Pleural Effusion

Question 1

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

Answer 1

Pleural effusion

Question 2

Etiology of pleural effusion

Answer 2

Pleural fluid formation > pleural fluid absorption

*Decreased lymphatic drainage

Question 3

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

Answer 3

Transudative

Question 4

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

Answer 4

Exudative

Question 5

Leading causes of transudative effusion

Answer 5

LV failure: MC

cirrhosis

Question 6

Leading causes of exudative effusion

Answer 6

Bacterial pneumonia
Malignancy
Viral Infection
Pulmonary Embolism

Question 7

Light Criteria (exudative effusions)

Answer 7

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

At least one

Question 8

Considerations for increased amylase

Answer 8

Esophageal rupture
Pancreatic pleural effusion
Malignancy

Question 9

Considerations for glucose <60 mg/dL

Answer 9

Malignancy
Bacterial Infections
Rheumatoid pleuritis

Question 10

Diagnostic modality if no diagnosis and no improvement of symptoms

Answer 10

Thoracoscopy or Open pleural biopsy

Question 11

Serum-PF gradient likely to be transudative

Answer 11

> 31 g/L

Question 12

Indications for diagnostic thoracentesis in effusion due to heart failure

Answer 12

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

Question 13

Measurement if effusion persists despite therapy

Answer 13

Pleural fluid proBNP

> 1500 diagnostic of CHF

Question 14

Mechanism of hepatic hydrothorax

Answer 14

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

Question 15

MC exudative pleural effusion

Answer 15

Parapneumonic

Question 16

Factors indicating need for tube thoracostomy

Answer 16

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

Question 17

2nd MC type of exudative pleural effusion

Answer 17

Malignant pleural effusions from metastatic disease

Question 18

3 tumors that cause malignant pleural effusions

Answer 18

Lung
Breast
Lymphoma

Question 19

Mineral associated with malignant mesotheliomas

Answer 19

Asbestos

Question 20

MCC of exudative effusion

Answer 20

Tuberculous pleuritis

Question 21

TB markers in pleural fluid of tuberculous pericarditis

Answer 21

Adenosine deaminase >40 IU/L

Gamma interferon >140 pg/ml

Question 22

MCC of chylothorax

Answer 22

Trauma

Question 23

Pleural fluid diagnostic of chylothroax

Answer 23

Milky, Triglyceride level >110 mg/dl

Question 24

Treatment for chylothorax

Answer 24

CTT + octreotide

Question 25

MCC of hemothorax

Answer 25

Trauma

Question 26

Diagnostic of hemothorax

Answer 26

Bloody, PF hematocrit >50% of peripheral blood hematocrit

Question 27

Treatment of hemothorax

Answer 27

CTT

Question 28

Meig’s syndome

Answer 28

Pleural effusion + Ascites + Benign ovarian tumors

Question 29

Presence of gas in the pleural space

Answer 29

Pneumothorax

Question 30

Positive pressure in pleural space throughout the respiratory cycle

Answer 30

Tension pneumothorax

Question 31

Mechanism of primary spontaneous pneumothorax

Answer 31

Rupture of apical blebs *almost exclusively in smokers

Question 32

Treatment of primary spontaneous pneumothorax

Answer 32

Simple aspiration *or stapling of blebs

Question 33

MCC of secondary spontaneous pneumothorax

Answer 33

COPD

Question 34

Treatment of secondary spontaneous pneumothorax

Answer 34

tube thoracostomy thoracoscopy thoracotomy with stapling of blebs and pleural abrasion

Question 35

Treatment of hemopneumothorax

Answer 35

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

Question 36

MCC of tension pneumothorax

Answer 36

Mechanical ventilation | Resuscitation

Question 37

Intervention in tension pneumothorax

Answer 37

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