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SB82 Thoracic Surgery - Loosely taken from Fiser's ABSITE review
|The azygous vein runs along the ___________ side and dumps into the ______________
|Where does the thoracic duct cross the midline from left to right? ______________
|The thoracic duct empties into the left subclavian vein at its junction with the ___________ ____________
|The phrenic nerve runs __________ to the hilum (anterior/posterior)
|The vagus nerve runs __________ to the hilum (anterior/posterior)
|This lung has a volume that is 55% of TLC _________ (right / left)
|The intercostal muscles contribute what percentage to the effort required for quiet inspiration? ______________
|Type I pneumocytes are responsible for ___________ ___________
|Type II pneumocytes are responsible for _________ ________________
|These structures provide direct air exchange between alveoli ______________
|Pores of Kahn
|How much pleural fluid is produced daily?
|Which pleura produces pleural fluid? __________
|Pleural fluid is cleared by lymphatics in the ___________ pleura
|Predicted post-op FEV-1 should be greater than _______
|DLCO represents diffusion capacity of what gas? __________________
|DLCO is based on what 3 factors?
|Pulmonary capillary surface area, Hgb content of blood, alveolar architecture
|Predicted post-op FVC should be greater than ____________
|What factor in assessing lung cancer has the strongest influence on survival? ______________
|What is the most common site of metastasis of lung cancer? __________
|How does recurrence of lung cancer most commonly present?
|Which stages of lung cancer are resectable?
|Stage 1, Stage 2, and Stage IIIa sometimes
|A patient is describes on clinic notes as having T2N1M0 lung cancer. What does this mean?
|The tumor is > 3 cm in diameter but is > 2 cm away from the carina. There are ipsilateral hilar nodes involved but none in the mediastinum. There are no distant metastases.
|A patient has a T3N2M0 lung tumor. What stage is this? What does each number mean?
|This is a stage IIIb cancer.The tumor is > 3 cm and invades the pericardium, pleura or diaphragm, or is < 2 cm from the carina. There are ipsilateral mediastinal nodes involved. It is unresectable.
|Which common type of lung cancer has a high risk of distant metastases? ____________
|Which common type of lung cancer has a higher risk of local recurrence? _____________
|Which lung cancer is more peripheral? _____________
|An âN3â lung cancer has what findings?
|Involvement of contralateral mediastinal nodes, or of supraclavicular nodes.
|What is the prognosis of small cell lung cancer? ___________
|What is the 5-yr survival rate of a stage 1 small cell lung cancer?
|What is the most common lung cancer associated with PTH-related paraneoplastic syndromes? _____________
|What is the most common lung cancer associated with ACTH-related paraneoplastic syndromes? _____________
|What is the most common lung cancer associated with SIADH? _____________
|Which is the most malignant lung tumor? ______________
|What is the common chemotherapeutic regimen for Non-small cell lung cancer? ______________
|What is the common chemotherapeutic regimen for small cell lung cancer? ______________
|Mediastinoscopy is used for what lung cancer related conditions?
|Centrally-located tumors, suspicious lymphadenopathy (> 0.8 – 1.0 cm)
|What structure(s) does the chamberlain procedure assess? How do you access it?
|Assesses aortopulmonary lymph nodes; go through left 2nd sternocostal cartilage
|What is a pancoast tumor?
|A tumor that invades the apex of the chest wall
|People with pancoast tumors develop miosis, ptosis, and anhidrosis, commonly referred to as _______________
|What percentage of coin lesions are malignant if age is < 50 years? Greater than 50 years?
|< 5%; > 50%
|What quality of a coin lesion suggests benign disease? ___________
|Which lung cancer can mimic pneumonia by growing along the alveolar walls? __________
|What is the 5-yr survival rate of the typical carcinoid tumor?
|What is the 5-yr survival rate of the Atypical carcinoid tumor?
|What is the treatment for a carcinoid lung tumor? ___________
|Which bronchial adenoma grows along the perineural lymphatics and is radiosensitive? ________
|Adenoid cystic adenoma
|What is the most common benign lung tumor? _____________
|How does a lung hamartoma appear on CT scan? ___________
|What is the treatment for lung hamartoma?
|No resection required – follow with a CT scan in 6 months
|The most common type of mediastinal tumor in adults and location (anterior/middle/posterior) _________
|Neurogenic tumor, posterior
|The most common anterior mediastinal mass in adults __________
|List of the 5 most common anterior mediastinal masses
|Thymoma, T-cell lymphoma, thyroid cancer and goiters, teratoma, parathyroid adenomas (5 “T”s)
|What percentage of thymomas require resection?
|What conditions of the thymus require resection?
|Thymoma, thymic enlargement, myasthenia gravis
|What percentage of patients with myasthenia gravis have an associated thymoma?
|Myasthenia gravis is caused by what mechanism?
|Antibodies to Ach receptors
|What percentage of patients with myasthenia gravis improve with thymectomy?
