Pulmonology Flashcards
Which clinical scenario is most consistent with the most common cause of transudative pleural effusion? (H20 C288 P2006)
A. 30 year old male with multiple sexual partners taking isoniazid + rifampicin
B. 60 year old male diabetic with orthopnea, exertional dyspnea and paroxysmal nocturnal dyspnea
C. 65 year old male with acute onset difficulty of breathing associated with purulent cough production
D. 80 year old male, previous smoker, who recently lost 25% of his original weight
The answer is B. Patients suspected of having a pleural effusion should undergo chest imaging to diagnose its extent. Chest ultrasound has replaced the lateral decubitus x-ray in the evaluation of suspected pleural effusions and as a guide to thoracentesis. When a patient is found to have a pleural effusion, an effort should be made to determine the cause. The first step is to determine whether the effusion is a transudate or an exudate. A transudative pleural effusion occurs when systemic factors that influence the formation and absorption of pleural fluid are altered. The leading causes of transudative pleural effusions in the United States are left ventricular failure and cirrhosis. An exudative pleural effusion occurs when local factors that influence the formation and absorption of pleural fluid are altered. The leading causes of exudative pleural effusions are bacterial pneumonia, malignancy, viral infection, and pulmonary embolism. The primary reason for making this differentiation is that additional diagnostic procedures are indicated with exudative effusions to define the cause of the local disease.
