PLEURAL EFFUSION

Question 1

Tuberculous pleural effusions are thought to be caused primarily by:
A) A bacterial infection of the pleura
B) A hypersensitivity reaction to tuberculous protein in the pleural space
C) A viral infection
D) Direct invasion of the pleura by Mycobacterium tuberculosis

Answer 1

A hypersensitivity reaction to tuberculous protein in the pleural space

Question 2

The pleural fluid in tuberculous pleuritis is most likely to be:
A) An exudate with predominantly small lymphocytes
B) A transudate with a high white blood cell count
C) Clear and colorless
D) A serosanguinous effusion

Answer 2

An exudate with predominantly small lymphocytes

Question 3

Which of the following tests can be used to establish the diagnosis of tuberculous pleuritis?
A) Chest X-ray only
B) Pleural fluid analysis showing elevated adenosine deaminase (>40 IU/L) or interferon γ (>140 pg/mL)
C) CT scan of the chest
D) Sputum culture for Mycobacterium tuberculosis

Answer 3

Pleural fluid analysis showing elevated adenosine deaminase (>40 IU/L) or interferon γ (>140 pg/mL)

Question 4

What is the most common cause of chylothorax?
A) Pulmonary embolism
B) Trauma, most frequently thoracic surgery
C) Congestive heart failure
D) Viral infection

Answer 4

Trauma, most frequently thoracic surgery

Question 5

A triglyceride level exceeding _______ in pleural fluid is suggestive of chylothorax.
A) 0.8 mmol/L (70 mg/dL)
B) 1.2 mmol/L (110 mg/dL)
C) 2.0 mmol/L (180 mg/dL)
D) 3.0 mmol/L (270 mg/dL)

Answer 5

1.2 mmol/L (110 mg/dL)

Question 6

What is the treatment of choice for most chylothoraces?
A) High-dose steroids and antibiotics
B) Insertion of a chest tube plus administration of octreotide
C) Surgical resection of the thoracic duct
D) Thoracotomy and pleural decortication

Answer 6

Insertion of a chest tube plus administration of octreotide

Question 7

If initial treatments for chylothorax fail, which procedure is effective in controlling most cases?
A) Ligation of the diaphragm
B) Percutaneous transabdominal thoracic duct blockage
C) Total parenteral nutrition (TPN)
D) Surgical excision of affected lung tissue

Answer 7

Percutaneous transabdominal thoracic duct blockage

Question 8

In a patient with bloody pleural fluid, a hematocrit greater than one-half of the hematocrit in the peripheral blood is diagnostic of:
A) Chylothorax
B) Hemothorax
C) Tuberculous pleuritis
D) Transudative pleural effusion

Answer 8

Hemothorax

Question 9

If the pleural hemorrhage exceeds 200 mL/h in a patient with hemothorax, which of the following treatments should be considered?
A) Anticoagulation therapy
B) Angiographic coil embolization, thoracoscopy, or thoracotomy
C) Increased tube thoracostomy drainage
D) Administration of corticosteroids

Answer 9

Angiographic coil embolization, thoracoscopy, or thoracotomy

Question 10

After coronary artery bypass surgery, pleural effusions commonly occur. What is the typical characteristic of effusions within the first few weeks?
A) Right-sided, clear yellow fluid with small lymphocytes
B) Left-sided, bloody fluid with large numbers of eosinophils
C) Right-sided, clear yellow fluid with small lymphocytes
D) Left-sided, purulent fluid with neutrophils

Answer 10

Left-sided, bloody fluid with large numbers of eosinophils

Question 11

Pleural effusions that occur after the first few weeks post-cardiac surgery are typically:
A) Right-sided and bloody with neutrophils
B) Left-sided and clear yellow with predominantly small lymphocytes
C) Right-sided and clear yellow with large eosinophils
D) Left-sided and purulent with a high white blood cell count

Answer 11

Left-sided and clear yellow with predominantly small lymphocytes