Pleural Malignancy

Question 1

What amount of liquid is normally found in the lungs?

Answer 1

4mls

Question 2

How much XS liquid is needed in the lungs to be detected in a CXR?

Answer 2

200ml

Question 3

what allows the pleura to slide smoothly during respiration?

Answer 3

serous fluid

Question 4

what creates a seal between the lung surface and the thoracic wall?

Answer 4

surface tension

Question 5

why do the hila of the lungs have no pleural coverage?

Answer 5

the 2 layers (lung surface and thoracic wall) combine around the hila of the lung

Question 6

d: pleural effusion

Answer 6

Abnormal collection of fluid in pleural space

Question 7

what is the term for draining the liquid?

Answer 7

pleural aspiration

Question 8

if the liquid comes out straw coloured, what diseases could it be?

Answer 8

cardiac failure

hypoalbuminaemia

Question 9

if the liquid comes out bloody, what diseases could it be?

Answer 9

trauma
malignancy
infection
infarction

Question 10

if the liquid comes out turbid/milky, what diseases could it be?

Answer 10

empyema

chylothorax

Question 11

if the liquid comes out foul smelling, what diseases could it be?

Answer 11

anaerobic empyema

Question 12

if the liquid comes out with food particles, what diseases could it be?

Answer 12

oesophageal rupture

Question 13

if the liquid comes out bilateral, what diseases could it be?

Answer 13

left ventricle failure
pulmonary thromboembolism
drugs
systemic path

Question 14

d: transudates + colour

Answer 14

clear
protein <30g/L
caused by a rise in pressure or low protein level of the blood vessels

Question 15

d: exudates + colour

Answer 15

cloudy
protein >30g/L
effusions result from leakages in the blood vessels due to inflammation of the pleura

Question 16

name some diseases producing transudates in effusion

Answer 16

Heart failure
Liver cirrhosis
Hypoalbuminaemia
Atelectasis (ITU or post surgery)
Peritoneal dialysis

Question 17

name some diseases producing exudates in effusion

Answer 17

Malignancy
Infection inc TB

Pulmonary infarct
Asbestos

Question 18

What is the normal fluid pH for effusion?

Answer 18

7.6

Question 19

what does a pH of <7.3 suggest?

Answer 19

pleural inflammation malignancy

Question 20

what does a pH of <7.2 require?

Answer 20

drainage in setting of infection

Question 21

is glucose in fluid high/low in infection?

Answer 21

low

Question 22

if lymphocytes were found in the fluid what would that suggest?

Answer 22

TB

malignancy

Question 23

if neutrophils were found in the fluid what would that suggest?

Answer 23

it was an acute process

Question 24

d: pleural tap

Answer 24

the removal of fluid from the area between the chest cavity and the tissue lining of the lungs

Question 25

medical name for a pleural tap?

Answer 25

thoracentesis

Question 26

name 2 ancillary effusions that are systemic tumour effects

Answer 26

embolism | hypoalbuminaemia

Question 27

name ancillary effusions that are local tumour effects

Answer 27

postobstructive infection, lymphatic obstruction, atelectasis

Question 28

d:atelectasis

Answer 28

collapse/closer of a lung

Question 29

why is a CT guided needle better than a thoracoscopy for a pleural biopsy?

Answer 29

can see where you are going

Question 30

what is a mesothelioma and where is it found?

Answer 30

Uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity

Question 31

what is a particular cause of mesothelioma?

Answer 31

asbestos

Question 32

d: sclerotherapy

Answer 32

is a procedure used to treat blood vessels or blood vessel malformations

Question 33

what is a good sclerosing agent?

Answer 33

TALC

Question 34

what may someone who has chronic pleural effusion get put in?

Answer 34

a pleural catheter

Question 35

what is a long term pleural catheter?

Answer 35

Vacuum in drainage bottle that provides suction to drain pleural fluid

Question 36

what is the max fluid a pleural catheter can drain a day?

Answer 36

1L

Question 37

d: pneumothorax

Answer 37

collapsed lung due to air leaking into pleural space

Question 38

symptoms of pneumothorax

Answer 38

``` Acute onset pleuritic chest pain SOB, hypoxia Signs Tachycardia Hyper-resonant percussion note Reduced expansion Quiet breath sounds on auscultation Hamman’s sign (‘Click’ on auscultation left side) ```

Question 39

what is a small pneumothorax?

Answer 39

<2cm of air

Question 40

what lever is pneumothorax air measured at?

Answer 40

hilar not apex

Question 41

treatments of pneumothorax

Answer 41

``` Oxygen even if no drain Aspiration 1st line in PSP Chest drain May need suction (air leak >48 hours) Surgical intervention ```

Question 42

what is a tension pneumothorax?

Answer 42

when a one-way valve is formed by an area of damaged tissue, EMERGENCY

Question 43

what happens in a tension pneumothorax?

Answer 43

One-way valve, progressively increasing pressure in pleural space Pushes other chest organs to opposite side to affected side Acute respiratory distress

Question 44

signs of tension pneumothorax

Answer 44

Trachea deviated to opposite side Hypotension Raised JVP Reduced air entry on affected side

Question 45

causes of tension pneumothorax

Answer 45

``` Ventilated patient (invasive or not) Trauma CPR esp PEA Blocked, kinked, misplaced drain Pre existing airways disease Patients undergoing hyperbaric treatment ```

Question 46

treatment of tension pneumothorax

Answer 46

Needle decompression Usually with large bore venflon Second intercostal space anteriorly, mid-clavicular line Hisssssssssssss........

Question 47

name some risk factors for pleural infection

Answer 47

``` diabetes mellitus immunosuppression including corticosteroids gastro-oesophageal reflux alcohol misuse intravenous drug abuse ```

Question 48

d: parapneumonic effusion

Answer 48

parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis

Question 49

d: empyema

Answer 49

collection of pus in the pleural cavity cause by microorganisms

Question 50

how do you treat pleural infection?

Answer 50

``` Antibiotics (often for several weeks) Drain effusion as needed Early discussion with surgeons if persistent sepsis Nutrition VTE prophylaxis ?role for fibrinolytics/Dnase Reassess patients who do not improve ```