Deck 24: Pleural Effusion and Empyema

Question 1

In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify?

A) Malignant disease
B) Fungal disease
C) Chylothorax
D) Tuberculosis

Answer 1

Malignant disease

Question 2

Which of the following are associated with a transudative pleural effusion?
1) Thin and watery fluid
2) Fluid has a lot of cellular debris
3) Fluid has high protein count
4) Few blood cells

A)2, 3
B)1, 4
C)1, 2, 3
D)1, 3, 4

Answer 2

1, 4

Question 3

An adult patient with a large pleural effusion requires placement of a thoracostomy tube. Which of the following statements are true regarding thoracostomy tube placement?
1) The tube is placed in the second to third intercostal space.
2) The tube is placed in the fourth to fifth intercostal space.
3) The tube is placed in the midclavicular line.
4) The tube is placed in the midaxillary line.

A)1, 4
B)2, 3
C)1, 3
D)2, 4

Answer 3

2, 4

Question 4

A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described?

A) Milky white
B) Straw colored
C) Red
D) Green

Question 5

Treatment of an empyema typically includes:

A) pleurodesis.
B) thoracostomy tube insertion.
C) lobectomy.
D) pneumonectomy.

Question 6

Pulmonary function testing on a patient with atelectasis associated with pleural effusion would likely reveal:
1) increased VC.
2) decreased ERV.
3) decreased FRC.
4) normal RV/TLC ratio.

A)1, 4
B)2, 3
C)2, 3, 4
D)1, 3, 4

Question 7

A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis?
1) Erythrocytes
2) Lymphocytes
3) Normal mesothelial cells
4) Malignant mesothelial cells

A)1, 4
B)2, 3
C)2, 3, 4
D)1, 2, 4

Question 8

A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, which of the following tests should be performed?
1) Specific gravity
2) Biochemical makeup
3) Cytologic examination
4) Bacterial culture

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Question 9

During a chest assessment on a patient with a large pleural effusion, which of the following would be expected?
1) Increased tactile and vocal fremitus
2) Hyperresonant percussion note
3) Diminished breath sounds
4) Tracheal shift

A)1, 4
B)1, 2
C)3, 4
D)1, 3, 4

Question 10

The major pathologic and structural changes associated with a significant pleural effusion include which of the following?
1) Diaphragm elevation
2) Atelectasis
3) Compression of the great vessels
4) Lung compression

A)1, 4
B)2, 3
C)2, 3, 4
D)1, 3, 4

Question 11

What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?

A) Up to 10%
B) Up to 20%
C) Up to 30%
D) Up to 40%

Question 12

While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?

A) Meniscus sign
B) Scarf sign
C) Transudate sign
D) Kerley B lines

Question 13

The anatomic alteration caused by a pleural effusion is:

A) pulmonary fibrosis.
B) separation of the visceral and parietal pleura.
C) adhesion of the visceral and parietal pleura.
D) pulmonary edema.

Question 14

Which of the following are chest radiograph findings associated with a large pleural effusion?
1) Blunting of the costophrenic angle
2) Fluid level on the affected side
3) Mediastinal shift toward the unaffected side
4) Elevated hemidiaphragm on the affected side

A)1, 3
B)2, 4
C)1, 2, 4
D)1, 2, 3

Question 15

What is the most common cause of a chylothorax?

A) Thoracic duct trauma
B) Abdominal tumor
C) GERD
D) Pyloric stenosis