Pleural Disorders

Question 1

What produces the pleural fluid?

Answer 1

parietal pleura

Question 2

Key characteristics of pleuritic chest pain

Answer 2

increased with deep inspiration and may be associated with pleural rub

Question 3

Clinical features of pleural effusion

Answer 3

SOB, cough, pleuritic chest pain

Question 4

What are the top three most common causes of pleural effusion?

Answer 4

CHF, pneumonia, malignancy

Question 5

What is the Lights Criteria for exudative effusion?

Answer 5

Pleural Protein : Serum Protein > 0.5. Pleural LDH : Serum LDH > 0.6. Pleural LDH > 200

Question 6

What causes exudative pleural effusion?

Answer 6

Anything that causes inflammatory or infiltrative disease of the pleura (neoplasm, infection)

Question 7

What causes transudative pleural effusion?

Answer 7

Anything that causes increased hydrostatic pressure or decreased capillary colloid osmotic pressure (CHF, hypoalbuminemia, cirrhosis)

Question 8

Define parapneumonic effusion

Answer 8

Pleural effusions that occur in the pleural space adjacent to a bacterial pneumonia

Question 9

In what percent of patients does a bloody pleural effusion without a history of trauma or pulmonary infarction indicate a neoplasm?

Answer 9

90%

Question 10

T/F atelectasis usually leads to small pleural effusions not requiring intervention

Answer 10

true

Question 11

Physcial exam findings of atelectasis

Answer 11

dullness to percussion, diminished vocal resonance, dimished tactile vocal fremitus, friction rub

Question 12

Define atelectasis

Answer 12

incomplete expansion of the lung which leads to collapse of the alveoli

Question 13

What is the etiology of primary spontaneous pneumothorax?

Answer 13

parenchymal blebs- small air-filled lesions just under the pleural surface.

Question 14

What is the etiology of secondary pneumothorax?

Answer 14

underlying pulmonary disease (COPD/Asthma/CF)

Question 15

How should you treat an open pneumothorax (sucking-chest wound)?

Answer 15

thoracostomy away from the traumatic wound

Question 16

Describe clinical management of asbestosis

Answer 16

CXR and PFTs every 3 to 5 years. Supplemental oxygen when there is resting hypoxemia. Pneumococcal and influenza vaccination

Question 17

Common physical findings of mesothelioma

Answer 17

Unilateral dullness to percussion at the lung base, Palpable chest wall masses, scoliosis towards the side of the malignancy

Question 18

T/F Most cases of mesothelioma will show bilateral pleural abnormality with a large, bilateral pleural effusion

Answer 18

False. Most cases of mesothelioma will show UNILATERAL pleural abnormality with a large, UNILATERAL pleural effusion

Question 19

What will you see on CXR of a young women of reproductive age who has lymphagioleiomyomatosis (LAM)?

Answer 19

hyperinflated lungs and a chylous effusion

Question 20

What is the treatment for LAM?

Answer 20

antiestrogen therapy (medroxyprogesterone, tamoxifen) or transplantation