1) There is usually a pleural rub.
Incorrect
CORRECT!
Pleural rubs occur due to friction between the two pleural surfaces – visceral (attached to the lungs) and parietal (attached to the chest wall) and can be heard if there is inflammation of the pleura due to conditions such as pneumonia or PE etc.. The presence of fluid between the two pleural surfaces prevent them from touching and therefore there is no rub to be heard.
2) A blood stained effusion is suspicious of underlying malignancy.
CORRECT!
Blood stained pleural effusions can occur due to malignancy, as well as pneumonia, pulmonary embolism and trauma.
Incorrect
3) A transudate has a greater protein content than 30g/l.
Incorrect
CORRECT!
Transudate effusions have a protein level less than 30g/L and as a rough guide can be thought of as due to excess fluid due to an organ failure – heart failure, liver failure, renal failure. Exudate effusions have a protein level greater than 30g/L and are due to conditions that exude protein, such as pneumonia, malignancy and pulmonary embolism.
4) Pleurodesis may be achieved by injecting talc.
CORRECT!
Pleurodesis is performed by inducing inflammation between the two pleural surfaces, this will lead to all the symptoms of pleurisy in the short term, but the inflammation that occurs can stick the two surfaces together and leave no space for fluid to accumulate.
Incorrect
5) Rapid drainage may result in vasogenic pulmonary oedema.
CORRECT!
Large volumes of pleural fluid should not be drained all at once, as this can cause re-expansion pulmonary oedema, which can be life threatening. Drains should only be allowed to drain approx 1L before being clamped for an hour to allow gradual re-expansion.
Incorrect
