Pleural Effusion

Question 1

Pleural effusion definition

Answer 1

Presence of any type of fluid in pleural space ( transudate, exudate, frank pus, blood, chyle)

Question 2

Name and cause of disease with transudate in pleural space

Answer 2

Hydrothorax
In HF

Question 3

Name and cause of disease with exudate in pleural space

Answer 3

Sera pus
Pneumonia

Question 4

Name of disease with frank pus in pleural space

Answer 4

Empyema thoracis

Question 5

Name of disease with blood in pleural space

Answer 5

Hemothorax

Question 6

Name of disease with chyle in pleural space

Answer 6

Chylothorax

Question 7

Broad causes of pleural effusion

Answer 7

Pleural membrane disease
Intrathoracic organs disease
Sub-diaphragmatic/ abdominal disease
Systemic disease

Question 8

Different effets of pleural effusion

Answer 8

Collapse of lungs at varying degree
Mediastinal shift
Diagrammatic depression
Occasional cyanosis
Significant dyspnea
Cardiorespiratory embarrassment

Question 9

Main causes of purulent and seropurulent pleural effusion

Answer 9

Tuberculosis (not in seropurulent )
Mycosis
Amoebiasis
Pulmonary infarction
Ovarian fibroma
Collagen disease
Pericarditis
Pancreatitis
Post pneumonic ( not in purulent )

Question 10

Main causes of empyema

Answer 10

Post pneumonic
Lung abscess
Subphrenic abscess

Question 11

Main causes of chylothorax

Answer 11

Trauma
Parasitic
Lymphatic

Question 12

Main cause of hemothorax

Answer 12

Trauma

Question 13

Symptoms suggesting Parapneumonic effusion

Answer 13

Short history of cough, fever, pleuritic chest pain

Question 14

Symptoms that suggest TB

Answer 14

Long history of cough, weight loss, drenching night sweats , fever

Question 15

If arthritis in a patients, disease you should think about

Answer 15

SLE
Rheumatoid arthritis

Question 16

If history of surgery for malignancy , yo should think about this when there is chest presentation

Answer 16

Carcinomatous involvement of the pleura

Question 17

Disease of interest when doing physical examination

Answer 17

Congestive cardiac failure
Meigs syndrome
Collagen dx
Stigmata of SLE or RA
Amoebic liver abscess
Tuberculosis
Severe weight loss

Question 18

Goals of imaging in pleural effusion

Answer 18

Degree of pleural effusion
Underlying dx identification
Pleural thickening , plaques in mesothelioma

Question 19

Do you see fluid accumulation posteriorly or frontally first in xray

Answer 19

Posteriorly and then in the front

Question 20

Earliest sign of pleural effusion in frontal view in xray

Answer 20

Blunting of costophrenic angles

Question 21

Amount of fluid required to see blunting on frontal view in xray

Answer 21

175ml

Question 22

Sign of large free pleural effusion except in hydropneumothorax in xray

Answer 22

Meniscus shaped contour convex meniscus
Silhouette sign

Question 23

Signs of very large pleural effusion in xray

Answer 23

Opaque hemithorax with mediastinal shift to contralateral side

Question 24

What do you see on chest xray of pleural effusion due to malignancy

Answer 24

Canon balls and masses

Question 25

Advantage of ultrasound

Answer 25

Can see fluid as small as 3-5ml and Loculation Can guide thoracocentesis in small fluid collection

Question 26

Sign of exudative effusion in ultrasound

Answer 26

Plankton sign with punctate, hyperechoic foci floating in effusion

Question 27

Ct scan Advatanges

Answer 27

Helps confirm diagnosis of effusion

Question 28

Skin tests done in pleural effusion

Answer 28

Tuberculin/PPD in tuberculosis Cocciodiocin skin test for coccidiodomycosis

Question 29

Sputum studies done in pleural effusion

Answer 29

ZN stain in AFB for TB Microscopy for infection Cytology for malignancy Culture and sensitivity for infection

Question 30

Features noted on thoracocentesis

Answer 30

Appearance Thickness Amount over specified time Biochem (glucose, protein, fat, enzymes ) Cytology

Question 31

Transudate definition

Answer 31

Fluid formed by increase in hydrostatic pressure or decreased capillary oncotic pressure

Question 32

Disease leading to transudate accumulation

Answer 32

Cardiac failure Nephrotic syndrome cirrhosis of liber Dressler’s syndrome Trauma Asbestos Yellow nail syndrome Urinothorax Medications (dasatinib)

Question 33

Exudate definition

Answer 33

increase in permeability of micro circulation or alteration in pleural space drainage to lymph nodes

Question 34

Dx leading to exudate accumulation

Answer 34

Bronchial carcinoma Secondary Malignancy Pneumonia Tb Mesothelioma RA SLE Lymphoma

Question 35

Disease causing straw colored pleural fluid

Answer 35

Autoimmune Parapneumonic Malignant

Question 36

Disease causing Chocolate brown pleural fluid

Answer 36

Amoebic pleural effusion

Question 37

Disease causing milky and turbid pleural fluid

Answer 37

Chylothorax

Question 38

Disease causing hemorrhagic /bloody pleural fluid

Answer 38

Trauma TB Malignancy

Question 39

Rheumatoid arthritis biochemistry

Answer 39

glucose in pleural fluid less than 30mg%

Question 40

TB biochemistry

Answer 40

Fluid glucose > blood glucose

Question 41

Malignant dx biochemistry

Answer 41

Fluid glucose < blood glucose Cytology with malignant cells in effusion in 50% of cases

Question 42

CCF , SLE, infection biochemistry

Answer 42

Fluid glucose = blood glucose

Question 43

Chylothorax biochemistry

Answer 43

Pleural fluid fat above 400mg

Question 44

Acute pancreatitis biochemistry

Answer 44

Raised serum amylase

Question 45

Treatment pleural effusion

Answer 45

Drainage Treatment of underlying dx

Question 46

4 ways to drain pleural effusion

Answer 46

Needle aspiration catheter aspiration Closed tube thoracostomy Pleuropneumonectomy