Lecture 4

What percentage of mesothelioma cases are benign?

A. 15%

B. 85%

C. 50%

D. 20%

What percentage of mesothelioma cases are benign?

A. 15%

B. 85%

C. 50%

D. 20%

Answer: A

What is the male-to-female ratio in malignant mesothelioma cases?

A. 1:1

B. 2:1

C. 3:2

D. 5:1

B

2. The __________ nodes drain all lobes of the lung into the hilar group.

Interlobar

What is the most common primary site for metastatic pleural tumors?

A. Breast

B. Lung

C. Liver

D. Colon

Answer: B

What is the main cause of mesothelioma?

What treatment extends survival in early-stage malignant mesothelioma?

Asbestos exposure (with smoking as a cofactor).

Radical extrapleural pneumonectomy or complete pleurectomy combined with radiotherapy

Which lymph node group is referred to as the “lymphatic sump of Borrie”?

A. Tracheobronchial nodes

B. Intrapulmonary nodes

C. Interlobar nodes

D. Anterior mediastinal nodes

Answer: C

Lymphatic drainage pattern of the left lung

Ipsilateral and contralateral drainage.

What is the main role of rigid bronchoscopy?

A. Biopsy

B. Foreign body removal

C. Diagnosis of TB

D. Chest imaging

Answer: B

Which imaging modality provides the best definition for lung abnormalities?

A. Chest X-ray

B. CT Scan

C. MRI

D. Bronchography

Answer: B

Indications for bronchoscopy.?

Diagnostic (biopsy for lung carcinoma, abscess) and therapeutic (foreign body removal).

Role of pulmonary angiography.

Embolization of intrapulmonary bleeding sources.

1. __________ bronchoscopy reaches up to the 5th generation bronchioles.

Flexible

1. Which congenital lung lesion is incompatible with life?

A. Hypoplasia

B. Bilateral agenesis

C. Pulmonary sequestration

D. Cystic adenomatoid malformation

Answer: B

2. What is the most common presentation of pulmonary sequestration?

A. Respiratory distress

B. Recurrent pneumonias

C. Hemoptysis

D. Chest pain

Answer: B

Define pulmonary hypoplasia.

Underdevelopment of the lungs, often linked with space-occupying anomalies like diaphragmatic hernia.

Treatment for pulmonary sequestration.

Lobectomy

What is the most common site for aspiration-related lung abscess?

A. Upper lobe

B. Apical lower lobe

C. Middle lobe

D. Basal segments

Answer: B

Which of the following is NOT a complication of a lung abscess?

A. Metastatic cerebral abscess

B. Empyema

C. Lung collapse

D. Pneumothorax

D

Causes of lung abscess.

Aspiration, TB, fungal infections, chronic sinusitis, obstruction (tumors/foreign bodies).

Common complication of lung abscess.

Metastatic cerebral abscess (due to pyaemic emboli).

. __________ therapy resolves 80-90% of acute lung abscesses.

Answer:

Medical

What is the characteristic X-ray finding for a ruptured hydatid cyst?

A. Water-lily sign

B. Crescent sign

C. Cavitation

D. Diffuse opacity

A

Imaging findings for hydatid cyst.

Dense homogenous opacity. 2. Collapsed laminated membrane produces an irregular projections in a fluid level due to rupture of the cyst—Water-lily appearance.

3. Crescentic cap of air,

Thoracotomy and enucleation of the cyst.  Lobectomy is done in cases with difficulty and complications.  Drugs like praziquantel or albendazole is given for a long period.

1. What is the main cause of bronchiectasis?

A. Chronic infection

B. Congenital abnormalities

C. Smoking

D. Pulmonary embolism

Answer: A

Which symptom is most characteristic of bronchiectasis?

A. Dyspnea

B. Excessive sputum production

C. Hemoptysis

D. Cyanosis

B

Main symptoms of bronchiectasis.

Excessive sputum production, hemoptysis.

Primary treatment modalities for bronchiectasis.

Antibiotics and chest physiotherapy; surgery for localized cases

Bronchiectasis is characterized by __________ of the terminal bronchioles due to chronic infection.

2. __________ and chest physiotherapy are the main treatments for bronchiectasis.

dilatation

Antibiotics

What is a major surgical indication in pulmonary TB?

A. Persistent bronchopleural fistula

B. Pneumothorax

C. Mild hemoptysisA

D. Asymptomatic tuberculoma

A

2. Which surgical procedure causes lung relaxation to close cavities?

A. Decortication

B. Thoracoplasty

C. Lobectomy

D. Pleural tap

Answer: B

Indications for surgery in pulmonary TB.

Bronchopleural fistula, major hemoptysis, resistant lung cavities.

1. __________ is a surgical option that involves removing infected pleural layers in TB.

Advanced TB cases with large cavities may require __________ to achieve elastic lung relaxation.

