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Flashcards in Pleural disease Deck (25):
1

Which conditions can cause a "pleural rub"?

Anything that causes inflammation of the pleura - PE or pneumonia

2

Is there a pleural rub audible in pleural effusion?

No, the fluid in the pleural cavity keeps the two surfaces from touching so there is no rub to be heard.

3

What is the pulmonary ligament?

Attachment of the root of the lung to the diaphragm
Consists of the two layers of pleura combining around the root of the lung

4

What type of nerves supply the parietal pleura and what are their names?

Somatic sensory - senses pain
Supplied by the intercostal and phrenic nerves

5

What type of nerves supply the visceral pleura and which nerve does this?

Autonomic - senses stretch
Vagus nerve

6

How is effusion diagnosed?

History
CXR
Aspiration - transudate or exudate?

7

What does an effusion with a bloody appearance indicate?

Trauma
Malignancy
Infection
Infarction

8

What does an effusion with a straw-coloured appearance indicate?

Cardiac failure
Hypoalbuminaemia

9

What does an effusion with a turbid/milky appearance indicate?

Chylothorax
Empyema

10

What is the definition of a transudate effusion?

Effusion with a protein level <30g/L

11

What is the definition of an exudate effusion?

Effusion with a protein level >30g/L

12

What does a transudate effusion indicate?

"Organ failure"
Cardiac failure
Liver cirrhosis
Nephrotic syndrome
Hypothyroidism

13

What does an exudate effusion indicate?

Malignancy
Infection
PE
Rheumatoid
TB
Benign asbestos related effusion
Pancreatitis

14

Which workers are at risk of developing asbestosis?

Miners
Construction workers
Boiler workers
Piping workers
Mechanics

15

What is the characteristic pathology of asbestosis?

Benign pleural plaques

16

What are benign pleural plaques at risk of developing into?

Mesothelioma - incurable cancer of the pleura

17

How is asbestosis diagnosed?

Asbestos bodies can be detected in sputum and biopsy

18

What other cancer are asbestosis patients at risk of developing?

Bronchial carcinoma

19

What interstitial lung disease does asbestos exposure also cause?

Pulmonary fibrosis producing a restrictive pattern

20

What changes occur in the pleura of patients with asbestosis?

Exudative pleural effusion
Diffuse pleural thickening
Benign pleural plaques

21

How is pleurodesis performed?

Inflammation is induced between the two pleural surfaces, leading to all symptoms of pleurisy in the short term, but ultimately the inflammation allows the two surfaces to stick together, leaving no space for fluid to accumulate - this can be done by injecting talc

22

What should the pH of aspirated effusion be?

pH 7.6
<7.2 needs to be drained

23

How should effusion be treated?

Treat underlying cause
Thoracentesis (chest drainage)

24

Why should large volumes of fluid not be drained all at once?

Risk of re-expansion pulmonary oedema - this can be life threatening

25

What volume of fluid should be drained at what rate?

1L should be drained before drain is clamped for an hour to allow gradual re-expansion