|80% (even if they do not have a thymoma)
|What is the most common variant of mediastinal T cell lymphoma? ___________
|What is the most common form of Hodgkin’s lymphoma _____________
|What is the treatment for mediastinal lymphomas?______________
|How is a mediastinal germ cell tumor diagnosed?
|Mediastinoscopy with biopsy
|What is the most common germ cell tumor of the mediastinum and its treatment?
|Teratoma, resection and chemotherapy
|What is the most common MALIGNANT germ cell tumor of the mediastinum and its treatment?
|Seminoma. Treat with radiation; if residual disease give chemotherapy; and if residual disease after that resect.
|An anterior mediastinal mass is discovered. Bloodwork shows elevated b-HCG and AFP. What is the diagnosis in 90% of these cases?
|What is the treatment for a non-seminomatous germ cell tumor?
|Cisplatin and radiation, followed by surgery if residual disease
|A bronchogenic cyst is usually located where in the chest cavity? What is the treatment?
|Posterior to the carina; resection
|A pericardial cyst is located where in the chest cavity? What is the treatment?
|At the right costophrenic angle; resection
|Ten percent of patients with neurogenic mediastinal tumors have involvement of what structure?
|What is the most common neurogenic mediastinal tumor? ______________
|What type of neurogenic mediastinal tumor produces catecholamines? ______________
|What percent of symptomatic mediastinal masses are malignant? Of Asymptomatic masses?
|What is the most common benign tracheal tumor in an adult? ____________
|What is the most common benign tracheal tumor in a child? ____________
|What is the most common MALIGNANT tracheal tumor in an adult? ____________
|Post-intubation tracheal stenosis occurs where after tracheostomy?
|At the stoma site
|Post-intubation tracheal stenosis occurs where after endotracheal intubation?
|At the cuff site
|Treatments for tracheal stenosis
|Serial dilation or laser
|Risk of trachea-innominate fistula occurs if the tracheostomy is below where?
|Below the second tracheal ring
|Treatments for TE fistula
|Tracheal resection, re-anastomosis, sternohyoid flap
|Lung abscesses are most commonly found where?
|Right lower lobe
|Pleural fluid with an empyema shows what findings?
|WBC >500cells/mL, bacteria
|What are the three phases of empyema and their treatments?
|Exudative phase (week 1) – chest tube and antibiotics; Fibroproliferative phase (week 2) – chest tube and antibiotics; Organized phase (week 3) – decortication of fibrous peel around lung
|Chronic non-resolving empyema may need this procedure ___________
|A patient develops a suspected chylothorax, and pleural fluid is sent for testing. Triglycerides come back at 150 mL / microliter fluid. Is this concerning for chylothorax?
|Yes; suspect chylothorax if triglycerides exceed 110 mL / microliter
|Chylothorax and a left-sided effusion indicates injury to the thoracic duct above what level?
|What is the treatment for chylothorax?
|Conservative management for 3-4 weeks (chest tube, octreotide, low-fat diet), then ligation of thoracic duct if that fails (80% successful)
|Massive hemoptysis (> 600 mL over 24 hours) is usually due to bleeding from what structures? _________
|What are the temporizing measures with massive hemoptysis?
|Place bleeding side down, rigid bronch to identify site, mainstem intubation of non-bleeding side
|What is the definitive treatment of massive hemoptysis?
|Lobectomy vs. pneumonectomy, or bronchial artery embolization if too unstable
|Spontaneous pneumothorax is more common on the _________ side
|Surgical indications for spontaneous pneumothorax (6)
|Recurrence, large blebs, air leak > 7 days, non re-expansion, high-risk profession, poor access to health care
|What are the most common cysts of the mediastinum? ________
|What is the treatment for bronchogenic cysts? ___________
|Lung tissue not connected to the bronchial tree is referred to as _____________
|Blood supply to sequestered lung tissue is usually from ___________
|Anomalous systemic arteries, usually from thoracic aorta
|This type of sequestration is usually seen in children __________, and receives its blood supply from ___________ veins
|This type of sequestration is usually seen in adults __________, and receives its blood supply from ___________ veins
|Treatment for pulmonary sequestration ____________
|A patient with a pulmonary lung nodule and a previous sarcoma history likely has a ______________
|A patient with a pulmonary lung nodule and a previous melanoma history likely has a ______________
|A patient with a pulmonary lung nodule and a previous head/neck tumor history likely has a ______________
|Primary lung cancer
|A patient with a pulmonary lung nodule and a previous breast cancer history likely has a ______________
|Primary lung cancer
|This uncommon type of pneumothorax occurs with a female patient’s menstrual cycle, and is thought to be caused by endometrial implants in the visceral pleura __________
|A parenchymal lung lesion associated with perihilar lymphadenopathy and with a positive TB test is called a ________ complex
|Sarcoidosis has ____________ granulomas
|Exudative effusions often have pleural fluid protein levels > _________ and pleural LDH to serum LDH ratios of > ____________
|Osler-Weber-Rendu disease causes these to form
|AV malformations between the pulmonary arteries and veins
|Most common benign chest wall tumor _________
|Most common MALIGNANT chest wall tumor _________