Flashcards in Lecture 8 Pleural Effusion (missed lecture) Deck (24)
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1
Normal pleural fluid:
pH is (acidic or alkaline); most cells are _____, there are no ____ typically
alkaline (7.6); MQ, no PMNs
2
pleural fluid is produced by the ____ pleura and absorbed by the ___ pleura. the pleural space should be virtually ____ free
parietal, visceral;
fluid
3
fluid accumulates in the pleural space by 3 mechanisms:
increased ____ of fluid into the space, increased production of fluid by ____ in the space, decreased ____ of fluid from the space
drainage, cells; drainage
4
at FRC, the intrapleural pressure is ____, preventing _____
negative, pneumothorax
5
development of pleural effusion:
____ pulmonary capillary pressure such as CHF;
increased capillary permeability such as in ____;
____ intrapleural pressure such as in atelectasis
increased,
pneumonia,
increased
6
development of pleural effusion:
____ plasma oncotic pressure such as nephrotic syndrome,
decreased
7
a chylothorax is due to ____ injury from trauma or malignancy. there is a large amount of _____. a pseudochylothorax has a high amount of ___
throacic duct; triglycerides (ie greater than 110); cholesterol (ie greater than 250)
8
transudate vs exudate:
which has a high protein count?
which is cloudy?
which us usually bilateral?
which occurs in states of increased vascular perm?
exudate, exudate, transudate, exudate
9
malignancy, pneumonia, collagen vascular disease, pancreatitis, and trauma all cause an ____ effusion
exudate
10
causes of transudative effusion: hepatic ____, _____, ____ syndrome
cirhossis, CHF, nephrotic
11
with pleural effusion, there is restricted lung ____ during ____. On physical exam, there is ____ to percussion, ____ tactile fremitus, ____ breath sounds, and _____.
expansion, inspiration;
dullness, decreased, decreasedd egophony
12
CXR shows blunted _____ angles. what position is most sensitive for CXR?
costophrenic;
lateral decubitus
13
fluid in CXR is seen as a dense ___ shadow with a ____ upper edge
white; concave
14
in atelectasis, the heart and mediastinum are shifted ____ the whited out hemithorax. in a massive pleural effusion, the heart and mediastinum are shifted ____ the whited out hemithorax
toward; away from
15
in thoracentesis, the needle should be inserted through the ____ border of the ____ rib
upper, lower
16
pleural fluid lactate dehydrogenase: serum LDH ratio:
in ____ it is less than 0.6. in ____, it is greater than 0.6
transudate; exudate;
ie exudate has increased LDH.
17
in an empeyema pleural effusion, pH is ____ and gluocse concentration is ____
reduced (ie acidic), reduced
18
What other condition usually causes a low gluocse concentration in the pleural fluid?
rheumatoid pleurisy
(also malignancy, Tb)
19
lactate levels are significantly higher in ____ and ____ pleural effusions than in other pleural effusions
bacteria, Tb
20
pleural effusions with elevated amylase typically indicate ____, ____ rupture, or malignancy
pancreatitis, esophageal
21
pleural effusions:
high Adenosine deaminase usually indicates ____;
high interferon gamma usually indicates ____
Tb, Tb pleuritis
22
markedly increased numbers of mesothelial cells + blood or eiosinophillic effusions suggests _____ as the cause of effusion
pulmonary embolism
23
a pleural biospy is most helpful in evaluating for ____.
Tb;
also maybe sarcoid, fungal
24
