Question 1

Treatment of an empyema usually includes:

Accepted Answer

A)  pleurodesis. 
B)  thoracostomy tube insertion. 
C)  lobectomy. 
D)  pneumonectomy. 
A)  pleurodesis. 
B)  thoracostomy tube insertion. 
C)  lobectomy. 
D)  pneumonectomy. B

Question 2

A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis?
1) Erythrocytes
2) Lymphocytes
3) Normal mesothelial cells
4) Malignant mesothelial cells

Accepted Answer

A)  1, 4 
B)  2, 3 
C)  2, 3, 4 
D)  1, 2, 3, 4 
A)  1, 4 
B)  2, 3 
C)  2, 3, 4 
D)  1, 2, 3, 4 C

Question 3

A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, all of the following tests should be performed EXCEPT:

Accepted Answer

A)  specific gravity. 
B)  biochemical makeup. 
C)  cytologic examination. 
D)  bacterial culture. 
A)  specific gravity. 
B)  biochemical makeup. 
C)  cytologic examination. 
D)  bacterial culture. A

Question 4

Which of the following are associated with a transudative pleural effusion?
1) Thin and watery fluid
2) Fluid has a lot of cellular debris
3) Fluid has high protein count
4) Few blood cells

Accepted Answer

A)  2, 3 
B)  1, 4 
C)  1, 2, 3 
D)  1, 3, 4 
A)  2, 3 
B)  1, 4 
C)  1, 2, 3 
D)  1, 3, 4

Question 5

The anatomic alteration caused by a pleural effusion is:

Accepted Answer

A)  pulmonary fibrosis. 
B)  separation of the visceral and parietal pleura. 
C)  adhesion of the visceral and parietal pleura. 
D)  pulmonary edema. 
A)  pulmonary fibrosis. 
B)  separation of the visceral and parietal pleura. 
C)  adhesion of the visceral and parietal pleura. 
D)  pulmonary edema.

Question 6

Which of the following are chest radiograph findings associated with a large pleural effusion?
1) Blunting of the costophrenic angle
2) Fluid level on the affected side
3) Mediastinal shift toward the unaffected side
4) Elevated hemidiaphragm on the affected side

Accepted Answer

A)  1, 3 
B)  2, 4 
C)  1, 2, 4 
D)  1, 2, 3 
A)  1, 3 
B)  2, 4 
C)  1, 2, 4 
D)  1, 2, 3

Question 7

What is the most common cause of a chylothorax?

Accepted Answer

A)  Thoracic duct trauma 
B)  Abdominal tumor 
C)  GERD 
D)  Pyloric stenosis 
A)  Thoracic duct trauma 
B)  Abdominal tumor 
C)  GERD 
D)  Pyloric stenosis

Question 8

During a chest assessment on a patient with a large pleural effusion, which of the following would be expected?
1) Increased tactile and vocal fremitus
2) Hyperresonant percussion note
3) Diminished breath sounds
4) Tracheal shift

Accepted Answer

A)  1 
B)  1, 2 
C)  3, 4 
D)  1, 3, 4 
A)  1 
B)  1, 2 
C)  3, 4 
D)  1, 3, 4

Question 9

In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify?

Accepted Answer

A)  Malignant disease 
B)  Fungal disease 
C)  Chylothorax 
D)  Tuberculosis 
A)  Malignant disease 
B)  Fungal disease 
C)  Chylothorax 
D)  Tuberculosis

Question 10

What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?

Accepted Answer

A)  Up to 10% 
B)  Up to 20% 
C)  Up to 30% 
D)  Up to 40% 
A)  Up to 10% 
B)  Up to 20% 
C)  Up to 30% 
D)  Up to 40%

Question 11

An adult patient with a large pleural effusion requires placement of a thoracostomy tube. Which of the following statements are true regarding thoracostomy tube placement?
1) The tube is placed in the 2nd to 3rd intercostal space.
2) The tube is placed in the 4th to 5th intercostal space.
3) The tube is placed in the midclavicular line.
4) The tube is placed in the midaxillary line.

