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General med - Resp > Pleural effusion > Flashcards

Pleural effusion Flashcards

1
Q

Causes of pleural effusion

A 
Heart, liver or renal failure 
Pneumonia 
Pulmonary embolism 
Cancer 
TB
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2
Q

Symptoms of pleural effusion

A

Progressive breathlessness
Pleuritic pain
Symptoms of underlying condition

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3
Q

Signs of pleural effusion

A 
Reduced chest wall movements on the affected side 
Stony dull percussion note 
Diminished or absent breath sounds 
Decreased vocal resonance 
Bronchial breathing just above effusion
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4
Q

Which patients are more likely to present with pleural effusion

A

Heart, liver or renal failure
Cancer
TB
Pleural infection

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5
Q

Diagnosis of pleural effusion

A

Chest radiography

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6
Q

Management of pleural effusion

A

Refer(or admit) the person for drainage of effusion and further IX of underlying cause

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7
Q

When does a transudative effusion occur

A

When there is disruption of the hydrostatic and oncotic forces operating across the pleural membranes

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8
Q

When does an exudative pleural effusion occur

A

When there is increased permeability of the pleural surface and/or capillaries, usually as a result of inflammation

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9
Q

What is the light criteria

A

Consists of measurement of the lactate dehydrogenase(LDH) and protein concentration in the pleural fluid and serum

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10
Q

When is a pleural effusion considered exudative

A

Pleural fluid -to-serum protein ratio > 0.5

Pleural fluid-to-serum LDH ratio > 0.6

Pleural fluid LDH concentration > 2/3 upper limit of normal for serum LDH

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11
Q

Most common causes of transudates

A

Heart failure
Cirrhosis
Hypoalbuminaemia
Peritoneal dialysis

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12
Q

Less common causes of transudates

A

Hypothyroidism
Nephrotic syndrome
Mitral stenosis
Pulmonary embolism(more likely to be exudate)

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13
Q

Common causes of exudates

A

Pneumonia

Malignancy

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14
Q

Less common causes of exudates

A 
Pulmonary infarction(from PE) 
Autoimmune disease(RA)
Asbestos exposure 
Pancreatitis 
Dressler's syndrome 
TB
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15
Q

Causes of chylothorax

A 
Neoplasm(lymphoma, metastatic carcinoma)
Trauma(operative and penetrating injuries) 
TB 
Sarcoidosis 
Cirrhosis 
Amyloidosis
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16
Q

What is pseudochylothorax

A

Accumulation of cholesterol crystals in a long-standing pleural effusion

17
Q

Causes of pseudochylothorax

A

TB
Rheumatoid arthritis
Poorly treated empyema

18
Q

Tracheal deviation in pleural effusions

A

With a large unilateral effusion, it is displaced away from the lesion

If there is associated collapse, trachea is deviated towards the lesion

19
Q

What does mediastinal shift in the presence of an effusion suggest

A

A large effusion that is in excess of a litre

20
Q

What type of pleural aspiration may be carried out if the pleural effusion is small or loculated

A

Ultrasound-guided pleural aspiration

21
Q

Which additional test can be carried out for a suspected empyema

A

Centrifuge to differentiate from chylothorax

22
Q

Which additional test can be carried out if a chylothorax is suspected

A

Cholesterol and triglyceride levels

Centrifuge; presence of cholesterol crystals and chylomicrons

23
Q

Which additional test can be carried out if a haemothorax is suspected

A

Haematocrit

24
Q

Use of pleural aspiration in bilateral pleural effusions

A

Aspiration should not be performed for bilateral effusions in a clinical setting strongly suggestive of transudate unless atypical features present

25
Q

Causes of bloody pleural fluid

A 
Malignancy 
Pulmonary embolus with infarction 
Trauma 
Benign asbestos pleural effusions 
Post-cardiac injury syndrome
26
Q

Purpose of pleural fluid haematocrit

A

If haematocrit of fluid is more than half of patient’s peripheral blood haematocrit, this confirms haemothorax

< 1% haematocrit of pleural fluid is insignificant

27
Q

Normal pleural pH

A

7.6

28
Q

Causes of pleural pH < 7.2 with a normal blood pH

A

Pleural infection and empyema

Rheumatoid disease and SLE

TB

Malignancy

Oesophageal rupture

29
Q

Why should pleural cytology specimen be repeated if negative

A

Malignant effusions are diagnosed by pleural fluid cytology alone in only 60% of cases

30
Q

Causes of low pleural glucose levels

A 
Empyema 
Rheumatoid disease 
SLE
TB
Malignancy 
Oesophageal rupture
31
Q

Management options for pleural effusions where aspiration has failed

A

Pleurodesis
Pleurectomy
Surgically implanted pleuroperitoneal shunts

32
Q

Management options for pleural effusions where aspiration has failed

A

Pleurectomy

Surgically implanted pleuroperitoneal shunts

33
Q

What is pleurodesis

A

Injection of a sclerosant to cause adhesion of the visceral and parietal pleura and to prevent reaccumulation of effusion

34
Q

Commonly used sclerosing agents

A

Tetracycline
Sterile talc
Bleomycin

35
Q

When is pleurodesis commonly used

A

Management of recurrent malignant effusions

36
Q

What might pleural fluid with low glucose indicate

A

Rheumatoid arthritis

TB

37
Q

What might pleural fluid with raised amylase indicate

A

Pancreatitis

Oesophageal perforation

General med - Resp (11 decks)

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