PassMED: Medical Finals Examination Revision

Pleural Effusion

Incidental findings	Clubbing, radiation burns, aspiration marks, lymphadenopathy
+ve signs	Stony dull percussion note, decreased breath sounds, decreased vocal resonance
Differential diagnosis	Pleural effusion cause depends upon transudate or exudate
Function	?respiratory compromise
Tests	CXR, ultrasound Pleural tap - protein, albumin, LDH, glucose, cytology, microbiology, acid fast bacilli Pleural biopsy, CT chest

Transudate
Cardiac failure
Nephrotic syndrome
Cirrhosis

Exudate
Neoplastic: Ca bronchus / met / mesothelioma
Infectious: Pneumonia, TB
Connective tissue: rheumatiod arthritis, SLE

Protein > 30 = exudate, protein < 30 = transudate
Lights criteria for exudate (i) pleural: serum protein > 0.5 (ii) pleural:serum LDH > 0.6 (iii) pleural LDH > 2/3 upper limit for serum LDH
Serum:effusion albumin gradient 1.2g/dl very specific for exudate
Can have area of bronchial breathing above dullness. c.f. Consolidation = bronchial breathing, increased vocal resonance; Collapse = trachea to side, absent breath sounds.
Meigs = Ovarian tumour with R effusion (transudate)