pleura

Question 1

transudate casues

Answer 1

transudate is low in protein. it is due to CHF, nephrotic syndrome, or hepatic cirrhosis

Question 2

exudate causes

Answer 2

high protein content; cloudy.
due to malignancy, pneumonia, collagen vascular disease, trauma (any state with increased vascular permeability). must be drained because of infection risk

Question 3

lymphatic pleural effusion

Answer 3

aka chylothorax. due to thoracic duct injury from trauma or malignancy. this is a milky white fluid with high levels of triglycerides.

Question 4

pneumothorax findings

Answer 4

air in the pleural space. see unilateral chest pain and dyspnea, decreased tactile fremitus, hyperresonance, and diminished breath sounds.

Question 5

spontaneous pneumothorax

Answer 5

accumulation of air in the pleural space. it usually occurs in tall, thin, young males becasue of rupture of apical blebs.

Question 6

tension pneumothorax

Answer 6

usually occurs in the setting of trauma or lung infection. air is able to enter the leural space but not to exit. trachea deviates away from the affected lung.

Question 7

What is mesothelioma? pathologic findings?

Answer 7

malignancy of the pleura. results in hemorrhagic pleural effusions, pleural thickening, and psammoma bodies

Question 8

What is a pancoast tumor?

Answer 8

tumor in the apex of the lung that affects the cervical sympathetic plexus, causing Horner syndrome, SVC syndrome, sensorimotor deficits, and hoarseness

Question 9

What is superior vena cava syndrome?

Answer 9

obstruction of the SVC that impairs blood drainage from the head, neck, and upper extremities. May see tongue swelling, jugular venous distention, and edema in the upper estremities.

Question 10

causes of superior vena cava syndrome?

Answer 10

malignancy, thrombosis from indwelling catheters.

Question 11

Why is superior vena cava syndrome dangerous?

Answer 11

medical emergency because it can raise the intracranial pressure and cause headaches, dizziness, and increased risk of aneurysm or rupture of intracranial arteries.

Question 12

Where do lung cancers metastasize?

Answer 12

adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly)

Question 13

adenocarcionoma: location, who gets it, mutations, and associations

Answer 13

peripheral. most common cancer in non-smokers and overall. activating mutations in k-ras, EGFR, and ALK. associated with clubbing/hypertrophic osteroarthropathy
may see gland formation or mucin production

Question 14

What is bronchioalveolar cancer?

Answer 14

adenocarcinoma in situ. see haziy infiltrates on CXR, much like with pneumonia. great prognosis. grows along the alveolar septa- looks like thickening of the alveolar walls.

Question 15

What is squamous cell lung cancer: location, histology, characteristics

Answer 15

central.
hilar mass arising from the bronchus. histo shows keratin pearls and intracellular bridges. associated with smoking. may produce parathyroid hormone related peptide, which can cause hypercalcemia

Question 16

Small cell lung cancer: location, characteristics, histology

Answer 16

central. associated with smoking.
very agressive.
see small dark blue cells- arises from neuroendocrine Kulchitsky cells.
may produced ACTH, ADH, or antibodies against presynaptic Ca channels (aka Lambert-Eaton syndrome)

Question 17

What is a common mutation in small cell lung cancer? Treatment?

Answer 17

myc. treat with chemo because it is inoperable

Question 18

large cell carcinoma: histo, location,

Answer 18

highly anaplastic undifferentialed tumor with a poor prognosis. less responsive to chemo, so do surgical removal. histo shows pleiomorphic giant cells

Question 19

characteristics of bronchial carcinoid tumor

Answer 19

excellent prognosis; mets are very rare.
symptoms usually d/t mass effect, though carcinoid syndrome (5-HT secretion causing flushing, diarrhea, and wheezing) are possible.

Question 20

histo of a bronchial carcinoid tumor

Answer 20

nests of neuroendocrine cells that are chromogranin A positive.