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What is a common cause of acute mediastinitis?
a) Histoplasmosis
b) Esophageal perforation
c) Tuberculosis
d) Ganglioneuroma
: b) Esophageal perforation
Which of the following is a sign of chronic mediastinitis?
a) Septic shock
b) Hamman’s sign
c) Mediastinal compression
d) Obstruction due to fibrosis
d) Obstruction due to fibrosis
. Which symptom is characteristic of acute mediastinitis?
a) Dysphagia
b) Substernal pain
c) Hoarseness of voice
d) Diplopia
Answer: b) Substernal pain
What is a key auscultatory sign in acute mediastinitis?
a) Scabbard trachea
b) Hamman’s sign
c) SVC syndrome
d) Pleural effusion
b) Hamman’s sign
Chronic mediastinitis is often caused by which of the following?
a) Oesophageal perforation
b) Sarcoidosis
c) Aortic aneurysm
d) Neurofibroma
b) Sarcoidosis
A 45-year-old male presents with sudden onset of fever, severe substernal chest pain, and dyspnea. His history includes an esophageal endoscopy performed three days ago. On auscultation, you hear a crunching sound synchronous with cardiac systole. Chest X-ray shows pneumomediastinum
What is the next best step in management?
a) Immediate thoracotomy
b) High-dose intravenous antibiotics and surgical drainage
c) Corticosteroid therapy
d) Observation and follow-up
A 42-year-old patient presents with fever, chest pain, and a crunching sound on auscultation during systole. He underwent cardiac surgery two weeks ago. Imaging reveals pneumomediastinum and fluid collection in the mediastinum.
Question: What is the most likely chronic complication if the infection persists without resolution?
a) Esophageal perforation
b) Granulomatous fibrosis causing obstruction
c) Pleural effusion
d) Superior vena cava thrombosis
Answer: b) Granulomatous fibrosis causing obstruction
Case: A 48-year-old patient underwent esophageal surgery one week ago. He now presents with fever, substernal pain, and crepitus on chest auscultation. Imaging reveals pneumomediastinum and mediastinal fluid collection.
Question: What is the most likely cause of his condition?
a) Postoperative pulmonary embolism
b) Esophageal perforation
c) Aortic aneurysm rupture
d) Lymphoma
Answer: b) Esophageal perforation
What are the common causes of acute mediastinitis?
Esophageal or pharyngeal leakage
Complication of endoscopy (e.g., esophageal perforation)
Tumor necrosis
What are the signs of acute mediastinitis
Fever
Substernal pain
Pneumomediastinum
Mediastinal compression
Hamman’s sign
What is the primary treatment for acute mediastinitis?
High-dose antibiotics and surgical drainage ± perforation closure.
List the common symptoms of mediastinal tumours.
Chest pain
Back pain
Respiratory distress
Venous congestion (SVC syndrome)
Hoarseness of voice (compression of recurrent laryngeal nerve)
Dysphagia
Horner’s syndrome
What is the most common tumour in the posterior mediastinum?
Neurofibroma (accounts for 75% of posterior mediastinal tumours).
What is the most common symptom of mediastinal tumours?
a) Fever
b) Chest pain
c) Venous congestion
d) Pleural effusion
b) Chest pain
List the classifications of mediastinal tumours based on location.
Superior mediastinal tumours: Retrosternal goitre
Anterior mediastinal tumours: Thymomas, teratomas, dermoids
Midmediastinal tumours: Lymphadenopathies, foregut duplication cysts
Posterior mediastinal tumours: Neurofibromas, ganglioneuromas
. What is a common feature of mediastinal tumours detected on chest X-rays?
a) Pneumomediastinum
b) Scabbard trachea
c) Asymptomatic presentation
d) Septic shock
c) Asymptomatic presentation
Which mediastinal tumour is most commonly found in the anterior mediastinum?
a) Retrosternal goitre
b) Neurofibroma
c) Lipoma
d) Foregut duplication cyst
a) Retrosternal goitre
Which investigation is essential for diagnosing mediastinal tumours?
a) Ultrasound
b) MRI
c) PET scan
d) Echocardiography
Answer: b) MRI
Case: A 32-year-old female with no significant medical history presents with hoarseness of voice and difficulty swallowing. Chest X-ray reveals a mass in the anterior mediastinum. Further imaging shows compression of the recurrent laryngeal nerve.
