Pleural Effusion

Question 1

What are the two types of pleura and what do they correspond to?

Answer 1

Visceral- outlines the lungs Parietal- outlines the chest wall Pleural cavity- between these two layers

Question 2

What is the function of pleural fluid?

Answer 2

Provides lubrication for the two pleural layers to slide over one another

Question 3

Are the hila of the lung covered by pleura?

Answer 3

No because the two layers combine around the hila.

Question 4

The pleural layers combine to form the _ _

Answer 4

Pulmonary ligament

Question 5

What is pleural effusion?

Answer 5

Abnormal collection of fluid in the pleural cavity

Question 6

What are some common causes of pleural effusion?

Answer 6

1. Chest infection/ lung cancer 2. Heart failure causing back flow i.e. oedema 3. Rheumatoid arthritis

Question 7

What are the symptoms of pleural effusion?

Answer 7

Depends on underlying cause 1. Breathlessness 2. Chest pain

Question 8

What does straw coloured pleural fluid suggest?

Answer 8

-Hypoalbuminaemia - cardiac failure

Question 9

What does bloody pleural fluid indicate?

Answer 9

• Infection - Cancer - Trauma - Infarction

Question 10

What does turbid/milky fluid indicate?

Answer 10

empyema, Chylothorax

Question 11

Prensence of food substances in the pleural fluid suggests what?

Answer 11

Oesophageal rupture

Question 12

What area some causes of a bilateral effusion?

Answer 12

• LVF - Drugs - Pulmonary-thrombo-embolism

Question 13

What are transudates and exudates in relation to PE?

Answer 13

Transudate- disruption of oncotic/hydrostatic pressures across the pleural membranes Exudate- leaky pulmonary capillaries, as a result of inflammation

Question 14

What levels of protein are seen in transudate & exudate pleural effusion?

Answer 14

Transudate= < 30g/l Exudate = >30g/l

Question 15

Clinical implications of both types of effusion?

Answer 15

Transudate - LVH - Liver cirrhosis - Hypoalbuminaemia Exudate - Infection - Malignancy - Pulmonary infarct Exudative pe- Serious pathology

Question 16

What does a lower than 7.3 fluid pH suggest?

Answer 16

Pleural Inflammation

Question 17

Glucose levels are low in pleural fluid caused by infection , malignancy, rheumatoid etc. T/F?

Answer 17

True

Question 18

What microbiological tests are carried out in pleural effusion?

Answer 18

1. Gram stain 2. PCR 3. Culture

Question 19

What is thoracentesis?

Answer 19

Using a needle to draw the pleural fluid out.

Question 20

What are some tissue biopsy tests that are useful for pleural effusion?

Answer 20

1. Thoracoscopy 2. Blind percutaneous pleural biopsy 3. CT guided needle pleural biopsy

Question 21

What is a mesothelioma?

Answer 21

Malignancy of the lining of the lung or the lining of the abdominal cavity

Question 22

Biggest risk factor for mesothelioma?

Answer 22

Length and degree exposure to Asbestos

Question 23

Symptoms of mesothelioma?

Answer 23

• Chest pain - Breathlessness - High fever - Malaise - Weight loss - Sweating - Cough

Question 24

Some investigations for mesothelioma?

Answer 24

1. Imaging 2. Fluid aspiration 3. Biopsy

Question 25

Treatment options for mesothelioma?

Answer 25

1. Radiotherapy 2. Chemotherapy 3. Surgery 4. palliative

Question 26

What is pleurodiesis?

Answer 26

Using an agent (TalC) into the pleural space to irritate the pleura, causing the two layers to stick together preventing further fluid build up.

Question 27

Common complications of using TalC?

Answer 27

1. Minor pleuritic pain/ fever 2. Pneumonitis 3. Pneumonia 4. Respiratory failure

Question 28

What do pleural catheters do?

Answer 28

Long term drains inserted into the pleura to drain fluid. Used mostly in malignant effusions.

Question 29

What scoring system is used to predict survival in malignant pleural effusion?

Answer 29

LDH ECOG PS Nuetropil : lymphocyte ratio Tumour type

Question 30

Main form of treatment?

Answer 30

To treat underlying cause - Heart failure- diuretics - infection- antibiotics - malignancy- catheter, radiation, chemo If excess fluid- Draining

Question 31

Tall, thin people are more likely to get pneumothorax. T/F?

Answer 31

True

Question 32

Some other risk factors for pneumothorax?

Answer 32

-Cannabis - smokers - other lung disease

Question 33

What are the two types of pneumothorax

Answer 33

Spontaneous- hole in chest wall. lung collapses Traumatic (tension) - hole in the lung wall, causes air to move out of the lungs into the chest cavity. Lung collapses

Question 34

Symptoms of pneumothorax?

Answer 34

- acute pleuritic chest pain - breathlessness - Hypoxic

Question 35

Signs of pneumothorax?

Answer 35

1. Tachycardia 2. Hyper resonant on percussion 3. Reduced expansion 4. Quiet breath sounds

Question 36

What investigations would you do for pneumothorax?

Answer 36

Chest X ray sufficient Small= \< 2cm rim of air Large= \>2cm rim of air

Question 37

Which point of the lungs is the rim of air measured?

Answer 37

Hilar not apex

Question 38

Management for pneumothorax?

Answer 38

- Oxygen - Chest drain - Aspiration - Suction - Surgical intervention

Question 39

Is tension pneumothorax an emergency? why?

Answer 39

Yes, risk of cardiac arrest

Question 40

What anatomical changes are seen in tension pneumothorax?

Answer 40

Increasing pressure of leaked air, Pushes mediastinal organs to opposite side of the pneumothorax Can cause acute respiratory distress

Question 41

Signs of tension pneumothorax?

Answer 41

1. Tracheal deviation to Opp side 2. Hypotension 3. Raised JVP 4. Reduced air entry on affected side

Question 42

Treatment for Tension pneumothorax?

Answer 42

Needle decompression. With large bore venflon

Question 43

What anatomical position is the needle inserted in tension pneumothorax?

Answer 43

2nd intercostal space anteriorly, Mid clavicular line