Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

(Emily) semester 2 > week 4 pleural disease > Flashcards

week 4 pleural disease Flashcards

1
Q

What should a normal pleura look like

A

a glistening, smooth, thin membrane which covers the thoracic cavity and the lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is pleural fluid produced

A

‘filtration’ process, from parietal pleura, it’s straw-coloured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What cells are in the pleural fluid? Where do they come from?

A

macrophages, lymphocytes, both filtered out from blood, mesothelial cells shed from pleural surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does pleural fluid look like

A

It’s straw-coloured, little to no odour,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The pleural cavity is at what pressure

A

sub=atmospheric, a negative pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most negative pressure of pleural cavity is at base or apex of the lung?

A

apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name three ‘important’ pleural problems

A

pleural effusion, pneumothorax, mesothelioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pleural effusion basic description

A

Excessive collection of fluid within the pleural cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pneumothorax basic description

A

Collection of air between visceral pleura and parietal pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Combo of fluid and air collection in between visceral and parietal pleura is called what?

A

hydropneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What’s a pleural malignancy called?

A

Mesothelioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pus in pleural space is called what?

A

Empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Blood in pleural space is called what

A

hemothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why does pleural effusion occur?

A

either excessive production, or reduced absorption

(excessive collection of fluid in pleural space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the two types of pleural effusion?

A

transudate or exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

transudate vs exudate

A

trans: purely due to filtration, low protein, non-inflam

exudate: high protein, is inflam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If exudate is high protein, what’s the cut off for classification?

A

3g/deciltre or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Light’s criteria for exudate vs transudate:

A

Exudate: pleural fluid protien/ serum fluid protein ratio > 0.5

pleural fluid LDH levels / serum fluid LDH levels > 0.6.

Pleural fluid LDH > 2/3 ULN serum of LDH

  • ULN = upper limit of normal
  • LDH = lactate dehydrogenase, enzyme found in blood and other bodily fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Very common causes of transudate?

A

organ failure, such as cardiac, liver, and renal failure account for majority of transudates

2 most common:
left ventricular failure
liver cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Transudates are rarely bilateral effusions

A

no, usually more often bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Transudates are common with subcutaneous edema and collections of fluid elsewhere within the body

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Would an exudate complicate situations where there is a background of chronic transudative effusions

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pulmonary causes of transudative effusions are common

A

false, rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Common causes of exudates

A

malignancy (pulmonary and non)
parapneumonic effusions, empyema
TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

So pulmonary causes for more exudate or transudate

A

exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Effusions associated with pneumonia, what type, and how often encountered with hospitalised patients with pneumonia?

A

exudate
25%-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

rheumatoid arthritis can cause what type of pleural effusion

A

yes, exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which of this list cannot cause exudates?
pulmonary emboli, clots in the lungs, benign asbestos effusions

A

false question, they all can

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

a reactive effusion due to infection or inflammation is usually what type

A

exudate

30
Q

why would knowing the protein content of the pleural fluid bring you a step closer to working out what caused the pleural effusion?

A

transudate= lower protien, non inflam
exudate= higher protien, yes inflam

31
Q

What order: investigation, exam, clinical history.

A

clinical history, exam, investigation

32
Q

Why would a bedside ultrasound be good for identifying suspected effusion? (2) Limitation?

A

can mark site in case you want to sample fluid
more sensitive than CXR
Need to be trained

33
Q

What test is done first usually to confirm or refute a pleural effusion?

A

chest X-Ray (easy to interpret)

34
Q

Advantage of CT scan for investigation into pleural effusion?

A

Being more able to easily visualise underlying lung tissue, and mediastinum

35
Q

How do you gain pleural fluid for testing?

A

needle

36
Q

Pleural fluid analysis: how?

A

possibly bedside ABG machine

37
Q

pH of pleural fluid assessment:

A

less than 7.2,
then in presence of pneumonia, indicate need for a chest drain

38
Q

why would acidic pleural fluid need to be drained

A

because if acidic, likely eventually form pus, in which case infection becomes more difficult to control

39
Q

Usual practice to send pleural fluid samples to:

A

biochemistry (culture for organisms)

microbiology (protiens and LDH, glucose)

cytology (for abnormal cells)

40
Q

If fluid is transudate, what do you do
vs exudate

A

treat underlying cause e.g. sepsis (so may not need imaging)

exudate: treat underlying cause e.g. pneumonia, but if not clear, may need further imaging

41
Q

List at least 3 causes for exudate pleural effusion, and transudate pleural effusion

A
42
Q

Why might spontaneous pneumothorax occur

A

cuz of weak surfaces on the lungs called blebs, which might rupture and then leak air into the pleural cavity, accumulates and compresses the underlying lung

43
Q

primary vs secondary spontaneous pneumothorax

A

2nd if underlying disease eg interstitial lung disease, COPD, asthma, CF

44
Q

could genetic disorders predispose spontaneous pneumothorax?

