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Pulmonology > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

Most common cause of pleural effusion. (Harrison’s 19th edition, pp 1716)

A

Left ventricular failure

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2
Q

Occurs when local factors that influence the formation and absorption of pleural fluid are altered. (Harrison’s 19th edition, pp 1716)

A

Exudative pleural effusion

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3
Q

The leading cause of Transudative pleural effusion. (Harrison’s 19th edition, pp 1716)

A

Left ventricular failure

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4
Q

Most common cause of exudative pleural effusion. (Harrison’s 19th edition, pp 1717)

A

Parapneumonic effusions

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5
Q

Refers to a grossly purulent effusion. (Harrison’s 19th edition, pp 1717)

A

Emphyema

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6
Q

Occurs when systemic factors that influence the formation and absorption of pleural fluid are altered. (Harrison’s 19th edition, pp 1716)

A

Transudative pleural effusion

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7
Q

Second most common type of exudative pleural effusion. (Harrison’s 19th edition, pp 1717)

A

Effusion secondary to malignancy

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8
Q

Three tumors that cause ~75% of all malignant pleural effusion. (Harrison’s 19th edition, pp 1717)

A

Lung carcinoma
Breast carcinoma
Lymphoma

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9
Q

Lights criteria. (Harrison’s 19th edition, pp 1716)

A

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 the serum
*Exudative pleural effusions meet at least one

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10
Q

Most important indication for chest tube insertion. (Harrison’s 19th edition, pp 1717)

A

Presence of gross pus in the pleural space

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11
Q

Indication for Chest tube insertion. (Harrison’s 19th edition, pp 1717)

A

Loculated pleural fluid
Pleural fluid pH < 7.2
Pleural fluid glucose < 3.3mmol/L (<60mg/dL)
Positive gram stain or culture of the pleural fluid
Presence of gross pus in the pleural space

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12
Q

Diagnosis of TB pleuritis. (Harrison’s 19th edition, pp 1718)

A

High levels of TB markers in pleural fluid

(adenosine deaminase > 40IU/L or interferon y > 140 pg/mL

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13
Q

Most common cause of hemathoraxes. (Harrison’s 19th edition, pp 1718)

A

Trauma

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14
Q

Most patients with hemothorax should be treated with? (Harrison’s 19th edition, pp 1718)

A

Tube thoracostomy

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15
Q

Amount of pleural hemorrhage in considering to do thoracospy or thoracotomy. (Harrison’s 19th edition, pp 1718)

A

> 200mL/hr

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16
Q

Most common cause of chylothorax. (Harrison’s 19th edition, pp 1718)

A

Trauma

Most frequently thoracic surgery

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17
Q

Diagnostic criteria for hemothorax by using the hematocrit. (Harrison’s 19th edition, pp 1718)

A

If the PF Hct > ½ of the serum Hct

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18
Q

The diagnosis most commonly overlooked in the differential diagnosis of a patient with an undiagnosed pleural effusion. (Harrison’s 19th edition, pp 1717)

A

Pulmonary embolism

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19
Q

Diagnosis of malignant pleural effusion. (Harrison’s 19th edition, pp 1717)

A

Pleural fluid cytology

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20
Q

The next best procedure for the diagnosis of malignant pleural effusion if cytology examination is negative and malignancy is strongly suspected. (Harrison’s 19th edition, pp 1717)

A

Thoracoscopy

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21
Q

Transudative pleural effusion. (Harrison’s 19th edition, pp 1718)

A 
superior vena cava Obstruction
Nephrotic syndrome
Myxedema
CHF
Cirrhosis
Urinothorax
Peritoneal dialysis
(ON My Clear CUP)
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22
Q

The likely diagnosis if pleural fluid amylase level is elevated. (Harrison’s 19th edition, pp 1718)

A

Esophageal rupture

Pancreatic disease

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23
Q

Condition that should be considered if the patient is febrile, has predominantly polymorphonuclear cells in the pleural fluid, and has no pulmonary parenchymal abnormalities. (Harrison’s 19th edition, pp 1718)

A

Intraabdominal abscess

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24
Q

Triad of Benign ovarian tumors, Ascites and pleural effusion. (Harrison’s 19th edition, pp 1718)

A

Meigs’ syndrome

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25
Q

Medical manipulations that can induce pleural effusions. (Harrison’s 19th edition, pp 1718)

A 
Coronary artery bypass surgery
Abdominal surgery
Radiation therapy
Liver transplant
Lung transplant
Heart transplant
Intravascular insertion of central lines
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26
Q

