[MCQ] Disorders of the Pleura and Mediastinum- Part 3

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Disorders of the Pleura and Mediastinum- Part 3

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Question 1

Which of the following treatments for primary spontaneous pneumothorax surely prevents recurrences ?

A	Simple aspiration
B	Stapling of blebs
C	Pleural abrasion
D	All of the above

Question 1 Explanation:

Initial recommended treatment for primary spontaneous pneumothorax is simple aspiration. If the lung does not expand or if patient has recurrent pneumothorax, thoracoscopy with stapling of blebs and pleural abrasion is indicated. Thoracoscopy or thoracotomy with pleural abrasion is ~100% successful in preventing recurrences.

Question 2

Secondary spontaneous pneumothoraces are most frequently found in ?

A	During mechanical ventilation or resuscitative efforts
B	Asthma
C	COPD
D	Lung malignancy

Question 2 Explanation:

Most secondary spontaneous pneumothoraces are due to COPD, but pneumothoraces have been reported with virtually every lung disease

Question 3

Patients with secondary spontaneous pneumothorax should be treated in the first instance with ?

A	Tube thoracostomy
B	Bleb resection
C	Pleural abrasion
D	Simple aspiration

Question 3 Explanation:

Simple aspiration

Question 4

Which of the following is a cause of iatrogenic pneumothorax ?

A	Transthoracic needle aspiration
B	Thoracentesis
C	Insertion of central intravenous catheters
D	All of the above

Question 4 Explanation:

Leading causes of iatrogenic pneumothorax are transthoracic needle aspiration, thoracentesis and insertion of central intravenous catheters.

Question 5

Tension pneumothorax is most frequently found in ?

A	During mechanical ventilation/resuscitative efforts
B	Asthma
C	COPD
D	Lung malignancy

Question 5 Explanation:

Lung malignancy

Question 6

In treating ‘Tension pneumothorax’, a large-bore needle is inserted into pleural space through ?

A	Second anterior intercostal space
B	Third anterior intercostal space
C	Fourth anterior intercostal space
D	Fourth anterior intercostal space

Question 6 Explanation:

Tension pneumothorax is a medical emergency. A large-bore needle is inserted into pleural space through 2nd anterior intercostal space. Needle is left in place until a thoracostomy tube can be inserted

Question 7

Mediastinum is separated into how many compartments ?

A	2
B	3
C	4
D	5

Question 7 Explanation:

Mediastinum is the region between pleural sacs, separated in 3 compartments

Question 8

Thoracic duct is present in which compartment of mediastinum ?

A	Anterior
B	Middle
C	Posterior
D	None of the above

Question 9

Azygos and hemiazygos veins are present in which compartment of mediastinum ?

A	Anterior
B	Middle
C	Posterior
D	None of the above

Question 9 Explanation:

Anterior mediastinum extends from the sternum anteriorly to pericardium & brachiocephalic vessels posteriorly. It contains thymus gland, anterior mediastinal lymph nodes & internal mammary arteries & veins. Middle mediastinum lies between anterior & posterior mediastina & contains heart, ascending & transverse arches of aorta, venae cavae, brachiocephalic arteries & veins, phrenic nerves, trachea, main bronchi & their contiguous lymph nodes & pulmonary arteries & veins. Posterior mediastinum is bounded by pericardium & trachea anteriorly & vertebral column posteriorly. It contains descending thoracic aorta, esophagus, thoracic duct, azygos & hemiazygos veins & posterior group of mediastinal lymph nodes

Question 10

Lymphomas are most common lesion in which mediastinal compartment ?

A	Anterior
B	Middle
C	Posterior
D	Any of the above

Question 11

Lymph node enlargement from metastases are most common lesion in which mediastinal compartment ?

A	Anterior
B	Middle
C	Posterior
D	Any of the above

Question 11 Explanation:

The most common lesions in the anterior mediastinum are thymomas, lymphomas, teratomatous neoplasms, and thyroid masses. The most common masses in the middle mediastinum are vascular masses, lymph node enlargement from metastases or granulomatous disease, and pleuropericardial and bronchogenic cysts. In the posterior mediastinum, neurogenic tumors, meningoceles, meningomyeloceles, gastroenteric cysts, and esophageal diverticula are commonly found.

Question 12

Hamman ’s sign is characteristic of ?

