Pleural & Mediastinal Disease Flashcards

1
Q

Comparing pleural fluid and serum levels of _____ and _____ is used to distinguish transudative from exudative pleural effusions

A

LDH; protein

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2
Q

In which type of effusion is there more protein and LDH in the pleural fluid?

A

Exudative

if ANY of the following it is exudative:

Pleural protein:Serum protein >0.5

Pleural LDH:Serum LDH >0.6

Pleural fluid LDH >2/3 upper limits of serum LDH in the lab doing the measurement

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3
Q

In what type of effusion is there less protein and LDH in the pleural fluid as compared to the serum, as well as lower leukocyte count and pH between 7.45-7.55?

A

Transudate

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4
Q

Type of effusion caused by unbalanced hydrostatic forces and more commonly associated with heart failure and cirrhosis and less commonly nephrosis and constrictive pericarditis

A

Transudate

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5
Q

Type of effusion usually caused by inflammatory, infectious, and malignant conditions and less commonly by collagen vascular disease, intra-abdominal processes, and hypothyroidism

A

Exudate

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6
Q

Most common cause of transudate

A

Heart failure [usually left ventricular failure or CHF]

Note that diuresis can increase pleural fluid protein and LDH, resulting in discordant exudate

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7
Q

List causes of transudative effusion

A

Heart failure
Liver cirrhosis
Misplaced central line
Nephrotic syndrome

[others from reading included atelectasis, constrictive pericarditis, duropleural fistula, hypoalbuminemia, peritoneal dialysis, SVC obstruction, trapped lung, and urinothorax]

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8
Q

Small transudative effusion caused by increased negative intrapleural pressure; common in ICU patients

A

Atelectasis

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9
Q

Cause of bilateral transudative effusions in which heart size is normal, but JVD is present in 95% of cases

A

Constrictive pericarditis

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10
Q

Cause of transudative effusion in which there is CSF in the pleural space, caused by trauma or surgery

A

Duropleural fistula

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11
Q

List some causes of exudative pleural effusion

A

Malignancy

Pleuritis (often due to SLE or other collagen vascular diseases)

Venous thromboembolic disease (particularly in the case of pulmonary infarct)

Tuberculosis

Pneumonia or other infectious process

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12
Q

Condition in which pressure of air in pleural space exceeds ambient pressure throughout respiratory cycle; as air pressure builds, affected lung is compressed and all mediastinal tissues are displaced to the opposite side of the chest

A

Tension pneumothorax

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13
Q

What causes primary/spontaneous pneumothorax?

A

Rupture of subpleural blebs in response to high negative intrapleural pressure

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14
Q

Common management strategy for pneumothorax consisting of indwelling catheter in pleural space allowing for at-home drainage

A

PleurX catheter

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15
Q

Management strategy for pneumothorax that closes potential space between parietal and visceral pleura, utilizes talc, tetracycline, etc. through thorascope or in IR

A

Pleurodesis

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16
Q

What are some lifestyle recommendations for pts who have had a pneumothorax?

A

Counsel on smoking cessation and future avoidance of high altitude exposure, flying in unpressurized aircraft, and scuba diving

17
Q

Indications for thorascopy or open thoracotomy for pneumothorax

A

Recurrence of spontaneous pneumothorax

Any occurrence of bilateral pneumothorax

Failure of tube thoracostomy for first episode (lung does not re-expand, persistent air leak, etc.)

18
Q

Management of pneumothorax in patients with __________ is challenging because there is a tendency towards recurrence

A

Pneumocystis pneumonia

19
Q

Contents of anterior mediastinal compartment

A

Thymus gland

Anterior mediastinal LNs

Internal mammary arteries and veins

20
Q

Contents of middle mediastinal compartment

A

Heart

Ascending and transverse arches of aorta

Venae cavae

Brachiocephalic arteries and veins

Phrenic nerves

Trachea, main bronchi, and contiguous LNs

Pulmonary arteries and veins

21
Q

Contents of posterior mediastinal compartment

A

Descending thoracic aorta

Esophagus

Thoracic duct

Azygous and hemiazygous veins

Posterior group of mediastinal LNs

22
Q

Typical pathology found in anterior mediastinal compartment

A

Thymomas

Lymphomas [T cell, B cell, Hodgkins]

Teratomas

Thyroid masses

23
Q

Typical pathology found in middle mediastinal compartment

A

Vascular masses

LN enlargement from metastasis or granulomatous disease

Pleuropericardial cysts

Bronchogenic cysts

24
Q

Typical pathology found in posterior mediastinal compartment

A

Neurogenic tumors

Meningoceles and myelomeningoceles

Gastroenteric cysts

Esophageal diverticula

25
Q

What conditions might cause a pleural effusion with low pleural glucose?

A

Parapneumonic effusion

Malignant effusion

Tuberculosis

Hemothorax

Rheumatoid arthritis