Deck 25: Pleural Diseases

Question 1

A patient with nephritic syndrome is noted to have a large right-sided pleural effusion and a small to medium-sized left-sided pleural effusion. What would explain this finding?

A)The nephrosis is complicated by CHF.
B)The nephrosis is complicated by pulmonary emboli.
C)This is a common finding in patients with nephrosis.
D)This just a complicated case of nephrosis.

Answer 1

B

Question 2

At what point is intrapleural pressure most negative?

A)end exhalation
B)FRC
C)inspiration
D)maximal expiration

Answer 2

C

Question 3

What is the most common cause of pleural effusion that occurs due to lymphatic obstruction within the mediastinum?

A)cancer that has metastasized to the mediastinum
B)hepatic hydrothorax
C)malignant pleural effusion
D)tuberculous pleurisy

Answer 3

A

Question 4

Most pleural effusions are transudative.

Question 5

Exudative pleural effusions have more protein and inflammatory cells present compared to transudative effusions.

Question 6

Pleural fluid with a total protein concentration of less than 50% of the serum total protein level is one of the indications of transudative pleural effusion.

Question 7

What type of pleural problem is most likely to develop from rupture of the thoracic duct?

A)chylothorax
B)hemothorax
C)hydrothorax
D)pneumothorax

Question 8

What is the most common cause of pleural effusion in the clinical setting?

A)acute renal failure
B)congestive heart failure
C)liver disease
D)lung cancer

Question 9

Which of the following conditions is most closely associated with exudative pleural effusion?

A)cirrhosis of the liver
B)congestive heart failure
C)nephrotic syndrome
D)tuberculosis

Question 10

What is the most common cause of hemothorax?

A)chest trauma
B)malignancy
C)pulmonary embolism
D)surgery

Question 11

What is a common complication of pleurodynia (pleural pain)?

A)atelectasis
B)insomnia
C)pneumonia
D)pneumothorax

Question 12

Nephrotic syndrome causes pleural effusion by increasing oncotic pressure in the blood as a result of a protein leak into the urine.

Question 13

Which of the following statements about pleural fluid is FALSE?

A)Fluid can move easily between each hemithorax.
B)Normal protein concentration is between 1.3 and 1.4 g/dl.
C)The total volume is approximately 16 ml.
D)Total protein concentration is similar to that of interstitial fluid elsewhere in the body.

Question 14

What is the most common cause of a chylothorax?

A)chest trauma
B)malignancy
C)pulmonary embolism
D)surgery

Question 15

What is the most likely cause of a large unilateral pleural effusion in a 70 year old patient?

A)congestive heart failure
B)malignancy
C)pneumonia
D)tuberculosis

Question 16

Pleural effusion is a complication of ascites in less than 10% of the cases.

Question 17

The pleural effusions associated with heart failure are rarely drained.

Question 18

How much pleural fluid does a normal healthy adult have in each hemithorax?

A)5 ml
B)8 ml
C)12 ml
D)16 ml

Question 19

What is a common clinical finding even with small pleural effusions?

A)air bronchograms
B)arrhythmias
C)dyspnea
D)tachycardia

Question 20

What is a common cause of persistent fever in intensive care unit (ICU) patients with pneumonia?

A)congestive heart failure
B)most exudative effusions
C)parapneumonic effusions
D)transudative effusions

Question 21

What diagnostic procedure or technique is most sensitive for the identification of pleural effusion?

A)chest radiography
B)computed tomography
C)pleurodesis
D)thoracoscopy

Question 22

A quick diagnosis based on clinical presentation can significantly improve the survival rates in patients with tension pneumothorax.

Question 23

What are the functions of a chest tube in a patient with chest trauma that causes bleeding and pneumothorax?
I)to measure the rate of bleeding
II)to improve ventilation
III)to allow lung reexpansion

A)I and II
B)II and III
C)III only
D)I, II, and III

Question 24

Primary spontaneous pneumothorax occurs in a patient with no previous underlying lung disease.

Question 25

In what age group is a primary spontaneous pneumothorax most commonly seen?

A)under 15 years
B)18 to 25 years
C)35 to 45 years
D)over 60 years

Question 26

Dyspnea occurs in the majority of patients with a pneumothorax.

Question 27

Chest pain occurs in only a small percentage of patients with a pneumothorax.

