288 - Disorders of the Pleura

Question 1

What are the sources of pleural fluid (3)?

Answer 1

1. Parietal pleura lymph capillary
2. Interstitial spaces in the lung (through visceral pleura)
3. Peritoneal space (through the diaphragm)

Question 2

The lymph vessels can absorb ___ times the amount of the normal fluid production

Answer 2

20

Question 3

Pleural effusion will occur when there is a ____ increase in production or when there is a _____ in lymph ____

Answer 3

substantial
decrease
drainage

Question 4

____ is crucial when diagnosing pleural effusion

Answer 4

CXr

Question 5

Now days ____ is used instead of left lateral decubitus and is also used for guiding ____

Answer 5

Ultrasound

toracentesis

Question 6

When transudate fluid is more likely to occur (2)?

Answer 6

Systemic factors:

1. LV failure
2. Cirrhosis

Question 7

When exudate fluid is more likely to occur (4)?

Answer 7

Local factors

1. Pneumonia
2. Malignancy
3. Viral infection
4. PE

Question 8

Why is it important to differentiate between transudate and exudate?

Answer 8

Exudate- require further diagnostic in order to find the source of the fluid

Question 9

How will you differentiate between transudate and exudate?

Answer 9

1. LDH

2. fluid’s protein levels

Question 10

Exudate must meet one of the three following criteria

Answer 10

1. Pleural fluid protein/serum protein > 0.5
2. Pleural fluid LDH/serum LDH > 0.6
3. Pleural fluid LDH > 2/3 of the normal upper limit of serum LDH

Question 11

How often does transudate get identified as exudate?

Answer 11

25%

Question 12

When diagnosing exudate fluid we must obtain (5)

Answer 12

1. Macroscopic description of the fluid
2. Glucose levels
3. Differential cell count
4. Culture
5. Markers for TB

Question 13

The most common cause for pleural effusion is

Answer 13

LV HF

Question 14

Which of the HF patients with pleural effusion will we drain? (4)

Answer 14

1. Unilateral effusion
2. Fever
3. Pleuritic pain
4. Effusion + optimal HF treatment

Question 15

When the PF proBNP levels are > than ____ we can define it as secondary to the HF

Answer 15

1500 pg/ml

Question 16

___ of cirrhosis and ascites patients suffer from pleural effusion, which usually occur on the ___ side, causing ____

Answer 16

5%
Right side
Dyspnea

Question 17

Parapneumonic effusion is usually caused by: (3) and is the most common cause for _____ effusion in the US

Answer 17

1. Bacterial pneumonia
2. Lung abscess
3. Bronchiectasis
4. Exudative

Question 18

What is empyema?

Answer 18

Macroscopic pus collection

Question 19

What are the symptoms of patients with anaerobic infections (5)?

Answer 19

1. Sub acute disease
2. Weight loss
3. Acute leukocytosis
4. Anemia
5. Aspiration

Question 20

What are the 5 most important factors that when met require more than just paracentesis?

Answer 20

1. Loculated PF
2. PF pH < 7.2
3. PF glucose < 3.3 mmol/L
4. G (+) stain or positive culture of PF
5. Pus in the PF

Question 21

What are the 3 most common malignancies causing exudative pleural effusion?

Answer 21

1. Lung carcinoma
2. Breast carcinoma
3. Lymphoma

Question 22

High amylase in PF will suggest

Answer 22

Esophagus rapture or pancreatic disease

Question 23

Fever together with PNM in PF and without lung abnormality suggests

Answer 23

Abdominal abscess