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CPR II Exam 2 > Chapter 15: The Lung - Pleura > Flashcards

Chapter 15: The Lung - Pleura Flashcards

1
Q

Radiation used in therapy for tumors in the lung or mediastinum often causes what type of pleuritis?

A

Serofibrinous pleuritis

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2
Q

A purulent pleural exudate (empyema) usually results from what?

A

Bacterial or mycotic seeding of the pleural space; by contiguous spread from intrapulmonary infections, but may also be from lymphatic or hematogenous dissemination

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3
Q

Which inflammatory-type of pleural effusion is characterized by loculated, yellow-green, creamy pus composed of masses of neutrophils admixed with other leukocytes?

A

Empyema

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4
Q

Empyema of the lungs may resolve, but more often the exudate organizes into what; causes what complications?

A
  • Organizes –> dense, tough fibrous adhesions
  • Frequently obliterate the pleural space or envelope the lungs
  • Restricting pulmonary expansion
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5
Q

Which type of pleuritis is manifested by sanguineous inflammatory exudates?

A

Hemorrhagic pleuritis

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6
Q

Hemorrhagic pleuritis is found in what 3 settings?

A
  • Hemorrhagic diatheses
  • Rickettsial diseases
  • Neoplastic involvement
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7
Q

What are the 3 major mechanisms underlying transudative pleural effusions; examples?

A
  • ↑ hydrostatic pressure; “overflow” from the lung interstitium = CHF
  • ↓ plasma oncotic pressure = nephrotic syndrome
  • Movement of transudative ascitic fluid thru the diaphargam = cirrhosis
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8
Q

What are the 2 major mechanisms underlying exudative pleural effusions; some examples?

A
  • Inflammation –> infection (TB, pneumonia), PE (infarction), CT disease (SLE, RA), adjacent to subdiaphragmatic disease (pancreatitis, subphrenic abscess)
  • Malignancy
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9
Q

What is the arrow indicating on this CT scan?

A

Pleural effusion

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10
Q

How will a pleural effusion associated with mediastinal carcinomatosis appear grossly due to decreased lymph drainage?

A

Milky chylous effusion = Chylothorax

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11
Q

Noninflammatory collections of serous fluid within pleural cavities are known as what; appear how grossly?

A

Hydrothorax; clear fluid that is straw colored

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12
Q

What is the most common cause of hydrothorax; other causes?

A
  • Most common = Cardiac failure
  • Also, renal failure and cirrhosis
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13
Q

Hemothorax is a usually fatal complication associated with what?

A

Ruptured aortic aneurysm or vascular trauma

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14
Q

Pneumothorax is most commonly associated with what 3 conditions?

A
  • Emphysema
  • Asthma
  • Tuberculosis
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15
Q

Spontaneous idiopathic penumothorax most often occurs in which age group and is due to what?

A
  • Young patients
  • Rupture of small, peripheral, usually apical subpleural blebs
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16
Q

Typical course of spontaneous idiopathic penumothorax; and likelihood or recurrence?

A
  • Typically subsides spontaneously as air is resorbed
  • Reccurent attacks = common
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17
Q

When injury to chest wall results in a one-way valve allowing air into the pleural space, but not out, effectively acting as a pump and ↑ pressure, this is known as?

A

Tension pneumothorax

18
Q

A tension pneumothorax is due to expansion of which structure?

A

Chest wall (not lungs per se)

19
Q

What is one of the more devastating consequences of Empyema that makes it hard to treat and hard to clear out?

A

Creating loculations –> web-like traps for fluid

20
Q

What type of pneumothorax is this?

A

Primary pneumothorax

21
Q

What type of pneumothorax is this?

A

Tension pneumothorax

22
Q

Which type of pneumothorax is associated with pleural cavity pressure is < atmospheric pressure?

Pleural cavity pressure > atmospheric pressure?

A
  • Pleural cavity < atmospheric = primary pneumothorax
  • Pleural cavity > atmospheric = tension pneumothorax
23
Q

In spontaneous idiopathic pneumothorax which direction will the trachea shift?

A

TOWARD the side of collapse

24
Q

What is more common primary pleural tumors or secondary tumors from metastasis?

A

Secondary from metastasis

25
Q

The most frequent metastatic malignancies of the pleura arise from which 2 sites?

A

Breast and lung

26
Q

In most metastatic involvements of the pleura what type of effusion follows?

A

Serous or sero-sangioneous often containing neoplastic cells

27
Q

Which soft-tissue tumor has a propensity to occur in the pleura is often attached to the surface by a pedicle?

A

Solitary fibrous tumor

28
Q

Which immunostaining features of solitary fibrous tumors are helpful in distinguishing these tumors from malignant mesotheliomas?

A

CD34+ and keratin-negative

29
Q

What do solitary fibrous tumors show microscopically?

A

Whorls of reticulin and collagen fibers w/ interspersed spindle cells resembling fibroblasts

30
Q

Solitary fibrous tumors are highly associated with a cryptic inverion of which chromosome and this creates which fusion gene unique to this tumor?

A

Chromosome 12 —> NAB2-STAT6 fusion gene

31
Q

Homozygous deletion of which tumor suppressor gene occurs in about 80% of mesothelioma; involves which chromosome?

A

CDKN2A/INK4-α on chromosome 9p

32
Q

How does malignant mesothelioma appear grossly?

A

Affected lung is ensheathed by a thick layer of soft, gelatinous, grayish-pink tumor tissue

33
Q

What are the 3 variants of growth that can be seen microscopically with mesothelioma?

A
  • Epithelioid
  • Sarcomatoid
  • Mixed
34
Q

Epithelioid type of mesothelioma resembles adenocarcinoma; how can it be differentiated via immunohistochemical stains for which 5 markers?

A
  • (+) Keratin
  • (+) Calretinin
  • (+) Wilms tumor 1 (WT-1)
  • (+) Cytokeratin 5/6
  • (+) D2-40
35
Q

The mesenchymal type of mesothelioma (sarcomatoid type) appears as what type of sarcoma and resembles?

A

Spindle cell sarcoma, resembling fibrosarcoma

36
Q

Sarcomatoid mesotheliomas may only stain positive for which marker?

A

Keratin

37
Q

What are the typical presenting features of malignant mesothelioma?

A
  • Chest pain
  • Dyspnea
  • Recurrent pleural effusions**
38
Q

Malignant mesothelioma often invades lung directly and commonly metastasizes to which LN and organs?

A
  • Hilar LN’s
  • Eventually –> liver and other distant organs
39
Q

What is the prognosis of malignant mesothelioma?

A

50% die within 12 months; few survive longer than 2 years

40
Q

What are found in increased numbers in the lungs of patients with mesothelioma?

A

Asbestos bodies and asbestos plaques

CPR II Exam 2 (23 decks)

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