Pleural Effusion Flashcards
____has replaced the lateral decubitus x-ray in the evaluation of suspected pleural effusions and as a guide to thoracentesis.
Chest ultrasound
A ____occurs when systemic factors that influence the formation and absorption of pleural fluid are altered.
transudative pleural effusion
An ___occurs when local factors that influence the formation and absorption of pleural fluid are altered. T
exudative pleural effusion
The leading causes of exudative pleural effusions are _____
bacterial pneumonia
malignancy
viral infection
pulmonary embolism.
Exudative pleural effusions meet at least one of the following criteria, whereas transudative pleural effusions meet none:
Pleural fluid protein/serum protein >0.5
Pleural fluid LDH/serum LDH >0.6
Pleural fluid LDH more than two-thirds the normal upper limit for serum
If this gradient [difference between the protein levels in the serum and the pleural fluid] is ____ the exudative categorization by these criteria can be ignored because almost all such patients have a transudative pleural effusion.
> 31 g/L (3.1 g/dL),
A patient with a pleural effusion has pleural fluid protein/serum protein = 0.7, pleural fluid LDH/serum LDH = 0.8, and pleural fluid LDH above two-thirds the normal upper serum limit. How should the effusion be classified?
A. Transudative
B. Exudative
C. Indeterminate
D. Reactive
B
Which imaging modality has replaced the lateral decubitus x-ray in evaluating pleural effusions?
A. Chest MRI
B. Chest CT
C. Chest ultrasound
D. Chest fluoroscopy
C
In a pleural effusion with clinical suspicion of a transudative process but exudative lab findings, what additional test can help determine the correct classification?
A. Pleural fluid pH
B. Serum-to-pleural fluid protein gradient
C. Pleural fluid amylase
D. Chest CT scan
B
Which of the following is NOT commonly associated with exudative pleural effusion?
A. Bacterial pneumonia
B. Malignancy
C. Cirrhosis
D. Pulmonary embolism
C
A patient has pleural fluid LDH/serum LDH = 0.4 and pleural fluid protein/serum protein = 0.3. What is the most likely classification of the pleural effusion?
A. Exudative
B. Transudative
C. Indeterminate
D. Reactive
B
Which of the following values would correctly identify a pleural effusion as exudative using Light’s criteria?
A. Pleural fluid protein/serum protein = 0.4
B. Pleural fluid LDH/serum LDH = 0.5
C. Pleural fluid LDH = 60% of the upper normal serum LDH limit
D. Pleural fluid LDH = 70% of the upper normal serum LDH limit
D
What is the most appropriate next step in the diagnostic evaluation after confirming the presence of a pleural effusion on chest ultrasound?
A. Start empiric antibiotics
B. Perform thoracentesis and fluid analysis
C. Order a repeat ultrasound in 2 weeks
D. Schedule a CT-guided biopsy
B
What is the first diagnostic step after identifying a pleural effusion?
A. Obtain a CT scan of the chest
B. Perform diagnostic thoracentesis and measure pleural fluid protein and LDH
C. Perform a spiral CT to check for pulmonary embolism
D. Start empiric treatment for tuberculosis
B
What classification is assigned if pleural fluid LDH is greater than two-thirds of the upper normal serum LDH limit?
A. Transudative effusion
B. Exudative effusion
C. Parapneumonic effusion
D. Tuberculous effusion
B
Which of the following findings in pleural fluid would lead to consideration of malignancy, bacterial infection, or rheumatoid pleuritis?
A. Glucose <60 mg/dL
B. Pleural fluid LDH/serum LDH >0.6
C. Pleural fluid protein/serum protein >0.5
D. Absence of TB markers
A
The most common cause of pleural effusion is___
left ventricular failure.
A pleural fluid N-terminal pro-brain natriuretic peptide (NT-proBNP) level ____pg/mL is virtually diagnostic of an effusion that is secondary to congestive heart failure.
> 1500
Hepatic Hydrothorax is usually ____ sided
Right
____ refers to a grossly purulent effusion.
Empyema
If the free fluid separates the lung from the chest wall by ____, a therapeutic thoracentesis should be performed.
> 10 mm
Factors indicating the likely need for a procedure more invasive than a thoracentesis (in increasing order of importance) include the following:
- Loculated pleural fluid
- Pleural fluid pH <7.20
- Pleural fluid glucose <3.3 mmol/L (<60 mg/dL)
- Positive Gram stain or culture of the pleural fluid
- Presence of gross pus in the pleural space
If the fluid cannot be completely removed with the therapeutic thoracentesis, consideration should be given to inserting a ____ and instilling the combination of a ____or performing a ___
chest tube
fibrinolytic agent (e.g., tissue plasminogen activator, 10 mg) and deoxyribonuclease (5 mg)
thoracoscopy with the breakdown of adhesions.
Patients with ____ bacterial pneumonia and pleural effusion present with an acute febrile illness consisting of chest pain, sputum production, and leukocytosis.
Patients with ____ infections present with a subacute illness with weight loss, a brisk leukocytosis, mild anemia, and a history of some factor that predisposes them to aspiration.
aerobic
anaerobic
