SB82 Thoracic Surgery - Loosely taken from Fiser's ABSITE review
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| The azygous vein runs along the ___________ side and dumps into the ______________ | Right SVC
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| Where does the thoracic duct cross the midline from left to right? ______________ | T4-5
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| The thoracic duct empties into the left subclavian vein at its junction with the ___________ ____________ | Internal jugular
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| The phrenic nerve runs __________ to the hilum (anterior/posterior) | Anterior
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| The vagus nerve runs __________ to the hilum (anterior/posterior) | Posterior
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| This lung has a volume that is 55% of TLC _________ (right / left) | Right
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| The intercostal muscles contribute what percentage to the effort required for quiet inspiration? ______________ | 20%
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| Type I pneumocytes are responsible for ___________ ___________ | Gas exchange
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| Type II pneumocytes are responsible for _________ ________________ | Surfactant production
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| These structures provide direct air exchange between alveoli ______________ | Pores of Kahn
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| How much pleural fluid is produced daily? | 1-2 L
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| Which pleura produces pleural fluid? __________ | Parietal
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| Pleural fluid is cleared by lymphatics in the ___________ pleura | Visceral
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| Predicted post-op FEV-1 should be greater than _______ | 0.8
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| DLCO represents diffusion capacity of what gas? __________________ | Carbon monoxide
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| DLCO is based on what 3 factors? | Pulmonary capillary surface area, Hgb content of blood, alveolar architecture
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| Predicted post-op FVC should be greater than ____________ | 1.5 L
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| What factor in assessing lung cancer has the strongest influence on survival? ______________ | Nodal involvement
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| What is the most common site of metastasis of lung cancer? __________ | Brain
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| How does recurrence of lung cancer most commonly present? | Disseminated metastases
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| Which stages of lung cancer are resectable? | Stage 1, Stage 2, and Stage IIIa sometimes
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| 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.
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| 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.
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| Which common type of lung cancer has a high risk of distant metastases? ____________ | Adenocarcinoma
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| Which common type of lung cancer has a higher risk of local recurrence? _____________ | Squamous cell
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| Which lung cancer is more peripheral? _____________ | Adenocarcinoma
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| An âN3â lung cancer has what findings? | Involvement of contralateral mediastinal nodes, or of supraclavicular nodes.
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| What is the prognosis of small cell lung cancer? ___________ | Poor
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| What is the 5-yr survival rate of a stage 1 small cell lung cancer? | 50%
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| What is the most common lung cancer associated with PTH-related paraneoplastic syndromes? _____________ | Squamous cell
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| What is the most common lung cancer associated with ACTH-related paraneoplastic syndromes? _____________ | Small cell
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| What is the most common lung cancer associated with SIADH? _____________ | Small cell
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| Which is the most malignant lung tumor? ______________ | Mesothelioma
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| What is the common chemotherapeutic regimen for Non-small cell lung cancer? ______________ | Carboplatin, taxol
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| What is the common chemotherapeutic regimen for small cell lung cancer? ______________ | cisplatin, etoposide
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| Mediastinoscopy is used for what lung cancer related conditions? | Centrally-located tumors, suspicious lymphadenopathy (> 0.8 – 1.0 cm)
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| What structure(s) does the chamberlain procedure assess? How do you access it? | Assesses aortopulmonary lymph nodes; go through left 2nd sternocostal cartilage
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| What is a pancoast tumor? | A tumor that invades the apex of the chest wall
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| People with pancoast tumors develop miosis, ptosis, and anhidrosis, commonly referred to as _______________ | Horner’s syndrome
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| What percentage of coin lesions are malignant if age is < 50 years? Greater than 50 years? | < 5%; > 50%
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| What quality of a coin lesion suggests benign disease? ___________ | Smooth contour
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| Which lung cancer can mimic pneumonia by growing along the alveolar walls? __________ | Bronchioalveolar
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| What is the 5-yr survival rate of the typical carcinoid tumor? | 90%
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| What is the 5-yr survival rate of the Atypical carcinoid tumor? | 60%
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| What is the treatment for a carcinoid lung tumor? ___________ | Resection
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| Which bronchial adenoma grows along the perineural lymphatics and is radiosensitive? ________ | Adenoid cystic adenoma
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| What is the most common benign lung tumor? _____________ | Hamartoma
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| How does a lung hamartoma appear on CT scan? ___________ | Popcorn lesion
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| What is the treatment for lung hamartoma? | No resection required – follow with a CT scan in 6 months
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| The most common type of mediastinal tumor in adults and location (anterior/middle/posterior) _________ | Neurogenic tumor, posterior
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| The most common anterior mediastinal mass in adults __________ | Thymoma
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| List of the 5 most common anterior mediastinal masses | Thymoma, T-cell lymphoma, thyroid cancer and goiters, teratoma, parathyroid adenomas (5 “T”s)
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| What percentage of thymomas require resection? | 100%
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| What conditions of the thymus require resection? | Thymoma, thymic enlargement, myasthenia gravis
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| What percentage of patients with myasthenia gravis have an associated thymoma? | 10%
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| Myasthenia gravis is caused by what mechanism? | Antibodies to Ach receptors
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| What percentage of patients with myasthenia gravis improve with thymectomy? | 80% (even if they do not have a thymoma)
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| What is the most common variant of mediastinal T cell lymphoma? ___________ | Lymphoblastic
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| What is the most common form of Hodgkin’s lymphoma _____________ | Nodular sclerosing
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| What is the treatment for mediastinal lymphomas?______________ | Chemoradiation
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| How is a mediastinal germ cell tumor diagnosed? | Mediastinoscopy with biopsy
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| What is the most common germ cell tumor of the mediastinum and its treatment? | Teratoma, resection and chemotherapy
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| 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.
