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week 4 Flashcards

1
Q

what is pleural effusion ?

A

abnormal collection of fluid in the pleural space

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2
Q

plural effusion always require drainage T/F

A

false
as in some cases like heart failure

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3
Q

what is the difference between the plural aspirate and thoracentesis/ pleural tap

A

A pleural aspirate, also known as pleural fluid, is the fluid that is obtained from the pleural space during a medical procedure called thoracentesis or pleural tap

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4
Q

what does the difference appearance of pleural fluid tells us ?

straw coloured

bloody

turbid/milky

foul smelling

food particles

bilateral

A

Straw-coloured e.g. cardiac failure, hypoalbuminaemia

Bloody e.g. trauma, malignancy, infection, infarction

Turbid/Milky e.g. empyema, chylothorax

Foul smelling - Anaerobic empyema

Food particles - oesophageal rupture

Bilateral – LVF, PTE, drugs, systemic path

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5
Q

what is the difference between the transduate and exuduate

A
  1. Exudate:
    • Exudate is a fluid that leaks out of blood vessels and accumulates in body cavities or tissues as a result of inflammation or injury.
    • It is characterized by a higher protein content, cellular debris, and inflammatory cells (such as neutrophils) compared to transudate.
    • Exudate formation is typically associated with conditions involving inflammation, infection, or tissue damage, such as pneumonia, pleuritis, abscesses, or wounds.
    • Common characteristics of exudative fluids include turbidity, high specific gravity, elevated protein levels, and an elevated white blood cell count.
  2. Transudate:
    • Transudate is a fluid that passes through blood vessel walls and accumulates in body cavities or tissues due to imbalances in hydrostatic and oncotic pressures, without significant inflammation.
    • It has a lower protein content and lacks cellular debris and inflammatory cells compared to exudate.
    • Transudate formation is typically associated with conditions involving changes in hydrostatic pressure (e.g., heart failure, liver cirrhosis) or oncotic pressure (e.g., hypoalbuminemia).
    • Common characteristics of transudative fluids include clarity, low specific gravity, low protein levels, and a low white blood cell count.
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6
Q

what are the amount of protein present in each transdates and exudates

A

trans: less than 30g/l
exudates : more than 30 g/l (extra)

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7
Q

what are the conditions that can cause exudates ?

A

things that can make the endothelial more permeable:
malignancy
infection inc. TB
pulmonary infarct
asbestos

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8
Q

what are the conditions that can cause transudates ?

A

thing that can cause pressure imbalance :
heart failure
liver cirrhoisis
hypoalbuminaeamia
peritoneal dialysis

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9
Q

fluid PH in case of plural effusion

what is the normal PH?

A

about 7.6

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10
Q

what does the ph value of less than 7.3 suggests ?

A

pleurla inflammation

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11
Q

what does PH of less than 7.2 suggest?

A

requires drainage in the setting of an infection

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12
Q

what does low glucose levels suggests in case of plural aspirate ?

A

infection
TB
rheumatoid arthritis
malignancy
esophageal rupture

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13
Q

what does presence of amylase in plural aspirate mean ?

A

Amylase : raised in pancreatitis and oesophageal rupture

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14
Q

what does presence of triglycerides in plural aspirate mean?

A

Triglycerides : chylothorax (trauma to lymphatics, malignancy and LAM)

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15
Q

what does presence of cholesterol crystals in plural aspirate mean?

A

Cholesterol crystals: pseudochylothorax

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16
Q

what does presence of creatinine in plural aspirate mean?

A

urinothorax

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17
Q

what does rise of adenosine deaminases in plural aspirate mean?

A

TB

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18
Q

what are the symptoms of mesothelioma ?

A

fever, chest pain, cough, breathlessness, sweating, weight loss

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19
Q

investigation for mesothelioma

A

Imaging : nodularity + plural thickening

biopsy

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20
Q

treatment for mesothelioma

A

pleurodese effusions eg using talc
chemo
surgery
radio
pleural taps
long term catheter

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21
Q

treatment of plural effusion

A

treat the underlining casus like LVF

LVF using diuretics

malignancy - drain, pleurodesis, long term catheter

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22
Q

what are the two classes of pneumothorax ?

A

primary : no underlying cause
secondary : underlying casus like lung disease like COPD

