Pleural Disease

Front 1

Lungs are derived from ____ but pleura are derived from _____/

Back 1

endoderm, mesoderm

Front 2

Tightly adherent to lung.

Back 2

Visceral pleura

Front 3

Lines chest wall.

Back 3

Parietal pleura

Front 4

Pleura allow lungs to do what?

Back 4

move independently in the chest

Front 5

If pleural space scars, are lungs still fxnal?

Back 5

yes, unless scarring is so severe to trap lung and prevent m'ment

Front 6

T/F: Pleura are critical for life.

Back 6

False

Front 7

What advantage does the pleural space give to thoracic surgeons?

Back 7

you can reinflate a collapsed lung

Front 8

What is the consistency of pleura?

Back 8

like vinyl on a backpack

Front 9

T/F: Pleura is difficult to see radiographically in the absence of disease.

Back 9

True

Front 10

Pleural plaque is ____ pleura.

Back 10

thickened

Front 11

Histological appearance of pleura.

Back 11

Layer of mesothelial layer, followed by a layer of collagen and elastic fibers w/ blood vessels

Front 12

2-12 microns in diameter, allow fluid that has been filtered in pleural space to escape to lymphatics

Back 12

stomata

Front 13

Stomata are only found in the ___ pleura.

Back 13

parietal

Front 14

Visceral pleura is supplied by ____ arteries, drains into ____ veins.

Back 14

bronchial, pumlmonary

Front 15

Parietal pleura is fed by ____ arteries, drains into ___.

Back 15

intercostal, systemic circulation

Front 16

Average pressure of pleural space?

Back 16

-5 cm H2O

Front 17

Normally turnover rate of transudate is ___ ml/day, this is the same amount that is normally in there.

Back 17

20

Front 18

Abnormal accumulationof fluid (>100-200 ml) in pleural space.

Back 18

pleural effusion

Front 19

Mechanisms of pleural effusion.

Back 19

altered starling forces - high hydrostatic or low oncotic pressures
increased capillary permeability - inflammation
reduced elimination - lymphatic obstruction w/ cancer
entry from somewhere else - diaphragm

Front 20

How does fluid enter pleural space from diaphragm?

Back 20

diaphragm has openings that act like one way valves. Ascitic fluid in peritoneum gets into pleural space b/c of lower pressure

Front 21

Definition of transudate:

Back 21

All three criteria:
pleural fluid/serum protein ratio < 0.5
pleral fluid/serum LDH < 0.6
pleural fluid LDH < 2/3 upper limit of normal for serum LDH

Front 22

Definition of exudate:

Back 22

Failure to meet one of the following criteria:
pleural fluid/serum protein ratio < 0.5
pleral fluid/serum LDH < 0.6
pleural fluid LDH < 2/3 upper limit of normal for serum LDH

Front 23

Tap effusion using needle through chest wall

Back 23

thoracentesis

Front 24

3 common causes of transudate:

Back 24

CHF (most common) - increased hydrostatic pressures
nephrotic syndrome - low blood protein
cirrhosis - low protein, also get ascites

Front 25

High pulomary circulation causes ___ ___ and ___ pleural effusion.

Back 25

pulmonary edema, visceral

Front 26

High pressure in systemic circulation causes _____ ____ and ___ pleural effusion.

Back 26

peripheral edema, parietal

Front 27

Pleural effusion tends to be ___ but is worse on ___.

Back 27

bilateral, right

Front 28

Four common causes of exudate:

Back 28

pneumonia
cancer
pulmonary thromboemboli
collagen vascular disease

Front 29

Parapneumonic effusions can get infected b/c of all the bacteria and white cells in exudate...this is called?

Back 29

empyema

Front 30

What is the cut off for tapping a parapneumonic effusion?

Back 30

more than 1 cm of fluid on lateral decubitis film

Front 31

Most common causes of malignant effusions?

Back 31

LC and breast cancer

Front 32

What defines a LC (stage 3b) that is not resectable?

Back 32

cancer cells in pleural fluid

Front 33

How does cancer cause an exudative effusion?

Back 33

blocking the lymphatics and disrupting the capillaries

Front 34

Why does PE result in a exudative effusion?

Back 34

infarction at level of embolus so there's damaged tissue and inflammation -->leaky capillaries

Front 35

An effusion due to PE often contains what?

Back 35

blood

Front 36

Two common collagen vascular diseases that can give effusions.

Back 36

RA and lupus

Front 37

Which collagen vascular disease has the highest prevalence of pleural effusion?

Back 37

RA

Front 38

Low glucose in an exudative effusion indicates?

Back 38

empyema or RA

Front 39

High amylase in an exudative effusion indicates?

Back 39

pancreatitis or esophageal perforation

Front 40

Lymphocytes in an exudative effusion indicates?

Back 40

TB

Front 41

Blood in an exudative effusion indicates?

Back 41

3T's:
Tumor
Trauma
Thromboemboli

Front 42

What determines the difference between bloody effusion and hemothorax?

Back 42

hematocrit>50% of peripheral blood hematocrit indicates hemothorax that must be drained

Front 43

High triglycerides in exudative effusion indicates?

Back 43

chylothorax, due to thoracic duct being interuppted by lymphoma

Front 44

Air in the chest.

Back 44

Pneumothorax

Front 45

Tall young men are susceptible to ____ pneumothoracies. Why?

Back 45

spontaneous

Lung is long and has a lot of weight, putting traction on top of lung. This causes subpleural bullae which ruptures, giving a pneumothorax and deflating lung.

Front 46

Patient has one spontaneous pneumothorax. Your course of action?
With a second?

Back 46

Put in chest tube and let air leak out.

After second one, scar chest wall by abrading parietal pleural to prevent another.

Front 47

What can cause bullous changes leading to possible pneumothorax?
How do these patients tolerate this?

Back 47

emphysema

Don't tolerate it well b/c of underlying disease... you should scar chest wall after first occurence.

Front 48

Hole in lung acts as a one way valve that pulls air into chest, but air can't get out. With each breath pneumothorax gets bigger and bigger.

Back 48

Tension pneumothorax

Front 49

Tension means that pressure is greater in pleural space/atmosphere?

Back 49

pleural space

Front 50

What can a tension pneumothorax lead to?

Back 50

one lung shifts past midline and impedes fxn of other lung and impedes venous return to chest

Front 51

Most common cause of pleural plaque.

Back 51

asbestos exposure

Front 52

T/F: A patient w/ pleural plaques is more likely to get mesothelioma than another patient (who is also exposed to asbestos).

Back 52

False

Front 53

Lay term for pleural pain?
Which means?

Back 53

pleurisy/pleuritic pain
inspiratory pain

Front 54

Does pleuritic pain always come from pleura?

Back 54

No, can break a rib and have inspiratory pain w/o pleural involvement. Pericarditis can also cause inspiratory pain.

Front 55

When someone complains of pleuritic pain check for?

Back 55

pneumonia

Front 56

If someone complains of pleuritic pain, but has clear CXR and no fever, you should check for?

Back 56

pulmonary thromboemboli

Front 57

You can see pleural pain from a ____ infection that usually gives an ____

Back 57

viral, effusion