Pleural effusion and pneumonia

Question 1

what is a pleural effusion

Answer 1

fluid in the potential space between the visceral and parietal pleura

Question 2

how do patients with pleural effsuion present

Answer 2

history of SOB, dyspnoea, chest pain, non-productive cough

Question 3

what will you find on examination in patient with pleural effusion

Answer 3

SOB, dyspnoea, splinting, tachypnea, resp distress.

REDUCED VESICULAR SOUNDS AND AIR ENTRY, THERE MAY BE MEDIASTINAL SHIFT, STONY DULLNESS, REDUCED RESONANCE AND VOCAL FREMITUS

Question 4

Investigations for pleural effusion

Answer 4

1. PA radiograph with blunting of costophrenic angle and curvy linear meniscus of fluid in pleural space
2. Pleurocynthesis: WCC, total protein, albumin, LDH, glucose, pH
3. MC&S: TB culture and ADA

Question 5

from what age will cytology of a pleural effusion be required

Answer 5

> 45 because of concern around malignancy

Question 6

How will the fluid present macroscopically for possible malignancy

Answer 6

blood stained

Question 7

what is the concern about pleural fluid being milky or chylous

Answer 7

thoracic duct injury

Question 8

when would an empyema be considered

Answer 8

if the pleural effusion fluid is turbid

Question 9

What differentials would cause a transudate

Answer 9

LVF, Cirrhosis, protein losing enteropathy, nephrotic syndrome

Question 10

differentials of exudate as pleural effusion aspirate

Answer 10

infectious causes(TB), malignancy in smokers, metastases, connective tissue disorders, vascular diseases

Question 11

Does mesothelioma cause exudate or transuadate?

Answer 11

exudate

Question 12

what criteria is used to distinguish transudate from exudate in effusion

Answer 12

Light’s criteria

Question 13

what is pneumonia

Answer 13

inflammation distal to the terminal bronchiol

Question 14

CAP is caused by what

Answer 14

H.influenzae, strep pneumoniae

Question 15

how does infective pneumonia present

Answer 15

fever, chills, rigors, chest pain. sob, purulent sputum

Question 16

why do some causes of pneumonia be classified as atypical

Answer 16

because they present with nausea, vomiting, rashes, diarrhoea, inflammatory arthritis

Question 17

where are fungal pneumonias seen

Answer 17

advanced immunosuppressed individuals or in transplantation

Question 18

what are the typical fungal causes of pneumonia

Answer 18

histoplasmosis, cryptococcis, aspergillus

Question 19

What virus causes pneumonia in immunosuppressed

Answer 19

CMV

Question 20

what lung cancers can present as pneumonias

Answer 20

lymphoma, adenicarcinoma in situ

Question 21

Is ILD a infective or non-infective cause of pneumonia

Answer 21

non-infective

Question 22

can stony dullness be seen in pneumonia

Answer 22

yes, if there is a parapneumonic effusion

Question 23

what is the first investigation in suspected pneumonia

Answer 23

CXR

Question 24

What culture medias can be sent to the lab

Answer 24

sputum, tb pcr, blood culture, urine test

Question 25

in what case will urine testing be most appropriate?

Answer 25

if there is suspected legionella infection

Question 26

When can a CT scan be done in pneumonia

Answer 26

when there is uncertainty about cause

Question 27

what is the CURB-65 score and where is used

Answer 27

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)

Question 28

What curb score should be admitted to hospital

Answer 28

2 or more

Question 29

what should be checked daily in patients admitted and on antibiotics

Answer 29

HR, TEMP, RR

Question 30

The commonest form of lung cancer mimicking pneumonia is:

Answer 30

Adenocarcinoma

Question 32

best investigation to confirm the diagnosis of TB in a pleural effusion is:

Answer 32

TB culture

Question 33

empyema typically does not have: A. Low fluid glucose B. High Adenosine Deaminase C. High pH D. High fluid Lactate Dehydrogenase

Answer 33

C