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Respiratory > Pleural effusion > Flashcards

Pleural effusion Flashcards

1
Q

what is a pleural effusion

A

abnormal collection of fluid in pleural space

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2
Q

what type of effusions should raise concern

A

large unilateral ones

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3
Q

does a pleural effusion cause mediastinal shift

A

not really

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4
Q

what is transudate

A

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

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5
Q

what is exudate

A

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

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6
Q

what tests should be carries out to diagnose a pleural effusion

A

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

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7
Q

where does pleural effusion always collect?

A

at the base of the lungs

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8
Q

when can pleural effusions look like masses on CXR

A

when fluid collects between horizontal fissures

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9
Q

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

A

cardiac failure, hypoalbuminaemia

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10
Q

what conditions cause a pleural effusion to have a bloody appearance

A

trauma, malignancy, infection, infarction

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11
Q

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

A

empyema, chylothorax

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12
Q

what conditions cause a pleural effusion to be foul smelling

A

anaerobic empyema

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13
Q

what causes a pleural effusion to contain food particles

A

oesophageal rupture

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14
Q

what conditions cause a bi lateral pleural effusion

A

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

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15
Q

what conditions cause transudates

A

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

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16
Q

what conditions cause exudates

A

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

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17
Q

what is a normal pH for fluid in a pleural effusion

A

around 7.6

18
Q

what does a pH less than 7.3 suggest

A

pleural inflammation (malignancy)

19
Q

what does a Ph less than 7.2 require

A

drainage in the setting of infection

20
Q

when is glucose in the fluid of a pleural effusion low

A

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

21
Q

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

A

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

22
Q

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

A

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

23
Q

what does C4 mean

A

suspicion of malignancy

24
Q

what is a thoracentesis

A

pleural tap

25
Q

what types of cancer can present as a pleural effusion

A

any

26
Q

what types of tissue biopsy are there for pleural effusions

A

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

27
Q

why are biopsies often negative

A

bad technique, effusion ancillary to malignancy but not malignant

28
Q

what are the systemic effects of tumours that have ancillary effusions

A

embolism, hypoalbuminaemia

29
Q

what is hypoalbuminaemia

A

low levels of albumin in blood

30
Q

what are the local effects of tumours with ancillary effusions

A

postobstructive infection, lymphatic obstruction, atelectasis

31
Q

what is mesothelioma

A

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

32
Q

what treatment options are available for malignant pleural effusions

A

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

33
Q

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

A

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

34
Q

what is talc

A

sclerosing agent

35
Q

what is talc slurry

A

talc in suspension with lidocaine

36
Q

what is the most common complication of Talc

A

minor pleuritic pain and fever

37
Q

what is the purpose of long term pleural catheters

A

allow patients to control effusion and symptoms

38
Q

what are the complications of long term pleural catheters

A

incorrect placement, bleeding, infection

39
Q

what does a lent score predict

A

survival in malignant pulmonary effusion

40
Q

in what group of people is a pneumothorax more common

A

tall thin men, smokers, cannabis, underlying lung disease

41
Q

whats the difference between primary and secondary pneumothorax

A

secondary had underlying lung disease (e.g COPD)

Respiratory (26 decks)

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