Pleural Effusion Quiz: Trivia Exam!

18 Questions | Total Attempts: 3458

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Pleural Effusion Quiz: Trivia Exam! - Quiz

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Questions and Answers
  • 1. 
    Mrs. B is a 72-year-old woman who has increasing shortness of breath over a few weeks.. This radiograph shows all of the following EXCEPT:
    • A. 

      Moderate right pleural effusion

    • B. 

      Atelectasis in right upper lung

    • C. 

      Displacement of mediastinal structures

    • D. 

      No cardiomegaly

    • E. 

      No vascular redistribution

  • 2. 
    Which of the following might you ask the patient to help identify the cause of the radiographic abnormalities?
    • A. 

      Travel history

    • B. 

      Occupational exposures

    • C. 

      Smoking history

    • D. 

      Past medical history

    • E. 

      All of the above

  • 3. 
    All of the following is one of Light's Criteria (for the diagnosis of pleural exudative effusions) EXCEPT:
    • A. 

      Pleural proteins/serum proteins greater than 0.5 ratio

    • B. 

      Pleural LDH/serum LDH greater than 0.6 ratio

    • C. 

      LDH greater than 2/3 upper limit of normal for serum

    • D. 

      Total proteins greater than 2/3 upper limit of normal for serum

  • 4. 
    Which of the following causes of pleural effusion is Transudative?
    • A. 

      Rheumatoid Arthritis

    • B. 

      PE

    • C. 

      Pancreatitis

    • D. 

      Systolic Heart Failure

  • 5. 
    She is originally from Latvia and lived in a concentration camp during the war.  She has previously worked in the laundry department of a TB hospital.  No known asbestos exposures.  50 pack-year smoking history, past medical history significant for cryptogenic cirrhosis, and a diagnosis of lupus.  There is no history of heart failure.  Physical exam reveals RR 16, afebrile, not in acute distress, trachea not deviated, dull to percussion lower 1/3 R hemithorax, egophony and increased tactile fremitus above the level of effusion, no evidence of JVD, pedal edema, and normal S1 and S2 without adventitious sounds, and no ascites.  Diagnostic Thoracentesis and Pleural Fluid Analysis were performed.  Pleural fluid findings: pH 7.32, LDH 302, total proteins 48. Serum LDH 124, total proteins 78. Is this a transudate or exudate?
    • A. 

      Transudate

    • B. 

      Exudate

    • C. 

      Pedal edema

  • 6. 
    She is originally from Latvia and lived in a concentration camp during the war.  She has previously worked in the laundry department of a TB hospital.  No known asbestos exposures.  50 pack-year smoking history, past medical history significant for cryptogenic cirrhosis, and a diagnosis of lupus.  There is no history of heart failure.  Physical exam reveals RR 16, afebrile, not in acute distress, trachea not deviated, dull to percussion lower 1/3 R hemithorax, egophony, and increased tactile fremitus above the level of effusion, no evidence of JVD, pedal edema, and normal S1 and S2 without adventitious sounds, and no ascites.  Diagnostic Thoracentesis and Pleural Fluid Analysis were performed.  Pleural fluid findings: pH 7.32, LDH 302, total proteins 48. Serum LDH 124, total proteins 78. Culture and sensitivity and AFB- negative, cell count does not suggest infections, cytology negative. ANA 1:160 and remainder of connective tissue work-up negative.  LFTs in the normal range, no fluid in abdominal imaging, and no masses.  Pleural biopsy showed non-specific changes.  What do you do next? 
    • A. 

      Treat for infection

    • B. 

      Treat with anti-inflammatories

    • C. 

      Biopsy liver

    • D. 

      Thoracoscopy

  • 7. 
    27-year-old man, previously well, presents with a 1-week history of productive cough, left-sided chest pain, and the following CXR  The x-ray shows all of the following EXCEPT
    • A. 

      Large left-sided effusion

    • B. 

      Meniscus sign laterally

    • C. 

      Mediastinal shift

  • 8. 
    This CT shows/suggests:
    • A. 

      Multi-loculated effusion

    • B. 

      Airspace disease

    • C. 

      Pleural enhancement

    • D. 

      Infectious/inflammatory etiology

    • E. 

      Air bronchograms

    • F. 

      All of the above

  • 9. 
    Further history reveals 15 pack-year smoking history, recent "cold" that went to his chest resulting in cough with purulent sputum and fevers.  Poor dentition but no swallowing difficulties, a positive risk factor for HIV, but most recent testing several years ago was negative.  No recent travel, no TB contacts are known.  No joint pains, rashes, mouth ulcers, alopecia.  No history of heart, kidney, liver disease.  No risks for PE.  All of the following are risk factors for infectious effusions EXCEPT
    • A. 

      Very young or very old

    • B. 

      Women > men

    • C. 

      Diabetes

    • D. 

      Alcoholism or substance abuse

    • E. 

      Rheumatoid arthritis of chronic lung disease

    • F. 

      Poor dentition and aspiration risk

  • 10. 
    Which of the following would result in the classification of a pleural infection as Complex Parapneumonic?
    • A. 

