Pleural and mediastinal disease 2

Question 1

What is atelectasis?

Answer 1

The collapse or incomplete expansion of alveolar air spaces

Question 2

What is the pathogenesis of atelectasis?

Answer 2

(1) Obstruction

(2) Compression

Question 3

What are the causes of pleural effusions?

6

Answer 3

(1) Noninflammatory
(a) congestive heart failure
(b) rupture aortic aneurysm
(2) Inflammatory
(a) bacterial infections
(b) collagen vascular diseases

Question 4

What are the causes of pleuritis?

6

Answer 4

(1) Bacterial infections
(2) Rheumatoid arthritis
(3) Lupus erythematosis
(4) Uremia
(5) Radiation therapy
(6) Pulmonary infarcts

Question 5

What is empyema?

3

Answer 5

(1) Complication of pneumonia with pleural abscess formation
(2) Infection spreads to pleural cavity
(3) Leads to bacteremic dissemination and pleural fibrosis

Question 6

What are the diseases of the mediastinum?

5

Answer 6

(1) Lymphoma
(2) Thymoma
(3) Mediastinal germ cell tumors
(4) Carcinoid tumors
(5) Posterior mediastinum tumors

Question 7

What is the mediastinum anatomically bounded by?

5

Answer 7

(1) Thoracic inlet superiorly
(2) Diaphragm inferiorly
(3) Sternum anteriorly
(4) Spine posteriorly
(5) Pleura laterally

Question 8

What are the tumors of the anterior mediastinum?

6

Answer 8

(1) Thymoma
(2) Lymphoma
(3) Germ cell tumor
(4) Carcinoid
(5) Metastatic carcinoma
(6) Lipoma

Question 9

What are the tumors of the middle mediastinum?

2

Answer 9

(1) Sarcoma of the heart and pleura

(2) Lymphoma

Question 10

What are the tumors of the posterior mediastinum?

3

Answer 10

(1) Neural tumors: (a) schwannoma and (b) neurofibroma

(2) Ganglioneuroblastoma

Question 11

What are the symptoms of thymoma?

6

Answer 11

(1) Cough
(2) Dyspnea
(3) Chest pain
(4) Dysphagia
(5) Hoarseness
(6) Stridor

Question 12

What are the characteristics of thymoma?

2

Answer 12

(1) Thymoma has a dense fibrous capsule

2) Tumor is composed of epithelial cells and lymphocytes (lymphocytes are benign component of tumor

Question 13

What are the classifications of thymomas?

3

Answer 13

(1) Typical thymoma - usually benign but may behave aggressively
(2) Atypical thymoma - indeterminate
(3) Thymic carcinoma - malignant and aggressive

Question 14

What are the characteristics of typical thymoma?

3

Answer 14

(1) Small and uniform tumor
(2) No necrosis or hemorrhage
(3) No invasion of capsule by tumor

Question 15

What are the characteristics of thymic carcinoma?

3

Answer 15

(1) Large tumor
(2) Areas of necrosis and hemorrhage
(3) Invasion of tumor through capsule

Question 16

How are thymoma and Myasthenia Gravis related?

Answer 16

(1) Myasthenia gravis is an acquired autoimmune disorder resulting in acetylcholine receptor deficiency
(2) 65% of patients with MG have thymic lymphoid hyperplasia
(3) 15% of patients with MG have thymoma
(4) Tumors tend to behave less aggressively with MG

Question 17

What are the characteristics of mediastinal germ cell tumors?
(3)

Answer 17

(1) Most germ cell tumors arise in gonadal tissue
(2) Comprise 10% of anterior mediastinal tumors
(3) Marked male predominance
(4) Elevated HCG/AFP (human chorionic gonadotropin/α-fetoprotein)

Question 18

What are the classifications of mediastinal germ cell tumors?
(3)

Answer 18

(1) Benign - teratoma (mixed tumor elements)
(2) Seminoma - malignant
(3) Non-seminomatous tumors - malignant, high-grade

Question 19

What is thymic carcinoid?

4

Answer 19

(1) Rare mediastinal tumor
(2) Aggressive neoplasms that commonly invade locally to adjacent mediastinal structures
(3) Metastasize to regional lymph nodes
(4) Behave aggressively