Lecture 3 chest wall

What is the hallmark feature of Pectus Excavatum?

A. Forward projection of the sternum

B. Indrawing of the lower sternum

C. Absence of pectoral muscles

D. Poor rib development

Answer: B

Front: What is the treatment of congenital chest wall deformities primarily aimed at?

Back: Cosmetic improvement, not physiological reasons.

Poland’s Syndrome involves agenesis of the _________ muscles.

Answer: Pectoral

Which of the following is NOT associated with Poland’s anomaly?

A. Absence of pectoral muscles

B. Poor rib development

C. Lung hernia

D. Cosmetic deformity

Answer: C

Empyema necessitatis often results from:

A. Superficial skin infections

B. Inward extension of untreated superficial infections

C. Congenital chest deformities

D. Rib fractures

Answer: B

What are the clinical features of subpectoral abscess?

Superficial infections, if inadequately treated, can lead to _________.

Back: Erythema, induration, systemic sepsis, tenderness in the pectoral region.

Empyema

The treatment for subpectoral abscess includes:

A. Oral antibiotics only

B. Incisional drainage and systemic antibiotics

C. Physiotherapy

D. Surgical resection of the chest wall

Answer: B

Tietze syndrome is primarily:

A. Suppurative inflammation of the costochondral cartilages

B. Nonsuppurative inflammation of the costochondral cartilages

C. A form of lung hernia

D. A complication of subpectoral abscess

Answer: B

What is the main treatment for Tietze syndrome?

Tietze syndrome may represent a manifestation of _____________.

Back: Symptomatic treatment with NSAIDs or corticosteroids.

Answer: Seronegative rheumatic disease

Which of the following statements about Mondor disease is TRUE?

A. It is a systemic condition affecting multiple veins.

B. It carries a high risk of thromboembolism.

C. It is localized thrombophlebitis of the thoracoepigastric vein.

D. It requires aggressive anticoagulation therapy.

Answer: C

What are the clinical findings in Mondor disease?

Mondor disease is more commonly observed in _________.

Localized, tender, cordlike structure in the subcutaneous tissues

Answer: Women

What is the most common benign skeletal chest wall tumor?

A. Fibrous dysplasia

B. Chondroma

C. Osteochondroma

D. Desmoid tumor

Answer: A

Name the treatment for benign chest wall tumors like osteochondroma.?

Malignant chest wall tumors include __________, chondrosarcoma, and Ewing’s sarcoma.

Back: Wide local excision.

Answer: Fibrosarcoma

Prognosis of malignant chest wall tumors depends on:

A. Histological grade

B. Tumor stage

C. Patient age

Answer: D

The diagnostic hallmark of surgical emphysema is:

A. Subcutaneous swelling

B. Palpable crepitus

C. Tender mass

D. Pleural effusion on X-ray

Answer: B

Front: What are the common causes of surgical emphysema?

Severe cases of surgical emphysema are treated with _________.

Back: Lung injury, tracheal injury, chest wall trauma.

Answer: ICT

Which of the following findings is characteristic of a pleural effusion?

A. Hyper-resonance on percussion

B. Dullness on percussion

C. Tracheal shift to the same side

D. Normal breath sounds

Answer: B

How do you distinguish transudative from exudative pleural effusion?

Malignant pleural effusion often presents as __________ fluid.

Back: Transudate is protein-poor; exudate is protein-rich with inflammatory markers.

Answer: Bloody

The most common causative organism of empyema in healthy adults is:

A. Streptococcus pneumoniae

B. Staphylococcus aureus

C. H. influenzae

D. Aerobic gram-negative bacilli

Answer: B

Front: What are the three pathological stages of empyema?

Chronic empyema leads to a _________ chest with a functionless lung

Back: Exudative, fibrinopurulent, organizing stages.

Answer: Frozen

What is the key feature of empyema necessitans?

A. Frozen chest

B. Subcutaneous collection of pus

C. Pleuritic pain

D. Severe tracheal shift

Answer: B

Front: What is the treatment for empyema necessitans?

Empyema necessitans is often a complication of untreated _________.

Back: Drain the empyema via ICT, antibiotics, and sometimes direct drainage for tortuous tracks.

Answer: Empyema thoracis

Lung hernia is characterized by:

A. Fluid collection in the pleural space

B. Defect in the chest wall with protrusion of lung tissue

C. Air in the subcutaneous plane

D. Rib fracture with lung collapse

Answer: B

Front: What are the causes of lung hernia?

A lung hernia enlarges with ________ or Valsalva maneuver.

Back: Congenital defects, trauma, surgical operations.

Answer: Cough

Which of the following contributes to the chronicity of empyema?

A. Faulty drainage

B. Inappropriate antibiotics

C. Mismanagement of acute empyema

D. All of the above

Answer: D

Front: What is the most serious complication of chronic empyema?

Early _________ of empyema is critical to avoid chronicity.

Back: Frozen chest with functionless lung.

Answer: Drainage

If a lung is trapped and fails to re-expand despite drainage, the next step is:

A. Open drainage

B. Thoracotomy and decortication

C. Pleurodesis

D. Antibiotics only

Answer: B

Front: What is the first-line surgical treatment for empyema thoracis?

For recurrent empyema, _________ resection may be required for adequate drainage

Back: Insertion of an intercostal chest tube (ICT) with suction.

Answer: Rib

Malignant pleural effusions are most commonly caused by:

A. Pneumonia

B. Metastasis from breast or lung cancer

C. Subphrenic abscess

D. Trauma

Answer: B

How are malignant pleural effusions treated?