    • B. 

      >1cm, normal glucose & pH >7.2, gram stain neg

    • C. 

      >1cm, pH < 7.2, gram stain/culture +, no pus

    • D. 

      > 1cm, pH < 7.2, gram stain/culture +, frank pus

  • 11. 
    Further history reveals 15 pack-year smoking history, recent "cold" that went to his chest resulting in cough with purulent sputum and fevers.  Poor dentition but no swallowing difficulties, a positive risk factor for HIV, but most recent testing several years ago was negative.  No recent travel, no TB contacts are known.  No joint pains, rashes, mouth ulcers, alopecia.  No history of heart, kidney, liver disease.  No risks for PE.  On examination, he is febrile at 39.9, RR 28, O2 sat on room air 84, HR 128, BP 108/78.  He appears toxic.  Dull percussion on lower 1/2 L hemithorax, decreased breath sounds, and tactile fremitus lower 1/2 L hemithorax but with bronchial breathing above.  Egophony and increased tactile fremitus above the level of effusion.  No evidence of JVD, pedal edema, and normal S1 and S2 without adventitious sounds.  The remainder of the exam unremarkable.  Pleural fluid frankly purulent and foul-smelling, pH 6.9, glucose 1.1, LDH 780, TP 48, serum LDH 122, TP 80, glucose 5.1.  Many neutrophils and gram stain positive G+ cocci in pairs.  What do these results indicate?
    • A. 

      Exudative empyema

    • B. 

      Exudative complex parapneumonic

    • C. 

      Transudative empyema

    • D. 

      Transudative simple parapneumonic

  • 12. 
    Further history reveals 15 pack-year smoking history, recent "cold" that went to his chest resulting in cough with purulent sputum and fevers.  Poor dentition but no swallowing difficulties, a positive risk factor for HIV, but most recent testing several years ago was negative.  No recent travel, no TB contacts are known.  No joint pains, rashes, mouth ulcers, alopecia.  No history of heart, kidney, liver disease.  No risks for PE.  On examination, he is febrile at 39.9, RR 28, O2 sat on room air 84, HR 128, BP 108/78.  He appears toxic.  Dull percussion on lower 1/2 L hemithorax, decreased breath sounds and tactile fremitus lower 1/2 L hemithorax but with bronchial breathing above.  Egophony and increased tactile fremitus above the level of effusion.  No evidence of JVD, pedal edema, and normal S1 and S2 without adventitious sounds.  The remainder of the exam unremarkable.  Pleural fluid frankly purulent and foul-smelling, pH 6.9, glucose 1.1, LDH 780, TP 48, serum LDH 122, TP 80, glucose 5.1.  Many neutrophils and gram stain positive G+ cocci in pairs. What should be done first to manage this patient?
    • A. 

      Surgical management

    • B. 

      Broad-spectrum antibiotics

    • C. 

      Drained and a catheter left in place

  • 13. 
    A 37-year-old man with sudden onset of severe R chest pain associated with severe shortness of breath.  There were no other symptoms and he has been previously well.  He's taking small, shallow breaths, RR 24, afebrile, HR 108, O2 sat on room air 92%, BP 124/84.  Trachea midline.  Decreased breath sounds to right chest, increased resonance on right.  No crepitations or wheezes.  Remainder of exam unremarkable.  He was previously well and working at his desk when he suddenly developed sharp R chest pain.  No infectious contacts, no known lung disease including DVT/PE, works as an accountant, no chest trauma, 1ppd smoker since age 16, no significant family history, sharp right-sided chest pain, worse on inspiration, non-radiating but constant, no previous episodes, splinting and unable to take full breath due to chest pain, no hemoptysis, cough or sputum, no infectious symptoms.  What is the diagnosis?
    • A. 

      Pericarditis

    • B. 

      Pneumonia

    • C. 

      Pneumothorax

    • D. 

      Pulmonary embolism

  • 14. 
    All of the following risk factors predispose for spontaneous pneumothorax EXCEPT
    • A. 

      Young, tall, thin

    • B. 

      Male

    • C. 

      Female

    • D. 

      Smoking

    • E. 

      Subpleural blebs

    • F. 

      Airway inflammation

  • 15. 
    How much time do you have to correct this problem?
    • A. 

      No time - 14 gauge needle to 2nd intercostal space NOW

    • B. 

      You can go for coffee first, no rush

    • C. 

      ASAP but not emergent

  • 16. 
    To treat this problem, you could do all of the following EXCEPT
    • A. 

      Observation

    • B. 

      Simple aspiration

    • C. 

      14 gauge needle to 2nd intercostal space

    • D. 

      Chest tube drainage

  • 17. 
    What is the risk of recurrence?
    • A. 

      10-20%

    • B. 

      25-50%

    • C. 

      50-75%

    • D. 

      80-90%

  • 18. 
    How do you advise the patient if this happens again?
    • A. 

      Consider surgical pleurectomy and apical bullectomy

    • B. 

      VATS

    • C. 

      No scuba diving

    • D. 

      No flying for at least 8 weeks

    • E. 

      All of the above

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