Pleural Effusions

Question 1

acute, painful, pleural inflammation caused by parietal pleural irritation

Answer 1

pleuritis

Question 2

what is the cause of pleuritis in healthy individuals?

Answer 2

viral or bacterial infection

Question 3

what should be considered to be the cause of pleuritis in an ill patient? (2)

Answer 3

malignancy
effusion

Question 4

a patient presents with localized, sharp, and fleeting pain that is worse when coughing, sneezing, or deep breathing.

Answer 4

pleuritis

Question 5

where can pain in pleuritis refer to?

Answer 5

ipsilateral shoulder

Question 6

what is the treatment for pleuritis?

Answer 6

underlying cause
NSAIDs
cough suppressant

Question 7

pleural effusion that is caused by increased hydrostatic or decreased oncotic capillary pressure

Answer 7

transudative

Question 8

pleural effusion caused by increased production of fluid

Answer 8

exudative

Question 9

infection leading to pus in the pleural space

Answer 9

empyema

Question 10

what is hydrostatic pressure’s job?

Answer 10

pushes out fluid from vessels

Question 11

what is oncotic pressure’s job?

Answer 11

keeps in fluid from vessels

Question 12

what is the pathophysiology of transudative effusions?

Answer 12

low pleural fluid concentration of proteins and other large molecules

Question 13

what is the most common cause of transudative pleural effusion?

Answer 13

heart failure

Question 14

what is the pathophysiology of exudative pleural effusion?

Answer 14

increased permeability leads to elevated levels of proteins and other large molecules in the pleural fluid

Question 15

an exudative free flowing effusion that is small and resolves completely with antibiotics

Answer 15

uncomplicated parapneumonic effusion

Question 16

an exudative free flowing effusion that requires drainage

Answer 16

complicated parapneumonic effusion

Question 17

an exudative collection of pus in the pleural space in which the lung adheres to the chest wall as inflammation leads to scarring

Answer 17

empyema

Question 18

a patient presents with dyspnea, cough, pleural chest pain, dullness to percussion, egophony.

Answer 18

pleural effusion

Question 19

what would a chest xray look like in pleural effusion? (2)

Answer 19

fluid in gravity-dependent areas
costophrenic blunting

Question 20

what does an empyema look like in pleural fluid gross exam?

Answer 20

purulent, white and milky

Question 21

what is done in a pleural effusion for testing and therapeutic benefit?

Answer 21

thoracentesis

Question 22

what would pH and WBC count be in transudative pleural fluid?

Answer 22

7.4-7.55 (alkaline)
<1000

Question 23

what is light’s criteria for exudative pleural effusion?

Answer 23

pleural protein/serum protein > 0.5
pleural LDH/serum LDH > 0.6
pleural LDH > 2/3 x serum LDH

Question 24

what is the most common cause of exudative pleural effusions?

Answer 24

lung and breast cancer

Question 25

a lack of tumor cells on cytology with presumed malignancy etiology

Answer 25

para-malignant effusion

Question 26

what is the treatment for transudative and malignancy pleural effusion?

Answer 26

treat underlying cause
therapeutic thoracentesis

Question 27

what is the treatment for an uncomplicated parapneumonic pleural effusion?

Answer 27

treat infection

Question 28

what is the treatment for a complicated parapneumonic pleural effusion? (3)

Answer 28

treat infection
drain fluid
peel fibrous adhesions