The fluid in malignant pleural effusion is typically _________ and often bloody

Tube thoracostomy, video thoracoscopy, and chemical pleurodesis (palliative).

Answer: Exudative

Which of the following is a characteristic feature of exudative pleural effusion?

A. Protein content < 2.9 g/dL

B. LDH level > 0.45 times serum LDH upper limit

C. Pleural fluid pH > 7.2

D. Low red cell count

Answer: B

What clinical signs are associated with pleural effusion?

_________ is the gold standard diagnostic procedure for pleural effusion.

Back: Dullness on percussion, decreased breath sounds, tracheal shift.

Answer: Thoracentesis

A frozen chest occurs due to:

A. Delayed empyema drainage

B. Improper tube placement

C. Chronic pleural fibrosis

D. All of the above

Answer: D

What are the key features of a frozen chest?

frozen chest often results from _________ empyema mismanagement.

Back: Rigid, contracted chest with a functionless lung.

Answer: Chronic

Which pathogen is the most common cause of empyema in children under 6 months?

A. Streptococcus pneumoniae

B. Staphylococcus aureus

C. H. influenzae

D. Mycoplasma

Answer: B

Name three common organisms causing empyema in immunocompromised adults.

_________ empyema follows lobar pneumonia and is characterized by thick, fibrinous pus.

Back: Aerobic gram-negative bacilli, Staphylococcus aureus, fungal infections.

Answer: Pneumococcal

Which imaging technique is used to identify loculated empyema?

A. Chest X-ray

B. CT Scan

C. MRI

D. Both B and C

Answer: D

Front: What investigations are critical for empyema diagnosis?

_________ exercises are essential post-operatively to prevent empyema recurrence.

Back: X-ray, thoracentesis, pus culture, CT/MRI for loculations

Breathing

What is the second stage of empyema thoracis?

A. Exudative

B. Fibrinopurulent

C. Organizing

D. Chronic

Answer: B

What are the three stages of empyema thoracis?

During the organizing stage of empyema, _________ adhesions form, leading to a frozen chest.

Back: Exudative (acute), fibrinopurulent (subacute), and organizing (chronic).

Answer: Fibrinous

Which of the following is the most common source of secondary chest wall tumors?

A. Bone metastasis

B. Direct invasion from lung or breast cancer

C. Soft tissue metastasis

D. Hematogenous spread

Answer: B

Front: What is the initial step in diagnosing malignant chest wall tumors

Factors influencing prognosis of primary chest wall tumors include histological grade, tumor size, _________, and patient age.

Back: Biopsy for histological examination.

Answer: Stage

Which condition is associated with infection of costal cartilages and xiphoid?

A. Subpectoral abscess

B. Osteomyelitis of ribs

C. Empyema necessitatis

D. Tietze syndrome

Answer: B

Front: What are the complications of untreated chest wall infections?

Superficial infections that penetrate deeper layers of the chest wall can cause _________ necessitatis.

Back: Empyema, osteomyelitis, systemic sepsis.

Answer: Empyema

Which of the following is the confirmatory diagnostic tool for empyema thoracis?

A. Chest X-ray

B. CT Scan

C. Diagnostic aspiration

D. MRI

Answer: C

Front: Name two surgical options for persistent empyema

The aim of empyema treatment is early drainage to allow _________ expansion and avoid fibrosis.

Back: Rib resection (Eloiser's method) and decortication.

Answer: Lung

pleural effusion with low pleural glucose (<60 mg/dL) is most likely:

A. Transudative

B. Exudative

C. Empyema

D. Chylothorax

Answer: B

Front: What imaging feature on a chest X-ray suggests pleural effusion?

A pleural effusion with a foul smell and high LDH levels is classified as _________.

Back: Obliteration of the costophrenic angle with a concave meniscus.

Answer: Exudative

Which of the following is NOT a complication of chronic empyema?

A. Bronchopleural fistula

B. Frozen chest

C. Pneumothorax

D. Mediastinitis

Answer: C

Front: Name three complications of empyema thoracis.

Mismanagement of empyema can lead to _________ necessitans, where pus perforates the chest wall.

Back: Frozen chest, osteomyelitis of ribs, bronchopleural fistula.

Answer: Empyema

Chemical pleurodesis in malignant pleural effusion is primarily done to:

A. Treat infection

B. Prevent fluid re-accumulation

C. Improve lung compliance

D. Diagnose underlying malignancy

Answer: B

What is the prognosis for patients with malignant pleural effusion?

_________ pleurodesis is performed to obliterate the pleural space in malignant effusion

Back: Poor, as it indicates advanced disease.

Answer: Chemical

Which of the following is a key diagnostic feature of surgical emphysema?

A. Pleural fluid on aspiration

B. Subcutaneous crepitus on palpation

C. Pneumothorax on imaging

D. Tracheal deviation

Answer: B

What is the first step in managing mild surgical emphysema?

Severe cases of surgical emphysema may require _________ insertion for decompression.

Back: Treat the underlying cause conservatively.

Answer: Intercostal chest tube (ICT)

Mondor disease is best described as:

A. Deep vein thrombosis in the chest wall veins

B. Localized thrombophlebitis of thoracoepigastric vein

C. Suppurative lymphadenitis of axillary nodes

D. Inflammation of costal cartilages

Answer: B

How is Mondor disease treated?

Back: It is self-limiting, requiring no specific treatment.

What are common causes of pleural effusion?

The meniscus sign on a chest X-ray indicates _________ effusion.

Back: Heart failure, cirrhosis, malignancy, pneumonia, trauma

Pleural