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3- Respiratory Medicine > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

Pleural effusion definition

A

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

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2
Q

Name and cause of disease with transudate in pleural space

A

Hydrothorax
In HF

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3
Q

Name and cause of disease with exudate in pleural space

A

Sera pus
Pneumonia

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4
Q

Name of disease with frank pus in pleural space

A

Empyema thoracis

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5
Q

Name of disease with blood in pleural space

A

Hemothorax

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6
Q

Name of disease with chyle in pleural space

A

Chylothorax

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7
Q

Broad causes of pleural effusion

A

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

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8
Q

Different effets of pleural effusion

A

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

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9
Q

Main causes of purulent and seropurulent pleural effusion

A

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

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10
Q

Main causes of empyema

A

Post pneumonic
Lung abscess
Subphrenic abscess

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11
Q

Main causes of chylothorax

A

Trauma
Parasitic
Lymphatic

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12
Q

Main cause of hemothorax

A

Trauma

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13
Q

Symptoms suggesting Parapneumonic effusion

A

Short history of cough, fever, pleuritic chest pain

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14
Q

Symptoms that suggest TB

A

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

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15
Q

If arthritis in a patients, disease you should think about

A

SLE
Rheumatoid arthritis

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16
Q

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

A

Carcinomatous involvement of the pleura

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17
Q

Disease of interest when doing physical examination

A

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

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18
Q

Goals of imaging in pleural effusion

A

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

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19
Q

Do you see fluid accumulation posteriorly or frontally first in xray

A

Posteriorly and then in the front

20
Q

Earliest sign of pleural effusion in frontal view in xray

A

Blunting of costophrenic angles

21
Q

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

A

175ml

22
Q

Sign of large free pleural effusion except in hydropneumothorax in xray

A

Meniscus shaped contour convex meniscus
Silhouette sign

23
Q

Signs of very large pleural effusion in xray

A

Opaque hemithorax with mediastinal shift to contralateral side

24
Q

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

A

Canon balls and masses

25
Q

Advantage of ultrasound

A

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

26
Q

Sign of exudative effusion in ultrasound

A

Plankton sign with punctate, hyperechoic foci floating in effusion

27
Q

Ct scan Advatanges

A

Helps confirm diagnosis of effusion

28
Q

Skin tests done in pleural effusion

A

Tuberculin/PPD in tuberculosis
Cocciodiocin skin test for coccidiodomycosis

29
Q

Sputum studies done in pleural effusion

A

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

30
Q

Features noted on thoracocentesis

A

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

31
Q

Transudate definition

A

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

32
Q

Disease leading to transudate accumulation

A

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

33
Q

Exudate definition

A

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

34
Q

Dx leading to exudate accumulation

A

Bronchial carcinoma
Secondary Malignancy
Pneumonia
Tb
Mesothelioma
RA
SLE
Lymphoma

35
Q

Disease causing straw colored pleural fluid

A

Autoimmune
Parapneumonic
Malignant

36
Q

Disease causing Chocolate brown pleural fluid

A

Amoebic pleural effusion

37
Q

Disease causing milky and turbid pleural fluid

A

Chylothorax

38
Q

Disease causing hemorrhagic /bloody pleural fluid

A

Trauma
TB
Malignancy

39
Q

Rheumatoid arthritis biochemistry

A

glucose in pleural fluid less than 30mg%

40
Q

TB biochemistry

A

Fluid glucose > blood glucose

41
Q

Malignant dx biochemistry

A

Fluid glucose < blood glucose

Cytology with malignant cells in effusion in 50% of cases

42
Q

CCF , SLE, infection biochemistry

A

Fluid glucose = blood glucose

43
Q

Chylothorax biochemistry

A

Pleural fluid fat above 400mg

44
Q

Acute pancreatitis biochemistry

A

Raised serum amylase

45
Q

Treatment pleural effusion

A

Drainage
Treatment of underlying dx

46
Q

4 ways to drain pleural effusion

A

Needle aspiration
catheter aspiration
Closed tube thoracostomy
Pleuropneumonectomy

3- Respiratory Medicine (12 decks)

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