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HPIM 19th Pulmo > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

Excess quantity of fluid in the pleural space which should normally contain a very thin layer of fluid

A

Pleural effusion

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2
Q

Etiology of pleural effusion

A

Pleural fluid formation > pleural fluid absorption

*Decreased lymphatic drainage

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3
Q

Due to alteration of SYSTEMIC factors that influence formation and absorption of pleural fluid

A

Transudative

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4
Q

Due to alteration of LOCAL factors that influence the formation and absorption of pleural fluid

A

Exudative

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5
Q

Leading causes of transudative effusion

A

LV failure: MC

cirrhosis

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6
Q

Leading causes of exudative effusion

A

Bacterial pneumonia
Malignancy
Viral Infection
Pulmonary Embolism

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7
Q

Light Criteria (exudative effusions)

A

PF/serum protein >0.5
PF/serum LDH >0.6
PF LDH >2/3 upper normal serum limit

At least one

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8
Q

Considerations for increased amylase

A

Esophageal rupture
Pancreatic pleural effusion
Malignancy

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9
Q

Considerations for glucose <60 mg/dL

A

Malignancy
Bacterial Infections
Rheumatoid pleuritis

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10
Q

Diagnostic modality if no diagnosis and no improvement of symptoms

A

Thoracoscopy or Open pleural biopsy

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11
Q

Serum-PF gradient likely to be transudative

A

> 31 g/L

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12
Q

Indications for diagnostic thoracentesis in effusion due to heart failure

A

Unilateral or unequal effusion, (+) fever, (+) pleuritic chest pain

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13
Q

Measurement if effusion persists despite therapy

A

Pleural fluid proBNP

> 1500 diagnostic of CHF

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14
Q

Mechanism of hepatic hydrothorax

A

Direct movement of peritonea fluid through small holes in the diaphragm into the pleural space

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15
Q

MC exudative pleural effusion

A

Parapneumonic

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16
Q

Factors indicating need for tube thoracostomy

A

Presence of gross pus in the pleural space
Positive gram stain or culture of the pleural fluid
Pleural fluid glucose <60mg/dl
Pleural fluid pH <7.20
Loculated pleural fluid

17
Q

2nd MC type of exudative pleural effusion

A

Malignant pleural effusions from metastatic disease

18
Q

3 tumors that cause malignant pleural effusions

A

Lung
Breast
Lymphoma

19
Q

Mineral associated with malignant mesotheliomas

A

Asbestos

20
Q

MCC of exudative effusion

A

Tuberculous pleuritis

21
Q

TB markers in pleural fluid of tuberculous pericarditis

A

Adenosine deaminase >40 IU/L

Gamma interferon >140 pg/ml

22
Q

MCC of chylothorax

A

Trauma

23
Q

Pleural fluid diagnostic of chylothroax

A

Milky, Triglyceride level >110 mg/dl

24
Q

Treatment for chylothorax

A

CTT + octreotide

25
Q

MCC of hemothorax

A

Trauma

26
Q

Diagnostic of hemothorax

A

Bloody, PF hematocrit >50% of peripheral blood hematocrit

27
Q

Treatment of hemothorax

A

CTT

28
Q

Meig’s syndome

A

Pleural effusion + Ascites + Benign ovarian tumors

29
Q

Presence of gas in the pleural space

A

Pneumothorax

30
Q

Positive pressure in pleural space throughout the respiratory cycle

A

Tension pneumothorax

31
Q

Mechanism of primary spontaneous pneumothorax

A

Rupture of apical blebs

*almost exclusively in smokers

32
Q

Treatment of primary spontaneous pneumothorax

A

Simple aspiration

*or stapling of blebs

33
Q

MCC of secondary spontaneous pneumothorax

A

COPD

34
Q

Treatment of secondary spontaneous pneumothorax

A

tube thoracostomy
thoracoscopy
thoracotomy with stapling of blebs and pleural abrasion

35
Q

Treatment of hemopneumothorax

A

One chest tube in the superior part of the hemithorax to evacuate the air, another tube in the inferior part of the hemithorax to remove the blood

36
Q

MCC of tension pneumothorax

A

Mechanical ventilation

Resuscitation

37
Q

Intervention in tension pneumothorax

A

Large-bore needle inserted into the pleural space theough the second anterior ICS then thoracostomy tube inserted before removing needle

HPIM 19th Pulmo (11 decks)

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