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week 4 Flashcards

1
Q

what is pleural effusion ?

A

abnormal collection of fluid in the pleural space

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2
Q

plural effusion always require drainage T/F

A

false
as in some cases like heart failure

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3
Q

what is the difference between the plural aspirate and thoracentesis/ pleural tap

A

A pleural aspirate, also known as pleural fluid, is the fluid that is obtained from the pleural space during a medical procedure called thoracentesis or pleural tap

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4
Q

what does the difference appearance of pleural fluid tells us ?

straw coloured

bloody

turbid/milky

foul smelling

food particles

bilateral

A

Straw-coloured e.g. cardiac failure, hypoalbuminaemia

Bloody e.g. trauma, malignancy, infection, infarction

Turbid/Milky e.g. empyema, chylothorax

Foul smelling - Anaerobic empyema

Food particles - oesophageal rupture

Bilateral – LVF, PTE, drugs, systemic path

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5
Q

what is the difference between the transduate and exuduate

A
  1. Exudate:
    • Exudate is a fluid that leaks out of blood vessels and accumulates in body cavities or tissues as a result of inflammation or injury.
    • It is characterized by a higher protein content, cellular debris, and inflammatory cells (such as neutrophils) compared to transudate.
    • Exudate formation is typically associated with conditions involving inflammation, infection, or tissue damage, such as pneumonia, pleuritis, abscesses, or wounds.
    • Common characteristics of exudative fluids include turbidity, high specific gravity, elevated protein levels, and an elevated white blood cell count.
  2. Transudate:
    • Transudate is a fluid that passes through blood vessel walls and accumulates in body cavities or tissues due to imbalances in hydrostatic and oncotic pressures, without significant inflammation.
    • It has a lower protein content and lacks cellular debris and inflammatory cells compared to exudate.
    • Transudate formation is typically associated with conditions involving changes in hydrostatic pressure (e.g., heart failure, liver cirrhosis) or oncotic pressure (e.g., hypoalbuminemia).
    • Common characteristics of transudative fluids include clarity, low specific gravity, low protein levels, and a low white blood cell count.
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6
Q

what are the amount of protein present in each transdates and exudates

A

trans: less than 30g/l
exudates : more than 30 g/l (extra)

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7
Q

what are the conditions that can cause exudates ?

A

things that can make the endothelial more permeable:
malignancy
infection inc. TB
pulmonary infarct
asbestos

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8
Q

what are the conditions that can cause transudates ?

A

thing that can cause pressure imbalance :
heart failure
liver cirrhoisis
hypoalbuminaeamia
peritoneal dialysis

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9
Q

fluid PH in case of plural effusion

what is the normal PH?

A

about 7.6

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10
Q

what does the ph value of less than 7.3 suggests ?

A

pleurla inflammation

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11
Q

what does PH of less than 7.2 suggest?

A

requires drainage in the setting of an infection

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12
Q

what does low glucose levels suggests in case of plural aspirate ?

A

infection
TB
rheumatoid arthritis
malignancy
esophageal rupture

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13
Q

what does presence of amylase in plural aspirate mean ?

A

Amylase : raised in pancreatitis and oesophageal rupture

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14
Q

what does presence of triglycerides in plural aspirate mean?

A

Triglycerides : chylothorax (trauma to lymphatics, malignancy and LAM)

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15
Q

what does presence of cholesterol crystals in plural aspirate mean?

A

Cholesterol crystals: pseudochylothorax

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16
Q

what does presence of creatinine in plural aspirate mean?

A

urinothorax

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17
Q

what does rise of adenosine deaminases in plural aspirate mean?

A

TB

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18
Q

what are the symptoms of mesothelioma ?

A

fever, chest pain, cough, breathlessness, sweating, weight loss

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19
Q

investigation for mesothelioma

A

Imaging : nodularity + plural thickening

biopsy

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20
Q

treatment for mesothelioma

A

pleurodese effusions eg using talc
chemo
surgery
radio
pleural taps
long term catheter

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21
Q

treatment of plural effusion

A

treat the underlining casus like LVF

LVF using diuretics

malignancy - drain, pleurodesis, long term catheter

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22
Q

what are the two classes of pneumothorax ?

A

primary : no underlying cause
secondary : underlying casus like lung disease like COPD

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23
Q

pneumothorax is more common in ? 3

A

tall thin men
smokers
underlying lung disease

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24
Q

presentation of pneumothorax

A

PSP : may be asymptomatic even if moderately sized
SSP: usually symptomatic even if small

acute onset of chest pain
SOB hypoxia

signs : tachycardia
hyper-resonate percussion
reduced expansion
quite breath

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25
Q

investigations for pneumothorax

A

CXR
CT chest

26
Q

how will u differentiate between small pneumothoraxes and bullous

A

using CT chest

27
Q

management of pneumothorax

A

oxygen always
no treatment if asymtomatic
aspiration
chest drain
surgical intervention

28
Q

why tension pneumothorax is a medical emergency ?

A

can lead to cardiac arrest

29
Q

what is tension pneumothorax ?

A

One-way valve, progressively increasing pressure in pleural space

Pushes other chest organs to opposite side to affected side

Acute respiratory distress

30
Q

what are the signs of tension pneumothorax?

