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SB82 ThoracicSurgery

SB82 Thoracic Surgery - Loosely taken from Fiser's ABSITE review

QuestionAnswer
The azygous vein runs along the ___________ side and dumps into the ______________ Right SVC
Where does the thoracic duct cross the midline from left to right? ______________ T4-5
The thoracic duct empties into the left subclavian vein at its junction with the ___________ ____________ Internal jugular
The phrenic nerve runs __________ to the hilum (anterior/posterior) Anterior
The vagus nerve runs __________ to the hilum (anterior/posterior) Posterior
This lung has a volume that is 55% of TLC _________ (right / left) Right
The intercostal muscles contribute what percentage to the effort required for quiet inspiration? ______________ 20%
Type I pneumocytes are responsible for ___________ ___________ Gas exchange
Type II pneumocytes are responsible for _________ ________________ Surfactant production
These structures provide direct air exchange between alveoli ______________ Pores of Kahn
How much pleural fluid is produced daily? 1-2 L
Which pleura produces pleural fluid? __________ Parietal
Pleural fluid is cleared by lymphatics in the ___________ pleura Visceral
Predicted post-op FEV-1 should be greater than _______ 0.8
DLCO represents diffusion capacity of what gas? __________________ Carbon monoxide
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 ____________ 1.5 L
What factor in assessing lung cancer has the strongest influence on survival? ______________ Nodal involvement
What is the most common site of metastasis of lung cancer? __________ Brain
How does recurrence of lung cancer most commonly present? Disseminated metastases
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? ____________ Adenocarcinoma
Which common type of lung cancer has a higher risk of local recurrence? _____________ Squamous cell
Which lung cancer is more peripheral? _____________ Adenocarcinoma
An “N3” lung cancer has what findings? Involvement of contralateral mediastinal nodes, or of supraclavicular nodes.
What is the prognosis of small cell lung cancer? ___________ Poor
What is the 5-yr survival rate of a stage 1 small cell lung cancer? 50%
What is the most common lung cancer associated with PTH-related paraneoplastic syndromes? _____________ Squamous cell
What is the most common lung cancer associated with ACTH-related paraneoplastic syndromes? _____________ Small cell
What is the most common lung cancer associated with SIADH? _____________ Small cell
Which is the most malignant lung tumor? ______________ Mesothelioma
What is the common chemotherapeutic regimen for Non-small cell lung cancer? ______________ Carboplatin, taxol
What is the common chemotherapeutic regimen for small cell lung cancer? ______________ cisplatin, etoposide
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 _______________ Horner’s syndrome
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? ___________ Smooth contour
Which lung cancer can mimic pneumonia by growing along the alveolar walls? __________ Bronchioalveolar
What is the 5-yr survival rate of the typical carcinoid tumor? 90%
What is the 5-yr survival rate of the Atypical carcinoid tumor? 60%
What is the treatment for a carcinoid lung tumor? ___________ Resection
Which bronchial adenoma grows along the perineural lymphatics and is radiosensitive? ________ Adenoid cystic adenoma
What is the most common benign lung tumor? _____________ Hamartoma
How does a lung hamartoma appear on CT scan? ___________ Popcorn lesion
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 __________ Thymoma
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? 100%
What conditions of the thymus require resection? Thymoma, thymic enlargement, myasthenia gravis
What percentage of patients with myasthenia gravis have an associated thymoma? 10%
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? ___________ Lymphoblastic
What is the most common form of Hodgkin’s lymphoma _____________ Nodular sclerosing
What is the treatment for mediastinal lymphomas?______________ Chemoradiation
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? Nonseminoma
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? Spine
What is the most common neurogenic mediastinal tumor? ______________ Neurolemmoma
What type of neurogenic mediastinal tumor produces catecholamines? ______________ Paraganglioma
What percent of symptomatic mediastinal masses are malignant? Of Asymptomatic masses? 50%, 10%
What is the most common benign tracheal tumor in an adult? ____________ Papilloma
What is the most common benign tracheal tumor in a child? ____________ Hemangioma
What is the most common MALIGNANT tracheal tumor in an adult? ____________ SCC
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 ___________ Eloesser flap
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? T5-6
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? _________ Bronchial arteries
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 Right
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? ________ Bronchogenic cysts
What is the treatment for bronchogenic cysts? ___________ Resection
Lung tissue not connected to the bronchial tree is referred to as _____________ Sequestration
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 Extralobar, systemic
This type of sequestration is usually seen in adults __________, and receives its blood supply from ___________ veins Intralobar, pulmonary
Treatment for pulmonary sequestration ____________ Lobectomy
A patient with a pulmonary lung nodule and a previous sarcoma history likely has a ______________ Metastasis
A patient with a pulmonary lung nodule and a previous melanoma history likely has a ______________ Metastasis
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 __________ Catamenial
A parenchymal lung lesion associated with perihilar lymphadenopathy and with a positive TB test is called a ________ complex Ghon
Sarcoidosis has ____________ granulomas Noncaseating
Exudative effusions often have pleural fluid protein levels > _________ and pleural LDH to serum LDH ratios of > ____________ 3, 0.6
Osler-Weber-Rendu disease causes these to form AV malformations between the pulmonary arteries and veins
Most common benign chest wall tumor _________ Osteochondroma
Most common MALIGNANT chest wall tumor _________ Chondrosarcoma
Created by: StudyBug82