Veterinary Medicine Quiz: Pleural Space Disorders
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Questions and Answers

Which of the following best describes the function of pleural fluid?

  • To facilitate gas exchange between the lungs and blood.
  • To prevent friction between the pleura during respiration. (correct)
  • To provide structural support to the thoracic cavity.
  • To aid in the removal of cellular debris from the lungs.

    • A dog presents with rapid and shallow breathing and decreased lung sounds. Which of the following is the most likely cause based on the material presented?

  • Increased lung capacity due to hypertrophy.
  • An increase in pleural fluid lubricating the lungs.
  • Normal breathing compensation for increased oxygen demand.
  • Reduced tidal volume due to decreased lung expansion. (correct)

    • Which type of pneumothorax is most likely caused by a penetrating wound?

  • Spontaneous secondary pneumothorax
  • Spontaneous primary pneumothorax
  • Traumatic pneumothorax (correct)
  • Iatrogenic pneumothorax

    • Which of the following is NOT a typical cause of secondary spontaneous pneumothorax in dogs?

    <p>Pulmonary blebs or bullae (B)</p> Signup and view all the answers

    What does the 'glide sign' indicate when assessing the pleural space?

    <p>A normal finding when the visceral and parietal pleura make contact. (D)</p> Signup and view all the answers

    Which of the following is NOT a primary cause of hemothorax?

    <p>Pulmonary infection (C)</p> Signup and view all the answers

    What diagnostic finding is indicative of bilothorax?

    <p>A peripheral blood bilirubin to fluid bilirubin ratio less than 1:1 (D)</p> Signup and view all the answers

    In dogs, which bacterial family is most commonly associated with pyothorax?

    <p>Enterobacteriaceae (D)</p> Signup and view all the answers

    Which of the following clinical signs is LEAST likely to be associated with pleural space disease?

    <p>Bradycardia (B)</p> Signup and view all the answers

    Why is intermittent thoracocentesis not recommended for managing pleural space disease?

    <p>It is associated with a higher mortality rate. (D)</p> Signup and view all the answers

    What is the most common cause of pleural effusion?

    <p>Right sided heart disease (A)</p> Signup and view all the answers

    When performing thoracocentesis for a pneumothorax, in which location should the needle be inserted?

    <p>7th to 9th intercostal space at the highest part of the chest (A)</p> Signup and view all the answers

    Which of the following is a potential indication for therapeutic thoracocentesis?

    <p>Previously identified clinically significant pleural fluid (D)</p> Signup and view all the answers

    For a therapeutic thoracocentesis in a dog, which size catheter is most appropriate?

    <p>14-18 gauge (A)</p> Signup and view all the answers

    Which of these is a recommended position for a patient undergoing a therapeutic thoracocentesis?

    <p>Sternal recumbency (C)</p> Signup and view all the answers

    The lack of a glide sign during thoracic ultrasound is most suggestive of what condition?

    <p>Pneumothorax (D)</p> Signup and view all the answers

    What does the reflection coefficient (σ) in the fluid flux equation represent?

    <p>Effectiveness of the capillary wall in preventing protein passage (C)</p> Signup and view all the answers

    An increase in which parameter is most likely to cause a transudate or modified transudate effusion?

    <p>Capillary hydrostatic pressure (D)</p> Signup and view all the answers

    Which diagnostic method is LEAST likely to be useful in the initial diagnosis of a pleural effusion?

    <p>Culture (B)</p> Signup and view all the answers

    Which of the following is most likely to cause a pure transudate?

    <p>Decreased oncotic pressure (D)</p> Signup and view all the answers

    What characteristic of feline infectious peritonitis (FIP) is considered atypical?

    <p>Effusion in only very acute cases (D)</p> Signup and view all the answers

    Which of the following is least helpful in diagnosing FIP?

    <p>Cytology (A)</p> Signup and view all the answers

    For both a pleural effusion and pneumothorax, which intercostal space is generally used for needle placement?

