Pulmonary Pleural Disease

Question 1

Pleural effusion

Answer 1

the accumulation of excess pleural fluid and can be caused by:
- increased pulmonary capillary hydrostatic pressure, increased pulmonary capillary vascular permeability, decreased plasma osmotic pressure, increased negative pressure in the pleural space, lymphatic obstruction

Question 2

pleural effusion can be caused by ______ or __—– processes

Answer 2

inflammatory or non inflammatory

Question 3

Inflammatory causes of pleural effusion

Answer 3

the inflammatory process (pleuritic) results in transudate/ exudate being produced and the accumulation of the non-purulent transudate–> exudate (effusion) in the pleural space, with various amounts of fibrin formation.

Question 4

Transudate and exudate are both fluids collecting in body compartments, however transudate is usually __________ while exudate has a high ________

Answer 4

transudate: usually clear and relatively free of cells and proteins; exudate has a high content of cell, cellular debris and proteins

Question 5

may be ___, ___, or ____ transudate /exudate and may be associated with sharp, stabbing pain worsening with deep respiration (“_____” pain) and a _______

Answer 5

serous, serofibrinous, or fibrinous ; pleuritic pain and a pulmonary friction rub

Question 6

Pleural effusion is generally associated with _____ diseases, especially when they affect the _____ aspects of the lungs

Answer 6

infectious; peripheral (close to the pleural membrane)

such as: tuberculosis, pneumonia, lung infarcts, lung abscess and bronchiectasis

Question 7

Inflammatory Effusion: Empyema occurs when

Answer 7

the effusion contains purulent fluid indicating infection in the fluid (containing large numbers of WBC)
- usually unilateral

Question 8

Empyema usually results from ___ or ____ seeding of the pleural space. seeding usually occurs by ______ of organisms from pulmonary infection, but may also occur via the lymphatic or hematogenous routes or through the diaphragm

Answer 8

bacterial or fungal; contiguous spread;

Question 9

Empyema is characterized by ______ in the pleural space composed of ______

Answer 9

yellow-green, creamy pus in the pleural space; exudate with masses of neutrophils mixed with other leukocytes

Question 10

In Empyema, fibrin forms dense, tough _____ that frequently form the walls of ___ and attach the visceral to the parietal pleura (causing ___ with respiration and _____ pulmonary expansion)

Answer 10

fibrous adhesions; loculations; pain; restrictive

Question 11

Hemorrhagic Inflammatory Effusion (serosanguinous) is manifested by __

Answer 11

blood (sanguineous) mixed with inflammatory exudate

Question 12

Hemorrhagic Effusion is also associated with _____. Must be differentiated from _____

Answer 12

hemorrhagic disorders, infections, and cancers; hemothorax (bleeding into the pleural cavity, not from inflammatory response)

Question 13

Hydrothorax is the collection of __________

Answer 13

non-inflammatory, straw colored serous transudate fluid within the pleural cavities

Question 14

Hydrothorax can be ____ or ___lateral. most common cause is _____ and may be associated with generalized ____. It usually results in ____

Answer 14

unilateral or bilateral; left heart failure; edema; atelectasis.

Question 15

Hemothorax occurs with ______ into the pleural cavity. Usually results in _____

Answer 15

bleeding; atelectasis

Question 16

Chylothorax is accumulation of milky (fat-rich) ______ in the pleural cavity.

Answer 16

lymphatic fluid

Question 17

Chylothorax is caused by thoracic duct ____ or ___ or ____ of major lymphatic ducts (malignant conditions). Usually results in _____

Answer 17

trauma; obstruction or rupture; results in atelectasis

Question 18

Pneumothorax is introduction of ______ into the pleural space which usually results in ___

Answer 18

gas (usually air); atelectasis

Question 19

Spontaneous pneumothorax may occur with _____ allowing gas to enter into the pleural cavity. Associated with ___

Answer 19

rupture of the lung; emphysema, asthma, tuberculosis, abscess, neoplasm

Question 20

Spontaneous idiopathic pneumothorax probably due to rupture of _________. Generally occurs in relatively _____

Answer 20

small, peripheral, usually apical sub pleural blebs; tall, thin young people

Question 21

Traumatic pneumothorax usually caused by _____ injury to the chest wall or lung

Answer 21

perforating

Question 22

Tension pneumothorax: if the point of air entry acts as a _____-

Answer 22

one way, flap valve, permitting air entrance during inspiration but not permitting air escape during expiration, (it will act as a pump that progressively increases intrapleural pressure)

Question 23

In tension pneumothorax- it compresses the mediastium and the contralateral ling, may cause ______

Answer 23

tracheal deviation away form affected side, also hyper expanded chest that moves little with respiration, and an increased percussion not over affected side

Question 24

In pneumothorax, ____ of air from the pleural space air will occur slowly in spontaneous and traumatic pneumothorax, provided that the gas source becomes sealed (defect in lung or chest wall)

Answer 24

resorption

Question 25

small pneumothoraces can be treated with ___ and ____. Large pneumothoraces require ____

Answer 25

time and observation; chest tube insertion

Question 26

Pleural Tumors: ____ tumors are most common, most frequently arise from lung, breast, or ovary. Most metazoic cancers result in ______

Answer 26

metastatic; serous or serosanguinous pleural effusion that often contains neoplastic cells