Question: What is the most likely diagnosis?
a) Neurofibroma
b) Thymoma
c) Retrosternal goitre
d) Pleuro-pericardial cyst
Answer: c) Retrosternal goitre
A 45-year-old man reports progressive dyspnea and intermittent chest pain over the past three months. Physical examination reveals engorged neck veins and facial plethora. Imaging confirms a large anterior mediastinal mass compressing the superior vena cava.
Question: Which of the following additional findings would most likely indicate malignancy?
a) Hoarseness of voice due to nerve compression
b) Presence of pleural effusion
c) Erosion of major blood vessels causing hemorrhage
d) Dysphagia due to esophageal compression
Answer: c) Erosion of major blood vessels causing hemorrhage
c) Erosion of major blood vessels causing hemorrhage
Case: A 40-year-old man presents with chest pain, hoarseness, and difficulty swallowing. Imaging reveals a mass in the anterior mediastinum compressing the esophagus and recurrent laryngeal nerve.
Question: What additional finding would most strongly suggest a diagnosis of a malignant anterior mediastinal tumour?
a) Mediastinal lymphadenopathy
b) Pleural effusion
c) Erosion into major blood vessels
d) Horner’s syndrome
Answer: c) Erosion into major blood vessels
A 37-year-old male presents with back pain and mild dysphagia. Imaging reveals a mass in the posterior mediastinum compressing the esophagus. Biopsy confirms a neurogenic tumour.
Question: What is the most likely type of tumour?
a) Teratoma
b) Ganglioneuroma
c) Lymphoma
d) Lipoma
Answer: b) Ganglioneuro
Case: A 34-year-old woman with a known diagnosis of myasthenia gravis presents with worsening symptoms. Imaging shows a 3 cm mass in the anterior mediastinum. Despite treatment with neostigmine, her symptoms persist.
Question: What is the next best step in management?
a) Radiotherapy
b) Thymectomy
c) High-dose corticosteroids
d) Chemotherapy
Answer: b) Thymectomy
Answer: b) Thymectomy
Persistent symptoms in myasthenia gravis associated with a thymoma are an indication for thymectomy, particularly in younger patients.
5. Which diagnostic test is used for myasthenia gravis associated with thymomas?
a) MRI
b) Tensilon test
c) Mediastinoscopy
d) CT scan
Answer: b) Tensilon test
What percentage of thymomas are malignant?
a) 30%
b) 40%
c) 50%
d) 60%
Answer: c) 50%
What is the most common cause of SVC obstruction?
a) Lymphoma
b) Bronchogenic carcinoma
c) Thymoma
d) Tuberculosis
b) Bronchogenic carcinoma
Which treatment is most commonly used for malignant SVC obstruction?
a) Venous bypass
b) Thoracotomy
c) Palliative radiation and chemotherapy
d) Mediastinoscopy
c) Palliative radiation and chemotherapy
What are the features of myasthenia gravis?
Autoimmune disease with periodic remission
Antibodies to acetylcholine receptors in NMJ
Symptoms: ptosis, diplopia, dysarthria, dysphagia, respiratory muscle paralysis
What is the first-line treatment for myasthenia gravis related to thymomas?
a) Radiotherapy
b) Neostigmine bromide
c) Chemotherapy
d) Thoracotomy
Answer: b) Neostigmine bromide
What is the primary staging criterion for thymomas?
a) Symptoms severity
b) Tumour size
c) Tumour spread to adjacent tissues
d) Presence of antibodies
Answer: c) Tumour spread to adjacent tissues
Which sign is NOT typically associated with SVC obstruction?
a) Venous distention
b) Facial edema
c) Substernal pain
d) Respiratory symptoms
Answer: c) Substernal pain
What is the most appropriate initial treatment for malignant SVC obstruction?
a) Surgical excision
b) Palliative radiation therapy
c) Venous bypass surgery
d) Antibiotic therapy
Answer: b) Palliative radiation therapy
Case: A 50-year-old male presents with progressive weakness and fatigue. Physical examination reveals bilateral ptosis and muscle weakness that worsens with exertion. A chest CT shows a mass in the anterior mediastinum. Blood tests reveal the presence of anti-acetylcholine receptor antibodies.
