Pneumothorax & Pleural Effusions

Question 1

What are the risk factors for a Pneumothorax?

Answer 1

Pre existing lung disease
Height
Smoking
Cannabis
Diving
Trauma
Connective tissue disease - Marfarns, Ehlers Danlos, osteogenesis imperfecta

Question 2

How do you manage a Pneumothorax?

Answer 2

Oxygen and aspiration if symptomatic with >2cm rim of air on CXR
If persistent air leak for > 5days (Bronchopleural fistula) then refer to thoracic surgeons

Question 3

What advice would you give to a patient being discharged following a Pneumothorax?

Answer 3

No diving or flying until the issue is fully resolved

Question 4

How do you treat a tension Pneumothorax?

Answer 4

Put a wide bore cannula into the 2nd ICS, mid clavicular line on the effected side

Question 5

What investigations do you do in a patient with a suspected Pleural effusion?

Answer 5

A-E
CXR
ECG
Bloods - FBC, U&Es, LFTs, CRP, Bone profile, LDH, Clotting
ECHO - if HF suspected
Staging CT (With contrast) if suspect exudative cause

Question 6

What is a pleural plaque?

Answer 6

A discrete fibrous area

Question 7

How do you diagnose a Pleural effusion?

Answer 7

Ultrasound guided pleural aspiration then;
Biochemistry
Cytology
Microbiology (Including Acid Fast bacillus testing)

Question 8

What are the causes of a transudate effusion?

Answer 8

Pleural protein is

Question 9

What are the causes of exudate effusions?

Answer 9

Pleural protein > 30 g/L
Malignancy
Infection - Parapneumonic, TB, HIV
Inflammatory - RA, Pancreatitis, PE
Lymphatic disorders
Connective tissue disease
Yellow nail syndrome
Fungal infections
Drugs

Question 10

What is Light’s criteria?

Answer 10

Used if Pleural fluid protein is between 25 - 35 g/L
Exudate if one or more of the following - Pleural fluid/Serum protein > 0.5
Pleural fluid/Serum LDH > 0.6
Pleural fluid LDH > 2/3 of the upper limit of normal