    <p>7th-8th intercostal space (C)</p> Signup and view all the answers

    Neoplastic effusions can be any of the following EXCEPT:

    <p>Chylothorax (D)</p> Signup and view all the answers

    Before inserting the catheter for a thoracocentesis, what is the correct method of skin disinfection?

    <p>Aseptically scrub with chlorhexidine for 3 minutes followed by alcohol for dogs, betadine or povidone iodine for 3 minutes for cats followed by alcohol (A)</p> Signup and view all the answers

    Which of these is NOT a step in placing a thoracocentesis catheter using the technique described?

    <p>Angle the catheter caudally once inside the subcutaneous space (D)</p> Signup and view all the answers

    What is the most common cause of a diaphragmatic hernia?

    <p>Trauma (C)</p> Signup and view all the answers

    What is the recommended volume of sterile warm saline for pleural lavage in a patient?

    <p>10-20 mL/kg every 6 hours (B)</p> Signup and view all the answers

    What is the typical daily fluid production threshold that would prompt removal of a chest tube?

    <p>&lt; 2.2 ml/kg/day (D)</p> Signup and view all the answers

    What was a potential complication noted in the lab owned dogs with chest tubes?

    <p>Chewing out of the chest tube (B)</p> Signup and view all the answers

    What was concluded regarding the use of large vs small bore thoracostomy tubes in the cadaver study?

    <p>There was no significant difference in evacuation between the two sizes of tubes. (B)</p> Signup and view all the answers

    What is the typical prognosis for cats with chylothorax using medical management?

    <p>95% survival rate (C)</p> Signup and view all the answers

    Which of the following is a characteristic of chylous effusion?

    <p>Triglycerides are higher in the fluid than in serum (C)</p> Signup and view all the answers

    What cell type predominates in the cytology of a chylous effusion?

    <p>Small lymphocytes (D)</p> Signup and view all the answers

    Which of these can contribute to the pathogenesis of chylothorax?

    <p>Abnormal lymphatic vessels (C)</p> Signup and view all the answers

    Study Notes

    Pleural Space Disease

    • Pleura is a pair of serous membranes lining the thorax and lungs.
    • Parietal pleura includes costal (incomplete), mediastinal (incomplete), and diaphragmatic.
    • Visceral pleura is also called pulmonary pleura.
    • Pleural space is a potential space between parietal and visceral pleura filled with fluid (0.1-0.3 ml/kg).

    Pleural Space Fluid

    • Fluid prevents friction during respiration.
    • Pleural Effusion is fluid in the pleural space.
    • Types of pleural fluid:
      • Transudate
      • Modified Transudate
      • Exudate
    • Causes of pleural effusion:
      • Increased capillary hydrostatic pressure
      • Reduced capillary colloid osmotic pressure
      • Increased capillary wall permeability
      • Lymphatic drainage obstruction

    Pleural Space Air (Pneumothorax)

    • Pneumothorax is air in the pleural space.
    • Types of pneumothorax:
      • Traumatic (penetrating, blunt)
      • Spontaneous (primary, secondary, iatrogenic)
        • Iatrogenic: needle or scalpel, barotrauma, traumatic intubation, feeding tube misplacement
    • Imaging: chest radiographs.
    • Clinical signs of pneumothorax: rapid, shallow breathing; decreased lung expansion; reduced tidal volume; mild to severe orthopnea, dyspnea, cyanosis

    Pleural Space Soft Tissue

    • Includes diaphragmatic hernia, mass (neoplasia, granuloma, abscess).

