The Pleurae

Question 1

What does the term ‘pleurisy’ mean?

Answer 1

refers to a sharp localized pain arising from any disease of the pleura. It is made worse by deep insipiration and coughing.

Question 2

What are the common symptoms of a pleural effusion? (4)

Answer 2

pleuritic chest pain

dull aching pain

fullness of the chest

dyspnoea

Question 3

What would a physical examination of pleural effusion show?

Answer 3

decreased breath sounds

dullness to percussion

decreased vocal fremitus

Question 4

two categories of pleural effusons

Answer 4

Transudative effusion

Exudative effusion

Question 5

What are the characteristics of transudative effusions?

(imbalance of Starling’s forces)

Answer 5

low in protein

often bilateral

NOT associated with fever, pleuritic pain or tenderness to palpation

Question 6

What are the commonest causes of transudative effusions?

Answer 6

congestive heart failure

cirrhosis with ascites

nephrotic syndrome (Kidney conditions)

Question 7

Name some causes of exudative effusion

Answer 7

infection (bacterial pneumonia)

malignancy (Lungs or breast) - can obstruct lymphatic drainage

lymphoma

pulmonary embolism

oesophageal perforation

trauma

Question 8

What are ‘bat wings’ on a CXR?

Answer 8

beginning of pulmonary oedema at the hilum of the lungs

Question 9

What happens with LHF? (with the lungs)

Answer 9

Fluid backs up into the lungs causing pulmonary hypertension and the increase in pressure causes fluid to leak out into the interstitial space and finally into the pleural cavity.

Question 10

definition of pleuritic pain

Answer 10

sharp pain anywhere in the chest that is triggered by inspiration

Question 11

name some causes of pleurisy (6)

Answer 11

• infection; usually viral
• chest injury
• pulmonary embolism
• lung cancer
• aortic dissection
• some autoimmune diseases eg. lupus

Question 12

what are the signs of pleurisy? (3)

Answer 12

tachycardia

high temperature

chest sounds : The pleural friction rub

Question 13

management of Pleurisy

Answer 13

• treat the underlying cause
• infection is usually viral, so no supportive treatments needed
• analgesia (as per the analgesia ladder)
• cough suppressant
• drain an effusion

Question 14

name three weak opiods

Answer 14

codeine

dihydrocodeine

tramadol

Question 15

What do exudative effusions contain?

Answer 15

>> protein

>> LDH (Lactate dehydrogenase)

cholesterol

>> WBC

Question 16

What’s another name for lung cancer?

Answer 16

bronchial carcinoma

Question 17

What are the presenting symptoms of pneumothorax?

Answer 17

sudden onset of unilateral pleuritic pain or progressively increasing breathlessness.

Pallor and tachycardia may develop.

Shift of trachea and mediastinum.

Question 18

Who is most at risk of a PSP (primary spontaneous pneumothorax)?

Answer 18

Tall young men (20–40) with no underlying lung pathology.

Question 19

Who is an risk of secondary pneumothorax?

Answer 19

Patients with respiratory diseases that damage lung architecture (eg. COPD, asthma, pneumonia).

Also Marfan’s and CF.

Incidence increases with age and complications can be more severe due to reduced initial lung capacity.

Also; mechanical ventilation can be a problem in ICU.

Question 20

What can cause a tension pneumothorax?

Answer 20

trauma

mechanical ventilation

Question 21

What is the big danger of a tension pneumothorax?

Answer 21

Increased intrathoracic pressure causes mediastinal shift, compression of functioning lung, inhibition of venous return and shock due to reduced cardiac output.

Question 22

Cardinal symptoms of pneumothorax?

Answer 22

SUDDEN breathlessness

and/ or

SUDDEN pleuritic pain