Accepted Answer

A)  1, 4 
B)  2, 3 
C)  1, 3 
D)  2, 4 
A)  1, 4 
B)  2, 3 
C)  1, 3 
D)  2, 4

Question 12

The major pathologic and structural changes associated with a significant pleural effusion include all of the following EXCEPT:

Accepted Answer

A)  diaphragm elevation. 
B)  atelectasis. 
C)  compression of the great vessels. 
D)  lung compression. 
A)  diaphragm elevation. 
B)  atelectasis. 
C)  compression of the great vessels. 
D)  lung compression.

Question 13

While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?

Accepted Answer

A)  Meniscus sign 
B)  Scarf sign 
C)  Transudate sign 
D)  Kerley B lines 
A)  Meniscus sign 
B)  Scarf sign 
C)  Transudate sign 
D)  Kerley B lines

Question 14

A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described?

Accepted Answer

A)  Milky white 
B)  Straw colored 
C)  Red 
D)  Green 
A)  Milky white 
B)  Straw colored 
C)  Red 
D)  Green

Exam 24: Pleural Effusion and Empyema

Treatment of an empyema usually includes:

A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis? 1) Erythrocytes 2) Lymphocytes 3) Normal mesothelial cells 4) Malignant mesothelial cells

A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, all of the following tests should be performed EXCEPT:

Which of the following are associated with a transudative pleural effusion? 1) Thin and watery fluid 2) Fluid has a lot of cellular debris 3) Fluid has high protein count 4) Few blood cells

The anatomic alteration caused by a pleural effusion is:

Which of the following are chest radiograph findings associated with a large pleural effusion? 1) Blunting of the costophrenic angle 2) Fluid level on the affected side 3) Mediastinal shift toward the unaffected side 4) Elevated hemidiaphragm on the affected side

What is the most common cause of a chylothorax?

During a chest assessment on a patient with a large pleural effusion, which of the following would be expected? 1) Increased tactile and vocal fremitus 2) Hyperresonant percussion note 3) Diminished breath sounds 4) Tracheal shift

In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify?

What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?

The major pathologic and structural changes associated with a significant pleural effusion include all of the following EXCEPT:

While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?

A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described?

The Patient Interview

The Physical Examination and Its Basis in Physiology

Pulmonary Function Study Assessments

Arterial Blood Gas Assessments

Oxygenation Assessments

Cardiovascular System Assessments

Radiologic Examination of the Chest

Other Important Tests and Procedures

The Therapist-Driven Protocol Program and the Role of the Respiratory Therapist

Respiratory Failure and the Mechanical Ventilation Protocol

Recording Skills: The Basis for Data Collection, Organization, Assessment Skill

Chronic Obstructive Pulmonary Disease (COPD), Chronic Bronchitis, and Emphysema

Asthma

Bronchiectasis

Cystic Fibrosis

Pneumonia

Lung Abscess

Tuberculosis

Fungal Diseases of the Lung

Pulmonary Edema

Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension

Flail Chest

Pneumothorax

Kyphoscoliosis

Interstitial Lung Diseases

Cancer of the Lung

Acute Respiratory Distress Syndrome

Guillain-Barré Syndrome

Myasthenia Gravis

Sleep Apnea

Clinical Manifestations Common with Newborn and Early Childhood Respiratory Dis

Meconium Aspiration Syndrome

Transient Tachypnea of the Newborn

Respiratory Distress Syndrome

Pulmonary Air Leak Syndromes

Respiratory Syncytial Virus (Bronchiolitis or Pneumonitis)

Bronchopulmonary Dysplasia

Congenital Diaphragmatic Hernia

Congenital Heart Diseases

Croup Syndrome: Laryngotracheobronchitis and Acute Epiglottitis

Near Drowning/Wet Drowning

Smoke Inhalation, Thermal Injuries, and Carbon Monoxide Intoxication

Atelectasis

Filters