Question 1

Fluid drained from a thoracentesis has the appearance of pus. Which of the following microorganisms should the therapist typically suspect in children with empyema?&#10;A) Staphylococcus aureus&#10;B) Streptococcus pneumoniae&#10;C) Klebsiella pneumoniae&#10;D) Mycoplasma pneumoniae

Accepted Answer

Streptococcus pneumoniae is the most common organism causing parapneumonic effusion and empyema in children.

Question 2

What is the most common cause of pleural effusion in the pediatric population?&#10;A) Empyema&#10;B) Congestive heart failure&#10;C) Parapneumonic effusion&#10;D) Adenobacterial effusion

Accepted Answer

The most common cause of pleural effusion in pediatrics is a parapneumonic effusion, which indicates that the pleural fluid is the result of an underlying pneumonia. Although typically a bacterial pneumonia, parapneumonic effusion can also result from a virus, fungus, or parasite, or from tuberculosis. If the pneumonia extends to infect the pleural space as well, the effusion is termed an empyema.

Question 3

Which of the following mechanisms explains the accumulation of fluid in the pleural space of patients with ARDS?&#10;A) Increased capillary permeability&#10;B) Decreased osmotic pressure&#10;C) Increased hydrostatic pressure&#10;D) Obstructed lymphatic drainage

Accepted Answer

Increased capillary permeability (e.g., acute respiratory distress syndrome), decreased intravascular colloid osmotic pressure (e.g., low serum albumin), and increased pulmonary venous pressure (e.g., heart failure) are common contributors to accumulation of fluid in the pleural space. Obstructed lymphatic drainage is another factor that favors accumulation of fluid in the pleural space.

Question 4

The therapist is assessing a water seal and a collection chamber and observes bubbling in the water seal chamber. What should the therapist do at this time?&#10;A) Nothing because bubbling indicates normal function&#10;B) Increase the suction pressure&#10;C) Reassess the patient because bubbling indicates presence of air leak&#10;D) Remove the chest tube

Accepted Answer

The level of water in the suction control chamber determines the amount of negative pressure applied to the pleural space. Bubbling in the water seal chamber indicates ongoing air leaks, which are usually from the pleural space.

Question 5

Which of the following laboratory analyses would the respiratory therapist possibly conduct, using a sample of pleural fluid?&#10;A) Determination of the causative microorganism&#10;B) pH determination&#10;C) Determination that the effusion is an exudate or a transudate&#10;D) Composition testing

Accepted Answer

The respiratory therapist may be asked to determine the pleural fluid pH using a blood gas analyzer. The specimen must be collected anaerobically in a heparinized syringe and kept on ice until it is analyzed. A pH <7.0 or <0.15 pH unit below the arterial pH in a patient with parapneumonic effusion may indicate that the patient is at risk for prolonged effusion and subsequent lung entrapment. This has not been extensively studied in children.

Question 6

Which of the following clinical conditions causes fluid to accumulate in the pleural space?&#10;A) Congestive heart failure&#10;B) Asthma&#10;C) Cor pulmonale&#10;D) Chronic obstructive pulmonary disease

Accepted Answer

Increased capillary permeability (e.g., acute respiratory distress syndrome), decreased intravascular colloid osmotic pressure (e.g., low serum albumin), and increased pulmonary venous pressure (e.g., heart failure) are common contributors to accumulation of fluid in the pleural space.

Question 7

Excessive amounts of pleural fluid may require drainage through a chest tube. What is the normal amount of fluid present in the pleural space?&#10;A) 1 L&#10;B) 5 to 10 L&#10;C) 10 to 50 mL&#10;D) 1 to 5 mL

Accepted Answer

The pleural "space" is generally only a potential space with a normal fluid volume of 1 to 5 mL. The pleural membranes, however, are very thin and permeable to both liquid and gas; an estimated 5 to 10 L of fluid per day crosses from the parietal pleura to the visceral pleura in a normal adult.

Question 8

Which of the following are the most common symptoms associated with pneumothorax?&#10;A) Cough and headache&#10;B) Shortness of breath and chest pain&#10;C) Hemoptysis and chest pain&#10;D) Dry cough and dyspnea

Accepted Answer

A small percentage of patients with a pneumothorax are asymptomatic or have only mild and vague symptoms; however, it is much more common for chest pain and shortness of breath to accompany the pneumothorax.

Question 9

What type of auscultatory and percussion findings often reveal evidence of a pleural effusion?&#10;A) Wheezing; hyperresonance&#10;B) Crackles; bronchovesicular&#10;C) Crackles; dull&#10;D) Diminished; dull

Accepted Answer

Pleural effusions may be suspected clinically when there is an area of decreased-intensity breath sounds on chest auscultation with an associated dullness to percussion over the corresponding area.

Question 10

Which of the following clinical symptoms is associated with a pleural effusion?&#10;A) Chest pain&#10;B) Productive cough&#10;C) Dyspnea&#10;D) Dysphagia

Accepted Answer

The patient may experience few symptoms from a small pleural effusion but usually has symptoms of respiratory distress with larger accumulations. Chest pain, chest wall tenderness, dyspnea, and pain with coughing or deep breathing are often associated with pleural effusions.

Question 11

Which of the following conditions is considered a complication of a thoracentesis?&#10;A) Increased intracranial pressure&#10;B) Pneumothorax&#10;C) Pneumonia&#10;D) Consolidation

Accepted Answer

The answer of Which of the following conditions is considered...

Question 12

Which of the following factors determines the amount of fluid present in the pleural space?&#10;A) Intracapillary hydrostatic pressure&#10;B) Subatmospheric pressure in the pleural space&#10;C) Pleural pressure&#10;D) Intra-alveolar pressure

Accepted Answer

The answer of Which of the following factors determines the...

Question 13

What procedure should the therapist suggest to relieve a tension pneumothorax while awaiting more definitive treatment?&#10;A) Insertion of thoracostomy tubes&#10;B) Thoracotomy&#10;C) Thoracentesis with a large-bore needle&#10;D) Needle thoracostomy

Accepted Answer

The answer of What procedure should the therapist suggest to...

Question 14

When a pleural effusion is suspected, which of the following body positions are radiographs generally taken?&#10;A) Anteroposterior (AP) recumbent&#10;B) Posteroanterior (PA) recumbent&#10;C) Fowler&#10;D) Lateral decubitus

Accepted Answer

The answer of When a pleural effusion is suspected, which...

Deck 32: Disorders of the Pleura