Random pulmonology notes

Miscellaneous pulmonology notes:

Pleural pearls:

Normal pH of pleural fluid is 7.6 secondary to bicarbonate rich pleural fluid -so if you get a pH of 7.4 that’s actually abnormal

pH and glucose move the same direction- glucose can be falsely elevated or falsely low, rely on the pH
Diagnosis: Urinothorax- if pleural creatinine is greater than two times the serum creatinine
Pleural fluid adenosine deaminase?-high sensitivity for tuberculosis

Cytology will have low sensitivity when you tap midlung field because most of thelymphatics of vasculature are near the diaphragm and so that is why you end up missing it.
Sensitivity of cytology is around 60% but that increases about 10-15% on the second tap
Sensitivity of cytology for a thoracentesis for mesothelioma is around 20%
*Neurovascular bundle in the intercostal is unpredictable within 10 cm of the spine

chylous effusion- lymphoma obstructing the thoracic duct

75% of all pleural effusions?
CHF then pneumonia then malignancy (lung > breast >lymphoma)
CHF the pleural effusion is always transudative

“Never let the sun set on a pleural effusion” as true today as when it was said whenever that was.
CT scan for further evaluating pleural lining.
The parietal pleura secretes most of the effusion.


Miscellaneous neurology notes:

Clinical clue: Classic presentation of neuro invasive West Nile virus
Flaccid paralysis with parkinsonism typically, in the late summer
Post infection fatigue and less up to one year
*yellow fever vaccine can also cause false positive West Nile
**West Nile IgM to be positive in the serum and CSF up to one year


Potent pimpables: Neurological manifestation of Whipple's disease oculomasticatory myodysrhythmia