Unit 3 - Pleural Space Disease

Question 1

What air effusion known as?

Answer 1

pneumothorax

Question 2

What is lymph effusion known as?

Answer 2

chylothorax

Question 3

What is pus effusion known as?

Answer 3

pyothorax

Question 4

Whatis blood effusion known as?

Answer 4

hemothorax

Question 5

What is ‘water’ (pure transudate) effusion known as?

Answer 5

hydrothorax

Question 6

What is organ effusion known as?

Answer 6

diaphragmatic hernia

Question 7

What is the pleura?

Answer 7

thin layer of mesothelial cells

Question 8

What is visceral pleura?

Answer 8

pleura that covers lung surface

Question 9

What is parietal pleura?

Answer 9

pleura that lines thoracic wall, diaphragm, and mediastinum

Question 10

What is pleural fluid volume determined by?

Answer 10

Starling’s forces, lymphatic drainage, and mesothelial cells

Question 11

What are the different mechanisms that can cause pleural effusion?

Answer 11

Increased venous hydrostatic pressure, decreased oncotic pressure, impairment of lymphatic drainage, and increased vascular permeability

Question 12

What can cause increased venous hydrostatic pressure?

Answer 12

CHF, HWD, venous thrombosis, and neoplasia

Question 13

What can cause decreased oncotic pressure?

Answer 13

hypoalbuminemia

Question 14

What can cause impairment of lymphatic drainage?

Answer 14

increased venous pressure, lymphatic trauma, neoplasia, and lung lobe torsion

Question 15

What can cause increased vascular permeability?

Answer 15

pancreatitis, FIP, and neoplasia

Question 16

What is the pattern of dyspnea with pleural effusion (if present)?

Answer 16

restrictive

Question 17

What do you expect to hear on auscultation of a patient with pleural effusion?

Answer 17

Muffled/absent breath sounds

Question 18

What physical exam parameters should be noted along with pleural effusion?

Answer 18

Other cardiopulmonary abnormalities, thoracic compression, peripheral lymph nodes, abdominal palpation for masses, pain, and ascites, fever, mucous membranes, cranial nerves, and BCS/muscle condition

Question 19

If in respiratory distress, what is the first step to treating pleural effusion?

Answer 19

thoracocentesis

Question 20

What is the first step to treating pleural effusion if the patient is not in respiratory distress?

Answer 20

thoracic imaging and minimum database

Question 21

What supplies do you need for a thoracocentesis?

Answer 21

needle, over-the-needle or butterfly catheter, syringe, 3-way stopcock, extension tubing, sterile gloves, and bowl

Question 22

What is the ideal position for a thoracocentesis?

Answer 22

sternal recumbency

Question 23

Where should your needle be inserted for a thoracocentesis if its to get rid of air?

Answer 23

7th to 9th intercostal space, in front of the rib, about 2/3 of the way up between CCJ and spine

Question 24

Where should your needle be inserted for a thoracocentesis if its to get rid of fluid?

Answer 24

7th to 9th intercostal space, in front of the rib, closer to the CCJ

Question 25

What would you use EDTA tube for for effusion?

Answer 25

to preserve cell morphology for cytology

Question 26

What would you use a red-top tube for for effusion?

Answer 26

various biochemical tests

Question 27

What is the composition of transudates?

Answer 27

low protein, low cellular pleural fluid

Question 28

What are transudates caused by?

Answer 28

low oncotic pressure or increased hydrostatic pressure from early heart failure

Question 29

What are modified transudates?

Answer 29

transudates that have been ‘modified’ by the addition of cells, protein, and/or chyle

Question 30

What can cause modified transudates?

Answer 30

Right sided heart failure, pericardial disease, neoplasia, chylothorax, lung lobe torsion, and idiopathic

Question 31

What are exudates composed of?

Answer 31

high protein, high cellular effusions - predominant cell type is dependent on underlying cause

Question 32

What biochemical tests can you do for pleural effusion?

Answer 32

triglycerides (definitive for chylothorax), glucose (low in septic), and pH (low in septic)

Question 33

What thoracic imaging can you do for pleural effusion?

Answer 33

radiographs, thoracic ultrasound, and thoracic CT

Question 34

Neoplasia is a frequent cause of pleural effusion. Where can they locate?

Answer 34

visceral/parietal pleura, lungs, mediastinum, and lymph nodes/lymphatics

Question 35

What fluid types are associated with pleural fluid due to neoplasia?

Answer 35

modified transudate (or exudate) and chylous

Question 36

How is pleural fluid and neoplasia diagnosed?

Answer 36

ID cells on fluid cytology - most common with round cell neoplasia
Imaging if abscense of cells
+/- surgery for exploration and biopsy

Question 37

What is hemothorax?

Answer 37

hemorrhage into the pleural space

Question 38

What causes hemothorax?

Answer 38

trauma, neoplasia, COAGULOPATHY (rodenticide), and vessel rupture

Question 39

How do you know if the effusion from hemothorax is actually from the hemothorax and not the heart?

Answer 39

it should not clot

Question 40

What is the cellular make up of hemothorax?

Answer 40

macrophages +/- erythrophagocytosis, no platelets

Question 41

You should only tap a hemothorax if necessary to alleviate ______.

Answer 41

dyspnea - you can make it worse if coagulopathy is present

Question 42

Before tapping a hemothorax, you should assess what?

Answer 42

coagulation status - PT and PTT

Question 43

If rodenticide toxicity, what is the treatment of choice?

Answer 43

vitamin K and blood products

Question 44

If there is a bleeding mass, what is the treatment that is indicated?

Answer 44

surgery