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Revision Cards > Week 105 - Pleurisy > Flashcards

Week 105 - Pleurisy Flashcards

1
Q

What are the characteristics of pleuritic pain?

A
  • Sharp, Stabbing, Localised.
  • Exacerbated by Deep inspiration, Coughing, Movement.
  • Relieved by Shallow Breathing.
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2
Q

What would you notice from tactile vocal fremetis for both pneumothorax and an effusion?

A

Reduced Vibration

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3
Q

What would you notice when percussing both a pneumothorax and effusion?

A
  • Pneumothorax would be hyperresonant.
  • Effusion would be stony dull.
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4
Q

What would you expect to hear when auscultating a pneumothorax or effusion?

A

Reduced breath sounds as there is a layer of insulation. With an effusion you may hear increased bronchial breathing above the effusion.

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5
Q

What does a ‘pleural rub’ sound like and how is it caused?

A
  • Creaking with respiration, best heard at the begininning and end of the resp cycle.
  • Caused by the stick/slip vibration between the visceral and parietal pleurae, which are roughened by fibrinous exudate.
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6
Q

What is Hamman’s sign? (Pneumothorax)

A
  • Precordial bubbles/crackles. Synchronised with heart beat not resp.
  • “Mediastinal Crunch”
  • Caused by cardiac contraction forcing air through folds of pleura.
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7
Q

What is Hippocratic succussion?

A

This a splashing sound heard when shaking the chest during an effusion, due to fluid-air interaction.

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8
Q

What are the two degrees of spontaneous pneumothorax?

A

•1˚ - Congenital pleural bleb.
-Typically tall, thin, smoker.

•2˚ - Acute of chronic lung disease.

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9
Q

What are some of the iatrogrogenic causes of a pneumathorax?

A

Central venous access, nerve block, liver and lung biopsies.

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10
Q

At which size does a pneumothorax become classed as ‘large’?

A

Visible rim >2cm or hemithorax >20%

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11
Q

What is the presentation of a pneumothorax?

A
  • Sudden onset unilateral, pleuritic pain.
  • Dyspnoea
  • Increased RR, Increased HR.
  • Reduced expansion, hyperresonant, reduced breath sounds.
  • Slight hypoxia and cyanosis.
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12
Q

What are the four stages of management of a pneumothorax?

A

1) Allow to resorp spontaneously.
2) Needle Aspiration
3) Chest Drain
4) Surgery

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13
Q

What size tube should you use to drain air or pleural fluid?

A

28F

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14
Q

What is ‘Swinging’ (Chest drain) and why might it not be present?

A
  • Swinging is the normal oscilation of the water level due to respirtation.
  • Block or clot in the system, fully re-expanded lung.
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15
Q

At what point should you remove a chest drain?

A
  • No swinging.
  • No bubbling >24hr
  • <100ml/day drainage
  • X-ray shows reinflated lung.
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16
Q

What is a tension pneumothorax?

A
  • Increased plueral pressure on affected side.
  • Causes complete collapse of lung, mediastinal/tracheal deviation away from affected side.
  • Compresses other lung, leading to hypoxia and cyanosis.
17
Q

What are the complications of a tension pneumothorax?

A

• Compresses heart and occludes vena cavae.

  • Hypotension, tachycardia.
  • Neck vein distension.
  • Cardiac arrest.
18
Q

What is the presentation of a tension pneumothorax in addition to a normal pneumothorax?

A
  • Normal pneumothorax; Increased RR, Increased HR, Pleuritic pain, dyspnoea, hypoxia slight cyanosis.
  • Tension pneumothorax;
  • Tracheal shift.
  • Neck vein distension.
  • Severe hypoxia and cyanosis.
  • Decreased BP (Shock: Cold and Clammy)
  • PEA.
19
Q

What is the management of a tension pneumothorax?

A

Immediate

100% Oxygen

Thoracocentesis (14g venflon into affected side)

20
Q

What is subcutaneous emphysema?

A

• In a tension pneumothorax, the pressure in the pleural cavity may be so high that air is forced into the tissues.
- This causes massive oedema and airway obstruction.

• This results in subcutaneous crepitus-

  • “Crunching Snow”
21
Q

What is the definition of a pleural effusion?

A

Fluid in the pleural space.

22
Q

What are the two types of fluid that can be present in a pleural effusion and what are they?

A
  • Exudate and Trandudate.
  • Exudate, any fluid that filters from the circulatory system into lesions or areas of inflammation.
  • Transudate, is a fluid with a low protein concentrate, that results from increased fluid pressures.
23
Q

What are the main causes of a transudate effusion?

A
  • Heart failure
  • Renal failure
  • Hepatic failure
24
Q

What are the main causes of an exudate pleural effusion?

A
  • Neoplastic
  • Infection
  • Inflammatory
  • Post operative
  • Trauma
  • Pulmonary embolus
25
Q

What is the presentation of a plueral effusion?

A
  • Increasing SOB +/- dry cough.
  • Unilateral pleuritic chest pain.
  • Increased RR.
  • Reduced breath sounds, reduced fremitis, stony dull percussion, reduced expansion.
  • Slight hypoxia and cyanosis.
26
Q

What investigation can be performed for a pleural effusion?

A
  • Chest XR
  • Ultrasound
  • Diagnostic Tap
27
Q

How would a pleural effusion present on a chest X-Ray?

A
  • Blunting of the costophrenic angle.
  • Tracheal shift if large.
  • May also identify undelying causes.
28
Q

How would a pleural effusion present on a USS?

A

• One large pocket of fluid or several pockets.

29
Q

What tests should a diagnostic tap be sent for once 50ml has been aspirated?

A
  • pH (<7.2 indicates complicated parapneumonic effusion, empyema or malignancy).
  • Cytology
  • Protein / LDH /Glucose
  • AFB / TB Culture / General Culture
30
Q

‘Light’s Criteria’ defines a fluid as an exudate if it fits one of what three definitions?

A

1) The ratio of pleural fluid protein to plasma protein is >0.5.
2) The ratio of pleural fluid LDH to plasma LDH is >0.6. (Lactate dehydrogenase)
3) The pleural fluid LDH is greater than 0.6 the times of the normal upper limit for serum.

31
Q

If a pleural fluid has been identified as a transudate what investigations should then be performed?

A
  • ECHO
  • U&Es
  • LFT
32
Q

If the pleural fluid is identified as an exudate which investigations should be performed?

A
  • CT Thorax
  • Thorascopy
33
Q

What is the management of a pleural effusion?

A

1) Transudate - Treat the cause.

2) Exudate -
- Malignant - Drain and pleurodesis.
- Haemathorax - Large bore chest drain + surgery
- Emyema - Chest drain and IV antibiotics.

Revision Cards (61 decks)

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