Pleural Diseases

Question 1

What do the mesothelial cells look like on visceral pleura?Parietal pleura

Answer 1

very bumpy and loose

Parietal pleura mesothelial cells are very tight together

Question 2

How would you characterize the MC junctions in Visceral pleura?Parietal?

Answer 2

Tight in visceral, loose in parietal

Question 3

microcillia population on visceral and parietal?

Answer 3

tons of microcillia on viscera, sparse on parietal

Question 4

Characterize normal pleural fluid

Answer 4

Clear/odorless with very little in the way of protein

70% macrophages, 10% lymphocuytes, 2% polys

Question 5

Which way does fluid move?

Answer 5

From parietal pleura to visceral pleura. The intercostal arteries have a high hydrostatic pressure which pushes fluid into the pleural space through the parietal pleura (mesothelial junctions, which are loose). The visceral pleura has a very low hydrostatic pressure which allows fluid to move in.

Question 6

How are particles, protein and cells removed from the pleural fluid

Answer 6

Through lymphatic openings in the parietal pleura

Question 7

In general, what causes pleural effusions

Answer 7

Changes in hydrostatic and oncotic pressure

Question 8

Transudate

Answer 8

pleural effusion with very little protein

Question 9

Exudate

Answer 9

Rich in protein….real rich

Question 10

Causes of transudate

Answer 10

Increased hydrostatic pressure pushes fluid into the pleura. What happens is blood backs up in the pulmonary vasculature and the pulmonary circulation, which generally has fairly low jhydrostatic pressure, assumes a higher pressure and fluid is pushed in from both sides. Most commonly seen bilateral and cardiomegaly is present

• Atelectasis: Decreased pleural pressure, fluid comes in from both sides
• Decreased oncotic pressure: low albumin…fluid comes in bilaterally, due to malnutrition, renal loss, etc….

Question 11

Causes of exudative effusion

Answer 11

Inflammation, infection, cancer….always due to increased vascular permeability

Question 12

Signs of effusion

Answer 12

Decreased chest expansion, decreased breath sounds, no tactile fremitus, if one side is fluid filled the mediastinum will be pushed to that side.

Question 13

Whats the difference between transudates and exudate on lab work

Answer 13

Trans= protein below .5, exudates above
Trans= pleural LDH below .6, exudates above
Trans= Serum lactate below 200, exudates above

Question 14

pH, cell count, do not effect difference between transudates and exudates

Answer 14

truth…diff b/w transudate and exudate is protein

Question 15

If the pleural effusion is less than 10 mm on lateral decubitus x-ray….

Answer 15

do nothing

Question 16

Most common cause of transudate

Answer 16

CHF…..then nephrotic syndrome, then cirrhosis

Question 17

Most common cause of exudate

Answer 17

cancer, infection,

Question 18

When do you perform thoracentesis

Answer 18

when the fluid level is over 10 cm on lateral decubitus film

Question 19

Most common cause of Lymphocytosis in thoracentesis

Answer 19

TB, Cancer…..some shit called AFB is usually positive in cancer

Question 20

• 5k=chronic exudates (TB, cancer)
• > 10K=inflammation (pneumo, pancreatitis, pulmonary infarction)
• > 50K = parapneumonic effusions only

Answer 20

ok

Question 21

Primary spontaneous pneumothorax

Answer 21

Usually appears in tall thin males, acute onset of pleuritic chest oain and dyspnea. High risk of recurrence

Question 22

When do tension pneumothoraxes occur

Answer 22

when a patient is on mechanical ventillation and the you get a pleural breach where air flows out of the lung and into the pleural space. You get circulatory collapse and impaired venous return.

Question 23

Signs of tension pneumothorax MUST KNOW

Answer 23

Mediastinal shift, lung collapes on x ray, diaphragm depression on that one side, hypotension and hypoxemia, must decompress with a large bore needle.

Question 24

Farmer falls off the tractor and breaksboth femures

Answer 24

Fat embolism

Question 25

What is the triad of fat embolism symptoms

Answer 25

Mental status change, petechiae in chest and neck, thrombocytopenia