Question 28

What underlying lung disease is most often present in a patient with secondary spontaneous pneumothorax?

A)asthma
B)chronic obstructive pulmonary disease (COPD)
C)interstitial pulmonary fibrosis
D)pneumonia

Question 29

What is the primary risk factor associated with spontaneous pneumothoraces?

A)cigarette smoking
B)heavy exercise
C)obesity
D)urban living

Question 30

Iatrogenic pneumothorax is the most common type of traumatic pneumothorax.

Question 31

Which of the following is NOT a typical complication of thoracentesis?

A)infection
B)intercostal artery laceration
C)rib fracture
D)pneumothorax

Question 32

What diagnostic procedure or technique is most commonly used to diagnosis the presence of a pleural effusion?

A)chest radiography
B)pleuroscopy
C)thoracentesis
D)thoracoscopy

Question 33

Chest tubes should be directed toward the base of the lung to evacuate a pneumothorax.

Question 34

What agent has proved to be the most successful in pleurodesis?

A)mixture of saline and Mucomyst
B)acetaminophen in suspension
C)saline solution mixed with heparin
D)talc suspended in saline

Question 35

What size of chest tube would you use in the management of trauma related pneumothoraces?

A)large
B)medium
C)small
D)size is immaterial

Question 36

Pleural effusions that occur secondarily to _____ are most often treated with pleurodesis.

A)ascites
B)congestive heart failure
C)malignancy
D)nephrotic syndrome

Question 37

Describe a secondary spontaneous pneumothorax.

A)pneumothorax that occurs secondary to cardiac complications
B)pneumothorax that occurs without trauma or any underlying disease
C)pneumothorax that results from nonpenetrating chest trauma
D)pneumothorax that results from underlying lung disease

Question 38

At what anatomic position should an 18-gauge IV catheter be placed to relieve a tension pneumothorax?

A)just inferior to the second rib
B)just inferior to the third rib
C)just superior to the second rib
D)just superior to the fourth rib

Question 39

Which of the following findings on a radiologic report would indicate the presence of a tension pneumothorax?

A)bilateral inversion of diaphragm, long narrow heart, flattened ribs
B)blunting of costophrenic angles, marked interstitial infiltrates, apical free air
C)contralateral mediastinal shift, diaphragmatic depression, flattening of ribs
D)ipsilateral mediastinal shift, sail-shape noted right hemithorax, marked interstitial infiltrates right sided

Question 40

What anatomical position is most likely to show the presence of a small pleural effusion in the upright chest radiograph?

A)apical regions
B)costophrenic angles
C)fissures
D)subdiaphragmatic region

Question 41

The administration of oxygen to a patient with a pneumothorax will speed the rate at which resolution occurs once the leak has stopped.

Question 42

What method of chest tube removal has been associated with the lowest level of pneumothorax recurrence?

A)Clamp the chest tube for 4 hours; if chest radiograph is good, remove the tube.
B)Clamp chest tube for 24 hours; if clinically stable, remove the tube.
C)Remove the chest tube as soon as the air leak resolves.
D)Remove the chest tube 48 hours after the air leak resolves.

Question 43

If accurate sizing on a pneumothorax is desired, what diagnostic technique would be most appropriate?

A)chest radiography
B)computed tomography
C)PET scan
D)ultrasonography

Question 44

What complication often occurs following rapid lung reexpansion due to the evacuation of air or fluid from the pleural space?

A)arrhythmias
B)pulmonary edema
C)pulmonary emboli
D)systemic hypotension

Question 45

What is the primary tool used to diagnosis a pneumothorax?

A)chest radiography
B)computed tomography
C)PET scan
D)ultrasonography

Question 46

For which type of pneumothorax is pleurodesis most commonly indicated?

A)iatrogenic
B)bronchopleural fistula
C)spontaneous
D)traumatic

Question 47

Which of the following could be early warning signs that a pneumothorax is enlarging?
I)decreased pulse oximetryt reading
II)development of a fever
III)increased respiratory rate
IV)mental confusion

A)I, II, and III
B)I and III
C)II only
D)I, II, III, and IV

Question 48

When using a small-bore catheter with a one-way valve such as a Heimlich valve, how can you determine definitively that there is or is not a small air leak?

A)Connect to an underwater seal.
B)Increase the FIO₂ and note clinical changes.
C)Listen for air movement.
D)Watch the valve to see if it moves.