Characteristic of pleural effusion caused by Coronary Artery Bypass Surgery. (Harrison’s 19th edition, pp 1718)

A

Within the 1st week – Typically left-sided and bloody, with large numbers of eosinophils and respond to 1 or 2 therapeutic thoracentesis
After the 1st few weeks – Left sided and clear yellow, with predominantly small lymphocytes, and tend to recur

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27
Q

Cause of TB pleuritis. (Harrison’s 19th edition, pp 1718)

A

Hypersensitivity reaction to tuberculous protein in the pleural space

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28
Q

Predominant cells in TB pleuritis. (Harrison’s 19th edition, pp 1718)

A

Small lymphocytes

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29
Q

Clinical manifestation of TB pleuritis. (Harrison’s 19th edition, pp 1718)

A

Fever
Weight loss
Dyspnea
Pleuritic chest pain

30
Q

Alternative diagnostic modality to establish the diagnosis of TB pleuritis aside from high levels of TB markers in the pleural fluid. (Harrison’s 19th edition, pp 1718)

A

Culture of the pleural fluid
Needle biopsy of the pleura
Thoracoscopy

31
Q

Recommended treatment for TB Pleuritis. (Harrison’s 19th edition, pp 1718)

A

Identical with PTB

32
Q

Occurs when there is an excess quantity of fluid in the pleural space. (Harrison’s 19th edition, pp 1716)

A

Pleural effusion

33
Q

Accumulation of pleural fluid happens when there is? (Harrison’s 19th edition, pp 1716)

A

Pleural fluid formation exceeds pleural fluid absorption

34
Q

Entry of fluid to the pleural space. (Harrison’s 19th edition, pp 1716)

A

Capillaries in the parietal pleura
From the interstitial spaces of the lung via the visceral pleura
From the peritoneal cavity via small holes in the diaphragm

35
Q

Exit of fluid from the pleural space. (Harrison’s 19th edition, pp 1716)

A

Lymphatics in the parietal pleura

36
Q

Capacity of the lymphatics to absorb fluid. (Harrison’s 19th edition, pp 1716)

A

20 times more than is formed

37
Q

Diagnostic modality of choice for Pleural effusion. (Harrison’s 19th edition, pp 1716)

A

Chest ultrasound

38
Q

Leading causes of transudative pleural effusions. (Harrison’s 19th edition, pp 1716)

A

LV failure

Cirrhosis

39
Q

Leading causes of exudative pleural effusions. (Harrison’s 19th edition, pp 1716)

A

Bacterial pneumonia
Malignancy
Viral infection
Pulmonary embolism

40
Q

Tests that should be obtained if a patient has an exudative pleural effusion. (Harrison’s 19th edition, pp 1716)

A 
Description of the appearance of the fluid
Glucose level
Differential cell count
Microbiologic studies
Cytology
41
Q

Computation that should be obtained if a patient is clinically thought to have a condition producing a transudative effusion but have met one or more exudative criteria. (Harrison’s 19th edition, pp 1718)

A

Serum-pleural fluid protein gradient
Lights criteria can be ignored if gradient is > 31g/L (3.1g/dL) because almost all patients have a transudative pleural effusion

42
Q

Indication to do diagnostic thoracentesis in patients with heart failure. (Harrison’s 19th edition, pp 1717)

A

If effusion is not bilateral and comparable in size
Febrile
(+) Pleuritic chest pain

43
Q

Diagnostic blood exam for effusion secondary to congestive heart failure. (Harrison’s 19th edition, pp 1717)

A

N-terminal pro-brain natriuretic peptide (NT-proBNP) > 1500pg/mL

44
Q

Occurs when the thoracic duct is disrupted and chyle accumulates in the pleural space. (Harrison’s 19th edition, pp 1718)

A

Chylothorax

45
Q

Presentation of patients with chylothorax. (Harrison’s 19th edition, pp 1718)

A

Dyspnea
Large effusion on CXR
Milky fluid on thoracentesis

46
Q

In chylothorax, triglyceride level in the pleural fluid. (Harrison’s 19th edition, pp 1718)

A

> 1.2mmol/L (110mg/dL)

47
Q

Diagnostics of choice on patients with chylothorax and no obvious trauma. (Harrison’s 19th edition, pp 1718)

A

Lymphangiogram

Mediastinal CT scan

48
Q

Treatment of choice for chylothorax. (Harrison’s 19th edition, pp 1718)

A

Insertion of chest tube + administration of ocreotide

If fails, Pleuroperitoneal shunt (unless patient has chylous ascites)

