Thoracic

Question 1

Initial tx for chylothorax?
How long can obs continue?
Treatment if obs fails for good surg cand
Poor Cand

Answer 1

CT
5-7d
Ligation
Embolization

Question 2

3 Lights Criteria? what does this tell us

Answer 2

pleural:serum protein >0.5
Plearual : serum LDH>0.6
pleural LDH>2/3 normal

Exudative effusion

Question 3

Causes of pleural effusion
1 inc pleural membrane perm
2 inc hydrostatic p
3 hypoalb

Answer 3

sepsis, malign, pe, panc

CHF, renal, iatrogenif fluid overload
cirrhosis, nephrotic, malnut

Question 4

how big is a visible effusion on cxray at minimum

Answer 4

300

Question 5

MC extra pelvic location for endometriosis?

What complication can this cause

Answer 5

thoracic
ectopic implants cause ptx – catamenial

Question 6

secondary ptx definition

Answer 6

underlying cause

Question 7

indications for surgical pleurodesis for ptx

Answer 7

Persistent air leak (≥ 4 days)

Failure of the lung to fully expand with adequate chest tube placement

Prevention of recurrent pneumothorax
After a first (or second) spontaneous pneumothorax in patients with no underlying pulmonary disease

In an individual in a high-risk profession (ie, scuba diver, pilot) after a first spontaneous pneumothorax

After a first pneumothorax in a patient with limited access to hospital care for geographic or social reasons

Question 8

pleurodesis for poor surgical candidates?

Answer 8

talc or doxy

Question 9

chance of ptx recurrence after first?

risk after pleurectomy?
vats with bleb?

Answer 9

60

1
2 to 5%

Question 10

what muscle is spared during a muscle sparing thoracotomy

Answer 10

lat

Question 11

3 non small cell ca in lung

Answer 11

adeno, large cell, squamous

Question 12

leading cause of cancer related death in us?

Answer 12

lung

Question 13

lung cancer 5y survival per stage

Answer 13

Five-year survival is 45% to 50% at stage I, 30% at stage II, 5% to 14% at stage III, and less than 5% at stage IV.

Question 14

single nodule mets to lung (2)

Answer 14

sarcoma and melanoma

Question 15

multifocal mets for lung

Answer 15

head and neck, breast, colon, renal, lung

Question 16

current lung ca screening guidelines

Answer 16

55 to 80 years who have a 30-pack year smoking history and currently smoke or have quit within the past 15 years.

Question 17

what bearing does a malignant effusion have on surgical indication

Answer 17

usually precludes with poor prognosis

Question 18

lung mets work up

Answer 18

markers - cca 19-9, cea, afp, bhcg

CT CAP, PET

colonoscopy

biopsy

Question 19

t staging for lung

Answer 19

T1 tumors: ≤ 3 cm in diameter
T2 tumors: > 3 but ≤ 5 cm in diameter
T3 tumors: > 5 but ≤ 7 cm in diameter (or invading the parietal pleural/chest wall, phrenic nerve, or pericardium, or two tumors in the same lobe)
T4 tumors: > 7 cm in diameter (or invading the mediastinum, diaphragm, heart, great vessels, trachea/carina, esophagus, recurrent laryngeal nerve, or spine, or separate nodules within the same lung but separate lobes)

Question 20

supraclavicular or cervical lymphadenopathy concerning lung cancer?

what needs to be performed?

Answer 20

poor prognosis, N3

needs FNA

Question 21

% of lung cancer with adrenal mets

Answer 21

7

Question 22

high met area for small cell lung and pancoast

Answer 22

brain

Question 23

what lung cancer stage gets neoadjuvant

Answer 23

stage 3

Question 24

what are the FEv1 and dlco values assoc with good surgical candidates

what needs to be performed if too low? values?

Answer 24

80%

predicted post op 40%

Question 25

cervical nerve roots in arm

Answer 25

Question 26

what needs to be performed prior to pancoast tumor resection

Answer 26

chemo rads

Question 27

only rad onc emergency

Answer 27

pancoast

Question 28

main chemo reg for lung ca mab tx? mech?

Answer 28

paclitaxel or plat based bevacizumab; VEGF inhib

Question 29

pulm nodule work up per size

Answer 29

Question 30

MC ant mediastinal tumor followed by...

Answer 30

thymoma T cell lymphoma

Question 31

posterior mediastinal tumors

Answer 31

neurogenic

Question 32

thymoma paraneoplastic percent and specific diseases

Answer 32

Associated with paraneoplastic syndromes in 30% to 50% of cases The most common is myasthenia gravis, followed by hypogammaglobulinemia and pure red cell aplasia.

Question 33

who is hodgkin medistinal lymphoma found in germ cell tumors: MC ____ site is mediastinum

Answer 33

bimodal peds and young women extragonadal

Question 34

MC malignant germ cell tumor of mediastinum

Answer 34

seminoma

Question 35

MC middle medistinal mass

Answer 35

Cysts bronchogenics are the issue not cardiac

Question 36

4 neurogenic mediastinal tumors? what compartment? whish is malignant

Answer 36

neuroblastoma - mal neurofibroma schwannoma paraganglioma posterior

Question 37

mc posterior mediastinal tumor specifically

Answer 37

schwannoma

Question 38

MC mediastinal peds tumors per compartment

Answer 38

ant - lymphoma mid - cysts post - neurogenic

Question 39

MG thymoma patient presentation? medical management?

Answer 39

Affected patients often present with ocular symptoms (eg, ptosis, diplopia), fatigue, and weakness. Medical management may include anticholinesterases (pyridostigmine, neostigmine), glucocorticoids, and plasmapheresis.

Question 40

thymoma staging and resectability, next steps

Answer 40

Stage I: encapsulated tumor Resectable Stage II: capsular invasion into adjacent mediastinal fat or pleural tissue Resectable Stage III: invasion into neighboring structure (pericardium, great vessel, lung) Possible thymectomy based on preoperative evaluation; otherwise induction chemotherapy Stage IV Stage IVa (pleural or pericardial dissemination): generally unresectable; possibly surgical debulking and chemoradiation Stage IVb (lymphatic-hematogenous metastases): generally unresectable; possibly surgical debulking and chemoradiation

Question 41

biopsy for thymoma?

Answer 41

only if considering chemo

Question 42

Describe borders for thymectomy and blood supply

Answer 42

Question 43

chamberlain procedure

Answer 43

Question 44

surgical concept regarding pericardial fat v thymus during thymectomy

Answer 44

take all fat anterior to pericardium as it all looks the same

Question 45

2 complications to worry about for thymectomy and their treatments

Answer 45

Myasthenic crisis: respiratory failure and bulbar weakness Provide urgent therapy with plasmapheresis or intravenous immunoglobulin. Cholinergic crisis: increased secretions, urination, defecation, and emesis Counteract muscarinic activation with atropine or glycopyrrolate.

Question 46

3 sources of mediastinitis

Answer 46

tooth, trach, esoph

Question 47

operative sternal mediastinitis bugs posterior mediastinal bugs

Answer 47

Sternal mediastinitis after sternotomy is most commonly associated with Staphylococcus, followed by Pseudomonas and Acinetobacter. strep and staph

Question 48

3 causes of chronic medistinitis

Answer 48

histoplasma, autoimmun or malignancy

Question 49

what arteries feed sternum

Answer 49

internal mamm