Question: What is the most appropriate initial treatment?
a) Radiotherapy for the thymoma
b) Thymectomy
c) Administration of neostigmine
d) Immunosuppressive therapy with corticosteroids
Answer: c) Administration of neostigmine
Answer: c) Administration of neostigmine
Rationale: The patient has myasthenia gravis associated with thymoma. Symptomatic relief with acetylcholinesterase inhibitors like neostigmine is the initial step. Thymectomy can be considered later.
Case: A 60-year-old male presents with facial swelling, dyspnea, and distended neck veins. He also reports a history of chronic cough and significant weight loss over the past three months. Imaging reveals a mass in the superior mediastinum compressing the SVC.
Question: What is the most likely cause of his symptoms?
a) Thymoma
b) Bronchogenic carcinoma
c) Tuberculosis
d) Superior mediastinal lymphadenopathy
Answer: b) Bronchogenic carcinoma
Rationale: SVC syndrome is most commonly caused by bronchogenic carcinoma, especially in patients with chronic cough and weight loss.
Case: A 35-year-old woman presents with muscle weakness that worsens throughout the day. She has difficulty swallowing and double vision. A chest CT reveals a 4 cm anterior mediastinal mass. Laboratory tests show antibodies to acetylcholine receptors.
Question: Which finding would most strongly suggest invasive thymoma rather than benign?
a) Tumour confined to the capsule
b) Spread to adjacent tissues such as the pleura
c) Association with myasthenia gravis
d) No systemic symptoms
Answer: b) Spread to adjacent tissues such as the pleuraRationale: Invasive thymomas are classified by their spread to adjacent tissues, while benign thymomas remain confined to the capsule.
Case: A 67-year-old male with a 40-pack-year smoking history presents with swelling of the face and upper limbs, headache, and shortness of breath. Imaging shows a mass compressing the superior vena cava and significant collateral vein formation.
Question: What is the most urgent step in management?
a) Start corticosteroid therapy
b) Obtain tissue biopsy for histological diagnosis
c) Immediate chemotherapy
d) Venous bypass surgery
Answer: b) Obtain tissue biopsy for histological diagnosis
Rationale: SVC syndrome is often caused by malignancy, and a tissue biopsy is crucial to guide further treatment (e.g., radiation or chemotherapy).
Case: A 34-year-old woman with a known diagnosis of myasthenia gravis presents with worsening symptoms. Imaging shows a 3 cm mass in the anterior mediastinum. Despite treatment with neostigmine, her symptoms persist.
Question: What is the next best step in management?
a) Radiotherapy
b) Thymectomy
c) High-dose corticosteroids
d) Chemotherapy
Answer: b) Thymectomy
Hint: Persistent symptoms in myasthenia gravis associated with a thymoma are an indication for thymectomy, particularly in younger patients.
Case: A 50-year-old woman presents with progressive muscle weakness, ptosis, and difficulty swallowing. A CT scan reveals a mass in the anterior mediastinum, and serology confirms anti-acetylcholine receptor antibodies.
Question: Which of the following findings suggests advanced thymoma rather than myasthenia gravis alone?
a) Symptoms improving with neostigmine
b) Tumour confined within the thymic capsule
c) Invasion into adjacent mediastinal structures
d) Diplopia and dysphagia
Answer: c) Invasion into adjacent mediastinal structures
Hint: Advanced thymomas are characterized by local invasion into nearby tissues, distinguishing them from benign thymomas or isolated myasthenia gra
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