Pleural Diseases

Question 1

what is important for the management of the pleural fluid that resides on the parietal layer?

Answer 1

stoma that lead to the lymphatic channels

Question 2

is normal fluid acidic or alkalotic?

Answer 2

alkalotic

Question 3

what three cell types are commonly found in pleural fluid?

Answer 3

macrophages
lymphocytes
neutrophils

Question 4

what does transudate fluid usually consist of in the pleura?

Answer 4

non inflammatory fluid with low protein

Question 5

what does exudate fluid usually consist of in the pleura?

Answer 5

inflammatory proteinaceous fluid

Question 6

three symptoms of pleural effusion

Answer 6

dyspnea
cough
chest pain

Question 7

what is the meniscus sign in pleural effusions?

Answer 7

looks like the meniscus of water where the fluid is resting in the cavity

Question 8

what is a thoracentesis and when is it used?

Answer 8

this is fluid biopsy of pleural effusions that helps with diagnosis

Question 9

do chronic or rapid onset pleural effusion patients present with dyspnea?

Answer 9

more so the rapid onset

Question 10

what does it signal when effusion is bloody?

Answer 10

cancer, pulmonary infarction, trauma or recent surgery

Question 11

what does it signal when effusion is milky or orange?

Answer 11

chylothorax or injury to thoracic duct

Question 12

what does it signal when effusion has pus in it?

Answer 12

empyema

Question 13

list the three rules for determining if effusion is exudate or transudate? how many need to be present to be considered an exudate?

Answer 13

fluid protein/serum protein over 0.5
pleural LDH/serum LDH over 0.6
pleural fluid LDH in upper 2/3 of normal LDH range

only 1/3

Question 14

name a common cardiac cause of transudate effusion?

Answer 14

CHF

Question 15

name two common causes of exudate effusion

Answer 15

malignancy and pneumonia

Question 16

what do neutrophils suggest in effusion?

Answer 16

acute inflammation…likely infectious

Question 17

what two etiologies lead to eosinophils in an effusion?

Answer 17

blood and air

Question 18

what do lymphocytes signal for effusion?

Answer 18

malignancy or TB

Question 19

what four things to consider with effusion and low glucose levels in fluid?

Answer 19

parapneumonic or empyema
rheumatic disease
Malignancy
TB

Question 20

with extremely low glucose levels in effusion…what should we be thinking about?

Answer 20

rheumatic disease

Question 21

what two things to consider with LDH over 1000, in effusion?

Answer 21

complicated parapneumonic or empyema

and Malignancy

Question 22

if triglycerides are elevated in effusion…what is it?

Answer 22

chylothorax

Question 23

if there is amylase in pleural effusion…what two things are we thinking about?

Answer 23

pancreatitis

esophageal rupture

Question 24

what is the pleurodesis procedure for effusions? when should you do this?

Answer 24

when you totally drain the cavity of all fluid and then add talk or doxycycline that will irritate the layers and make them stick together…do it with recurrent effusions

Question 25

name three treatment options for pleural effusions

Answer 25

chest tube drainage
therapeutic thoracentesis
drain catheter

Question 26

what is pleuritis?

Answer 26

any inflammatory process involving the parietal pleura and leads to pain

Question 27

which of the lung pleura layers has nerve fibers?

Answer 27

parietal

Question 28

what is the cause of a tension pneumothorax?

Answer 28

it is a one way valve that causes air to flow into the pleural space and not be able to go back out into the lung…more and more fills in and it becomes a medical emergency

Question 29

what are the first two steps in management of a tension pneumothorax?

Answer 29

needle aspiration then asap chest tube

Question 30

what is the malignancy of the pleura called?

Answer 30

mesothelioma

Question 31

does the risk of mesothelioma increase with smoking?

Answer 31

NO

Question 32

what is the risk factor for mesothelioma?

Answer 32

asbestosis

Question 33

what does the effusion associated with mesothelioma look like? is it exudative or transudative?

Answer 33

exudative…bloody tumor