A	Pneumomediastinum
B	Chronic mediastinitis
C	Tension Pneumothorax
D	Traumatic Pneumothorax

Question 13

Hamman’s sign is best elicited in which position ?

A	Upright
B	Supine
C	Left lateral
D	Prone

Question 13 Explanation:

Physical examination in pneumomediastinum reveals subcutaneous emphysema in suprasternal notch & Hamman’s sign, which is a crunchi

Question 14

In pneumomediastinum, mediastinal air is absorbed faster if the patient is given ?

A	High concentrations of oxygen
B	CO2 inhalation
C	IV Hypertonic saline
D	High doses of IV glucocorticoids

Question 14 Explanation:

In pneumomediastinum, the mediastinal air will be absorbed faster if the patient inspires high concentrations of oxygen

Question 15

Word egophony comes from Greek “ego” which means ?

A	Temper
B	Silence
C	Cat
D	Goat

Question 15 Explanation:

Word egophony comes from Greek “ego” meaning goat. It describes change in pronounced sound of E to A. Mechanism in massive pleural effusions is upward displacement & compression or consolidation of lung at the top of effusion.

Question 16

Which of the following is the cause of bilateral diaphragmatic paralysis ?

A	Multiple sclerosis
B	Anterior horn disease
C	Muscular dystrophy
D	All of the above

Question 16 Explanation:

Most common causes of bilateral diaphragmatic paralysis include high spinal cord injury, thoracic trauma (including cardiac surgery), multiple sclerosis, anterior horn disease, and muscular dystrophy

Question 17

Most patients with severe diaphragmatic weakness may present with ?

A	Hypercapnic respiratory failure
B	Atelectasis
C	Pneumonia
D	All of the above

Question 17 Explanation:

Most patients with severe diaphragmatic weakness present with hypercapnic respiratory failure, frequently complicated by cor pulmonale and right ventricular failure, atelectasis, and pneumonia

Question 18

Most common cause of unilateral paralysis of diaphragm is ?

A	Thoracic trauma
B	High spinal cord injury
C	Nerve invasion from malignancy
D	Toxins

Question 18 Explanation:

The most common cause of unilateral paralysis of the diaphragm is nerve invasion from malignancy, usually a bronchogenic carcinoma. If the patient does not have malignancy, then usually no cause for the paralysis is found

Question 19

“Sniff test” is used for the confirmation of ?

A	Unilateral paralysis of diaphragm
B	Bilateral diaphragmatic paralysis
C	Nasal polyp
D	OSA

Question 19 Explanation:

Diagnosis of unilateral paralysis of diaphragm is suggested by finding an elevated hemidiaphragm on the chest roentgenogram. Confirmation is best established with the “sniff test”. When a patient is observed with fluoroscopy while sniffing, the paralyzed diaphragm will move paradoxically upward due to the negative intrathoracic pressure

Question 20

Which of the following is a pathophysiologic effect of severe kyphoscoliosis ?

A	Restrictive lung disease
B	Ventilation-perfusion imbalance
C	Cor pulmonale
D	All of the above

Question 20 Explanation:

The major pathophysiologic effects of severe kyphoscoliosis are restrictive lung disease and ventilation-perfusion imbalances that result in chronic alveolar hypoventilation, hypoxic vasoconstriction, and eventually pulmonary arterial hypertension and cor pulmonale.

Question 21

In kyphoscoliosis, at what angle of curvature, marked ventilatory abnormalities develop commonly ?

A	> 60º
B	> 70º
C	> 80º
D	> 90º

Question 21 Explanation:

The severity of the cardiopulmonary disease correlates roughly with the degree of scoliosis. If the angle of curvature is <60°, ventilatory impairment is rare, while if it is >90°, marked ventilatory abnormalities develop commonly

Question 22

Which of the following pectus excavatum is false ?

A	Congenital condition
B	Respiratory symptoms are uncommon
C	Pulmonary function tests are nearly normal
D	None of the above

Question 22 Explanation:

Pectus excavatum (Funnel chest) is a congenital condition. The lower portion of sternum is displaced posteriorly and anterior ribs are markedly bowed, which results in a depressed panel in anterior chest. Respiratory symptoms are uncommon, and pulmonary function tests are nearly normal.

Question 23

Which of the following about pectus carinatum is false ?

