Pleural Diseases

Question 1

What are the two layers of the pleura?

Answer 1

Visceral pleura and Parietal pleura.

Question 2

What is the primary blood supply for the visceral pleura?

Answer 2

Bronchial circulation.

Question 3

Which nerves supply the parietal pleura?

Answer 3

Intercostal nerve and phrenic nerve.

Question 4

What is the main function of serous fluid in the pleural cavity?

Answer 4

To lubricate the pleural surfaces and generate surface tension for thoracic cavity expansion during inspiration.

Question 5

What regulates pleural fluid formation?

Answer 5

The balance of hydrostatic and oncotic pressures between the parietal and visceral pleura, and lymphatic drainage.

Question 6

What is pleural effusion?

Answer 6

An excess quantity of fluid in the pleural space due to increased fluid formation or decreased fluid removal.

Question 7

What are the classifications of pleural effusion based on Light’s criteria?

Answer 7

Transudate and Exudate.

Question 8

What is the most common cause of transudative pleural effusion?

Answer 8

Congestive heart failure.

Question 9

What are the diagnostic imaging options for pleural effusion?

Answer 9

Chest radiograph, ultrasound, and CT scan.

Question 10

What is the first-line treatment for primary spontaneous pneumothorax?

Answer 10

Simple aspiration.

Question 11

What is the hallmark of tension pneumothorax?

Answer 11

Positive pressure in the pleural space throughout the respiratory cycle.

Question 12

What structures are located in the superior mediastinum?

Answer 12

Thymus, trachea, esophagus, aortic arch, brachiocephalic trunk, superior vena cava, and vagus nerve.

Question 13

What is the most common cause of acute mediastinitis?

Answer 13

Direct invasion following surgical interventions.

Question 14

What imaging modality is diagnostic of choice for acute mediastinitis?

Answer 14

CT scan.

Question 15

What is the treatment for fibrosing mediastinitis?

Answer 15

Supportive treatment targeting underlying causes, often requiring biopsy for diagnosis.

Question 16

What is Light’s diagnostic criterion for exudative pleural effusion?

Answer 16

Pleural fluid protein/serum protein ratio >0.5, Pleural fluid LDH/serum LDH ratio >0.6, or Pleural fluid LDH >2/3 the upper limit of normal for serum.

Question 17

What is the most common cause of exudative pleural effusion in the US?

Answer 17

Parapneumonic effusion.

Question 18

What is empyema?

Answer 18

A grossly purulent effusion associated with bacterial infections.

Question 19

What are the symptoms of pleural effusion?

Answer 19

Chest pain, shortness of breath, dry cough, orthopnea, and lightheadedness if fluid volume is large.

Question 20

What is a subpulmonic effusion?

Answer 20

A pleural effusion located beneath the lungs, often elevating the diaphragm.

Question 21

How does malignancy cause pleural effusion?

Answer 21

By increasing vascular permeability or obstructing lymphatic drainage.

Question 22

What is the most common malignancy causing pleural effusion?

Answer 22

Lung cancer.

Question 23

What is pleurodesis?

Answer 23

A procedure to obliterate the pleural space by inducing inflammation and fibrosis with a sclerosing agent.

Question 24

What is the main nerve supplying the diaphragm?

Answer 24

Phrenic nerve.

Question 25

What is pneumothorax?

Answer 25

Air in the pleural space, causing partial or complete lung collapse.

Question 26

What is the primary cause of primary spontaneous pneumothorax?

Answer 26

Rupture of apical pleural blebs.

Question 27

What are the types of pneumothorax?

Answer 27

Spontaneous (primary and secondary), Traumatic, and Tension pneumothorax.

Question 28

What imaging finding is typical in tension pneumothorax?

Answer 28

Mediastinal shift to the unaffected side.

Question 29

What are the subdivisions of the inferior mediastinum?

Answer 29

Anterior, middle, and posterior portions.

Question 30

What is Hamman's sign in pneumomediastinum?

Answer 30

A crunching or clicking noise synchronous with the heartbeat.

Question 31

What is the diagnostic hallmark of chylothorax?

Answer 31

Milky pleural fluid with triglyceride levels >110 mg/dL.

Question 32

What is a bronchogenic cyst?

Answer 32

A congenital anomaly commonly found in the middle mediastinum.

Question 33

What is the treatment for acute mediastinitis?

Answer 33

Mediastinal exploration, drainage, and broad-spectrum antibiotics.

Question 34

What is the most common cause of transudative pleural effusion?

Answer 34

Congestive heart failure.

Question 35

What imaging modality guides thoracocentesis?

Answer 35

Ultrasound.

Question 36

What are the signs of pleural effusion on percussion?

Answer 36

Dullness on the affected side.

Question 37

What are common symptoms of pleural effusion?

Answer 37

Chest pain, shortness of breath, dry cough, and orthopnea.

Question 38

What is the treatment for a parapneumonic effusion with pH <7.20?

Answer 38

Chest tube thoracostomy (CTT).

Question 39

Which cancers commonly cause malignant pleural effusion?

Answer 39

Lung cancer, breast cancer, and lymphoma.

Question 40

What is pleurodesis used for?

Answer 40

To obliterate the pleural space by inducing pleural adhesion and fibrosis.

Question 41

What causes chylothorax?

Answer 41

Disruption of the thoracic duct due to trauma or tumors.

Question 42

What is the primary imaging finding in tension pneumothorax?

Answer 42

Mediastinal shift to the unaffected side.

Question 43

What are the symptoms of primary spontaneous pneumothorax?

Answer 43

Sudden chest pain and shortness of breath.

Question 44

What is pneumomediastinum?

Answer 44

Gas in the mediastinum.

Question 45

What is the most common cause of acute mediastinitis?

Answer 45

Postoperative deep sternal infections.

Question 46

What structures are in the superior mediastinum?

Answer 46

Thymus, trachea, esophagus, aortic arch, superior vena cava, and vagus nerve.

Question 47

What are the regions of the mediastinum?

Answer 47

Superior, anterior, middle, and posterior.

Question 48

What is the hallmark clinical sign of pneumomediastinum?

Answer 48

Hamman's sign (a crunching noise synchronous with the heartbeat).

Question 49

What is fibrosing mediastinitis?

Answer 49

Abnormal proliferation of collagen and fibrous tissue within the mediastinum.

Question 50

What causes tuberculous pleuritis?

Answer 50

A hypersensitivity reaction to tuberculous protein.

Question 51

What are the main findings of malignant mesothelioma on imaging?

Answer 51

Pleural thickening and a shrunken hemithorax.

Question 52

What diagnostic test confirms malignant mesothelioma?

Answer 52

Image-guided needle biopsy or thoracoscopy.

Question 53

What is the treatment for tension pneumothorax?

Answer 53

Immediate needle decompression followed by chest tube placement.

Question 54

What is Meigs syndrome?

Answer 54

Pleural effusion and ascites associated with ovarian cancer.

Question 55

What is the function of the phrenic nerve?

Answer 55

It supplies motor innervation to the diaphragm.