Pleural Effusion and Tube Thorascopy

Question 1

Which type of pneumothorax needs urgent treatment with a large bore needle in 2nd ICS + chest tube?

Answer 1

Tension pneumothorax

Question 2

Most common cause of pneumothorax

Answer 2

Iatrogenic (traumatic)

-Invasive procedures (central line, throacentesis)
-Mechanical ventilation
-CPR

Question 3

What is the most important respiratory muscle?

Answer 3

The diaphragm!

Question 4

What are the cornerstones of treatment for parapneumonic/empyema pleural effusions?

Answer 4

Antibiotics and drainage

Question 5

Pleural fluid analysis with Hct >50% venous blood suggests what condition?

Answer 5

Hemothorax

Question 6

Which, primary or secondary spontaneous pneumothorax, is more symptomatic?

Answer 6

Secondary

Question 7

Which, transudative or exudative serous fluid in the pleural space, is mostly caused by increased hydrostatic and oncotic pressures?

Answer 7

Transudative

Question 8

Tube thoracostomy is best used in patients with these types of pleural effusions

Answer 8

Complicated parapneumonic/empyema

Pneumothorax

Hemothorax

Malignant effusion

Question 9

Which nerves innervate the diaphragm?

Answer 9

C3, C4, C5

Question 10

Best imaging for mediastinal tumors

Answer 10

CT most common

Barium swallow for obstructions

Question 11

Best diagnostic tool for pleural plaques?

Answer 11

CT scan

Question 12

Which, primary or secondary spontaneous pneumothorax, is more common in tall, thin, smoking males?

Answer 12

Primary

Question 13

Abnormal accumulation of fluid in the pleural space is most often caused by this force

Answer 13

Increased hydrostatic pressure

Question 14

Which cause of pleural effusion can have transudative and exudative serous fluid

Answer 14

Pulmonary embolism

Question 15

Symptoms associated with secondary spontaneous pneumothroax

Answer 15

Chest pain, dyspnea, low BP, cyanosis, death

Question 16

Best imaging tool to assess shape of diaphragm?

Answer 16

Chest x-ray

Question 17

Which, primary or secondary spontaneous pneumothorax, has a high recurrence rate of 50% > 62% > 83%?

Answer 17

Primary

Question 18

Which, primary or secondary spontaneous pneumothorax, is associated with rupture of subpleural blebs?

Answer 18

Primary

Question 19

Best diagnostic tool for pleural effusions

Answer 19

Thoracentesis

Question 20

Transudative serous fluid in both sides of the pleural space is most commonly caused by what disease?

Answer 20

CHF

Question 21

Physical exam signs for pleural effusion

Answer 21

Dull percussion

Decreased breath sounds

Decreased fremitus/egophony

Question 22

Which, transudative or exudative serous fluid, has lower protein and LDH levels?

Answer 22

Transudative

Question 23

Define pneumothorax

Answer 23

Presence of air in the pleural space

Question 24

How will a diaphragm present on chest x-ray in cases of diaphragmatic paralysis?

Answer 24

Elevated on side of paralysis

Question 25

Most common cause of diaphragmatic paralysis

Answer 25

Malignancy - bronchogenic cancer

Question 26

Which type of pleural effusion will have high (>10k) white blood cell levels on a cell count/differential?

Answer 26

Parapneumonic with empyema

Question 27

What substances are used to obliterate pleural space?

Answer 27

Pleural sclerosants

Question 28

Which pneumothorax presents with a tracheal shift?

Answer 28

Tension pneumothorax Emergency!

Question 29

In which type of pleural effusion is thoracentesis unneccessary?

Answer 29

CHF with bilateral and equal effusion

Question 30

Most common disease causes of pleural effusion

Answer 30

CHF the most common Also malignancy, pneumonia, PE

Question 31

Apart from COPD, what other conditions can cause diaphragmatic dysfunction?

Answer 31

Myopathies: polymyocitis, MD, MS, ALS, hypothyroidism

Question 32

How will a diaphragm present on chest x-ray in cases of hyperinflated lungs?

Answer 32

Flattened diaphragm

Question 33

Causes of secondary spontaneous pneumothorax

Answer 33

COPD TB Pneumocystis pneumonia Fibrosis Carcinoma

Question 34

Which imaging technique is used to assess paradoxical motion of the diaphragm?

Answer 34

Fluoroscopy

Question 35

Which type of pleural effusion typically presents with symptoms of fever, chest pain, cough, and dyspnea

Answer 35

Parapneumonic effusion with empyema

Question 36

Increased triglyceride levels in pleural fluid analysis suggests what type of effusion?

Answer 36

Chylous effusion

Question 37

When to not use pleural sclerosants?

Answer 37

In cases of trapped lung

Question 38

Which, transudative or exudative serous fluid in the pleural space, is mostly caused by pleural capillary/venule membrane breakdown or lymph obstruction?

Answer 38

Exudative (result of increased permeability)

Question 39

Which, transudative or exudative serous fluid, has higher protein and LDH levels?

Answer 39

Exudative

Question 40

True or false. Mediastinal tumors are more malignant in adults than children.

Answer 40

False Children - 45% Adults - 25%

Question 41

Best treatment for diaphragmatic disorders?

Answer 41

Treat underlying condition