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23
Q

pneumothorax is more common in ? 3

A

tall thin men
smokers
underlying lung disease

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24
Q

presentation of pneumothorax

A

PSP : may be asymptomatic even if moderately sized
SSP: usually symptomatic even if small

acute onset of chest pain
SOB hypoxia

signs : tachycardia
hyper-resonate percussion
reduced expansion
quite breath

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25
investigations for pneumothorax
CXR CT chest
26
how will u differentiate between small pneumothoraxes and bullous
using CT chest
27
management of pneumothorax
oxygen always no treatment if asymtomatic aspiration chest drain surgical intervention
28
why tension pneumothorax is a medical emergency ?
can lead to cardiac arrest
29
what is tension pneumothorax ?
One-way valve, progressively increasing pressure in pleural space Pushes other chest organs to opposite side to affected side Acute respiratory distress
30
what are the signs of tension pneumothorax?
trachea deviation hypotension (^///^) raided JVP reduced air entry on affected side
31
treatment of tension PTX
needle decompression Second intercostal space midclavicular line
32
what is empyema ?
pus
33
pleural infection is always followed by penumonia T/F
false, its not necessary
34
what are the two types of pleural infection ?
complicated and simple complicated : gram +, ph less than 7.2, low glucose, septations and loculations simple : none of above and are easy to treat with antibiotics
35
management of pleural infection
antibiotics (co-amoxiclav) avoid aminoglycosides as they have poor pleural penetration drain
36
what are the causes of ILD ?
environmental : minerals (asbestos), radiation, mechanical ventilation. hypersensitivity : avian proteins, mouldy hay idiopathic : connective disease, idiopathic pulmonary fibrosis
37
how interstitial lung diseases are diagnosed ?
clinical radiological histological : transbronchial biopsy or thoracoscopic biopsy
38
what is usual interstitial pneumonia ?
its pathological term for the idiopathhic pulmonary fibrosis leads to respiratory failure unknown cause occurs mostly in the basal region of the lower lobes appearance: patchy inertial fibrosis with spatial and temporal heterogeneity early lesions : fibroblastic foci : dec. fibroblasts, inc. collagen deposits late lesions : honeycombing, dense fibrosis + metaplasia + hyperplastic type 2 pneumocytes
39
What are the features of early and the late stage of the ILD?
early : alveolitis late : fibrosis (scarring) and eventual leading to honeycombing
40
what are the clinical features of ILD?
hypoxia, respiratory failure, secondary pulmonary hypertesnion, and right-heart failure
41
two main pathological category of intestinal lung
fibrosing : idiopathic ILD/ UIP, connective tissue disease associated, pneumoconiosis. granulomatous : sarcoidosis, HP
42
what is connective tissue disease- associated ILD ?
occurs as the symptoms in case of the connective tissue diseases like rheumatoid arthritis causes : interstial fibrosis pleuritis and pleural effusion rheumatoid nodules in RA = palisaded histiocytes and necrobiotic center
43
what are rheumatoid nodules ?
peripheral zone of palisaded histiocytes necrobiotic center
44
pneumoconiosis
Lung disease caused by reaction to inhaled mineral dust, organic and inorganic particles, chemical fumes and vapours Usually in an occupational setting Examples: Coal workers’ pneumoconiosis Silicosis Asbestosis
45
what are the outcomes of the asbestos-related disease?
pleural plaques recurrent pleural effusions interstitial fibrosis lung carcinoma mesothelioma shows similar pattern as UIP
46
sarcoidosis types of disease ? which type of hypersensitivity ? parts affected ?
non caseating systemic granulomatous disease with lung and hilar involvement type 4 multi-system involvement : lungs, lymph nodes, joints, liver, skin, eyes.
47
Hypersensitivity Pneumonitis (HP)
Spectrum of immunologically induced interstitial inflammatory lung disorders caused by exposure to inhaled antigens occurs in individuals alergic to causative agents like bacteria fungi etc Acute :exacerbations initially With prolonged exposure – chronic disease can develop – chronic interstitial fibrosis leading to respiratory failure
48
what are intestinal diseases ? what is its pattern ? two symptoms ?
disease affecting the lung interstitium ; alveoli, terminal bronchi. restrictive lung disease pattern dry cough and breathlessness
49
sarcoidosis is less common in smokers yes or no ?
yes
50
symptoms for acute and chronic sarcoidosis
acute : arthritis fever parotitis bilateral hilar lymphadenopathy erythema nodosum chronic: lung infiltrates peripheral lymphadenopathy hypercalcemia skin infiltrates
51
diagnosis of sarcoidosis
CXR, CT tissue biopsy pulmonary function test blood test
52
treatment of sarcoidosis
acute : no treatment chronic : oral steroids immunosuppression = azathioprine / methotrexate anti-TNF therapy
53
hypersensitivity pneumonitis which type of hypersensitivity ?
type 3
54
symptoms, signs, treatment for acute hypersensitivity pneumonitis
cough, breathlessness , fever myalgia signs : pyrexia, crackles, hypoxia CXR: widespread pulmonary infiltrates treatment : oxygen, steroid, antigen avoidance
55
signs, treatment for acute hypersensitivity pneumonitis
signs: crackles, clubbing CXR : pulmonary fibrosis removal of antigen, oral steroids if breathless
56
What causes idiopathic pulmonary fibrosis ?
caused by imbalance of fibrotic repair system more common in smokers
57
Idiopathic pulmonary fibrosis is more common in smokers t/f
true
58
true or false ipf is not an inflammatory disease
true
59
clinical presentation of IPF examination
progressive breathlessness and dry cough clubbing, bilateral fine inspiratory crackles
60
antibiotics for IPF
nintedanib and pirrenidone

resp (2 decks)

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