A

occasionally

45
Q

Traumatic pneumothorax example that isn’t to do with a knife injury?

A

blunt trauma, fractured ribs, ribs pierce lung

46
Q

hydrogenic pneumothorax occur in hospital why

A

after CT guided biopsy, US guided biopsy, maybe on ventilator when pressure used to inflate lung will result in injury to lung and cause pneumothorax

possibly when inserting central venous line, or doing pacemaker

47
Q

What is the life threatening tension pneumothorax?

A

air within pleural cavitybuilds up to the point that it causes pressure and pushes central structures of the chest eg trachea, and squashes other lung

And of heart: pressure of heart, doesn’t fill well, results in drop in blood oxygen levels

compression of opposite lung= drop in blood oxygen levels

escalates, can lead to cardiorespiratory arrest

48
Q

how to solve tension pneumothorax?

A

emergency release of air under pressure, either by popping needle in or putting a chest drain on

49
Q

Symptoms of tension pneumothorax?

A

chest pain, sob, rapid heart rate, shallow breathing, anxiety, ashen/blue skin

50
Q

Presentation of spontaneous pneumothorax?

A

sudden, often young man, they’ve dismissed as a bit of pain after exercise

Occasionally history of biopsy, line insertion, mechanical ventilation

51
Q

Examination when pneumothorax looks like:

A

either looking absolutely fine or not!

hypoxic
breathing fast (tachypneic)
reduced chest wall movement, reduced or no chest sounds, highly resonant

52
Q

Why is it easy to miss a pneumothorax at apex?

A

cuz of other structurea

53
Q

Can you diagnose a pneumothorax with ultrasound?

A

with experience, but useful when bed bound

54
Q

When is a CT useful when diagnosing pneumothoraxes?

A

when in people with complex pneumothorax, e.g. when already COPD, or CF

55
Q

Do you need to do CT for pneumothorax?

A

CXR would normally suffice

56
Q

What are the 4 different options for pneumothorax management?

A
  1. Observe
  2. Aspiration (if over 2cm in size, and patient is well- just put needle and air in cavity, to suck out air)
  3. Chest drain insertion (place tube into pleural cavity by bedside, under local anesthetic, to create a channel for air to be ‘drained’. Left in place till pneumothorax is resolved)
  4. Surgery (if recurrent, unresolving events)
57
Q

Are secondary pneumothorax’s likely to heal by themselves?

A

nah so may use chest drain

58
Q

Is there a chance of recurrence for pneumothorax’s?

A

yes.
don’t lift heavy weights, or fly (could develop tension pneumothorax), until lung completely re-expanded.

59
Q

If ipsilateral recurrence, what is suggested?

A

probably surgical repair

60
Q

How common is it for a pleural tumor to be benign?

A

It’s actually rare. Usually malignant

61
Q

Most pleural malignancies present as what

A

pleural effusions

62
Q

Pleural malignanicies are more common when there is cancer elsewhere in the body. What can we infer about how common secondary vs primary pleural effusions are?

A

Secondary effusions are common. primary ones are not.

63
Q

Secondary pleural effusions (as a type of malignancy) are usually the result of what cancer?

A

intra-parenchymal lung cancer

breast, ovarian, renal, GI, thyroid

64
Q

What’s the most common primary malignant tumor?

A

malignant mesothelioma (which is rare and aggressive)

65
Q

What pleural malignancy commonly arises from exposure to asbestos dust?

A

malignant mesothelioma (it’s pretty rare, but pretty aggressive)

66
Q

Why does asbestos cause malignant mesothelioma?

A

fibres reach pleura
cause inflammation
this triggers repair
cycle of inflam/repair triggers tumour formation

67
Q

What does malignant mesothelioma present as?

A

SOB, unexplained weight loss, CHEST PAIN, clubbed, palpable neck nodes

68
Q

How quickly does asbestos malignant mesothelioma develop?

A

Between 20-40 years

69
Q

Potential of mesothelioma. CXR normal. What else could be useful?

A

If high index of suspicion, CT thorax very useful.

70
Q

For diagnosing mesothelioma, what do we need?

A

Tissue sample. Not just pleural fluid, which is all you need in effusion

You need to establish actual invasion of tissue

71
Q

How do we obtain a pleural biopsy for diagnosing mesothelioma?

A

CT/US guided biopsy
Abram’s needle
Thoracoscopy (during which we can spray lining of lungwith sterile talcum powder to obliterate pleural space, and stop fluid fromre-accumulating

72
Q

Are there management options for mesothelioma?

A

limited, it’s incurable
chemo ONLY IF FIT ENOUGH- usually not fit enough by time they’re diagnosed.

So just treat symptoms e.g. SOB, pain

Consider trials.

Patient advised to get compensation accordingly.

(Emily) semester 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions