Chapter 15: The Lung - Pleura Flashcards Preview

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Flashcards in Chapter 15: The Lung - Pleura Deck (40)
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1

Radiation used in therapy for tumors in the lung or mediastinum often causes what type of pleuritis?

Serofibrinous pleuritis

2

A purulent pleural exudate (empyema) usually results from what?

Bacterial or mycotic seeding of the pleural space; by contiguous spread from intrapulmonary infections, but may also be from lymphatic or hematogenous dissemination

3

Which inflammatory-type of pleural effusion is characterized by loculated, yellow-green, creamy pus composed of masses of neutrophils admixed with other leukocytes?

Empyema

4

Empyema of the lungs may resolve, but more often the exudate organizes into what; causes what complications?

- Organizes --> dense, tough fibrous adhesions

- Frequently obliterate the pleural space or envelope the lungs

- Restricting pulmonary expansion

5

Which type of pleuritis is manifested by sanguineous inflammatory exudates?

Hemorrhagic pleuritis

6

Hemorrhagic pleuritis is found in what 3 settings?

- Hemorrhagic diatheses

- Rickettsial diseases

- Neoplastic involvement

7

What are the 3 major mechanisms underlying transudative pleural effusions; examples?

- ↑ hydrostatic pressure; "overflow" from the lung interstitium = CHF

- ↓ plasma oncotic pressure = nephrotic syndrome

- Movement of transudative ascitic fluid thru the diaphargam = cirrhosis

8

What are the 2 major mechanisms underlying exudative pleural effusions; some examples?

- Inflammation --> infection (TB, pneumonia), PE (infarction), CT disease (SLE, RA), adjacent to subdiaphragmatic disease (pancreatitis, subphrenic abscess)

- Malignancy

9

What is the arrow indicating on this CT scan?

Pleural effusion

10

How will a pleural effusion associated with mediastinal carcinomatosis appear grossly due to decreased lymph drainage?

Milky chylous effusion = Chylothorax

11

Noninflammatory collections of serous fluid within pleural cavities are known as what; appear how grossly?

Hydrothorax; clear fluid that is straw colored

12

What is the most common cause of hydrothorax; other causes?

- Most common = Cardiac failure

- Also, renal failure and cirrhosis

13

Hemothorax is a usually fatal complication associated with what?

Ruptured aortic aneurysm or vascular trauma

14

Pneumothorax is most commonly associated with what 3 conditions?

- Emphysema

- Asthma

- Tuberculosis

15

Spontaneous idiopathic penumothorax most often occurs in which age group and is due to what?

- Young patients

- Rupture of small, peripheral, usually apical subpleural blebs

16

Typical course of spontaneous idiopathic penumothorax; and likelihood or recurrence?

- Typically subsides spontaneously as air is resorbed

- Reccurent attacks = common

17

When injury to chest wall results in a one-way valve allowing air into the pleural space, but not out, effectively acting as a pump and ↑ pressure, this is known as?

Tension pneumothorax

18

A tension pneumothorax is due to expansion of which structure?

Chest wall (not lungs per se)

19

What is one of the more devastating consequences of Empyema that makes it hard to treat and hard to clear out?

Creating loculations --> web-like traps for fluid

20

What type of pneumothorax is this?

Primary pneumothorax

21

What type of pneumothorax is this?

Tension pneumothorax

22

Which type of pneumothorax is associated with pleural cavity pressure is < atmospheric pressure?

Pleural cavity pressure > atmospheric pressure?

- Pleural cavity < atmospheric = primary pneumothorax

- Pleural cavity > atmospheric = tension pneumothorax

23

In spontaneous idiopathic pneumothorax which direction will the trachea shift?

TOWARD the side of collapse

24

What is more common primary pleural tumors or secondary tumors from metastasis?

Secondary from metastasis

25

The most frequent metastatic malignancies of the pleura arise from which 2 sites?

Breast and lung

26

In most metastatic involvements of the pleura what type of effusion follows?

Serous or sero-sangioneous often containing neoplastic cells

27

Which soft-tissue tumor has a propensity to occur in the pleura is often attached to the surface by a pedicle?

Solitary fibrous tumor

28

Which immunostaining features of solitary fibrous tumors are helpful in distinguishing these tumors from malignant mesotheliomas?

CD34+ and keratin-negative

29

What do solitary fibrous tumors show microscopically?

Whorls of reticulin and collagen fibers w/ interspersed spindle cells resembling fibroblasts

30

Solitary fibrous tumors are highly associated with a cryptic inverion of which chromosome and this creates which fusion gene unique to this tumor?

Chromosome 12 ---> NAB2-STAT6 fusion gene