Pleural Disorders (Harrisons 263) Flashcards

1
Q

Transudative pleural effusion occurs when…

A

…SYSTEMIC factors influencing pleural fluid are altered.

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2
Q

Exudative pleural effusion occurs when…

A

…LOCAL factors influencing pleural fluid are altered.

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3
Q

Most common cause of pleural effusion

A

Left ventricular failure

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4
Q

Why does left ventricular failure cause pleural effusion?

A

Increased amounts of fluid in the interstitial spaces of lungs exit across the visceral pleura, overwhelming the lymphatic system’s capacity to remove fluid

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5
Q

How can we determine that a pleural effusion is secondary to heart failure?

A

A pleural fluid BNP of > 1500 is “virtually diagnostic”

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6
Q

Hepatic hydrothorax

A

Direct movement of peritoneal fluid through small openings in the diaphragm into the pleural space

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7
Q

Parapneumonic effusions

A

Associated with bacterial pneumonia, lung abscess, or bronchiectasis

Most common cause of EXUDATIVE pleural effusion in the US

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8
Q

If the fluid in a parapneumonic effusion separates the lung from chest wall by > 10mm…

A

…a therapeutic thoracentesis should be performed

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9
Q

Factors that indicate the need for a procedure more invasive than thoracentesis, in order of increasing importance:

A

1) Loculated pleural fluid
2) Pleural fluid pH < 7.2
3) Pleural fluid glucose < 60 mg/dL
4) Positive Gram stain or culture of pleural fluid
5) Presence of gross pus in the pleural space

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10
Q

How is a malignant effusion diagnosed?

A

Cytology of the pleural fluid

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11
Q

Mesotheliomas are…

A

primary tumors of the mesothelial cells that line the pleural cavities.

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12
Q

What’s the most common factor in mesothelioma?

A

Asbestos exposure

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13
Q

The most commonly overlooked diagnosis of a patient with a pleural effusion:

A

pulmonary embolism

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14
Q

Jeopardy!

A very common cause of pleural effusion in many parts of the world, but relatively uncommon in the US.

A

What is tuberculosis?

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15
Q

How do we diagnose a tuberculous pleuritis?

A

high levels of TB markers in the pleural fluid

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16
Q

Pleural effusions can be caused by viral infection. Why is it important to know this?

A

They tend to resolve spontaneously with no long-term effects, and one should not try too aggressively to diagnose an undiagnosed effusion if the patient is improving clinically.

17
Q

How do we diagnose hemothorax?

A

If the pleural fluid obtained from thoracentesis has a hematocrit more than half of that in the peripheral blood

18
Q

What usually causes hemothorax?

A

That would be trauma!

But ruptured blood vessel or tumor can do it too.

19
Q

What’s a pneumothorax?

A

presence of gas in the pleural space

20
Q

What’s a spontaneous pneumothorax?

A

One that occurs without trauma

21
Q

Jeopardy!

A spontaneous pneumothorax that happens in the absence of lung disease

A

What is a primary spontaneous pneumothorax, Alex?

22
Q

Jeopardy again!

A spontaneous pneumothorax that happens in the presence of lung disease.

A

What is a secondary pneumothorax?

23
Q

Spontaneous secondary pneumothorax can happen with any lung disease, but mostly they stem from…

A

COPD!

24
Q

True or False: Traumatic pneumothorax results from penetrating trauma only.

A

False! It can result from non-penetrating trauma as well.

25
Q

How is simultaneous hemopneumothorax treated?

A

One chest tube in the upper chest (evacuating air) and one in the lower chest (draining blood).

26
Q

What are the most common causes of iatrogenic pneumothorax?

A

1) transthoracic needle aspiration
2) thoracentesis
3) insertion of CVL

27
Q

Tension pneumothorax: not a big deal right?

A

WRONG! It is a medical emergency & it’s probably gonna kill yer patient if you don’t fix it!

28
Q

Why does tension pneumothorax kill people?

A

Increased pressure in the thorax is also increased pressure in the mediastinum, which reduces cardiac output. Oh no!

29
Q

When does tension pneumothorax usually happen?

A

During mechanical ventilation or resuscitation. (Oops. Our bad.)

30
Q

Signs of tension pneumothorax:

A

1) Difficulty in ventilation or high peak inspiratory pressures
2) large hemithorax with no breath sounds
3) Hyperresonance to percussion
4) shift of mediastinum away from the tension pneumo

31
Q

How do we fix a tension pneumo?

A

Large bore needle inserted into the pleural space through 2nd intercostal space. If a lot of air escapes, time to place a chest tube!