Decortication

thoracoplasty

What is the primary cause of shock lung?

A. Major chest trauma

B. Tuberculosis

C. Pulmonary embolism

D. Lung abscess

A

Which mechanism leads to pulmonary consolidation in shock lung?

A. Air trapping in alveoli

B. Microthromboembolism in small vessels

C. Excessive mucus production

D. Bronchial constriction

B

Pathogenesis of shock lung.

Microthromboembolism → pulmonary consolidation → reduced compliance.

Key treatments for shock lung.

Endotracheal intubation, ventilator support, antibiotics, steroids.

2. __________ is a critical intervention in shock lung to maintain oxygenation.

Ventilator support

Which type of lung cyst is caused by the parasite Echinococcus granulosus?

A. Emphysematous cyst

B. Hydatid cyst

C. Epithelial cyst

D. Pseudocyst

B

Types of lung cysts.

Epithelial cyst, emphysematous cyst, hydatid cyst, pseudocyst.

Treatment for emphysematous cysts.

Localized: excision. Generalized: conservative management and pleurodesis.

Hydatid cyst rupture into the bronchial tree can cause __________.

The __________ test can help diagnose hydatid cysts.

anaphylaxis

Casoni’s

1. Which diagnostic tool is the gold standard for identifying lung abscess?

A. Sputum culture

B. CT scan

C. Bronchoscopy

D. Chest X-ray

Answer: B

Which imaging modality provides the water-lily appearance in hydatid cysts?

A. MRI

B. Ultrasound

C. Chest X-ray

D. Bronchography

C. Chest X-ray

Key diagnostic tools for lung lesions.

CT scan (detailed anatomy), chest X-ray (initial evaluation), biopsy (definitive diagnosis).

2. __________ biopsy is preferred for intrathoracic lesions requiring tissue diagnosis.

Answer:

Percutaneous transthoracic

Malignant mesothelioma is more common in females due to genetic predisposition.

Answer: False (It is more common in males, with a 2:1 ratio).

True/False Questions

Radical extrapleural pneumonectomy improves survival in Stage III mesothelioma.

False (It is effective in early stages, Stage I–II).

A 55-year-old male with a history of asbestos exposure presents with dyspnea and chest pain. CT scan shows pleural thickening and multiple nodules. Biopsy confirms malignant mesothelioma. Which of the following management plans is most appropriate?

A. Chemotherapy with cisplatin only.

B. Complete pleurectomy with radiotherapy (Stage I).

C. Radical extrapleural pneumonectomy for Stage IV.

D. No treatment, as long-term survival is rare.

Answer: B

Explanation: Surgery combined with radiotherapy is effective in early stages (I–II). Stage IV is not resectable.

Case:

A 40-year-old woman undergoes a right lower lobectomy due to bronchiectasis. Post-surgical imaging shows persistent fluid accumulation. Which lymphatic group is most likely involved in the drainage problem?

A. Hilar nodes

B. Mediastinal nodes

C. Interlobar nodes

D. Tracheobronchial nodes

Answer: C

Explanation: Interlobar nodes drain all lobes into the hilar group; obstruction here can cause fluid retention.

True/False Questions

1. Flexible bronchoscopy is limited to the third generation of bronchioles

2. Pulmonary angiography is primarily used to diagnose pulmonary embolism.

Answer: False (It reaches the fifth generation).

Answer: True

A 65-year-old smoker presents with hemoptysis and weight loss. Chest X-ray shows a central mass, and bronchoscopy reveals obstruction. Which diagnostic tool will most likely confirm malignancy?

A. Sputum cytology

B. Percutaneous needle biopsy

C. Bronchoscopic biopsy

D. Mediastinoscopy

Explanation: Bronchoscopic biopsy is ideal for central lesions, while percutaneous biopsy is used for peripheral lesions.

True/False Questions

1. Pulmonary sequestration is characterized by an abnormal connection to the bronchial tree.

Bilateral pulmonary agenesis is compatible with life.

Answer: False (It has no connection to the bronchial tree).

False

A newborn presents with respiratory distress and chest X-ray shows a mass-like lesion in the left lower lobe. CT confirms an isolated blood supply from the aorta. What is the best management?

A. Antibiotics and observation

B. Lobectomy

C. Surgical resection of the mass

D. Bronchoscopy

Answer: B

Explanation: Pulmonary sequestration requires lobectomy for definitive treatment.

True/False Questions

. Medical management resolves 50% of acute lung abscesses.

Answer: False (It resolves 80–90%).

A 45-year-old alcoholic presents with fever, foul-smelling sputum, and pleuritic chest pain. Chest X-ray reveals a localized opacity with a fluid level. Despite antibiotics, symptoms persist. What is the next best step?

A. Bronchoscopy

B. CT-guided drainage

C. Lobectomy

D. Continued medical management

B

Explanation: Persistent abscesses may require CT-guided drainage or surgery if antibiotics fail.