A	Structurally, it is the reverse of pectus excavatum
B	Associated with congenital atrial or ventricular septal defects
C	Severe prolonged childhood asthma
D	None of the above

Question 23 Explanation:

Pectus carinatum (Pigeon breast) This condition is the reverse of pectus excavatum with the sternum protruding anteriorly. This deformity is associated with congenital atrial or ventricular septal defects and severe prolonged childhood asthma

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

1.Which of the following treatments for primary spontaneous pneumothorax surely prevents recurrences ?
A. Simple aspiration
B. Stapling of blebs
C. Pleural abrasion
D. All of the above

2. Secondary spontaneous pneumothoraces are most frequently found in ?
A. During mechanical ventilation or resuscitative efforts
B. Asthma

C. COPD
D. Lung malignancy

3. Patients with secondary spontaneous pneumothorax should be treated in the first instance with ?
A. Tube thoracostomy
B. Bleb resection
C. Pleural abrasion
D. Simple aspiration

4. Which of the following is a cause of iatrogenic pneumothorax ?
A. Transthoracic needle aspiration
B. Thoracentesis
C. Insertion of central intravenous catheters
D. All of the above

5. Tension pneumothorax is most frequently found in ?
A. During mechanical ventilation/resuscitative efforts
B. Asthma
C. COPD
D. Lung malignancy

6. In treating ‘Tension pneumothorax’, a large-bore needle is inserted into pleural space through ?
A. Second anterior intercostal space
B. Third anterior intercostal space
C. Fourth anterior intercostal space
D. Fifth anterior intercostal space

7. Mediastinum is separated into how many compartments ?
A. 2
B. 3
C. 4
D. 5

8. Thoracic duct is present in which compartment of mediastinum ?
A. Anterior
B. Middle
C. Posterior
D. None of the above

9. Azygos and hemiazygos veins are present in which compartment of mediastinum ?
A. Anterior
B. Middle
C. Posterior
D. None of the above

10. Lymphomas are most common lesion in which mediastinal compartment ?
A. Anterior
B. Middle
C. Posterior
D. Any of the above
11. Lymph node enlargement from metastases are most common lesion in which mediastinal compartment ?
A. Anterior
B. Middle
C. Posterior
D. Any of the above

12. Hamman ’s sign is characteristic of ?
A. Pneumomediastinum
B. Chronic mediastinitis
C. Tension Pneumothorax
D. Traumatic Pneumothorax
13. Hamman’s sign is best elicited in which position ?
A. Upright
B. Supine
C. Left lateral
D. Prone

14. In pneumomediastinum, mediastinal air is absorbed faster if the patient is given ?
A. High concentrations of oxygen
B. CO
2 inhalation
C. IV Hypertonic saline

D. High doses of IV glucocorticoids

15. Word egophony comes from Greek “ego” which means ?
A. Temper
B. Silence
C. Cat
D. Goat

16. Which of the following is the cause of bilateral diaphragmatic paralysis ?
A. Multiple sclerosis
B. Anterior horn disease
C. Muscular dystrophy
D. All of the above

17. Most patients with severe diaphragmatic weakness may present with ?
A. Hypercapnic respiratory failure
B. Atelectasis
C. Pneumonia
D. All of the above

18. Most common cause of unilateral paralysis of diaphragm is ?
A. Thoracic trauma
B. High spinal cord injury
C. Nerve invasion from malignancy
D. Toxins

19. “Sniff test” is used for the confirmation of ?
A. Unilateral paralysis of diaphragm
B. Bilateral diaphragmatic paralysis
C. Nasal polyp
D. OSA

20. Which of the following is a pathophysiologic effect of severe kyphoscoliosis ?
A. Restrictive lung disease

B. Ventilation-perfusion imbalance
C. Cor pulmonale
D. All of the above
.
21. In kyphoscoliosis, at what angle of curvature, marked ventilatory abnormalities develop commonly ?
A. > 60º
B. > 70º
C. > 80º
D. > 90º

22. Which of the following pectus excavatum is false ?
A. Congenital condition
B. Respiratory symptoms are uncommon
C. Pulmonary function tests are nearly normal
D. None of the above

23. Which of the following about pectus carinatum is false ?
A. Structurally, it is the reverse of pectus excavatum
B. Associated with congenital atrial or ventricular septal defects
C. Severe prolonged childhood asthma
D. None of the above

Disorders of the Pleura and Mediastinum

[MCQ] Disorders of the Pleura and Mediastinum- Part 3

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Disorders of the Pleura and Mediastinum- Part 3

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