Pleurisy, Pleural Effusions, and Empyema

Question 1

What is pleurisy

Answer 1

Inflammation of the pleura

Question 2

MC cause of pleural effusion in children

Answer 2

Bacterial pneumonia

Question 3

Most common causes of pleural effusion in children second to bacterial pneumonia

Answer 3

1) Heart failure 2) Rheumatologic 3) Metastatic intrathoracic malignancy

Question 4

Inflammatory processes in the pleura are divided into 3

Answer 4

1) Dry or plastic 2) Serofibrinous or serosanguinous 3) Purulent pleurisy or empyema

Question 5

Etiologies of dry/plastic pleurisy

Answer 5

1) Bacterial or viral pulmonary infection 2) Acute URTI 3) Tb 4) Connective tissue disease (e.g. RF)

Question 6

Principal symptom of dry/plastic pleurisy

Answer 6

Pain

Question 7

In dry/plastic pleurisy, the child often lies on which side relative to the affected side

Answer 7

ON the affected side in an attempt to decrease respiratory excursions

Question 8

A leathery, rough, inspiratory and expiratory friction rub may be heard in which phase of illness in cases of dry/plastic pleurisy

Answer 8

Early or late

Question 9

T/F Patients with pleurisy and pneumonia should always be screened for Tb

Answer 9

T

Question 10

T/F In pneumonia with pleural effusion, immobilization of the chest and cough suppressive drugs are indicated

Answer 10

F

Question 11

T/F In pleural effusion without pneumonia, strapping of the chest to restrict expansion may afford relief

Answer 11

T

Question 12

Which type of pleurisy is associated with inflammatory conditions of the abdomen or mediastinum

Answer 12

Serofibrinous/serosanguinous

Question 13

Type of pleurisy associated with primary or metastatic neoplasms of the lung, pleura, or mediastinum

Answer 13

Serofibrinous/serosanguinous

Question 14

Hemorrhagic pleurisy are usually associated with what condition

Answer 14

Tumors

Question 15

Pleural fluid usually come from

Answer 15

Capillaries of the parietal pleura

Question 16

Pleural fluid is absorbed by what structures

Answer 16

Pleural stomas and lymphatics of the parietal pleura

Question 17

The rate of pleural fluid formation is dictated by what law

Answer 17

Starling Law

Question 18

Normally, only ___mL fluid is present in the pleural space

Answer 18

4-12

Question 19

Mechanism of pleural effusion formation in pleural inflammation

Answer 19

1) Increased pleural membrane permeability 2) Increase proteinaceous fluid formation 2) Lymphatic absorption obstruction

Question 20

Serofibrinous pleurisy is often preceded by

Answer 20

Plastic pleurisy

Question 21

PE finding particularly in infants with pleurisy

Answer 21

Bronchial breathing

Question 22

Exudate: Protein level

Answer 22

> 3 g/dL

Question 23

Exudate: Pleural fluid:Serum protein ratio

Answer 23

> 0.5

Question 24

Exudate: Pleural fluid LDH

Answer 24

Less than 200 IU/L

Question 25

Exudate: Pleural fluid: Serum LDH ratio

Answer 25

>0.6

Question 26

Exudate: pH

Answer 26

Less than 7.2

Question 27

Pleural fluid glucose level in malignancy, rheumatoid disease, and Tb

Answer 27

Less than 60 mg/dL

Question 28

Pleural fluid exam finding of many small lymphocytes and pH less than 7.2 suggests what

Answer 28

Tuberculosis

Question 29

SG of pleural fluid if it is a hydrothorax

Answer 29

Less than 1.015

Question 30

Cells seen in pleural fluid in cases of hydrothorax

Answer 30

Mesothelial cells

Question 31

Order of resolution of pleural effusion from quickest

Answer 31

Bacterial pneumonia > Tb, CT disease > Neoplasm

Question 32

T/F When diagnostic thoracentesis is performed, as much fluid as possible should be removed for therapeutic purposes

Answer 32

T

Question 33

Rapid removal of >1L of pleural fluid may be associated with the development of

Answer 33

Reexpansion pulmonary edema

Question 34

Management for significant reaccumulation of pleural fluid after thoracentesis

Answer 34

Chest tube drainage

Question 35

CTT is indicated in suspected parapneumonic pleural effusion given what characteristics if the pleural fluid

Answer 35

1) pH less than 7.2 2) Pleural fluid glucose less than 50 mg/dL

Question 36

Thrombolytic therapy in cases of pleural effusion is indicated when

Answer 36

Pleural fluid is clearly purulent

Question 37

Purulent pleurisy (empyema) is most often associated with what etiology

Answer 37

S. pneumoniae pneumonia

Question 38

MC cause of empyema in developing nations, Asia, and posttraumatic empyema

Answer 38

S. aureus

Question 39

Empyema is most frequently encountered in what age group

Answer 39

1) Infants 2) Preschool children

Question 40

Stage of empyema wherein fibrinous exudate forms on the pleural surfaces

Answer 40

Exudative stage

Question 41

Stage of empyema wherein fibrinous septa form causing loculation of fluid and thickening of parietal pleura

Answer 41

Fibrinopurulent stage

Question 42

Stage of empyema wherein there is fibroblast proliferation

Answer 42

Organizational stage

Question 43

Stage of empyema wherein there is formation of thick-walled cavities

Answer 43

Organizational stage

Question 44

Condition in which pus dissects through the chest wall

Answer 44

Empyema necessitatis

Question 45

T/F Thoracentesis should always be performed whenever empyema is suspected

Answer 45

T

Question 46

of neutrophils that would point to a possible empyema

Answer 46

>100,000/uL

Question 47

T/F Blood cultures have a higher yield than cultures of pleural fluid

Answer 47

T

Question 48

Bronchopleural fistulas and pyopneumothorax commonly develops in what type of pneumonia

Answer 48

Staphylococcal

Question 49

This procedure is indicated if fibrinolysis and VATS are ineffective in empyema

Answer 49

Open decortication

Question 50

T/F Instillation of antibiotics into the pleural cavity improves results

Answer 50

F