True/False Questions

The water-lily sign on X-ray is characteristic of hydatid cyst rupture.

Hydatid cysts are caused by Echinococcus multilocularis

True

False (They are caused by Echinococcus granulosus).

A 35-year-old shepherd presents with chest pain and dyspnea. Chest X-ray shows a dense homogenous opacity with an air-fluid level. Casoni’s test is positive. What is the first-line treatment?

A. Albendazole only

B. Thoracotomy and enucleation of the cyst

C. Lobectomy

D. Observation

B

Explanation: Surgical removal is the first-line treatment for hydatid cysts, supplemented by albendaz

True/False Questions

Localized bronchiectasis responds poorly to surgery.

Chest physiotherapy is the primary treatment for all cases of bronchiectasis.

False (It responds well).

True

A 28-year-old woman presents with a history of recurrent infections, productive cough, and hemoptysis. Chest CT shows dilated bronchi in the right lower lobe. What is the best initial treatment?

A. Antibiotics and physiotherapy

B. Bronchoscopy with lavage

C. Lobectomy

D. Steroids

Answer: A

What is the main purpose of a pleural tap?

A. Drain excess air from the pleural cavity

B. Drain fluid from the pleural cavity

C. Perform a biopsy on the pleural lining

D. Remove blood clots from the lung

Answer: B

Which of the following is most likely to indicate the need for a pleural tap?

A. Tension pneumothorax

B. Pleural effusion

C. Empyema with pus accumulation

D. Bronchial obstruction

Answer: B

1. What condition is primarily treated using intercostal tube drainage?

A. Pleural effusion

B. Empyema

C. Hemothorax

D. Tension pneumothorax

Answer: B

2. Intercostal tube drainage is indicated in empyema for which primary reason?

A. To relieve trapped air

B. To drain pus from the pleural space

C. To prevent lung collapse

D. To increase oxygenation

Answer: B

. What is the primary purpose of rib resection in empyema management?

A. To access the lungs for lobectomy

B. To create a permanent drainage channel for pus

C. To increase thoracic cavity space

D. To collapse the affected lung

Answer: B

Which surgical technique involves rib resection for continuous empyema drainage?

A. Decortication

B. Eloisier’s Drainage

C. Thoracoplasty

D. Pneumonectomy

Answer: B

1. Lung resection is commonly indicated for which condition?

A. Pneumothorax

B. Tuberculoma

C. Pleural effusion

D. Empyema

Answer: B

Which of the following is the most appropriate method for treating a resistant tuberculoma?

A. Pleural tap

B. Lobectomy

C. Artificial pneumothorax

D. Decortication

Answer: B

1. What is the main difference between lobectomy and pneumonectomy?

A. Lobectomy removes the entire lung, while pneumonectomy removes one lobe.

B. Lobectomy removes one lobe, while pneumonectomy removes the entire lung.

C. Lobectomy is for cancer, while pneumonectomy is for infections.

D. Lobectomy is a non-surgical procedure, while pneumonectomy is surgical.

Answer: B

2. Which condition most commonly necessitates pneumonectomy?

A. Empyema

B. Tuberculoma affecting multiple lobes

C. Pleural effusion

D. Simple pneumothorax

Answer: B

What is the main goal of decortication in empyema management?

A. To remove fibrous pleural layers restricting lung expansion

B. To induce lung collapse for healing

C. To drain pus continuously through a rib resection

D. To reduce pleural

Answer: A

Decortication is most commonly performed for which of the following conditions?

A. Acute lung abscess

B. Fibrous pleural thickening causing lung restriction

C. Early-stage pleural effusion

D. Tuberculoma

Answer: B

What is the purpose of thoracoplasty in tuberculosis management?

A. To create permanent lung collapse around a lesion

B. To increase lung expansion

C. To remove fibrous layers

D. To drain fluid from the pleural cavity

Answer: A

Thoracoplasty involves which of the following?

A. Resection of ribs to allow lung collapse

B. Removal of pleural thickening

C. Insertion of an intercostal tube

D. Use of nitrogen for pneumothorax cr

A

1. What substance is used to create an artificial pneumothorax?

A. Oxygen

B. Nitrogen

٨C. Carbon dioxide

D. Helium

Answer: B

Artificial pneumothorax is indicated for which condition?

A. Pleural effusion

B. Empyema

C. Tuberculosis cavities

D. Bronchiectasis

Answer: C

What is the goal of inducing temporary phrenic nerve palsy?

A. To reduce diaphragm movement and pressure on the lung

B. To increase pleural cavity pressure for healing

C. To drain pus from the pleural cavity

D. To relax the intercostal muscles

Answer: A

Temporary phrenic nerve palsy is achieved by which method?

A. Surgical cutting of the nerve

B. Chemical injection to paralyze the nerve

C. Physical compression of the nerve

D. Electrical stimulation of the nerve

Answer: B