A

trachea deviation
hypotension (^///^)
raided JVP
reduced air entry on affected side

31
Q

treatment of tension PTX

A

needle decompression
Second intercostal space midclavicular line

32
Q

what is empyema ?

A

pus

33
Q

pleural infection is always followed by penumonia T/F

A

false, its not necessary

34
Q

what are the two types of pleural infection ?

A

complicated and simple

complicated : gram +, ph less than 7.2, low glucose, septations and loculations

simple : none of above and are easy to treat with antibiotics

35
Q

management of pleural infection

A

antibiotics (co-amoxiclav)
avoid aminoglycosides as they have poor pleural penetration

drain

36
Q

what are the causes of ILD ?

A

environmental : minerals (asbestos), radiation, mechanical ventilation.

hypersensitivity : avian proteins, mouldy hay

idiopathic : connective disease, idiopathic pulmonary fibrosis

37
Q

how interstitial lung diseases are diagnosed ?

A

clinical
radiological
histological : transbronchial biopsy or thoracoscopic biopsy

38
Q

what is usual interstitial pneumonia ?

A

its pathological term for the idiopathhic pulmonary fibrosis

leads to respiratory failure

unknown cause

occurs mostly in the basal region of the lower lobes

appearance: patchy inertial fibrosis with spatial and temporal heterogeneity

early lesions : fibroblastic foci : dec. fibroblasts, inc. collagen deposits
late lesions : honeycombing, dense fibrosis + metaplasia + hyperplastic type 2 pneumocytes

39
Q

What are the features of early and the late stage of the ILD?

A

early : alveolitis

late : fibrosis (scarring) and eventual leading to honeycombing

40
Q

what are the clinical features of ILD?

A

hypoxia, respiratory failure, secondary pulmonary hypertesnion, and right-heart failure

41
Q

two main pathological category of intestinal lung

A

fibrosing : idiopathic ILD/ UIP, connective tissue disease associated, pneumoconiosis.

granulomatous : sarcoidosis, HP

42
Q

what is connective tissue disease- associated ILD ?

A

occurs as the symptoms in case of the connective tissue diseases like rheumatoid arthritis

causes : interstial fibrosis
pleuritis and pleural effusion
rheumatoid nodules in RA = palisaded histiocytes and necrobiotic center

43
Q

what are rheumatoid nodules ?

A

peripheral zone of palisaded histiocytes
necrobiotic center

44
Q

pneumoconiosis

A

Lung disease caused by reaction to inhaled mineral dust, organic and inorganic particles, chemical fumes and vapours

Usually in an occupational setting

Examples:
Coal workers’ pneumoconiosis
Silicosis
Asbestosis

45
Q

what are the outcomes of the asbestos-related disease?

A

pleural plaques
recurrent pleural effusions
interstitial fibrosis
lung carcinoma
mesothelioma

shows similar pattern as UIP

46
Q

sarcoidosis
types of disease ?
which type of hypersensitivity ?
parts affected ?

A

non caseating systemic granulomatous disease with lung and hilar involvement

type 4

multi-system involvement : lungs, lymph nodes, joints, liver, skin, eyes.

47
Q

Hypersensitivity Pneumonitis (HP)

A

Spectrum of immunologically induced interstitial inflammatory lung disorders caused by exposure to inhaled antigens

occurs in individuals alergic to causative agents like bacteria fungi etc

Acute :exacerbations initially

With prolonged exposure – chronic disease can develop – chronic interstitial fibrosis leading to respiratory failure

48
Q

what are intestinal diseases ?

what is its pattern ?

two symptoms ?

A

disease affecting the lung interstitium ; alveoli, terminal bronchi.

restrictive lung disease pattern

dry cough and breathlessness

49
Q

sarcoidosis is less common in smokers yes or no ?

A

yes

50
Q

symptoms for acute and chronic sarcoidosis

A

acute : arthritis
fever
parotitis
bilateral hilar lymphadenopathy
erythema nodosum

chronic:
lung infiltrates
peripheral lymphadenopathy
hypercalcemia
skin infiltrates

51
Q

diagnosis of sarcoidosis

A

CXR, CT
tissue biopsy
pulmonary function test
blood test

52
Q

treatment of sarcoidosis

A

acute : no treatment
chronic : oral steroids
immunosuppression = azathioprine / methotrexate anti-TNF therapy

53
Q

hypersensitivity pneumonitis
which type of hypersensitivity ?

A

type 3

54
Q

symptoms, signs, treatment for acute hypersensitivity pneumonitis

A

cough, breathlessness , fever myalgia

signs : pyrexia, crackles, hypoxia
CXR: widespread pulmonary infiltrates
treatment : oxygen, steroid, antigen avoidance

55
Q

signs, treatment for acute hypersensitivity pneumonitis

A

signs: crackles, clubbing
CXR : pulmonary fibrosis
removal of antigen, oral steroids if breathless

56
Q

What causes idiopathic pulmonary fibrosis ?

A

caused by imbalance of fibrotic repair system

more common in smokers

57
Q

Idiopathic pulmonary fibrosis is more common in smokers t/f

A

true

58
Q

true or false
ipf is not an inflammatory disease

A

true

59
Q

clinical presentation of IPF

examination

A

progressive breathlessness and dry cough

clubbing, bilateral fine inspiratory crackles

60
Q

antibiotics for IPF

A

nintedanib and pirrenidone

resp (2 decks)

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