RESPIRATORY
RESPIRATORY
Embedded Files
PLEURAL EFFUSION
PLEURAL EFFUSION
ABOUT THE SESSION
ABOUT THE SESSION
This is a self-directed learning resource designed to be worked through in the clinical environment.
Learning objectives:
Learning objectives:
- Take a focused history from a patient presenting with possible pleural effusion and consider appropriate differential diagnoses
- Suggest and interpret results of relevant investigations for suspected pleural effusion
- Understand the initial management of a patient with pleural effusion
- Recognise indications and risks of pleural procedures for pleural effusion
Total time:
45 minNumber of students:
1-2Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Charlotte HaydenUploaded:
14th September 2019Last updated:
14th September 2019Resources needed for this session:
Resources needed for this session:
Pen, paper, whiteboard or flipchart paper if possible
Resources linked to this session:
Resources linked to this session:
None
Activity 1: Examination Skills
20 minActivity 1: Examination Skills
Take a focused history from a patient with a pleural effusion to include past medical history, social history, family history and review of systems. Perform a focused respiratory examination on a patient.
Activity 2: Diagnostic Reasoning
5 minActivity 2: Diagnostic Reasoning
Construct a list of three key differential diagnoses. For each one, consider two features in the history/examination that make them more or less likely.
Consider:
- What initial investigations would be useful and what are you expecting them to show?
- Compare and contrast clinical findings on examination would you expect to find in a patient presenting with pleural effusion, pneumonia and pneumothorax. Specifically consider: percussion note, vocal resonance, tactile fremitus and tracheal deviation. Compare your notes with the table found here.
Activity 3: Pathophysiology
5 minActivity 3: Pathophysiology
Recap basic pathophysiology by constructing a mind-map/diagram:
- What kinds of fluid can accumulate in the pleural space? What is the mechanism behind these?
- How can pleural effusions be classified?
- What are the differential diagnoses for dullness to percussion and/or reduced vocal resonance?
Activity 4: Basic Radiology Interpretation
5 minActivity 4: Basic Radiology Interpretation
Assess the patient’s chest x-ray. If none is available, use the examples below. Systematically interpret the x-rays in turn, using an A to E approach.
Example 1:
- What is the most obvious abnormality?
- How would you expect the patient to appear clinically?
Example 2:
- How does this differ to the example above?
- How would you expect the patient to appear clinically?
Activity 5: Further Management
10 minActivity 5: Further Management
Find some relevant guidelines on the management of pleural effusions (e.g. BTS Pleural Guidelines 2010).
Consider the patient you have seen and confirm how they should be managed according to these criteria.
- Does this patient need a pleural procedure? If so, what kind?
Activity 6: Procedures
10 minActivity 6: Procedures
If the patient goes on to have a pleural procedure e.g. pleural aspiration or chest drain insertion complete the following tasks:
- Find the local LocSSIPs for pleural procedures. Work through the questions with reference to the patient you have seen.
- Find and complete the relevant sections of a mock consent form with the indication and risks for the procedure. Practice taking consent from a colleague if possible. NB. Medical students should not take consent from the patient - this should be done by the qualified professional performing the procedure.
Summary and Feedback
5 minSummary and Feedback
Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.
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References and Further Reading
References and Further Reading
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