Disease of Mediastinum and Pleura

Question 1

The mediastinum is broken into three compartments: ____________.

Answer 1

anterior, middle, and posterior

Question 2

The anterior mediastinum contains the ________________.

Answer 2

thymus, aortic root and great vessels, substernal thyroid and inferior parathyroid, lymphatic vessels and nodes, and the inferior aspect of the trachea and esophagus

Question 3

The middle compartment contains the ____________.

Answer 3

heart, pericardial sac, innominate veins and SVC, trachea and major bronchi, hila, lymph nodes, and phrenic, vagus, and laryngeal nerves

Question 4

The posterior compartment contains the ____________.

Answer 4

esophagus, descending aorta, azygous and hemiazygous veins, thoracic duct, lymph nodes, sympathetic ganglia, and vagus nerves

Question 5

80% of asymptomatic mediastinal masses are __________.

Answer 5

benign.

Question 6

50% of symptomatic masses are _________.

Answer 6

malignant

Question 7

Most mediastinal masses in adults are in the _________ compartment; most are __________.

Answer 7

anterior; asymptomatic

Question 8

Most mediastinal masses in children are in the ________ compartment; most are ________.

Answer 8

posterior; symptomatic

Question 9

What are the four T’s of anterior compartment masses?

Answer 9

Teratoma, thymic neoplasm, thyroid neoplasm, and (terrible) lymphoma

Question 10

What are some local complications of mediastinal masses?

Answer 10

SVC syndrome, tracheal obstruction, vascular invasion, and esophageal rupture

Question 11

The visceral and parietal pleura connect at the ___________.

Answer 11

hila of the lungs

Question 12

Spontaneous pneumothorax simply means __________.

Answer 12

not resulting from trauma (whether iatrogenic, barotrauma, or regular trauma)

Question 13

Spontaneous pneumothorax can be __________, in which it occurs alone, or _________, in which it happens secondary to lung disease.

Answer 13

primary; secondary

Question 14

Primary spontaneous pneumothorax has a high rate of _________.

Answer 14

recurrence

Question 15

_______ can mimic pneumothorax.

Answer 15

Large bullae, skin folds, and stomach herniation

Question 16

What are treatment options for pneumothorax?

Answer 16

Observation, supplemental oxygen, simple aspiration, tube thoracostomy, and pleurodesis (trying to get the pleura to “reattach”)

Question 17

What is tension pneumothorax?

Answer 17

When intrapleural pressure is greater than airway pressure, resulting in collapse of the lungs; this leads to hemodynamic collapse by decreasing the cardiac output

Question 18

100% oxygen can only fix _________.

Answer 18

small pneumothoraces; it does this by increasing the partial pressure of alveolar oxygen. This causes nitrogen to flow into the alveoli (along its gradient). Oxygen replaces the nitrogen in the thoracic cavity, which is good because oxygen is absorbed by the body more readily than nitrogen.

Question 19

The intercostal neurovascular bundle is just ______ the rib, so always insert needles ________.

Answer 19

below; above

Question 20

Using Light’s criteria, transudates must have _______________.

Answer 20

LDH(pl)/LDH(ser) less than 0.6 and prot(pl)/prot(ser) less than 0.5

Question 21

Using Light’s criteria, exudates must have ______________.

Answer 21

LDH(pl)/LDH(ser) greater than 0.6 or prot(pl)/prot(ser) greater than 0.5 or LDH(pl) upper 2/3 of serum normal

Question 22

Pleural plaques are most often caused by __________.

Answer 22

asbestos exposure

Question 23

Most pleural tumors are ____________.

Answer 23

from metastases (especially lung, breast, and lymph cancers)

Question 24

Most mediastinal cysts arise in the _________ compartment.

Answer 24

middle

Question 25

Diaphragmatic hernias can be in _______ compartment.

Answer 25

any

Question 26

Pleural thickening results from __________.

Answer 26

asbestos, trauma, neoplasm, inflammation, and hemorrhage