Thoracocentesis

Question 1

What is thoracocentesis?

Answer 1

removing pleural fluid for diagnostic testing

Question 2

Clue in stem: “Low protein, clear fluid, due to increased hydrostatic pressure”

Answer 2

CHF –> transudate

Question 3

Clue in stem: “Cloudy, high LDH, low glucose, many neutrophils”

Answer 3

Pneumonia –> exudate

Question 4

Clue in stem: “Lymphocytic predominance, low glucose, low pH”

Answer 4

TB or rheumatoid effusion

Question 5

Clue in stem: “ Bloody pleural fluid”

Answer 5

Malignancy, PE, trauma

Question 6

Clue in stem: “Milky pleural fluid”

Answer 6

Chylothorax –> ^ triglycerides from thoracic duct leak

Question 7

Normal appearance of pleural fluid?

Answer 7

clear, pale yellow

• normal pleural fluid is clear and serous

Question 8

Normal protein amount of pleural fluid?

Answer 8

< 1.5 g/dL

Question 9

Why is the normal amount of protein in the pleural fluid low?

Answer 9

because normal pleura filters plasma ultrafiltrate

Question 10

Normal amount of LDH in the pleural fluid?

Answer 10

< 200 IU/L or < 50% of serum LDH

Question 11

What is the normal amount of glucose in the pleural fluid?

Answer 11

~ serum glucose (70 - 100 mg/dL)

Question 12

What is the normal pH of the pleural fluid?

Answer 12

~ 7.60

Question 13

Why is the pH of the pleural fluid slightly higher than blood?

Answer 13

due to bicarbonate secretion

Question 14

What is the cell count in the pleural fluid normally?

Answer 14

< 1000 WBCs /uL

Question 15

What types of cells normally comprise the pleural fluid?

Answer 15

mostly macrophages and mesothelial cells

Question 16

What is the normal amount of RBCs found in the pleural fluid?

Answer 16

< 10,000/uL

Question 17

Describe the amount of RBCs in the pleural fluid?

Answer 17

very few red cells normally

Question 18

Pleural fluid protein/serum protein that suggests exudate?

Answer 18

> 0.5 (positive if)

Question 19

Pleural fluid protein/serum protein that suggests transudate?

Answer 19

≤ 0.5 (if all false)

Question 20

Pleural fluid LDH/serum LDH that suggests exudate?

Answer 20

> 0.6 (positive if)

Question 21

Pleural fluid LDH/ serum LDH that suggests transudate?

Answer 21

≤ 0.6

Question 22

Pleural fluid LDH that suggests exudate?

Answer 22

> 2/3 upper limit of normal serum

Question 23

What is purpose of Reids index?

Answer 23

to quantify the enlargment of bronchial mucous glands that occurs in chronic bronchitis

Question 24

How is Reids Index measured?

Answer 24

ratio of thickness of the mucous-gland layer to the thickness of the entire bronchial wall, from the basement membrane to the inner perichondrium

Question 25

How would one interpret Reids index?

Answer 25

* Typically considered less than 50% * index greater than this suggests hypertrophy and hyperplasia of the glands, a characteristic of chronic bronchitis

Question 26

Give the type of fluid (exudate/transudate), protein, LDH, and glucose amounts in the pleural fluid, as well as pH, cell type/s, and any additional information about the pleural fluid in cases of CONGESTIVE HEART FAILURE.

Answer 26

Type: Transudate Protein:↓ LDH:↓ Glucose: Normal pH: Normal Cell Type: Few cells Notes: ↑ hydrostatic pressure

Question 27

Give the type of fluid (exudate/transudate), protein, LDH, and glucose amounts in the pleural fluid, as well as pH, cell type/s, and any additional information about the pleural fluid in cases of CIRRHOSIS/NEPHROTIC SYNDROME.

Answer 27

Type: Transudate Protein: ↓ LDH: ↓ Glucose: Normal pH: Normal Cell Type: Few cells Notes: ↓ oncotic pressure

Question 28

Give the type of fluid (exudate/transudate), protein, LDH, and glucose amounts in the pleural fluid, as well as pH, cell type/s, and any additional information about the pleural fluid in cases of PNEUMONIA (PARAPNEUMONIC EFFUSION).

Answer 28

Type: Exudate Protein: ↑ LDH: ↑ Glucose: ↓ pH: ↓ Cell Type: Neutrophils Notes: Inflammation ↑ capillary permeability

Question 29

Give the type of fluid (exudate/transudate), protein, LDH, and glucose amounts in the pleural fluid, as well as pH, cell type/s, and any additional information about the pleural fluid in cases of TUBERCULOSIS.

Answer 29

Type: Exudate Protein: ↑ LDH: ↑ Glucose: ↓ pH: ↓ Cell Type: Lymphocytes Notes: Chronic Inflammation

Question 30

Give the type of fluid (exudate/transudate), protein, LDH, and glucose amounts in the pleural fluid, as well as pH, cell type/s, and any additional information about the pleural fluid in cases of MALIGNANCY.

Answer 30

Type: Exudate Protein: ↑ LDH: ↑ Glucose: ↓ pH: ↓ Cell Type: Atypical cells Notes: Tumor invasion or lymphatic obstruction

Question 31

Give the type of fluid (exudate/transudate), protein, LDH, and glucose amounts in the pleural fluid, as well as pH, cell type/s, and any additional information about the pleural fluid in cases of PULMONARY EMBOLISM.

Answer 31

Type: Exudate (sometimes transudate) Protein: ↑ LDH: ↑ Glucose: Normal pH: Normal Cell Type: Variable Notes: Infarction or Inflammation

Question 32

Give the type of fluid (exudate/transudate), protein, LDH, and glucose amounts in the pleural fluid, as well as pH, cell type/s, and any additional information about the pleural fluid in cases of RHEUMATOID EFFUSION.

Answer 32

Type: Exudate Protein: ↑ LDH: ↑ but can be down Glucose: ↓ pH: ↓ Cell Type: Lymphocytes Notes: autoimmune inflammation

Question 33

What is rheumatoid effusion of the pleural fluid?

Answer 33

A rheumatoid pleural effusion occurs when rheumatoid arthritis (RA) causes inflammation of the pleura (the lining of the lungs), leading to exudative pleural fluid — not joint fluid this time, but in the chest cavity. * It’s one of the extra-articular manifestations of RA.

Question 34

Protein amount in the pleural fluid if the pleural space is filled with transudate?

Answer 34

< 3 g/dL protein

Question 35

Protein amount in the pleural fluid if the pleural space is filled with exudate?

Answer 35

> 3 g/dL protein