Flashcards
Pleural Effusion & Empyema
Cards in this deck (20)
- 13 possible causative mechanisms for pleural effusion- Increased drainage of fluid into pleural space
- Increased production of fluid by cells in pleural space
- Decreased drainage of fluid from pleural space - 2Pathophysiology of transudative effusionsElevated capillary pressure (e.g, CHF)
OR
Decreased plasma oncotic pressure (e.g, hypoalbuminemia) - 3Pathophysiology of exudative effusionsIncreased permeability of pleural surfaces
OR
Decreased lymphatic flow from pleural surface due to damage to membranes/vasculature - 47 conditions that can cause transudative effusions- CHF
- Cirrhosis
- PE
- Nephrotic syndrome
- Peritoneal dialysis
- Hypoalbuminemia
- Atelectasis - 55 conditions that can cause exudative effusions- Malignancy
- Bacterial pneumonia or TB
- Viral infection
- PE
- Collagen vascular disease - 6What condition can cause either transudative or exudative effusions?PE
- 7Light's criteriaFor an effusion to be EXUDATIVE, at least one of these must be true:
1. Fluid:serum protein >0.5
2. Fluid:serum LDH > 0.6
3. Fluid LDH > 2/3 upper limit of normal serum LDH - 83 causes of elevated pleural fluid amylasePancreatitis
Esophageal rupture
Malignancy - 9Types of effusions with pH < 7.2Parapneumonic
or
Empyema - 10If pleural fluid glucose > 60, consider ___________.Rheumatoid arthritis
- 11_____ mL of pleural fluid must accumulate before an effusion can be seen on CXR250 mL
- 12Best type of CXR to detect small pleural effusionsLateral decubitus
- 13Pneumothorax is a complication in ______% of thoracenteses10-15%
- 14When should you not perform a thoracentesis, based on effusion size?If effusion is <10-mm thick on lateral decubitus CXR
- 15Treatment of transudative pleural effusions- Diuretics
- Sodium restriction
- Therapeutic thoracentesis, if large enough to cause dyspnea - 16Treatment of exudative effusionsTreat underlying cause
- 17Treatment of uncomplicated parapneumonic effusionsAntibiotics
- 18Treatment of complicated parapneumonic effusions or empyemaChest tube drainage
Intrapleural injection of thrombolytics (streptokinase or urokinase) can accelerate drainage
Surgical lysis of adhesions may be required - 19Most empyemas occur as a complication of ________________.bacterial pneumonia
- 20Difference between parapneumonic effusion and empyemaParapneumonic effusion - noninflected effusion secondary to bacterial PNA
Empyema - complicated parapneumonic effusion, meaning it's become infected
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- USMLE Step 2 Pulmonology (2c Diseases of the Pleura) Flashcards on Pleural Effusion & Empyema, created by Aaron Samide on 12/05/2016.
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- Aaron Samide
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