduction?

A
  • hypoalbuminemia

- cirrhosis

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

What causes increase in flow of fluid from other cavities?

A
  • peritoneal dialysis

- cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of pleural effusion?

A
  • asymptomatic
  • dry cough
  • breathlessness
  • pleuritic chest pain
  • shoulder pain/heaviness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clinical signs of pleural effusion?

A
  • reduced chest expansion
  • reduced tactile vocal fremitus
  • trachea deviation
  • stony dull percussion
  • reduced or absent breath sounds
  • bronchial breathing?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Normal protein count in pleural space?

A

30g/L
> = exudate
< = transudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Light’s criteria function

A
  • helps to distinguish between exudate and transudate if individual has borderline pleural protein (25-30) OR abnormal serum protein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Light’s criteria for exudate

A

EXUDATE IF

  • pleural fluid protein/serum protein >0.5
  • pleural fluid LDH/serum LDH >0.6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Common Causes of exudates

A
  • para pneumonic effusion
  • malignancy
  • PE
  • Rheumatoid arthritis
  • mesothelioma
23
Q

Less common causes of exudates

A
  • drugs
  • empyema
  • TB
  • pancreatitis
  • oesophageal rupture
  • post cardiac injury (dressler’s syndrome)
  • post CABG
  • benign asbestos-related effusion
24
Q

Common causes of transudates

A
  • LV failure
  • cirrhotic liver disease
  • peritoneal dialysis
  • nephrotic syndrome
25
Q

Less common causes of transudates

A
  • constrictive pericarditis
  • hypothyroidism
  • Meig’s syndrome
26
Q

Investigations for pleural effusion

A
  • CXR
  • Pleural fluid analysis
  • Chest US scan
  • Chest CT scan
  • pleural biopsy (image guided/medical thoracoscopy)
  • video assisted thoracic surgery (VATS)
27
Q

Pleural aspiration

A
  • insert needle in safe triangle

- patient in position with arm on head OR sitting down leaning on arm with pillow or lying down on arm

28
Q

Safe triangle borders

A
  • anterior = lateral border of pec major
  • posteriorly = lateral edge of lattisimus dorsi
  • inferiorly = line along 5th ICS
  • superiorly = axillae
29
Q

Pleural Fluid analysis

A
  • appearance
  • pH
  • protein
  • glucose
  • LDH
  • cytology (malignant cells, differential cell counts)
  • microbiology (gram stain and culture, AFB)
30
Q

Diagnostic Algorithm

A
  • History, exam, CXR

- clinically transudate?

31
Q

How to treat transudate?

A
  • treat cause
  • see if resolved
  • if not = refer to chest physician
  • they will likely pleural aspirate via US guidance with other diagnostic tests
32
Q

How to treat exudate?

A
  • after done transudate investigations and ruled out
  • fluid analysis
  • treat cause appropriately
  • CT thorax if fluid analysis doesn’t give cause
  • if still uncertain = medical thoracoscopy or surgical VATS or biopsy with chest drain for symptomatic relief
33
Q

VATS

A
  • video associated thoracic surgery
  • general anaesthetic
  • minimal invasive
  • multiple incisions between ribs
  • visualise pleura and can take biopsies and drain fluid
  • helps in making diagnosis
  • advantage as small incisions
  • less pain than traditional thoracotomy
34
Q

Pleural infection presentation

A
  • fever
  • sputum
  • chest pain
  • breathlessness
35
Q

high risk groups for pleural infection

A
  • diabetes
  • excess ETOH intake
  • GORD
  • IVDU
  • aspiration and poor dental hygiene
  • malaise/weight loss
  • pleural effusion with fever
  • slow response to pneumonia
36
Q

Investigations for pleural infection

A
  • diagnostic pleural tap for exudate/pus
  • blood culture
  • chest US
  • chest CT
37
Q

How may pleural infection progress?

A
  • simple parapenumonia effusion
  • complicated parapneumonic effusion
  • empyema
38
Q

Simple parapneumonic effusion investigation results

A
  • ABs resolve
  • fluid = clear, sterile, normal pH, glucose and LDH
  • chest drain usually not required
39
Q

Complicated parapneumonic effusion investigation results

A
  • fibrinopurlent fluid
  • fluid infected
  • glucose <2.2
  • LDH > 1000
  • fluid gram stain positive
  • chest drain needed
40
Q

Empyema investigation results

A
  • pus in pleural space
  • free flowing
  • multi loculated
  • fluid gram stain positive
  • fibroblasts causing thick pleura
  • chest drainage required
41
Q

What causes CAP?

A
  • streptococcus (mileri, pneumoniae, intermedius) cause majority
  • then anaerobes
  • then staph aureus
  • then gram negative aerobes (Enterobacteriaceae, E coli)
42
Q

What causes HAP?

A
  • often gram negative aerobes (E coli, pseudomonas, Klebsiella)
  • staphylococci (MRSA, S aureus)
  • Anaerobes
43
Q

Management of pleural infection

A
  • AB
  • Chest tube drainage
  • intrapleural fibrinolytics (not routine)
  • nutritional support
  • surgery (VATS, thoracotomy, open thoracic drainage)
44
Q

Indicates for chest tube drainage in pleural infection

A
  • purulent or turbid fluid
  • pleural fluid pH<7.2
  • organisms in pleural fluid gram stain or culture
45
Q

Define mesothelioma

A
  • malignant tumour of serosal surfaces
  • asbestos exposure major RF
  • latent >40yrs of exposure
46
Q

Prognosis of mesothelioma

A
  • poor

- 9-12 months

47
Q

3 main types of asbestos fibres

A
  • crocidolite= blue (thinnest)
  • armosite = brown
  • chysotile = white (most commonly used now)
48
Q

Symptoms and signs of mesothelioma

A
  • chest pain (dull ache)
  • pleural effusion symptoms
  • weight loss and fatigue
  • chest wall invasion
49
Q

Investigations for mesothelioma

A
  • CXR and CT thorax
  • pleural fluid analysis (bloody/straw coloured)
  • biopsy (US or CT guided of pleura OR medical thoracoscopy or VATS)
50
Q

CXR of mesothelioma

A
  • loss of volume
  • pleural effusion
  • pleural thickening
51
Q

Histological types of mesothelioma

A
  • epithelioid (better prognosis)
  • mixed (biphasic)
  • sarcomatoid
52
Q

Management of mesothelioma?

A
  • pleural effusion = drainage and pleurodesis
  • radiotherapy = pain relief and reduce chest wall invasion risk
  • chemo
  • surgery (high mortality, selected cases)
  • pain relief
  • palliative care
  • compensation for asbestos exposure
53
Q

Chemo for mesothelioma

A
  • cisplatin with pemetrexed or gemcitibine

CR3 (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions