17 - Pleural/Mediastinal Dz

Question 1

sx of pleural effusion

Answer 1

dyspnea
cough
pleuritic chest pain

Question 2

first thing to evaluate with a pleural effusion

Answer 2

transudate vs exudate

Question 3

Light’s criteria

Answer 3

pleural effusion transudate vs exudate criteria

exudate has at least one of these criteria:
pleural/serum protein > 0.5
pleural/serum LDH > 0.6
LDH > 2/3 upper limit

Question 4

sources of transudative pleural effusions

Answer 4

CHF
cirrhosis
nephrotic syndrome
ascites
peritoneal dialysis
hypoalbuminemia

Question 5

sources of exudative pleural effusions

Answer 5

infections
maligancy
collagen vascular diorders
pulm embolism
GI dz (pancreatitis, esophageal rupture, abdom abscess)

Question 6

MCC pleural effusion

Answer 6

CHF

Question 7

what type of pleural effusion definitely must be drained/fixed because it won’t resolve spontaneously?

Answer 7

parapneumonic (assoc w/ infection)

Question 8

what should make you especially suspicious of a TB effusion?

Answer 8

super high (~90%) lymphocytes

Question 9

which malignancies most likely to cause pleural effusion?

Answer 9

lung, breast, lymphoma

Question 10

primary spontaneous pneumothorax

Answer 10

rupture of apical pleural “blebs”
20-30 yo, tall thin, normally smoker, male > female
acute onset severe unilateral chest pain w/ dyspnea
tend to recur (20-30%)

Question 11

secondary spontaneous pneumothorax MC with what cause?

Answer 11

COPD (emphysema)

Question 12

tension pneumothorax

Answer 12

occurs during mech ventilation or resuscitation
cyanosis, hypotension, no breath sounds on that side, trachea shifts away
tx w/ large bore catheter > chest tube

Question 13

clinical features of mediastinal masses

Answer 13

cough
chest pain
dysphagia
some signs of nerve compression - hoarseness, Horner’s syndrome, diaphragmatic paralysis

Question 14

anterior mediastinal masses (4)

Answer 14

terrible T's:
thymoma (MC)
teratoma
thyroid
tumor (lymphoma)

Question 15

thymoma

Answer 15

mass in anterior mediastinum
pt is 40-60 yo
2/3 asymptomatic, most benign
associated with “parathymic syndromes”, MC is myasthenia gravis

Question 16

middle mediastinal masses (5)

Answer 16

lymphoma
granulomatous dz (TB, histo) - LAN
developmental cysts
vascular masses (aneurysms)
diaphragmatic hernia

Question 17

posterior mediastinal masses (5)

Answer 17

neurogenic tumors (MC) - usually asymptomatic in adults, half symptomatic in kids
esophageal lesions
diaphragmatic hernia
aneursyms
lymphoma

Question 18

Hamman’s sign

Answer 18

crunch or click synchronous w/ heartbeat heard w/ pneumomediastinum

Question 19

chronic/fibrosing mediastinitis MC assoc w/

Answer 19

histoplasmosis