pleural disease

Question 1

patient presents with rapid shallow breathing and decreased lung sounds, where is the main localization

Answer 1

pleural space

Question 2

what are signs associated with pleural space disease

Answer 2

muffled heart sounds, decreased lung sounds, rapid shallow breathing

Question 3

what is the first step in working up a case that you suspect pleural disease

Answer 3

radiographs and/or ultrasound

Question 4

where do you perform a thoracocentesis

Answer 4

between 7-8 intercostal space just above the CCJ. at the cranial border of the rib

Question 5

when is your first choice to place a chest tube

Answer 5

pyothorax, or you are having to drain the chest multiple times with reoccurrence

Question 6

generally, what are the transudate ranges for fluid samples

Answer 6

lower protein [] and lower nucleated cell count

Question 7

how do you tell the difference between pure transudate and modified transudate

Answer 7

pure: is the lowest with only mononuclear cells (lymphs and monos)

modified: higher ranges with slightly higher nucleated cell counts and neutrophils on top of the mononuclear cells

Question 8

what are the reasons we see transudate in the thorax

Answer 8

increased hydrostatic pressure
decreased oncotic pressure
lymphatic obstruction

Question 9

signs of transudate pleural effusion on an exam

Answer 9

abnormal jugular pulses, gallop/arrhtyhmias, murmurs, ,muffled heart sounds

Question 10

what are the causes of decreased plasma oncotic pressure

Answer 10

loosing albumin or decreased production
PLE- increased loss
liver disease- decreased production

Question 11

what is on our differential list for any type of pleural effusion

Answer 11

neoplasia

Question 12

what is the difference between nonseptic and septic exudate

Answer 12

both are high numbers
nonseptic: nondegenerate cells, no organisms

septic: degenerative neuts are predominant, bacti observed

Question 13

what are unique clinical signs of non/septic exudate

Answer 13

fever, lethargy, anorexia, weight loss

Question 14

what antibiotic do we reach for in exudate effusion

Answer 14

clavamox

Question 15

what is unique about chylous effusion

Answer 15

cells are mostly small lymphs and nondegenerate neuts as it becomes more chronic

moderate numbers

Question 16

where is the chylous from?

Answer 16

leaking from the thoracic duct

Question 17

if you have a dog presenting with lethargy, anorexia, weight loss, ex. intol, and cough which pleural effusion is higher on your ddx

Answer 17

exudate and chylous effusion

Question 18

you diagnose chylous effusion. what could be the primary cause

Answer 18

nothing
lung torsion
HW
neoplasia
trauma
diaph hernia

Question 19

chronic pleural inflammation results in ______. why do we care?

Answer 19

fibrosis. cant drain all of the fluid out because this can cause the lungs to rupture from fibrous tissue limiting the expansion

Question 20

how do you medically manage chylous effusion

Answer 20

low fat diet, periodical thoracocentesis, rutin?

Question 21

hemorrhagic effusion vs hemothorax

Answer 21

hemothorax clots

Question 22

what is the only neoplasia can you ddx from cytology of pleural effusion

Answer 22

lymphoma

Question 23

how do you treat traumatic pneumothroax

Answer 23

conservatively, cage rest, periodic thoracocentesis

Question 24

how to do you work up spontaneous pnuomothorax

Answer 24

remove air, exal for underlying disease

Question 25

prefered treatment for idiopathic chylous effusion

Answer 25

sx ligation because medical management often doesnt work