Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory > Pleural Malignancy > Flashcards

Pleural Malignancy Flashcards

1
Q

What is the anatomy of the pleura?

A

Serous membrane
The visceral pleural covers the lungs and form the interlobar fissures
The parietal pleura covers the mediastinum, diaphragm and inner surface of the thorax
Inferior margins of the pleura considerably lower than the corresponding border of the lung
Usually contains approx 4mls
Need approx. 200mls of fluid to be detected on a plain CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the purpose of the pleural fluid?

A

Lubricates the 2 pleural surfaces allowing the pleura to slide smoothly during respiration. The surface tension allow the lung surface to stay touching the thoracic wall creating a seal between the 2 surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where do the 2 layers combine?

A

Around the hila of the lung, so the hila has no pleural coverage
The pleural layers combine to form the pulmonary ligament which runs inferiorly and attaches the root of the lung to the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a pleural effusion?

A

An abnormal collection of fluid in the pleural space. It is a common presentation of numerous diseases but does not always require drainage or sampling (cardiac failure) but a large unilateral effusion should raise concern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is a pleural effusion diagnosed?

A 
History and examination 
PA CXR
Pleural aspirate if it is not convincingly cardiac failure 
Biochemistry - is it a transudate or exudate (Transudate is fluid pushed through the capillary due to high pressure within the capillary. Exudate is fluid that leaks around the cells of the capillaries caused by inflammation)
Cytology 
Culture 
Contrast enhanced CT chest 
Pleural tap
Pleural biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can the pleural fluid look like?

A 
Straw-coloured 
Bloody
Turbid/milky
Foul smelling
Food particles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does straw-coloured pleural fluid indicate?

A

Cardiac failure

Hypoalbuminemia -level of albumin in the blood is abnormally low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does bloody pleural fluid indicate?

A

Trauma
Malignancy
Infection
Infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does turbid/milky pleural fluid indicate?

A

Empyema
Chylothorax - lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does foul smelling pleural fluid indicate?

A

Anaerobic empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does food particles in the pleural fluid indicate?

A

Oesophageal rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does bilateral pleural effusion indicate?

A

Left ventricular failure
PTE
Drugs
Systemic path

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What will the biochemistry show for a transudate pleural effusion?

A 
Protein <30 g/L
Heart failure 
Liver cirrhosis
Hypoalbuminaemia
Atelectasis 
Peritoneal dialysis 
Does not always have a benign aetiology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What will the biochemistry show for an exudate pleural effusion?

A 
Protein >30 g/L 
Malignancy 
Infection inc TB
Pulmonary infarct 
Asbestos 
Always look for a serious pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What will you look for in cytology and cell counts?

A

Look for malignant cells (2 samples will dx up to 2/3 of malignant effusions)
Lymphocytes - think TB, malignancy although any long standing effusion will eventually become lymphocytic
Neutrophils suggest an acute process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What will be looked for in microbiology?

A

Gram stain and microscopy
Culture
PCR, AFB stain and liquid culture
Put in blood culture bottles for higher yield

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What marker will favour neoplasia over hyperplasia in a pleural tap?

A

Thick membrane staining with EMA and negative with desmin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does C4 mean?

A

Suspicious of malignancy but not confirmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does it mean if the pleural effusion clears up in less than 2 months?

A 
CHF (congestive heart failure) 
Acute pancreatitis 
Post CABG
Post Tx
Pulmonary embolism 
Sarcoisodid 
Traumatic chylothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does it mean if the pleural effusion clears up in 2-6 months?

A 
TBC - not sure
Post CABG
Cardiac injury 
Sarcoidosis 
Benign asbestos 
Chronic pancreatitis
21
Q

What does it mean if the pleural effusion clears up in 6-12 months?

A

Rheumatoid

Benign asbestos

22
Q

What does it mean if the pleural effusion is benign persistent?

A

YNS - yellow nail syndrome
Trapped lung
Lymphangiectasia

23
Q

What is an ancillary effusion?

A 
Systemic tumour effects:
Embolism, hypoalbuminaemia 
Local tumour effects:
Postobstructive infection
Lymphatic obstruction 
Atelectasis
24
Q

What is meothelioma?

A

An uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity

25
Q

What are the chances of developing mesothelioma?

A

It increases with the degree and length of time exposed to asbestos. Occasionally may occur in people who have not worked with asbestos but have been associated with people who have
Often takes 30-40

26
Q

What are some symptoms of mesothelioma?

