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Respiratory > Pleural Dz > Flashcards

Pleural Dz Flashcards

1
Q

no sensory fibers on the?

A

visceral pleura

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2
Q

pleural fluid arises from?

A

pleural capillaries, interstitium, lymphatics, and peritoneal cavity

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3
Q

pH is usually?

A

alkalotic

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4
Q

lymphatic clearance is ___X higher than fluid formation

A

28x

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5
Q

what types of cells

A

macrophages, monocytes, lymphocytes

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6
Q

causes of pleural effusion

A

increased hydrostatic gradient, increased permeability, decreased oncotic gradient, anatomic issues, decreased pleural fluid absorption (lymph obstruction or elevated SVP, aquaporins)

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7
Q

most common causes of pleural effusion are?

A

CHF, parapneumonic, maligancies, PE, viral

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8
Q

clinical features of pleural effusion

A

dyspnea (due to decreased muscle tension), cough, chest pain, fever

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9
Q

physical exam of pleural effusion shows?

A

dullness to percussion, reduced breath sounds, absent fremitis, reduced expansion of affected side

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10
Q

physiologic effects of a pleural effusion are more from the ____ than the ____

A

diaphragm, lung

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11
Q

radiographic findings of pleural effusion (standing)

A

apparent elevation of hemidiaphragm, apex more lateral, contralateral mediastinal shift

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12
Q

radiographic findings of pleural effusion (supine)

A

homogenous density over lung, loss of diaphragm

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13
Q

diagnostic evaluation of pleural effusion

A

thoracentesis, dry tap unless sx

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14
Q

contraindication for thoracentesis

A

bleeding/anticoag therapy, hemodynamic instability

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15
Q

pleural fluid analysis should always include:

A

LDH, total protein, albumin, cell count, glucose, cytology, gram stain

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16
Q

Light’s criteria for exudate

A

pleural protein/serum protein > 0.5 OR pleural LDH/serum LDG > 0.6 OR pleural LDH > 163

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17
Q

what cause pleural exudate?

A

pneumonia, malignancy, PE, GI disease, sometimes CHF

18
Q

exudate is a sign of?

A

inflammation and disease of pleura

19
Q

transudate is due to?

A

pressure imbalance only (pleura are ok)

20
Q

causes of transudate

A

CHF, PE, cirrhosis, protein wasting dz

21
Q

CHF can cause pseudoexudates due to?

A

diuretic therapy

22
Q

other studies that could be helpful

A

bilirubin, cholesterol, albumin

23
Q

CHF induced pleural effusions are?

A

bilateral, more often right sided, and not actually exudates

24
Q

hepatic hydrothorax is?

A

pleural transudate secondary to cirrhosis and ascites, usually right sided (due to movement of ascites and decreased albumin)

25
Q

thoracentesis of an empyema shows?

A

purulent, odorous exudate high in LDH

26
Q

orange or milky fluid suggests?

A

chylothorax

27
Q

eosinophils found in?

A

air and blood

28
Q

lymphocytes found in?

A

malignancy or TB

29
Q

PMN predominance suggests?

A

parapneumonic and/or empyema

30
Q

high LDH suggests?

A

parapneumonic or malignancy

31
Q

pleural fluid characteristics associated with severe parapneumonic effusion or empyema

A

pus, positive gram stain, glucose under 40, acidic, super high LDH, loculated

32
Q

bloody effusion

A

hemothorax OR trauma, malignancy, PE, infection

33
Q

check amylase if suspect?

A

pancreatitis, esophageal rupture, or malignancy

34
Q

malignant effusions are?

A

mildly exudative, predominanty lymphocytes, often bloody, sign of stage IV cancer

35
Q

malignant pleural effusions usually caused by what 3 types of cancer

A

lung, breast, lymphoma

36
Q

treatment of malignant pleural effusion

A

palliative thoracentesis or small bore cath for intermittent drainage

37
Q

what is a chylothorax?

A

pleural fluid accumulation due to disruption of thoracic duct (trauma or tumor) –> high triglycerides in exudate

38
Q

TB effusion shows?

A

exudate, lymphocytic, positive for ADA

39
Q

exam signs of pneumothorax

A

decreased breath sounds, decreased fremitis, hyperresonance, tracheal deviation, hypotension, tachycardia

40
Q

on CXR, pneumothorax may show?

A

lucent area alongside outer edge of lung, deep sulcus

41
Q

tx of pneumothorax

A

100% oxygen, observation, tube thoracostomy

Respiratory (15 decks)

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