Pleural effusion

Question 1

reexpansion pulmonary edema pathophysiology?

Answer 1

inc pulmonary blood flow and capillary failure in ipsilateral side->cytokine inflamation on ipsi and contralateral side

Question 2

treatment of complicated pleural effusion?

Answer 2

thoracostomy with instillation of TPA gyrase

Question 3

findings of a pleural effusion from a ruptured esophagus?

Answer 3

exudative, low pH, and a high amylase

Question 4

things that cause a transudative effusion?

Answer 4

cirrhosis, CHF, nephrotic syndrome, iatrogenic infusion of crytalloids into pleural space, urinothorax

Question 5

defining characteristic of urinothorax?

Answer 5

pleural/serum Cr >1

Question 6

best test for evaluation pleural effusion?

Answer 6

CT equivalent to US

Question 7

physiology of effusion?

Answer 7

pleural fluid arises from parietal pleura vasculature and then is reabsorbed by the lymphatics

Question 8

Lights critera?

Answer 8

pleural/serum: protein >.5, LDH >.6

Question 9

pseudoexudate in pleural effusion?

Answer 9

due to diuretic use, can account for albumin (serum albumin- pleural albumin) if <1.2

Question 10

bloody pleural fluid?

Answer 10

TB malignancy

Question 11

milky pleural fluid?

Answer 11

chylous

Question 12

anchovy paste pleural fluid?

Answer 12

ameoba

Question 13

high triglycerides in pleural fluid?

Answer 13

chylothorax

Question 14

high Cr in pleural fluid?

Answer 14

urinothorax

Question 15

Post CABG pleural effusion?

Answer 15

L>R, exudate,

Question 16

TB pleural fluid?

Answer 16

exudate, lymphocyte predominance, positive ADA, culture negative

Question 17

drugs that cause an exudative effusion?

Answer 17

nitrofurantoin, methotrexate, amiodarone, phenytoin

Question 18

exudate with increased amylase?

Answer 18

ruptured pancreatic pseudocyst

Question 19

chylothorax?

Answer 19

milky with triglycerides >11

Question 20

treatment for a retaine dhemothorax?

Answer 20

VATS

Question 21

when to do thoracotomy for hemothorax?

Answer 21

> 200 cc/hr, or 1500 in 24 hour

Question 22

TPA plus dornase benefit for empyema?

Answer 22

reduce need for surgery and decrease LOS

Question 23

pleural fluid salivary isoamylase effusion cause?

Answer 23

boerhaave

Question 24

pancreatic isoamylase in fluid?

Answer 24

pseudocyst

Question 25

how to prevent reexpansion pulmonary edema?

Answer 25

limit end exp pleural pressure to -20 cm h2o, gradual removal of fluid

Question 26

effusion of RA?

Answer 26

exudative and lymphocytic

Question 27

pseudoexudate

Answer 27

transudative efusion with elevated protein or LDH secondary to diuretic use

Question 28

how to increase specificity for exudate?

Answer 28

serum - pleural albumin <1.2

Question 29

drugs that cause exudate?

Answer 29

NFT, MTX, phenytoin, amiodarone

Question 30

parapneumonic effusion labs

Answer 30

LDH>1000, ph <7.2 need chest tube

Question 31

how to treat venous air embolism?

Answer 31

left lateral decubitus and trendelenburg

puts RVOT lower than RV and improves RV

Question 32

position for arterial air embolism

Answer 32

remain flat to reduce cerebral gas embolism