Resp - 28 - Pleural Effusion

Front 1

what kind of disease pushes trachea to the opposite side of the lesion? same side?

Back 1

pleural problems push trachea to the opposite side (either have fluid effusion or air like in pneuomothorax)

trachea deviation to same side as the lesion is often due to lung parenchymal disease - fibrosis/loss of lung volume pulls the trachea to the same side

Front 2

pleural fluid formation and drainage

Back 2

pleural fluid secretion is greatest at the apex

drainage is greatest at the base through lymph in the parietal pleura

visceral pleura not involved with fluid turnover

usually no net fluid - amount secreted = amount drained

Front 3

transudate vs exudate

Back 3

transudate - not much cells or protein, just fluid - low protein, low LDH, high glucose, low WBC - clear solution

exudate - lots of protein and/or cells - often caused by direct pleural membrane damage by infection, cancer, pulm infarction, pleuritis

Front 4

common causes of pleural effusion

Back 4

pneumonia
cancer
CHF

Front 5

physical exam of pleura effusion vs penumothorax

Back 5

percussion

dullness in effusion

hyperresonent with pneumothorax

Front 6

bilateral pleural effusion think what

Back 6

CHF is most common

Front 7

thoracocentesis

Back 7

if fluid depth more than 1 cm

Front 8

90% lymphocytes in effusion

50% lymphocytes in effusion

see RBC in effusion

Back 8

90% - think TB then possibly cancer

50% - think cancer first, then tB

RBC - see trauma, PE, infarction

Front 9

chylothroax

Back 9

triglycerides in the pleural effusion - due to lymphoma or damage to thoracic duct

Front 10

pseudochylothroax

Back 10

cholesterol in pleural effusion

Front 11

urinothorax

Back 11

urine in the pleural effusion - due to kidney damage

Front 12

pleural fluid analysis look for

Back 12

pleural total protein/serum total rotein > 0.5

pleural LDH/serum LDH > 0.6

pleural LDH > 2/3 upper limit of normal for serum LDH

all these indicate exudate