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| An anterior mediastinal mass is discovered. Bloodwork shows elevated b-HCG and AFP. What is the diagnosis in 90% of these cases? | Nonseminoma
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| What is the treatment for a non-seminomatous germ cell tumor? | Cisplatin and radiation, followed by surgery if residual disease
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| A bronchogenic cyst is usually located where in the chest cavity? What is the treatment? | Posterior to the carina; resection
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| A pericardial cyst is located where in the chest cavity? What is the treatment? | At the right costophrenic angle; resection
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| Ten percent of patients with neurogenic mediastinal tumors have involvement of what structure? | Spine
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| What is the most common neurogenic mediastinal tumor? ______________ | Neurolemmoma
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| What type of neurogenic mediastinal tumor produces catecholamines? ______________ | Paraganglioma
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| What percent of symptomatic mediastinal masses are malignant? Of Asymptomatic masses? | 50%, 10%
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| What is the most common benign tracheal tumor in an adult? ____________ | Papilloma
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| What is the most common benign tracheal tumor in a child? ____________ | Hemangioma
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| What is the most common MALIGNANT tracheal tumor in an adult? ____________ | SCC
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| Post-intubation tracheal stenosis occurs where after tracheostomy? | At the stoma site
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| Post-intubation tracheal stenosis occurs where after endotracheal intubation? | At the cuff site
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| Treatments for tracheal stenosis | Serial dilation or laser
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| Risk of trachea-innominate fistula occurs if the tracheostomy is below where? | Below the second tracheal ring
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| Treatments for TE fistula | Tracheal resection, re-anastomosis, sternohyoid flap
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| Lung abscesses are most commonly found where? | Right lower lobe
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| Pleural fluid with an empyema shows what findings? | WBC >500cells/mL, bacteria
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| 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
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| Chronic non-resolving empyema may need this procedure ___________ | Eloesser flap
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| 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
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| Chylothorax and a left-sided effusion indicates injury to the thoracic duct above what level? | T5-6
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| 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)
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| Massive hemoptysis (> 600 mL over 24 hours) is usually due to bleeding from what structures? _________ | Bronchial arteries
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| What are the temporizing measures with massive hemoptysis? | Place bleeding side down, rigid bronch to identify site, mainstem intubation of non-bleeding side
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| What is the definitive treatment of massive hemoptysis? | Lobectomy vs. pneumonectomy, or bronchial artery embolization if too unstable
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| Spontaneous pneumothorax is more common on the _________ side | Right
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| Surgical indications for spontaneous pneumothorax (6) | Recurrence, large blebs, air leak > 7 days, non re-expansion, high-risk profession, poor access to health care
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| What are the most common cysts of the mediastinum? ________ | Bronchogenic cysts
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| What is the treatment for bronchogenic cysts? ___________ | Resection
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| Lung tissue not connected to the bronchial tree is referred to as _____________ | Sequestration
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| Blood supply to sequestered lung tissue is usually from ___________ | Anomalous systemic arteries, usually from thoracic aorta
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| This type of sequestration is usually seen in children __________, and receives its blood supply from ___________ veins | Extralobar, systemic
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| This type of sequestration is usually seen in adults __________, and receives its blood supply from ___________ veins | Intralobar, pulmonary
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| Treatment for pulmonary sequestration ____________ | Lobectomy
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| A patient with a pulmonary lung nodule and a previous sarcoma history likely has a ______________ | Metastasis
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| A patient with a pulmonary lung nodule and a previous melanoma history likely has a ______________ | Metastasis
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| A patient with a pulmonary lung nodule and a previous head/neck tumor history likely has a ______________ | Primary lung cancer
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| A patient with a pulmonary lung nodule and a previous breast cancer history likely has a ______________ | Primary lung cancer
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| 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
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| A parenchymal lung lesion associated with perihilar lymphadenopathy and with a positive TB test is called a ________ complex | Ghon
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| Sarcoidosis has ____________ granulomas | Noncaseating
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| Exudative effusions often have pleural fluid protein levels > _________ and pleural LDH to serum LDH ratios of > ____________ | 3, 0.6
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| Osler-Weber-Rendu disease causes these to form | AV malformations between the pulmonary arteries and veins
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| Most common benign chest wall tumor _________ | Osteochondroma
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| Most common MALIGNANT chest wall tumor _________ | Chondrosarcoma
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