Week 105 Pleurisy

Question 1

What is pleuritic chest pain?

Answer 1

Sharp and stabbing pain

Made worse by inspiration

Question 2

What is Pleural effusion

Answer 2

excess fluid in pleural cavity

Question 3

What is pneumothorax

Answer 3

abnormal collection of air in pleural space leading to collapse of lung

Question 4

Name features of pneumothorax

Answer 4

normally due to trauma

hyper-resonant percussion tone

Question 5

Name features of pleural effusion

Answer 5

• due to underlying pathological process
  Pleural effusion - stony dull percussion tone
  Pleural friction rub can be heard in pleural effusion
  Pleural effusion - non productive cough
  Meniscus sign on CXR

Question 6

Name types of pneumothorax

Answer 6

Simple (no tracheal deviation)

Tension (trachea deviates from affected side)

Question 7

What are the treatments for the two types of pneumothorax?

Answer 7

Simple pneumothorax - aspirate (16-18G cannula)

Tension pneumothorax - chest drain (needle thoracostomy)

Question 8

What types of pleural fluid can be aspirated during pleural effusion?

Answer 8

Aspirate pleural fluid and send for cytology, protein, pH etc
Transudate - pleural fluid with low protein content (less than 30g/dl)
Exudate - excess protein (more than 30 g/dl)
Transudate - pump failure (Heart, Liver, Renal failure)
Exudate - infection, malignancy (cancer, TB)

In pleural effusion always look for underlying cause

Question 9

A 42 y/o has a left sided pleural effusion confirmed on CXR. What is the next appropriate step in his management?

Answer 9

Aspirate pleural fluid and send off for analysis

Question 10

A 19 y/o man has been stabbed in the neck and brought to A&E. Over the apex of his right lung he has hyperresonant percussion notes, and reduced tactile vocal fremitus. On CXR the trachea is deviated towards the left hand side. What is the likely diagnosis?

Answer 10

Right sided tension pneumothorax