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Respiratory > Pleural effusion > Flashcards

Pleural effusion Flashcards

1
Q

What is a pleural effusion?

A

Build up of fluid in the pleural cavity

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2
Q

What are the main presentations of pleural effusion?

A
  • Dyspnoea
  • Non-productive cough
  • Chest pain
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3
Q

What would you find on examination of someone with a pleural effusion?

A
  • Reduced breath sounds
  • Reduced chest expansion
  • Dullness to percuss over effusion
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4
Q

What sign might you find with a large pleural effusion?

A

Tracheal deviation

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5
Q

What is the protein content of an exudative pleural effusion?

A

More than 30g/L (3g/dL) of protein

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6
Q

What is the protein content of an transudative pleural effusion?

A

Less than 30g/L (3g/dL) of protein

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7
Q

What criteria is used to differentiate between transudative and exudative pleural effusions in borderline cases?

A

Lights criteria

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8
Q

When would lights criteria be applied?

A

If the protein level is between 25-35 g/L, Light’s criteria should be applied.

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9
Q

What is the main exudative cause of a pleural effusion?

A

Pneumonia

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10
Q

What are the other possible exudative causes of pleural effusion?

A
  • Infection: Tuberculosis/ pneumonia
  • Connective tissue: Rheumatoid arthritis/ SLE
  • Malignancy: Lung cancer
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11
Q

What is the main transudative cause of a pleural effusion?

A

Heart failure
( or Constrictive pericarditis)

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12
Q

What are the other possible transudative causes of pleural effusion?

A
  • Hypoalbuminaemia
  • Hypothyroidism
  • Meigs’ syndrome’s
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13
Q

What does hypoalbuminaemia/ hypoproteinaemia include?

A

Liver disease (cirrhosis)
Nephrotic syndrome
Malabsorption

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14
Q

What is Meig’s syndrome?

A

Triad of:
Pleural effusion
Benign ovarian tumour
Ascites

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15
Q

What is the main investigation for pleural effusion?

A

Chest x-ray (Posterior-anterior (PA) )

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16
Q

What might you see on a chest x-ray that would indicate pleural effusion?

A
  • Blunting of the costophrenic angle
    *White out of one hemifield (if large)
    *Fluid in lung fissures
17
Q

What is the function of an ultrasound?

A

Increases the likelihood of successful pleural aspiration

18
Q

What can a contrast CT be used for in someone with a pleural effusion?

A

Investigating the underlying cause

19
Q

What would low glucose and high protein in the fluid indicate?

A

Rheumatoid arthritis
Tuberculosis

20
Q

What would heavy blood staining and high protein in the fluid indicate?

A

Tuberculosis

21
Q

What would a fluid with a pH <7.2 indicate?

A

Empyema

22
Q

What is the most important factor in determining if a chest tube is placed or not?

A

pH

23
Q

What is the initial management of a pleural effusion?

A

Oxygen therapy and attempts to reduce respiratory distress medically

24
Q

What would you do after attempts to reduced respiratory distress fail?

A

Ultrasound guided pleural aspiration

25
Q

What is the management of a pleural effusion if there are increasing oxygen requirements?

A

Chest drain

26
Q

What is the management for large pleural effusions or empyema’s?

A

Intercostal drain

27
Q

What can be considered for recurrent pleural effusions?

A

Pleurodesis or pleurectomy

28
Q

What would you see on a chest x-ray of a small pleural effusion?

A

Blunting of the costophrenic angle

29
Q

What is the function of USS in someone with a pleural effusion?

A

Identifying the presence of pleural fluid
Guiding diagnostic or therapeutic aspiration

30
Q

When would you consider carrying out a CT scan in someone with pleural effusion?

A

If it is exudative effusion, CT should be done to asess pleural thickening and nodularity, and look for underlying cause

31
Q

What would you look for in a CT scan of someone with an exudative pleural effusion?

A

Pleural thickening and nodularity
Look for underlying cause

32
Q

When would you carry out a CT scan in someoen with an exudative pleural effusion?

A

After it has been drained

Respiratory (47 decks)

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