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Respiratory > Pleural Malignancy > Flashcards

Pleural Malignancy Flashcards

1
Q

What is a pleural effusion

A

Buildup of fluid in pleural cavity

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2
Q

What pleura covers lung hilum

A

None, the two layers combine around the hilum

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3
Q

What is the pulmonary ligament

A

Combination of pleural layers that attaches lungs inferiorly to the diaphragm

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4
Q

When does pleural effusion not require sampling or drainage

A

If it’s caused by cardiac failure

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5
Q

Transudate vs exudate

A

Transudate is fluid pushed through capillaries due to high pressure (low protein content < 30g/L).
Exudate is fluid a around capillary cells due to inflammation (high protein content > 30g/L)

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6
Q

Straw coloured pleural fluid

A

Cardiac failure, hypoalbuminaemia

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7
Q

Bloody pleural fluid

A

Trauma, malignancy, infection, infarction

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8
Q

Turbid/milky pleural fluid

A

Empyema (pus), chylothorax (lymph)

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9
Q

Foul smelling pleural fluid

A

Anaerobic empyema

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10
Q

Food particles in pleural fluid

A

Oesophageal rupture

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11
Q

Bilateral pleural fluid

A

LVF, pulmonary thromboembolism, drugs

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12
Q

Common causes of transudates

A

Heart failure, liver cirrhosis, hypoalbuminaemia, atelectasis, peritoneal dialysis

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13
Q

Common cause of exudates

A

Malignancy, infection including TB, pulmonary infarction, asbestos

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14
Q

What does fluid pH < 7.3 suggest

A

Pleural inflammation due to malignancy

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15
Q

What is fluid pH < 7.2

A

Requires drainage in setting of infection

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16
Q

Lymphoctye vs neutrophil presence in pleural fluid

A

Neutrophils suggest an acute process whereas presence of lymphocytes suggests TB or malignancy

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17
Q

Example of an acid-fast stain

A

Ziehl-Neelsen stain where the acid-fast bacteria stand out as bright red against a blue background

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18
Q

Does increasing volume of aspirate in thoracentesis increase yield

A

No

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19
Q

Third and subsequent sample effective in thoracentesis pleural aspirate

A

No, second sample increases yield slightly. Third and more are useless

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20
Q

Why are biopsies often negative

A

Pleural disease is often discontinuous

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21
Q

Systemic causes of ancillary effusions

A

Systemic tumour effects such as embolism or hypoalbuminaemia (type of hypoproteinaemia)

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22
Q

What is mesothelioma

A

Malignant tumour of lining of lungs or sometimes abdominal cavity

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23
Q

What increases likelihood of developing mesothelioma

A

Degree and length of exposure to asbestos. May also occur in persons who have been associated with people who have worked with asbestos

24
Q

Symptoms of mesothelioma

A

Breathlessness, chest pain, weight loss, fever, sweating and cough

25
Q

Cytological yield of mesothelioma

A

Poor, avoid repeated aspiration

26
Q

What can be seen on imaging of mesothelioma

A

Pleural nodularity, circumferential pleural thickening, local invasion and lung entrapment

27
Q

Treatment of mesothelioma

A

Pleurodesis, radiotheraphy, chemotherapy, surgery, palliative care

28
Q

Talc slurry vs talc poudrage for pleurodesis

A

Talc poudrage is preferred due to lower incidence of chest pain during the procedure. Poorer results also seen with talc slurry

29
Q

Common complications of talc pleurodesis

A

Minor pleuritic pain and fever

30
Q

When are long term catheters generally used

A

Patients with malignant effusions. Allows patients to control their effusion and symptoms

31
Q

Complications of long term pleural catheter

A

Incorrect placement, bleeding, infection

32
Q

How can survival be predicted in malignant pleural effusions

A 
Using the LENT score -
LDH - Lactate dehydrogenase
ECOG score - Ability of patients to tolerate therapies
serum Neutrophil to lymphocyte ratio
Tumour type
33
Q

Treatment for LVF pleural effusion

A

Diuretics

34
Q

Treatment for infection related pleural effusion

A

Drain, antibiotics, surgery

35
Q

Treatment for malignancy related pleural effusion

A

Drain, pleurodesis, long term pleural catheter

36
Q

What is a pneumothorax

A

Abnormal collection of air between plural space

37
Q

Pneumothorax usually occurs in

A

Tall thin men, smokers, cannabis users, underlying lung disease

38
Q

Types of pneumothorax

A

Primary - Normal lungs, apical bullae rupture

Secondary - Underlying lung disease eg: COPD

39
Q

Which type of pneumothorax symptomatic

A

Secondary spontaneous pneumothorax is usually symptomatic even if small unlike primary spontaneous pneumothroax which are largely asymptomatic

40
Q

General signs of pneumothorax

A

Dyspnoea, hypoxia, acute onset pleuritic chest pain, tachycardia, hyper-resonant percussion sound, reduced expansion, quiet breath sounds on auscultation

41
Q

What is Hamman’s sign

A

A mediastinal crunch or click sound, similiar to crackles, heard upon auscultation. It correlates with the heart beat and not respirations

42
Q

How can amount of pneumothorax be approximated

A

Measure rim of air at hilar level not apex
Small < 2 cm rim of air
Large > 2 cm rim of air
2 cm rim of air is approx 50 % pneumothorax

43
Q

Is chest x-ray sufficient to diagnose pneumothorax

A

Yes

44
Q

Management of pneumothorax

A

Oxygen even if no drain
Aspiration if primary spontaneous pneumothorax, time consuming, avoids chest drain and may fail is ago > 50 or secondary spontaneous pneumothorax
Surgery
May need suction (air leak > 48 hours)

45
Q

Treatment of asymptomatic and small pneumothorax

A

No treatment if asymptomatic and small

46
Q

When can aspiration fail in pneumothorax

A

If age > 50 or secondary spontaneous pneumothorax

47
Q

When should surgery be considered for pneumothorax

A 
Secondary ipsilateral ptx
Primary contralateral ptx
Bilateral spontaneous ptx
Persistent air leaks
Risk professions after first ptx (divers, pilots)
48
Q

Pneumothorax follow up

A

Chest x-ray until resolution
Discuss flying and diving
Risk of re-occurrence
Smoking caessation

49
Q

What is tension pneumothorax

A

Progressive build-up of air in pleural space usually due to lung laceration which allows air to escape into the pleural space but not return

50
Q

Is tension pneumothorax an emergency

A

Yes

51
Q

Signs of tension pneumothorax

A

Trachea deviated to opposite signs, Hypotension, raised JVP, reduced air entry on affected side

52
Q

Treatment of tension pneumothorax

A

Needle compression, usually with large bore venflon

53
Q

Causes of tension pneumothorax

A

Ventilated patient, trauma, CPR, blocked/kinked/misplaced drain, pre-existing airway disease, patients undergoing hyperbaric treatment

54
Q

Where is venflon inserted for needle compression

A

Second intercoastal space, mid-clavicular line

55
Q

How can empyema be cleared

A

Paraneumonic effusions can be cleared by drainage however empyema can rapidly coagulate and organize to fibrous peels even with antibiotics. This needs surgery

Respiratory (26 decks)

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