Question 1

Which of the following are major causes of an exudative pleural effusion?
1) Empyema
2) Chylothorax
3) Pancreatitis
4) Peritoneal dialysis
A)1, 4
B)2, 3
C)1, 2, 3
D)1, 2, 3, 4

Accepted Answer

C

Question 2

Your patient has a large pleural effusion. It will act as a/an:
A) restrictive lung disorder.
B)obstructive lung disorder.
C)obstructive > restrictive lung disorder.
D)restrictive > obstructive lung disorder.

Accepted Answer

Pleural effusion is the accumulation of excessive fluid in the pleural space. This abnormal accumulation of fluid in the pleural cavity can compress the lung parenchyma and affect the normal expansion of the lung during inspiration. As a result, patients with pleural effusion exhibit a decrease in lung volumes, which is characteristic of restrictive lung disorders. In restrictive lung disorders, the lungs' ability to expand is limited, leading to a decreased total lung capacity, decreased vital capacity, and decreased functional residual capacity. Therefore, option A is the correct answer.

Question 3

Your 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)check for bacteria.

Accepted Answer

Specific gravity is not typically performed on pleural effusion samples, as it is not as relevant in identifying the cause of the effusion as the other tests listed. Biochemical makeup, cytologic examination, and checking for bacteria are all common tests performed to determine the underlying cause of a pleural effusion.

Question 4

While reviewing the upright chest radiograph of your patient, you see a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this sign of a pleural effusion called?
A) Meniscus sign
B)Scarf sign
C)Transudate sign
D)Kerley B lines

Accepted Answer

The fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls is called a meniscus sign, which is a classic radiographic finding of a pleural effusion. The other options, Scarf sign, Transudate sign, and Kerley B lines, are not relevant to pleural effusions.

Question 5

Your are assisting the physician who is performing a thoracentesis. It is suspected that the patient has a hemothorax. If that is the case, how would the pleural effusion fluid appear?
A) White color
B)Light yellow color
C)Red color
D)Green color

Accepted Answer

If the patient has a hemothorax, the pleural effusion fluid would appear red due to the presence of blood in the fluid.

Question 6

Usual chest radiograph findings on a patient with a large pleural effusion include:
1) blunting of the costophrenic angle.
2) fluid level on the affected side.
3) mediastinal shift to the unaffected side.
4) mediastinal shift to the affected side.
A)1, 3
B)2, 4
C)1, 2, 4
D)1, 2, 3

Accepted Answer

Blunting of the costophrenic angle, a fluid level on the affected side, and mediastinal shift to the unaffected side are all usual chest radiograph findings on a patient with a large pleural effusion.

Question 7

The causes of a transudative pleural effusion include:
1) congestive heart failure.
2) fungal pneumonia.
3) pulmonary embolism.
4) hemothorax.
A)1, 3
B)2, 4
C)1, 3, 4
D)1, 2, 3, 4

Accepted Answer

Transudative pleural effusion is caused by an imbalance in hydrostatic and oncotic pressures in the pleural space. The most common causes of transudative pleural effusion are congestive heart failure and pulmonary embolism. Fungal pneumonia and hemothorax are potential causes of exudative pleural effusion.

Question 8

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

Accepted Answer

Transudative pleural effusions are caused by increased fluid buildup due to changes in hydrostatic or osmotic pressure, and are typically caused by underlying conditions such as heart failure, cirrhosis, or kidney failure. The fluid in transudative pleural effusions is thin and watery (1) with few blood cells (4), and has a low protein count (2). Therefore, choices 2 and 3, which suggest high cellular debris and high protein count, respectively, are not associated with transudative pleural effusions.

Question 9

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.

Accepted Answer

A large effusion could cause the diaphragm to be depressed, not elevated.

Question 10

Your patient with a large pleural effusion will have a chest tube inserted. Which of the following statements are true of this procedure?
1) Tube placement in the 2nd to 3rd intercostal space
2) Tube placement in the 4th to 5th intercostal space
3) Tube placement in the midclavicular line
4) Tube placement in the midaxillary line
A)1, 4
B)2, 3
C)1, 3
D)2, 4

Accepted Answer

For a pleural effusion, the chest tube is typically placed in the 4th to 5th intercostal space at the midaxillary line.

