Pleural effusion and pneumonia Flashcards
what is a pleural effusion
fluid in the potential space between the visceral and parietal pleura
how do patients with pleural effsuion present
history of SOB, dyspnoea, chest pain, non-productive cough
what will you find on examination in patient with pleural effusion
SOB, dyspnoea, splinting, tachypnea, resp distress.
REDUCED VESICULAR SOUNDS AND AIR ENTRY, THERE MAY BE MEDIASTINAL SHIFT, STONY DULLNESS, REDUCED RESONANCE AND VOCAL FREMITUS
Investigations for pleural effusion
- PA radiograph with blunting of costophrenic angle and curvy linear meniscus of fluid in pleural space
- Pleurocynthesis: WCC, total protein, albumin, LDH, glucose, pH
- MC&S: TB culture and ADA
from what age will cytology of a pleural effusion be required
> 45 because of concern around malignancy
How will the fluid present macroscopically for possible malignancy
blood stained
what is the concern about pleural fluid being milky or chylous
thoracic duct injury
when would an empyema be considered
if the pleural effusion fluid is turbid
What differentials would cause a transudate
LVF, Cirrhosis, protein losing enteropathy, nephrotic syndrome
differentials of exudate as pleural effusion aspirate
infectious causes(TB), malignancy in smokers, metastases, connective tissue disorders, vascular diseases
Does mesothelioma cause exudate or transuadate?
exudate
what criteria is used to distinguish transudate from exudate in effusion
Light’s criteria
what is pneumonia
inflammation distal to the terminal bronchiol
CAP is caused by what
H.influenzae, strep pneumoniae
how does infective pneumonia present
fever, chills, rigors, chest pain. sob, purulent sputum
why do some causes of pneumonia be classified as atypical
because they present with nausea, vomiting, rashes, diarrhoea, inflammatory arthritis
where are fungal pneumonias seen
advanced immunosuppressed individuals or in transplantation
what are the typical fungal causes of pneumonia
histoplasmosis, cryptococcis, aspergillus
What virus causes pneumonia in immunosuppressed
CMV
what lung cancers can present as pneumonias
lymphoma, adenicarcinoma in situ
Is ILD a infective or non-infective cause of pneumonia
non-infective
can stony dullness be seen in pneumonia
yes, if there is a parapneumonic effusion
what is the first investigation in suspected pneumonia
CXR
What culture medias can be sent to the lab
sputum, tb pcr, blood culture, urine test
in what case will urine testing be most appropriate?
if there is suspected legionella infection
When can a CT scan be done in pneumonia
when there is uncertainty about cause
what is the CURB-65 score and where is used
It is used in the ER when assessing the patient originally and it is used for a 30 day mortality risk and not for admission.
Confusion
Urea
Resp rate
Bp
65(age)
What curb score should be admitted to hospital
2 or more
what should be checked daily in patients admitted and on antibiotics
HR, TEMP, RR
The commonest form of lung cancer mimicking pneumonia is:
Adenocarcinoma
best investigation to confirm the diagnosis of TB in a pleural effusion is:
TB culture
empyema typically does not have:
A. Low fluid glucose
B. High Adenosine Deaminase
C. High pH
D. High fluid Lactate Dehydrogenase
C
