Pleural effusion

Question 1

what is a pleural effusion

Answer 1

abnormal collection of fluid in pleural space

Question 2

what type of effusions should raise concern

Answer 2

large unilateral ones

Question 3

does a pleural effusion cause mediastinal shift

Answer 3

not really

Question 4

what is transudate

Answer 4

fluid pushed through the capillary due to high pressure within the capillary

Question 5

what is exudate

Answer 5

fluid that leaks around the cells of the capillaries caused by inflammation

Question 6

what tests should be carries out to diagnose a pleural effusion

Answer 6

history + exam, PA CXR, aspirate, bio chem (trans/exudate), cytology, culture

Question 7

where does pleural effusion always collect?

Answer 7

at the base of the lungs

Question 8

when can pleural effusions look like masses on CXR

Answer 8

when fluid collects between horizontal fissures

Question 9

what conditions cause a pleural effusion to have a straw-coloured appearance

Answer 9

cardiac failure, hypoalbuminaemia

Question 10

what conditions cause a pleural effusion to have a bloody appearance

Answer 10

trauma, malignancy, infection, infarction

Question 11

what conditions cause a pleural effusion to have a milky/turbid appearance

Answer 11

empyema, chylothorax

Question 12

what conditions cause a pleural effusion to be foul smelling

Answer 12

anaerobic empyema

Question 13

what causes a pleural effusion to contain food particles

Answer 13

oesophageal rupture

Question 14

what conditions cause a bi lateral pleural effusion

Answer 14

LVF, PTE (pleural thromboendarterectomy), drugs, systemic path, heart failure

Question 15

what conditions cause transudates

Answer 15

heart failure, liver cirrhosis, hypoalbuminaemia, atelectasis, peritoneal dialysis

Question 16

what conditions cause exudates

Answer 16

malignancy, infection (inc TB), pulmonary infarct, asbestos

Question 17

what is a normal pH for fluid in a pleural effusion

Answer 17

around 7.6

Question 18

what does a pH less than 7.3 suggest

Answer 18

pleural inflammation (malignancy)

Question 19

what does a Ph less than 7.2 require

Answer 19

drainage in the setting of infection

Question 20

when is glucose in the fluid of a pleural effusion low

Answer 20

in infection, TB, rheumatoid arthritis, malignancy, oesophageal rupture, SLE (systemic lupus erythematosus)

Question 21

what are you looking for in in cytology of a pleural effusion

Answer 21

malignant cells, lymphocytes (TB), neutrophils (acute process (inflammation/infection)

Question 22

what microbiology tests can be used to analyse a pleural effusion sample

Answer 22

gram stain microscopy, culture, PCR, AFB stain, liquid culture

Question 23

what does C4 mean

Answer 23

suspicion of malignancy

Question 24

what is a thoracentesis

Answer 24

pleural tap

Question 25

what types of cancer can present as a pleural effusion

Answer 25

any

Question 26

what types of tissue biopsy are there for pleural effusions

Answer 26

blind percutaneous, CT guided cutting needle, thoracoscopy, thoracotomy (incision into pleural space

Question 27

why are biopsies often negative

Answer 27

bad technique, effusion ancillary to malignancy but not malignant

Question 28

what are the systemic effects of tumours that have ancillary effusions

Answer 28

embolism, hypoalbuminaemia

Question 29

what is hypoalbuminaemia

Answer 29

low levels of albumin in blood

Question 30

what are the local effects of tumours with ancillary effusions

Answer 30

postobstructive infection, lymphatic obstruction, atelectasis

Question 31

what is mesothelioma

Answer 31

tumour of the ling of the lung or (very occasionally) lining of the abdominal cavity

Question 32

what treatment options are available for malignant pleural effusions

Answer 32

palliate symptoms, repeated pleural taps, drain and/or pleurodesis, long term pleural catheters, surgical options (abrasion, pleurectomy

Question 33

what is a pleurodesis and when is it (+/- drain) completed

Answer 33

pleural space obliterated, talc slurry (talc + lidocaine) or during thoracoscopy

Question 34

what is talc

Answer 34

sclerosing agent

Question 35

what is talc slurry

Answer 35

talc in suspension with lidocaine

Question 36

what is the most common complication of Talc

Answer 36

minor pleuritic pain and fever

Question 37

what is the purpose of long term pleural catheters

Answer 37

allow patients to control effusion and symptoms

Question 38

what are the complications of long term pleural catheters

Answer 38

incorrect placement, bleeding, infection

Question 39

what does a lent score predict

Answer 39

survival in malignant pulmonary effusion

Question 40

in what group of people is a pneumothorax more common

Answer 40

tall thin men, smokers, cannabis, underlying lung disease

Question 41

whats the difference between primary and secondary pneumothorax

Answer 41

secondary had underlying lung disease (e.g COPD)