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Flashcards in Pleural Diseases Deck (45):
1

What is the difference between transudates and exudates?

Transudates = low protein content

Exudates = high protein content

2

What are the causes for pleural exudates?

- infections
- neoplastic
- hepatic
- renal
- inflammatory (RA, SLE, scleroderma)

3

What are some causes for pleural transudate?

- raised microvascular pressure
- reduced pleural surface pressure
- major atelectasis

4

What are 3 common causes for large pleural effusions?

(3 T's)
Tumor
TB
Trauma

5

What is the M/C/C of transudative pleural effusion?

Heart failure (usually left & right)
Effusion is usually bilateral.

6

What is Meigs-Salmon syndrome?

a) benign ovarian tumor
b) pleural effusion
c) ascites

7

Which anatomical structure is usually response for the chylothorax?

Thoracic duct (close to aortic arch and mid-esophagus and surgery to these two areas can cause chylothorax).

8

What are the radiographic differences between pleural effusion and empyema?

Empyema
- lenticular shape
- unilateral or asymmetric
- forms obtuse angle with chest wall
- thickened pleura (split pleural sign)

9

What are the 3 types of pneumothorax? And which one is the M/C?

1) Spontaneous M/C
2) Tension
3) Traumatic (iatrogenic)

10

How many and what types of spontaneous pneumothorax are there?
Which is the M/C?

1) Primary (M/C) -- rupture of bleb

2) Secondary (eg. airflow obstruction, interstitial lung disease)

11

Which side is more common to develop primary spontaneous pneumothorax?

Right side

12

What is tension pneumothorax and which pop'n are most prone to develop it?

Intrapleural pressure becomes positive, compressing normal lung.

Usually seen in mechanically ventilated and chest trauma patients.

13

What are 2 radiographic findings seen with tension pneumothorax?

- diaphragmatic depression
- medastinal shift

14

Which pop'n is most likely to get traumatic pneumothorax?

Newborns

15

What is the normal allowed amount for apical capping?

<5mm

16

Apical capping exceeding 5mm is associated with which disease process?

Inflammatory disease (eg. TB)

17

What are the most likely benign differentials for a localized pleural tumor and which is M/C?

- Lipoma (M/C)
- Fibroma
- Hemangioma
- Neurofibroma

18

Fibrous localized tumors of the pleural M/C arise from which pleura?

Visceral pleura (87%)

19

True or false: smoking increases the risk for malignant mesothelioma.

False. It does not.

20

What are the 3 types of malignant mesothelioma and which one is M/C?

a. Epithelial (M/C)
b. Sarcomatous
c. Mixed

21

What are the M/C causes for pleural calcification?

HEATR
- Hemothorax
- Empyema
- Asbestosis
- Talcosis/TB
- Radiation

22

What is the M/C of acute mediastinitis?

Spontaneous or iatrogenic esophageal rupture (90%).
eg. Boerhaave syndrome

23

What is a key radiographic feature indicating perforation of the esophagus?

Pneumomediastinum

24

What is the M/C/C for chronic mediastinitis in the US?

Histoplasma capsulatum

25

Chronic mediastinitis is characterized by what feature?

Progressive proliferation of fibrous tissue within mediastinum that encases and obstructs vital structures.

26

A continuous diaphragm sign is suggestive of which condition?

pnumomediastinum

27

What is the M/C primary tumor of the anterior mediastinum in adults?

Thymoma (20%)

28

Thymomas M/C present unilateral or bilateral?

Unilateral

29

What is the M/C thymic carcinoma?

squamous cell carcinoma

30

Neuroendocrine tumors of the thymus originate in which cells?

Kulchitsky cells

31

What is the M/C extragonadal location for germ cell tumors (eg. teratoma)?

Mediastinum

32

Dermoid cysts contain mostly which embryological componenets?

Ectodermal (eg. skin, hair, cartilage)

33

What endocrine condition is often associated with the thymus?

Myasthenia gravis

34

Which malignant germ cell tumor is likely to be found in the anterior mediastinum?

Seminoma (seen in young men)

35

What is a very sensitive and specific method for determining an intrathoracic mass to be thyroid in nature?

Radionuclide w/ iodine

36

What is the M/C mediastinal mass of thyroid origin?

Benign multinodular goiter

37

What are the two variants of Castleman Disease and which one is M/C?

a) Hyaline vascular (M/C 90%)
- seen in children & young adults
b) Plasma cell (10%)

38

Castleman disease is known to overlap with which multicentric syndrome?

POEMS

39

What are the differentials for egg-shell calcifications?

1. Silicosis
2. Coal miners pneumoconiosis
3. Sarcoidosis
4. Lymphoma following radiation
5. Idiopathic
6. TB/Fungal infections

40

What is the M/C abnormality of the middle mediastinum?

Lymph node enlargement

41

What are the 2 classifications used for aortic aneurysms?

1) DeBakey
2) Stanford

42

What is the Standford classification for aortic aneurysms?

Type A = Affects Ascending Aorta and Arch
- requires surgical management

Type B = Begins Beyond Brachiocephalic vessels
- requires medical management

43

What is the DeBakey classification for aortic aneurysms?

Type 1: ascending & descending aorta
Type 2: ascending aorta
Type 3: descending aorta

44

What are some differentials for middle mediastinal masses?

1. Lymph nodes
2. Bronchogenic cyst
3. Aortic aneurysm
4. Carcinoma of bronchus

45

What are some differentials for posterior mediastinal masses?

1. Aorta (aneurysm/tortous)
2. Extramedullary haemopoiesis
3. Neural tumor
4. Hiatal hernia
5. Bone tumor (metastases, myeloma etc.)
6. Dilated esophagus