Pleural Effusion (not a condition, I know shush)

Question 1

What is a pleural effusion?

Answer 1

Abnormal collection of fluid in the pleural space

Question 2

Straw-coloured effusion indicates?

Answer 2

Cardiac failure

Hypoalbuminaemia

Question 3

Bloody effusion indicates?

Answer 3

Trauma
Malignancy
Infection
Infarction

Question 4

Turbid/milky effusion indicates?

Answer 4

Empyema

Chylothorax

Question 5

Foul-smelling effusion indicates?

Answer 5

Anaerobic empyema

Question 6

Food particles in an effusion indicated?

Answer 6

Oesophageal rupture

Question 7

What does transudate means?

Answer 7

Low protein (<30 g/L)

Question 8

What causes transudate pleural effusions?

Answer 8

Cardiac failure 
Hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption) 
Hypoalbuminaemia
Atelectasis 
Peritoneal dialysis

Question 9

What does exudate mean?

Answer 9

High protein (>30 g/L)

Question 10

What causes exudate pleural effusion?

Answer 10

Increased leakiness of pleural cavity secondary to infection 
Pneumonia 
TB 
Connective tissue disease
Malignancy 
RA
SLE 
Asbestos

Question 11

What characterises a simple para-pneumonic effusion?

Answer 11

Clear fluid
pH > 7.2
LDH <1000
Glucose > 2.2

Question 12

What characterises a complicated parapneumonic effusion?

Answer 12

pH <7.2
LDH > 1000
Glucose <2.2

Question 13

Complicated parapneumonic effusions require?

Answer 13

Chest tube drainage

Question 14

How do you identify a pleural effusion on CXR?

Answer 14

D-sign

Question 15

What are symptoms of a pleural effusion?

Answer 15

Chest pain
Cough
Fever
Breathlessness

Question 16

What are signs of pleural effusion?

Answer 16

Decreased chest expansion
Stony dull percussion note
Decreased breath sounds on affected side
Decreased vocal remits + vocal resonance

Question 17

Which tests can be performed?

Answer 17

CXR
USS
Aspiration
(Biopsy (if aspiration inconclusive))

Question 18

What would be seen on CXR with a small pleural effusion?

Answer 18

blunted costodiaphragmatic angles

Question 19

What would be seen on CXR with a larger pleural effusion?

Answer 19

Water-dense shadows with concave upper corders

Question 20

How can a pleural effusion be resolved?

Answer 20

Thoracentesis

Tube thoracotomy

Question 21

Virtually all cancers may metastasise to the pleura. How do you treat malignant effusions?

Answer 21

Palliate symptoms 
Repeated pleural taps 
Drain and/or pleurodesis 
Long-term pleural catheter
Surgery (abrasion / pleurectomy)

Question 22

What is Pulmonary Oedema?

Answer 22

Accumulation of fluid in the lung interstitium +/- alveolar spaces

Question 23

What kind of defect is pulmonary oedema and subsequently what type of spirometry does it show?

Answer 23

Restrictive

Question 24

What causes pulmonary oedema?

Answer 24

ncreased hydrostatic pressure

Cellular injury to alveolar lining cells or alveolar endothelium from localised pneumonia or ARDS