Deck 24: Pleural Effusion and Empyema

Question 1

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.

Answer 1

separation of the visceral and parietal pleura.

Question 2

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%

Answer 2

Up to 40%

Question 3

What is the most common cause of a chylothorax?

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

Answer 3

Thoracic duct trauma

Question 4

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 5

The major pathologic and structural changes associated with a significant pleural effusion include all of the following EXCEPT:

A) diaphragm elevation.
B) atelectasis.
C) compression of the great vessels.
D) lung compression.

Question 6

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 7

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 2nd to 3rd intercostal space.
2) The tube is placed in the 4th to 5th 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

Question 8

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 9

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, all of the following tests should be performed EXCEPT:

A) specific gravity.
B) biochemical makeup.
C) cytologic examination.
D) bacterial culture.

Question 10

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, 3, 4

Question 11

Treatment of an empyema usually includes:

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

Question 12

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

Question 13

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

Question 14

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