    Pleural Space Disease - Clinical Signs

    • Mild to severe orthopnea
    • Dyspnea
    • Cyanosis
    • Rapid, shallow breathing
    • Decreased lung expansion
    • Reduced tidal volume
    • Dull or quiet heart and lung sounds

    Pleural Space Disease - Treatment

    • Thoracocentesis
    • Thoracostomy Tube
    • Continuous Suction
    • Blood Pleurodesis
    • Lung Lobectomy

    Pleural Space Disease - Fluid Analysis

    • Assessment of oxygenation
    • Thoracic Radiographs, TFAST, Echocardiogram
    • TP or TNCC
    • NT-proBNP
    • Cytology
    • Culture
    • Radiographs, Ultrasound/POCUS, CT
    • Table 28-1 describes various characteristics and criteria of fluid types and exudates.
    • Pure Transudate (Hydrothorax): decreased oncotic pressure, increased hydrostatic pressure
    • Modified Transudate: increased post-hepatic hydrostatic pressure, decreased vascular permeability
    • Exudates: Feline Infectious Peritonitis (FIP), Neoplastic Effusions (e.g., pyothorax, billthorax, hemothorax, and chylothorax)

    Feline Infectious Peritonitis (FIP)

    • Coronavirus
    • Aseptic exudative effusion

    Pathophysiology

    • Infected macrophages deposited adjacent to small venules
    • Forms pyogranulomas in affected tissues
    • Inflammatory response can cause vasculopathy
    • Effusion accumulates in body cavities.

    Diagnosis

    • Pleural fluid characteristics: viscous, straw-colored, high protein, low nucleated cells count (NCC).
    • High serum antibody test (>1:1600)
    • RT-PCR on effusion
    • IHC on cells from effusion
    • Rivalta Test

    Diagnostics - Thoracentesis

    • Performed before thoracic radiographs
    • Signs of respiratory distress (increased respiratory effort) + reduced breath sounds

    Preparation for Thoracentesis

    • Aseptically scrub with chlorhexidine for dogs.
    • Betadine or povidone iodine for cats.
    • Continuous contact for 3 minutes before removing with alcohol.
    • Tent the skin away from body wall.
    • Make a stab incision into the site.
    • Stab completely through dermis.

    Materials

    • 3 ml syringe
    • 22 gauge 1" needle
    • Clippers & skin prep
    • Lidocaine for local anesthesia
    • 20, 35 or 60 ml syringe with stopcock and IV extension
    • #11 scalpel blade
    • 3 ml empty syringe
    • Catheter gauge (16-20 for cats, 14-18 for dogs)

    Positioning for Thoracentesis

    • Standing
    • Sternal recumbency
    • Lateral recumbency
    • Avoid sitting; will make landmark isolation difficult.

    Techniques

    • Butterfly catheter
    • Short intravenous catheter
    • Fenestrated plastic intravenous catheter

    Materials (continued)

    • 35-60 ml syringe
    • 3 way stopcock
    • 19 gauge or 22 gauge winged needle catheter

    Pleural Lavage

    • Sterile procedure
    • Warm saline (10-20 mL/kg every 6 hours).
    • Close monitoring ins/outs and fluid balance.
    • Heparin or tPA (humans only) can decrease adhesions in the pleural space.

    Chest Tube Maintenance

    • Must be maintained sterilely.
    • Daily site inspection and scrubbing.
    • Drain removal depends on fluid production (<2.2 ml/kg/day per tube).

    Pneumothorax Procedures

    • 7th-9th intercostal space, highest part of chest
    • Pleural effusion: 7th-8th intercostal space, just above costochondral junction

    Diaphragmatic Hernia

    • Usually traumatic (85%)
    • Supportive oxygen therapy
    • IVC and fluid therapy (if in shock)
    • Surgical intervention

    First Step for Affected Animals

    • Stabilize!!
    • Oxygen Therapy
    • Anxiolysis

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    Related Documents

    Pleural Space Disease - MEF 2025 - PDF

    Description

    Test your knowledge on pleural space disorders in dogs with this quiz. Covering topics such as pneumothorax, pleural effusion, and thoracocentesis, this quiz is essential for veterinary students and professionals. Assess your understanding of conditions affecting the pleural cavity and their management.

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