A

Breathlessness, chest pain, weight loss, fever, sweating and cough

27
Q

What are the 3 types of asbestos fibers?

A

Chystotile (white powder)
Amosite (brown)
Crocidolite (most dangerous)

28
Q

What investigations can be done to diagnose meothelioma?

A

Imaging - pleural nodularity, cicumferential pleural thickening, local invasion, lung entrapment
Pleural fluid aspiration - low cytological yield, avoid repeated aspiration
Biopsy - thoracoscopy

29
Q

What is the treatment of mesothelioma?

A 
Pleurodese effusions 
Radiotherapy 
Surgery 
Chemo
Paliative care 
Report deaths to the fiscal
30
Q

Where do all cancers metastasize to?

A

The pleura, this includes:
Lung cancer, breast cancer, upper GI, lymphoma, melanoma, ovary
The median survival is 3-12 months but there is large variation

31
Q

What are treatment options for malignant pleural effusion?

A 
Nothing and palliate symptoms
Repeated pleural taps
Drain and/or pleurodesis
Long term pleural catheters 
Surgical options (abrasion, pleurectomy)
32
Q

What are the complications to using a talc slurry?

A 
Minor pleuritic pain and fever 
Pneumonia 
Respiratory failure 
Talc pneumonitis/ARDS
Secondary empyema
Local tumour implantation at port site in messthelioma
33
Q

What is the purpose of a long term plueral catheter?

A

To allow patients to control their effusion and therefore symptoms
Inserted mostly in patients with malignant effusions
The drain is designed to remain in place for life though some will stop producing pleural fluid

34
Q

What are some complications of a long term pleural catheter?

A

Incorrect placement
Bleeding
Infection
Patients however can shower and fly

35
Q

How is survival predicted in MPE (malignant pleural effusion)

A 
The LENT score:
LDH
ECOG PS
Neutrophil to lymphocyte ratio 
Tumour type
36
Q

What are the treatment options for MPE?

A

Depends on underlying cause
LVF- diuretics
Infection - drain, antibiotics, may require surgery
Malignancy - drain, pleurodesis, long term pleural cathater
Watchful waiting of unilateral effusions will sometimes (10%) result in cancer being found

37
Q

Who is more likely to get a pneumothorax?

A 
More common in:
Tall thin men
Smokers
Cannabis 
Underlying lung disease
38
Q

What causes a primary pneumothorax?

A

Normal lungs

Apical bullae rupture

39
Q

What causes a secondary pneumothorax?

A

Underlying lung disease (COPD)

40
Q

What is the presentation of a pneumothorax?

A 
Acute onset pleuritic chest pain 
SOB, hypoxia 
Signs: 
Tachycardia
Hyper-resonant percussion note
Reduced expansion 
Quiet breath sounds on auscultation 
Hamman's sign (click on auscultation left side)
41
Q

What investigations can be done to diagnose a pneumothorax?

A

CXR - small <2cm rim of air
Large - >2cm of air
2cm rim is approx 50% pneumothorax by volume, it is measured at hilar level not apex
CT chest - useful to differentiate bullous lung disease or small pneumothorces

42
Q

How can pneumothoraxes be managed?

A

Oxygen even if no drain is inserted
No treatment is needed if the pneumothorax is asymptomatic and small
Aspirations is the 1st line in PSP - this avoids chest drain, but is time consuming and may fail
Chest drain
May need suction
Surgical intervention

43
Q

What indications are there for surgical intervention?

A 
Second ipsilateral ptx
First contralateral ptx
Bilateral spontaneous ptx
Persistent air leak
Risk professions (pilots, drivers) after first ptx
44
Q

What is the follow-up protocol for ptx?

A

CXR until resolution
Discuss flying and driving after
Risk of recurrence
Smoking cessation

45
Q

What is a tension pneumothorax?

A

An emergency that can lead to cardiac arrest
One-way valve that progressively increases pressure in the pleural space that pushes other chest organs to the opposite side to the affected side

46
Q

What are the signs of a tenion ptx?

A 
Acute respiratory distress
Trachea deviated to opposite side
Hypotension 
Raised JVP
Reduced air entry on affected side
47
Q

What can cause a tension pneumothorax?

A 
Ventilated patient
Trauma
CPR especially PEA
Blocked, kinked or misplaced drain
Pre-existing airway disease 
Patients undergoing hyperbaric treatment
48
Q

Where is the needle placed for relief of a tension ptx?

A

2nd intercostal space in the midclavicular line

Respiratory (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions