[MCQ] Disorders of the Pleura and Mediastinum- Part 2

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Disorders of the Pleura and Mediastinum- Part 2

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Question 1

Which is the most common symptom in cases of pleural effusion secondary to pulmonary embolization ?

A	Dyspnea
B	Pain
C	Cough
D	Hemoptysis

Question 1 Explanation:

Dyspnea is the most common symptom in with pleural effusion due to PE

Question 2

In pleural effusion secondary to pulmonary embolization, if pleural effusion increases in size after anticoagulation, the possibility is ?

A	Recurrent emboli
B	Hemothorax
C	Pleural infection
D	All of the above

Question 2 Explanation:

If pleural effusion secondary to PE increases in size after anticoagulation, probability is of recurrent emboli or a hemothorax or a pleural infection.

Question 3

Tuberculous pleural effusions are due to ?

A	Hematogenous spread of tubercular bacilli
B	Contiguous spread of tubercular bacilli
C	Hypersensitivity reaction to tuberculous protein in pleural space
D	All of the above

Question 3 Explanation:

Tuberculous pleural effusions are due to a hypersensitivity reaction to tuberculous protein in pleural space

Question 4

Which of the following is false about tuberculous pleural effusion ?

A	Contains predominantly small lymphocytes
B	Adenosine deaminase level > 40 IU/L
C	Interferon  level >140 pg/mL
D	Recommended treatment of pleural & pulmonary tuberculosis is not identical

Question 4 Explanation:

Tuberculous pleural fluid is an exudate with predominantly small lymphocytes. TB markers in pleural fluid like ADA is > 40 IU/L, interferon  is > 140 pg/mL, or positive PCR for tuberculous DNA. The recommended treatment of pleural and pulmonary tuberculosis is “identical”

Question 5

Pleural effusion that produces no shift of mediastinal structures to opposite side is suggestive of ?

A	Tuberculosis
B	Mesothelioma
C	Pulmonary adenocarcinoma
D	Metastasis to pleura

Question 6

Which of the following is false about AIDS & pleural effusions ?

A	Pleural effusions are uncommon
B	Most common cause is Kaposi’s sarcoma
C	Pleural effusions very uncommon with P. carinii infection
D	None of the above

Question 7

The most common cause of chylothorax is ?

A	Malignancy
B	Trauma
C	Developmental anomaly
D	Necrotizing infection

Question 7 Explanation:

Chylothorax occurs when thoracic duct is disrupted and chyle accumulates in pleural space. The most common cause of chylothorax is trauma.

Question 8

Which of the following is characteristic of pleural fluid biochemical analysis in a case of chylothorax ?

A	LDL > 120 mg/dL
B	Triglyceride > 110 mg/dL
C	HDL < 40 mg/dL
D	Total cholesterol > 300 mg/dL

Question 8 Explanation:

In chylothorax, thoracentesis reveals milky fluid and biochemical analysis reveals a triglyceride level of > 110 mg/dL.

Question 9

The treatment of choice for most chylothoraces is ?

A	Tube thoracostomy with chest tube drainage
B	Pleurodesis
C	Implantation of a pleuroperitoneal shunt
D	Ligation of thoracic duct

Question 9 Explanation:

Treatment of choice for most chylothoraces is insertion of a chest tube plus administration of octreotide. If these fail, a pleuroperitoneal shunt is placed unless patient has chylous ascites.

Question 10

Hemothorax is diagnosed when hematocrit of pleural fluid is how much of the peripheral blood hematocrit ?

A	> 25 %
B	> 33 %
C	> 50 %
D	> 75 %

Question 10 Explanation:

If hematocrit of bloody pleural fluid is >50% that of the peripheral blood, patient has a hemothorax

Question 11

Most hemothoraces are the result of ?

A	Trauma
B	Rupture of a blood vessel
C	Rupture of a blood vessel
D	Tuberculosis

Question 11 Explanation:

Most hemothoraces are due to trauma. Other causes include rupture of a blood vessel or tumor

Question 12

The treatment of choice for most hemothorax is ?

A	Tube thoracostomy with chest tube drainage
B	Pleurodesis
C	Thoracotomy
D	Blood transfusion

Question 12 Explanation:

Most patients with hemothorax are treated with tube thoracostomy, which allows continuous quantification of bleeding. If pleural hemorrhage exceeds 200 mL/hour, thoracotomy is considered

Question 13

Which WBC predominates in drug-induced pleural effusion ?

A	Neutrophil
B	Lymphocyte
C	Monocyte
D	Monocyte

Question 13 Explanation:

Several drugs can cause pleural effusion. Associated fluid is usually eosinophilic

Question 14

Drug-induced pleural disease can be due to all except ?

A	Nitrofurantoin
B	Dantrolene
C	Chloroquine
D	Methysergide

Question 15

Drug-induced pleural disease can be due to all except ?

A	Cephalosporins
B	Bromocriptine
C	Bromocriptine
D	Amiodarone

Question 15 Explanation:

Drug-induced Exudative pleural disease can be due to Nitrofurantoin, Dantrolene, Methysergide, Bromocriptine, Procarbazine, Amiodarone.

Question 16

Pleural effusions that occur following coronary artery bypass surgery within the first weeks are which sided ?

A	Right-sided
B	Left-sided
C	Bilateral
D	Any of the above

Question 16 Explanation:

Pleural effusions commonly occur within weeks following CABG surgery are left-sided & bloody, with large numbers of eosinophils & respond to therapeutic thoracenteses. Effusions occurring after first few weeks are left-sided & clear yellow with more of small lymphocytes & tend to recur

Question 17

Which of the following medical manipulations can cause pleural effusion ?

A	Endoscopic variceal sclerotherapy
B	Radiation therapy
C	Intra-vascular insertion of central lines
D	All of the above

Question 17 Explanation:

Medical manipulations that induce pleural effusions include abdominal surgery, endoscopic variceal sclerotherapy, radiation therapy, liver or lung transplantation, or intravascular insertion of central lines.

Question 18

All of the following are features of “Pulmonary Lymphangiomyomatosis (LAM)” except ?

A	Asthma
B	Emphysema
C	Recurrent pneumothorax
D	Chylous pleural effusion

Question 19

In “Pulmonary Lymphangiomyomatosis (LAM)”, characteristic pathological lesion is ?

A	Proliferation of lung lymphatic vessels
B	Proliferation of atypical pulmonary interstitial smooth muscle
C	Proliferation of surfactant producing alveolar cells
D	All of the above

Question 20

Which of the following treatment modalities have a beneficial role in “Pulmonary Lymphangiomyomatosis (LAM)” ?

A	Oophorectomy
B	Progesterone
C	Tamoxifen
D	All of the above

Question 21

Which of the following about pneumothorax is false ?

A	Spontaneous pneumothorax occurs without antecedent trauma to thorax
B	Primary spontaneous pneumothorax occurs in the absence of underlying lung disease
C	Secondary spontaneous pneumothorax occurs in presence of underlying lung disease
D	In tension pneumothorax, pressure in pleural space is positive at the end of inspiration

Question 21 Explanation:

In tension pneumothorax, pressure in pleural space is positive throughout the respiratory cycle

Question 22

Which of the following is false about primary spontaneous pneumothorax ?

A	Usually due to rupture of apical pleural blebs
B	Occur almost exclusively in smokers
C	50 % of patients with an initial primary spontaneous pneumothorax will have a recurrence
D	None of the above

Question 22 Explanation:

Primary spontaneous pneumothoraces are due to rupture of apical pleural blebs that lie within or immediately under the visceral pleura. They occur almost exclusively in smokers. Approximately one-half of patients with an initial primary spontaneous pneumothorax will have a recurrence.

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See all quizzes of Disorders of the Pleura and Mediastinum at here:

1. Which is the most common symptom in cases of pleural effusion secondary to pulmonary embolization ?
A. Dyspnea
B. Pain
C. Cough
D. Hemoptysis

2. In pleural effusion secondary to pulmonary embolization, if pleural effusion increases in size after anticoagulation, the possibility is ?
A. Recurrent emboli
B. Hemothorax
C. Pleural infection
D. All of the above

3. Tuberculous pleural effusions are due to ?
A. Hematogenous spread of tubercular bacilli
B. Contiguous spread of tubercular bacilli
C. Hypersensitivity reaction to tuberculous protein in pleural space
D. All of the above

4. Which of the following is false about tuberculous pleural effusion ?
A. Contains predominantly small lymphocytes
B. Adenosine deaminase level > 40 IU/L
C. Interferon  level >140 pg/mL
D. Recommended treatment of pleural & pulmonary tuberculosis is not identical

5. Pleural effusion that produces no shift of mediastinal structures to opposite side is suggestive of ?
A. Tuberculosis
B. Mesothelioma
C. Pulmonary adenocarcinoma
D. Metastasis to pleura
6. Which of the following is false about AIDS & pleural effusions ?
A. Pleural effusions are uncommon
B. Most common cause is Kaposi’s sarcoma
C. Pleural effusions very uncommon with P. carinii infection
D. None of the above

7. The most common cause of chylothorax is ?
A. Malignancy
B. Trauma
C. Developmental anomaly
D. Necrotizing infection

8. Which of the following is characteristic of pleural fluid biochemical analysis in a case of chylothorax ?
A. LDL > 120 mg/dL
B. Triglyceride > 110 mg/dL
C. HDL < 40 mg/dL
D. Total cholesterol > 300 mg/dL

9. The treatment of choice for most chylothoraces is ?
A. Tube thoracostomy with chest tube drainage
B. Pleurodesis
C. Implantation of a pleuroperitoneal shunt
D. Ligation of thoracic duct

10. Hemothorax is diagnosed when hematocrit of pleural fluid is how much of the peripheral blood hematocrit ?
A. > 25 %
B. > 33 %
C. > 50 %
D. > 75 %

11. Most hemothoraces are the result of ?
A. Trauma
B. Rupture of a blood vessel
C. Tumor
D. Tuberculosis

12. The treatment of choice for most hemothorax is ?
A. Tube thoracostomy with chest tube drainage
B. Pleurodesis
C. Thoracotomy
D. Blood transfusion

13. Which WBC predominates in drug-induced pleural effusion ?
A. Neutrophil
B. Lymphocyte
C. Monocyte
D. Eosinophil

14. Drug-induced pleural disease can be due to all except ?
A. Nitrofurantoin
B. Dantrolene
C. Chloroquine
D. Methysergide
15. Drug-induced pleural disease can be due to all except ?
A. Cephalosporins
B. Bromocriptine
C. Procarbazine
D. Amiodarone

16. Pleural effusions that occur following coronary artery bypass surgery within the first weeks are which sided ?
A. Right-sided
B. Left-sided
C. Bilateral
D. Any of the above

17. Which of the following medical manipulations can cause pleural effusion ?
A. Endoscopic variceal sclerotherapy
B. Radiation therapy
C. Intra-vascular insertion of central lines
D. All of the above

18. All of the following are features of “Pulmonary Lymphangiomyomatosis (LAM)” except ?
A. Asthma
B. Emphysema
C. Recurrent pneumothorax
D. Chylous pleural effusion

19. In “Pulmonary Lymphangiomyomatosis (LAM)”, characteristic pathological lesion is ?
A. Proliferation of lung lymphatic vessels
B. Proliferation of atypical pulmonary interstitial smooth muscle
C. Proliferation of surfactant producing alveolar cells
D. All of the above
20. Which of the following treatment modalities have a beneficial role in “Pulmonary Lymphangiomyomatosis (LAM)” ?
A. Oophorectomy
B. Progesterone
C. Tamoxifen
D. All of the above
21. Which of the following about pneumothorax is false ?
A. Spontaneous pneumothorax occurs without antecedent trauma to thorax
B. Primary spontaneous pneumothorax occurs in the absence of underlying lung disease
C. Secondary spontaneous pneumothorax occurs in presence of underlying lung disease
D. In tension pneumothorax, pressure in pleural space is positive at the end of inspiration

22. Which of the following is false about primary spontaneous pneumothorax ?
A. Usually due to rupture of apical pleural blebs
B. Occur almost exclusively in smokers
C. 50 % of patients with an initial primary spontaneous
pneumothorax will have a recurrence
D. None of the above

Disorders of the Pleura and Mediastinum

[MCQ] Disorders of the Pleura and Mediastinum- Part 2

I. Start the exam by click the “Start” button

Disorders of the Pleura and Mediastinum- Part 2

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