49
Q

Alternative treatment for chylothorax. (Harrison’s 19th edition, pp 1718)

A

Ligation of the thoracic duct

Percutaneous transabdominal thoracic duct blockage

50
Q

Patients with chylothoraxes should not undergo prolonged tube thoracostomy with chest tube drainage because this will lead to? (Harrison’s 19th edition, pp 1718)

A

Malnutrition

Immunologic incompetence

51
Q

Occurrence of pleural effusion in patients with cirrhosis and ascites. (Harrison’s 19th edition, pp 1717)

A

~5%

52
Q

Predominant mechanism of hepatic hydrothorax. (Harrison’s 19th edition, pp 1717)

A

Direct movement of peritoneal fluid through small openings in the diaphragm into the pleural space

53
Q

Characteristics of hepatic hydrothorax. (Harrison’s 19th edition, pp 1717)

A

Usually right sided

Frequently large enough to produce severe dyspnea

54
Q

Associated diseases for parapneumonic effusion. (Harrison’s 19th edition, pp 1717)

A

Bacterial pneumonia
Lung abscess
Bronchiectasis

55
Q

Presentation of patients with pleural effusion secondary to aerobic bacterial pneumonia. (Harrison’s 19th edition, pp 1717)

A

Acute febrile illness
Chest pain
Sputum production
Leukocytosis

56
Q

Presentation of patients with pleural effusion secondary to anaerobic bacterial pneumonia. (Harrison’s 19th edition, pp 1717)

A 
Subacute illness
Weight loss
Brisk leukocytosis
Mild anemia
Predisposing factors to aspiration
57
Q

Diagnostic modalities that can demonstrate presence of free pleural fluid. (Harrison’s 19th edition, pp 1717)

A

Lateral decubitus radiograph
Computed tomography (CT) of the chest
Ultrasound

58
Q

Therapeutic thoracentesis should be performed if the free fluid separates the lung from the chest wall by? (Harrison’s 19th edition, pp 1717)

A

> 10mm

59
Q

Most common symptom of patients with pleural effusion secondary to pulmonary embolism. (Harrison’s 19th edition, pp 1717)

A

Dyspnea

60
Q

Possible outcomes/complications for pleural effusions secondary to pulmonary embolism that increases in size after anticoagulation. (Harrison’s 19th edition, pp 1717)

A

Recurrent emboli
Hemothorax
Pleural infection

61
Q

Primary tumors that arise from the mesothelial cells that line the pleural cavities. (Harrison’s 19th edition, pp 1717)

A

Malignant mesotheliomas

62
Q

The usual diagnostic modality for diagnosing Mesothelioma. (Harrison’s 19th edition, pp 1717)

A

Image-guided needle biopsy

Thoracoscopy

63
Q

Most common risk factor for developing mesothelioma. (Harrison’s 19th edition, pp 1717)

A

Asbestos exposure

64
Q

Chest radiograph findings in Mesothelioma. (Harrison’s 19th edition, pp 1717)

A

Pleural effusion
Generalized pleural thickening
Shrunken hemothorax

65
Q

Presentation of patients with mesothelioma. (Harrison’s 19th edition, pp 1717)

A

Chest pain

Shortness of breath

66
Q

In malignant pleural effusion, this procedure should be done to induce pleurodesis. (Harrison’s 19th edition, pp 1717)

A

Pleural abrasion

67
Q

Alternative diagnostic modality for malignant pleural effusion. (Harrison’s 19th edition, pp 1717)

A

CT/UTZ guided needle biopsy of pleural thickening or nodules

68
Q

Treatment for malignant pleural effusion. (Harrison’s 19th edition, pp 1717)

A

Therapeutic thoracentesis
If symptoms are relieved, may do the ff:
1) Insertion of a small indwelling catheter.
2) tube thoracostomy with the instillation of a sclerosing agent (doxycycline 500mg)

69
Q

Treatment for parapneumonic pleural effusion. (Harrison’s 19th edition, pp 1717)

A

Initial and repeat thoracentesis
if fluid not completely removed, may do the ff:
1) Chest tube insertion + combination of fibrinolytic agent (10mg Tissue plasminogen activator) and Deoxyribonuclease (5mg) instillation
2) Thoracoscopy with breakdown of adhesions
if ineffective, do decortication

70
Q

Differential diagnosis if pleural fluid glucose level is < 60mg/dL. (Harrison’s 19th edition, pp 1717)

A

Malignancy
Bacterial infections
Rheumatoid pleuritis

Pulmonology (16 decks)

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