pleural disease

Question 1

parts of the pleura

Answer 1

visceral pleura
parietal pleura

Question 2

pluid fluid

Answer 2

straw coloured fluid that is generated through filtration of the proteins from the pleura .

Question 3

contents of the pleural fluid

Answer 3

macrophage
lymphocytes
mesothelial cells

Question 4

what is pleural pressure

Answer 4

pressure that is exerted by the pleural fluid that is mostly negative from negative 3 to negative 5 of water

Question 5

gradient of pleural pressure

Answer 5

most negative at the apex and least negative at the base

Question 6

pleural effusion

Answer 6

collection of fluid into the pleural space

Question 7

collection of air in the pleura

Answer 7

pneumothorax

Question 8

mass in the pleural space

Answer 8

mesothelioma

Question 9

hemothorax

Answer 9

blood in the pleural cavity

Question 10

types of pleural effusion

Answer 10

transudate
exudate
protein count exudate

Question 11

generation of the pleural fluid

Answer 11

pleural lymphatics in the parietal pleura

Question 12

transudate

Answer 12

there is collection of pleural fluid as a result of a non -inflammatory reaction

Question 13

exudate

Answer 13

accumulation of fluid that is of high protein content protein content is more than 3g per decilitre

Question 14

lights criteria

Answer 14

for transudates , ratio of protein in the pleural fluid to serum fluid ratio should be greater than 0.5

Question 15

causes of transudates

Answer 15

organ failure such as liver cirrhosis and left ventricular failure

Question 16

causes of exudates

Answer 16

malignancy ( pulmonary and non -pulmonary)
para-pneumonic effusions
empyema
tuberculosis

Question 17

investigation of pleural effusion

Answer 17

ultrasound which is conducted by a qualified technician
chest x -ray
ct of the thorax

Question 18

clinical feature of effusion on examination

Answer 18

dull percussion note

Question 19

pleural fluid analysis

Answer 19

aspiration
inspection of the fluid
pH bedside ABG machine , biochemistry , microbiology , cytology

Question 20

management of transudate

Answer 20

treatment of the underlying cause and this may not need CT imaging

Question 21

management of exudate

Answer 21

Exudate : Unless cause identified will need further investigation for eg further imaging , and or pleural biopsy​

Question 22

causes of a pneumothorax

Answer 22

1.primary spontaneous which happens on someone with no pre-existing conditions.
2.secondary spontaneous - happens because there is a pre-existing lung disease
3.traumatic caused by injury to chest wall
latrogenic
4.tension - air is so much that it pushes the lung to the other side of the chest wall .there is complete collapse of the lung , there is tracheal shift

Question 23

symptoms of tension pneumothorax

Answer 23

chest pain
shortness of breath
rapid heart rate
shallow breathing
anxiety
blue or ashen skin

Question 24

presentation of a pneumothorax

Answer 24

sudden chest pain and breathlessness
happens in tall thin and young men
with a history of biopsy /line insertion /mechanical ventilation

Question 25

examination of a chest wall with pneumothorax

Answer 25

breathing fast hypoxia reduced chest wall movements tracheal shift on the x-ray hyperresonance on percussion little or no sound on site where the biopsy is taken from.

Question 26

management of a pneumothorax

Answer 26

patient observation where the pneumothorax is small and patient is well aspiration over 2 cm in size chest drain insertion surgery in recurring events

Question 27

location where the pleural aspiration is carried out

Answer 27

on the safe triangle 2nd intercostal space midclavicular line

Question 28

pleural tumors

Answer 28

mesothelioma -primary malignancy in the pleural cavity and is associated with a poor outcome

Question 29

mesothelioma

Answer 29

aggressive cancer that is common in men , plumbers , electricians , ship builders , power plants , boilers and engines inhaled asbestos fibres reach the pleura and cause inflammation which provokes tumour formation

Question 30

symptoms of mesothelioma

Answer 30

takes longer to manifest latency is longer in old age . breathlessness chest pains weight loss clubbing and signs of pleural effusion

Question 31

staging of a mesothelioma

Answer 31

CT Thorax and Biopsy: needed to stage ( gauge extent eg any distant spread etc )​ ​Thickened pleura, pleural nodules or masses, pleural plaques, an effusion, soft tissue infiltration​

Question 32

what are the causes of transudates

Answer 32

heart failure pericarditis liver disease kidney disease basically factors that cause a reduced protein content and factors that cause a raised venous pressure

Question 33

protein content of transudates

Answer 33

25g/l

Question 34

causes of exudates

Answer 34

protein content above 35 g/l malignancy infection inflammation in a nutshell factors that cause an increase in the permiability of the pleural membrane