Question 11

Treatment of an empyema usually includes:
1) antibiotics for bacterial infection.
2) thoracentesis.
3) lung removal (pneumonectomy).
4) lung transplant.
A)1
B)2
C)2, 3
D)1, 2

Accepted Answer

Empyema is typically treated with a combination of antibiotics to address the underlying bacterial infection and thoracentesis, which involves draining the accumulated fluid from the pleural space. Lung removal (pneumonectomy) and lung transplant may be considered in more severe or advanced cases, but these are typically not the first-line treatments for empyema.

Question 12

Your patient with pneumonia of the left lung and related empyema has a distinctive breath sound heard over the affected area. What is the name of this characteristic breath sound?
A) Bronchial breath sound
B)Pleural friction rub
C)Empyema rhonchi
D)Pleural crackles

Accepted Answer

The characteristic breath sound heard over the affected area in a patient with pneumonia and related empyema is a pleural friction rub. This is caused by the inflamed pleura rubbing together during respiration, producing a grating, rubbing or creaking sound. Bronchial breath sounds are typically heard over the trachea and large bronchi, whereas pleural crackles are associated with fluid-filled airways or alveoli. Empyema rhonchi may occur in patients with empyema, but is not the characteristic breath sound associated with this condition.

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.

Accepted Answer

Pleural effusion is the accumulation of fluid in the pleural space, which naturally separates the visceral and parietal pleura. This condition does not cause fibrosis, adhesion, or edema directly but rather increases the space between the pleurae due to fluid accumulation.

Question 14

A large pleural effusion commonly demonstrates which of the following findings during a chest assessment?
1) Increased tactile and vocal fremitus
2) Hyperresonant percussion note
3) Diminished breath sounds
4) Tracheal shift
A)1
B)2, 3
C)3, 4
D)1, 3, 4

Accepted Answer

A large pleural effusion can cause the lung to collapse, leading to a shift in the trachea and mediastinum towards the unaffected side. This is reflected as tracheal shift. Due to decreased air-filled spaces, a pleural effusion will produce dullness to percussion with decreased tactile and vocal fremitus. Additionally, there will be a decrease in breath sounds heard over the affected area.

Question 15

Your patient has cancer related to his chronic asbestos exposure. What is his pleural effusion fluid likely to 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

Accepted Answer

The pleural effusion fluid from a patient with cancer related to chronic asbestos exposure is likely to show malignant mesothelial cells. The fluid may also show lymphocytes and normal mesothelial cells. Erythrocytes may or may not be present in the fluid. Therefore, options A, B, and D are all incorrect. The correct answer is option C, as it includes all the possible cell types that may be seen in pleural effusion fluid from a patient with cancer related to chronic asbestos exposure.

Quiz 23: Effusion and Empyema

Which of the following are major causes of an exudative pleural effusion? 1) Empyema 2) Chylothorax 3) Pancreatitis 4) Peritoneal dialysis

Your patient has a large pleural effusion. It will act as a/an:

Your 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:

While reviewing the upright chest radiograph of your patient, you see a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this sign of a pleural effusion called?

Your are assisting the physician who is performing a thoracentesis. It is suspected that the patient has a hemothorax. If that is the case, how would the pleural effusion fluid appear?

Usual chest radiograph findings on a patient with a large pleural effusion include: 1) blunting of the costophrenic angle. 2) fluid level on the affected side. 3) mediastinal shift to the unaffected side. 4) mediastinal shift to the affected side.

The causes of a transudative pleural effusion include: 1) congestive heart failure. 2) fungal pneumonia. 3) pulmonary embolism. 4) hemothorax.

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

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

Treatment of an empyema usually includes: 1) antibiotics for bacterial infection. 2) thoracentesis. 3) lung removal (pneumonectomy) . 4) lung transplant.

Your patient with pneumonia of the left lung and related empyema has a distinctive breath sound heard over the affected area. What is the name of this characteristic breath sound?

The anatomic alteration caused by a pleural effusion is:

A large pleural effusion commonly demonstrates which of the following findings during a chest assessment? 1) Increased tactile and vocal fremitus 2) Hyperresonant percussion note 3) Diminished breath sounds 4) Tracheal shift

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