Pleurisy, Pleural Effusions, and Empyema Flashcards Preview

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Flashcards in Pleurisy, Pleural Effusions, and Empyema Deck (50):
1

What is pleurisy

Inflammation of the pleura

2

MC cause of pleural effusion in children

Bacterial pneumonia

3

Most common causes of pleural effusion in children second to bacterial pneumonia

1) Heart failure 2) Rheumatologic 3) Metastatic intrathoracic malignancy

4

Inflammatory processes in the pleura are divided into 3

1) Dry or plastic 2) Serofibrinous or serosanguinous 3) Purulent pleurisy or empyema

5

Etiologies of dry/plastic pleurisy

1) Bacterial or viral pulmonary infection 2) Acute URTI 3) Tb 4) Connective tissue disease (e.g. RF)

6

Principal symptom of dry/plastic pleurisy

Pain

7

In dry/plastic pleurisy, the child often lies on which side relative to the affected side

ON the affected side in an attempt to decrease respiratory excursions

8

A leathery, rough, inspiratory and expiratory friction rub may be heard in which phase of illness in cases of dry/plastic pleurisy

Early or late

9

T/F Patients with pleurisy and pneumonia should always be screened for Tb

T

10

T/F In pneumonia with pleural effusion, immobilization of the chest and cough suppressive drugs are indicated

F

11

T/F In pleural effusion without pneumonia, strapping of the chest to restrict expansion may afford relief

T

12

Which type of pleurisy is associated with inflammatory conditions of the abdomen or mediastinum

Serofibrinous/serosanguinous

13

Type of pleurisy associated with primary or metastatic neoplasms of the lung, pleura, or mediastinum

Serofibrinous/serosanguinous

14

Hemorrhagic pleurisy are usually associated with what condition

Tumors

15

Pleural fluid usually come from

Capillaries of the parietal pleura

16

Pleural fluid is absorbed by what structures

Pleural stomas and lymphatics of the parietal pleura

17

The rate of pleural fluid formation is dictated by what law

Starling Law

18

Normally, only ___mL fluid is present in the pleural space

4-12

19

Mechanism of pleural effusion formation in pleural inflammation

1) Increased pleural membrane permeability 2) Increase proteinaceous fluid formation 2) Lymphatic absorption obstruction

20

Serofibrinous pleurisy is often preceded by

Plastic pleurisy

21

PE finding particularly in infants with pleurisy

Bronchial breathing

22

Exudate: Protein level

>3 g/dL

23

Exudate: Pleural fluid:Serum protein ratio

>0.5

24

Exudate: Pleural fluid LDH

Less than 200 IU/L

25

Exudate: Pleural fluid: Serum LDH ratio

>0.6

26

Exudate: pH

Less than 7.2

27

Pleural fluid glucose level in malignancy, rheumatoid disease, and Tb

Less than 60 mg/dL

28

Pleural fluid exam finding of many small lymphocytes and pH less than 7.2 suggests what

Tuberculosis

29

SG of pleural fluid if it is a hydrothorax

Less than 1.015

30

Cells seen in pleural fluid in cases of hydrothorax

Mesothelial cells

31

Order of resolution of pleural effusion from quickest

Bacterial pneumonia > Tb, CT disease > Neoplasm

32

T/F When diagnostic thoracentesis is performed, as much fluid as possible should be removed for therapeutic purposes

T

33

Rapid removal of >1L of pleural fluid may be associated with the development of

Reexpansion pulmonary edema

34

Management for significant reaccumulation of pleural fluid after thoracentesis

Chest tube drainage

35

CTT is indicated in suspected parapneumonic pleural effusion given what characteristics if the pleural fluid

1) pH less than 7.2 2) Pleural fluid glucose less than 50 mg/dL

36

Thrombolytic therapy in cases of pleural effusion is indicated when

Pleural fluid is clearly purulent

37

Purulent pleurisy (empyema) is most often associated with what etiology

S. pneumoniae pneumonia

38

MC cause of empyema in developing nations, Asia, and posttraumatic empyema

S. aureus

39

Empyema is most frequently encountered in what age group

1) Infants 2) Preschool children

40

Stage of empyema wherein fibrinous exudate forms on the pleural surfaces

Exudative stage

41

Stage of empyema wherein fibrinous septa form causing loculation of fluid and thickening of parietal pleura

Fibrinopurulent stage

42

Stage of empyema wherein there is fibroblast proliferation

Organizational stage

43

Stage of empyema wherein there is formation of thick-walled cavities

Organizational stage

44

Condition in which pus dissects through the chest wall

Empyema necessitatis

45

T/F Thoracentesis should always be performed whenever empyema is suspected

T

46

# of neutrophils that would point to a possible empyema

>100,000/uL

47

T/F Blood cultures have a higher yield than cultures of pleural fluid

T

48

Bronchopleural fistulas and pyopneumothorax commonly develops in what type of pneumonia

Staphylococcal

49

This procedure is indicated if fibrinolysis and VATS are ineffective in empyema

Open decortication

50

T/F Instillation of antibiotics into the pleural cavity improves results

F