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Respiratory > Pleural Malignancy > Flashcards

Pleural Malignancy Flashcards

1
Q

What amount of liquid is normally found in the lungs?

A

4mls

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2
Q

How much XS liquid is needed in the lungs to be detected in a CXR?

A

200ml

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3
Q

what allows the pleura to slide smoothly during respiration?

A

serous fluid

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4
Q

what creates a seal between the lung surface and the thoracic wall?

A

surface tension

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5
Q

why do the hila of the lungs have no pleural coverage?

A

the 2 layers (lung surface and thoracic wall) combine around the hila of the lung

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6
Q

d: pleural effusion

A

Abnormal collection of fluid in pleural space

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7
Q

what is the term for draining the liquid?

A

pleural aspiration

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8
Q

if the liquid comes out straw coloured, what diseases could it be?

A

cardiac failure

hypoalbuminaemia

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9
Q

if the liquid comes out bloody, what diseases could it be?

A

trauma
malignancy
infection
infarction

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10
Q

if the liquid comes out turbid/milky, what diseases could it be?

A

empyema

chylothorax

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11
Q

if the liquid comes out foul smelling, what diseases could it be?

A

anaerobic empyema

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12
Q

if the liquid comes out with food particles, what diseases could it be?

A

oesophageal rupture

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13
Q

if the liquid comes out bilateral, what diseases could it be?

A

left ventricle failure
pulmonary thromboembolism
drugs
systemic path

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14
Q

d: transudates + colour

A

clear
protein <30g/L
caused by a rise in pressure or low protein level of the blood vessels

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15
Q

d: exudates + colour

A

cloudy
protein >30g/L
effusions result from leakages in the blood vessels due to inflammation of the pleura

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16
Q

name some diseases producing transudates in effusion

A 
Heart failure
Liver cirrhosis
Hypoalbuminaemia
Atelectasis (ITU or post surgery)
Peritoneal dialysis
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17
Q

name some diseases producing exudates in effusion

A

Malignancy
Infection inc TB

Pulmonary infarct
Asbestos

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18
Q

What is the normal fluid pH for effusion?

A

7.6

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19
Q

what does a pH of <7.3 suggest?

A

pleural inflammation malignancy

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20
Q

what does a pH of <7.2 require?

A

drainage in setting of infection

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21
Q

is glucose in fluid high/low in infection?

A

low

22
Q

if lymphocytes were found in the fluid what would that suggest?

A

TB

malignancy

23
Q

if neutrophils were found in the fluid what would that suggest?

A

it was an acute process

24
Q

d: pleural tap

A

the removal of fluid from the area between the chest cavity and the tissue lining of the lungs

25
Q

medical name for a pleural tap?

A

thoracentesis

26
Q

name 2 ancillary effusions that are systemic tumour effects

A

embolism

hypoalbuminaemia

27
Q

name ancillary effusions that are local tumour effects

A

postobstructive infection,
lymphatic obstruction,
atelectasis

28
Q

d:atelectasis

A

collapse/closer of a lung

29
Q

why is a CT guided needle better than a thoracoscopy for a pleural biopsy?

A

can see where you are going

30
Q

what is a mesothelioma and where is it found?

A

Uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity

31
Q

what is a particular cause of mesothelioma?

A

asbestos

32
Q

d: sclerotherapy

A

is a procedure used to treat blood vessels or blood vessel malformations

33
Q

what is a good sclerosing agent?

A

TALC

34
Q

what may someone who has chronic pleural effusion get put in?

A

a pleural catheter

35
Q

what is a long term pleural catheter?

A

Vacuum in drainage bottle that provides suction to drain pleural fluid

36
Q

what is the max fluid a pleural catheter can drain a day?

A

1L

37
Q

d: pneumothorax

A

collapsed lung due to air leaking into pleural space

38
Q

symptoms of 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)
39
Q

what is a small pneumothorax?

A

<2cm of air

40
Q

what lever is pneumothorax air measured at?

A

hilar not apex

41
Q

treatments of pneumothorax

A 
Oxygen even if no drain
Aspiration 1st line in PSP
Chest drain
May need suction (air leak >48 hours)
Surgical intervention
42
Q

what is a tension pneumothorax?

A

when a one-way valve is formed by an area of damaged tissue,

EMERGENCY

43
Q

what happens in a tension pneumothorax?

A

One-way valve, progressively increasing pressure in pleural space
Pushes other chest organs to opposite side to affected side
Acute respiratory distress

44
Q

signs of tension pneumothorax

A

Trachea deviated to opposite side
Hypotension
Raised JVP
Reduced air entry on affected side

45
Q

causes of tension pneumothorax

A 
Ventilated patient (invasive or not)
Trauma
CPR esp PEA
Blocked, kinked, misplaced drain
Pre existing airways disease
Patients undergoing hyperbaric treatment
46
Q

treatment of tension pneumothorax

A

Needle decompression
Usually with large bore venflon
Second intercostal space anteriorly, mid-clavicular line
Hisssssssssssss……..

47
Q

name some risk factors for pleural infection

A 
diabetes mellitus 
immunosuppression including corticosteroids
gastro-oesophageal reflux
alcohol misuse 
intravenous drug abuse
48
Q

d: parapneumonic effusion

A

parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis

49
Q

d: empyema

A

collection of pus in the pleural cavity cause by microorganisms

50
Q

how do you treat pleural infection?

A 
Antibiotics (often for several weeks)
Drain effusion as needed
Early discussion with surgeons if persistent sepsis
Nutrition
VTE prophylaxis
?role for fibrinolytics/Dnase
Reassess patients who do not improve

Respiratory (27 decks)

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