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Medicine - Year 1 - Term 2 > W4 - Effusion, Pneumothorax & Mesothelioma > Flashcards

W4 - Effusion, Pneumothorax & Mesothelioma Flashcards

1
Q

What is the most common primary malignancy of pleura?

A

Mesothelioma

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2
Q

Are primary or secondary pleural tumours more common?

A

Primary

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3
Q

Name 2 characteristics of mesothelioma

A

Rare
Aggressive

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4
Q

Name 2 causes of mesothelioma

A

Occupational lung disease (so more common in men)

Inhaled asbestos dust/fibres

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5
Q

Name 6 occupations which mesothelioma occurs in

A

Plumbers
Electricians
Shipbuilding
Power plants
Boilers
Engines

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6
Q

Name 5 symptoms of mesothelioma

A

Chest pain
SOB
Weight loss
Clubbed, pleural effusion
Palpable neck nodes

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7
Q

Name 2 types of diagnosis for mesothelioma

A

CXR to look for pleural effusion and mass
Biopsy to stage

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8
Q

Name 3 types of biopsy used to stage mesothelioma

A

Blind pleural biopsy using Abram’s pleural needle

CT guided/US biopsy

Thorascopy - can also spray talcum (pleurodesis) to stop fluid reoccuring

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9
Q

Describe 6 management options for mesothelioma

A

Palliative care
Treat effusion
Chemo
Recruit to trials via MDTs
Palliative surgery
Advise patient about compensation

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10
Q

Describe the outlook for mesothelioma

A

Limited, survival poor

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11
Q

Name 2 palliative surgeries for select patients with mesothelioma

A

Pleurodesis in young patients

Decortication (peeling off thickened pleura) to relieve SOB

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12
Q

Define pneumothorax

A

Collection of air between visceral and parietal pleura

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13
Q

Is pneumothorax restrictive or obstructive?

A

Restrictive

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14
Q

Name 5 types of pneumothorax

A

Primary spontaneous
Secondary spontaneous
Traumatic
Iatrogenic
Tension

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15
Q

Define primary spontaneous pneumothorax, it’s believed cause and effect

A

Out of the blue pneumothorax in normal lungs. Believed to be due to weak areas on lung surface called “blobs” which rupture spontaneously an leak air into pleural cavity, compressing underlying lung.

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16
Q

Define secondary spontaneous pneumothorax and 6 related conditions

A

Out of the blue pneumothorax in someone with a pre-existing condition. Usually condition is:
Interstitial lung disease
COPD
Asthma
Cystic fibrosis
and rarely pleural endometriosis

17
Q

Name 6 presentations of pneumothorax

A

Sudden event
Chest pain
SOB
Tall thin young men
Sometimes underlying lung disease
History of biopsy/line insertion/mechanical ventilation

18
Q

Name 6 signs of pneumothorax

A

Tachypnoeic
Hypoxic
Reduced chest movement
Reduced/no breath sounds
Hyper-resonant percussion
Or exam may be normal!

19
Q

Name 3 investigations for pneumothorax

A

CXR
US
CT thorax

20
Q

Name 4 managements of pneumothorax

A

Watch and wait if they look well
Aspiration if over 2cm but well
Chest drain insertion
Surgery if recurrent/unresolving

21
Q

What’s the risk of recurrence of pneumothorax within the first year?

A

25-50%

22
Q

Following pneumothorax treatment, what 2 things should you advise a patient?

A

Avoid heavy lifting and flying for 1+ week

23
Q

Define pleural effusion

A

Excessive collection of fluid between parietal and visceral pleura

24
Q

Name the 2 types of pleural effusion

A

Transudate effusion - non-inflammatory

Exudate effusion - inflammatory

25
Q

How can we tell if effusion is transudate or exudate effusion?

A

Apply the Lights criteria

26
Q

Give the 3 Lights Criteria and whether they tell us which effusion we’re faced with

A

1) Protein - plural fluid to serum fluid ratio >0.5

2) Serum Lactate Dehydrogenase (LDH) - pleural fluid / serum fluid ratio >0.6

3) Pleural fluid LDH > 23 ULN serum LDH

If no criteria met, transudate effusion, otherwise exudate effusion

27
Q

In what 2 ways does transudate effusion present?

A

Bilateral
Subcutaneous oedema

28
Q

What is the difference between transudate and exudate fluid?

A

Transudate - low protein content
Exudate - 3g/dl or more protein content

29
Q

Name 2 common causes of transudate effusion

A

Left ventricular failure

Liver cirrhosis

30
Q

How do we diagnose and treat transudate effusion?

A

Treat underlying cause
May not need CT

31
Q

Name 4 common causes of exudate effusion?

A

Malignancy (pulmonary or not)

Parapneumonic effusion

Empyema

TB

32
Q

How do we treat exudate effusion

A

Unless cause is identified, will need further investigation (e.g. imaging) and/or pleural biopsy

33
Q

When might we need a chest drain with pleural effusion

A

pH less than 7.2 with pneumonia/blood/pus

34
Q

Name 4 investigations for pleural effusion

A

US
CXR
CT thorax
Pleural fluid analysis

35
Q

Name 6 types of pleural fluid analysis for effusion

A

Aspiration
Inspect fluid
pH (bedside ABG machine)
Biochemistry
Microbiology
Cytology

Medicine - Year 1 - Term 2 (13 decks)

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