Thoracic Surgery

Question 1

What diagnostic procedure is used to visualize vascular lesions or involvement within the thorax

Answer 1

MRI

Question 2

Which procedure diagnoses lung carcinoma and also recurrent laryngeal nerve involvement

Answer 2

Laryngoscopy

Question 3

What can be used to remove a foreign body, remove secretions and drain infections in the lung

Answer 3

Bronchoscopy

Question 4

Used to confirm lung/tracheobronchial tumor, source of hemoptysis, obtain lung biopsies, diagnose atelectasis or pneumonitis

Answer 4

Bronchoscopy

Question 5

Can be used to biopsy paratracheal and subcarinal lymph nodes

Answer 5

Mediastinoscopy

Question 6

Can be used to diagnose sarcoidosis, lymphoma and fungal infections

Answer 6

Mediastinoscopy

Question 7

Used to detect organisms and suspected malignancies in pleural effusions

Answer 7

Thoracentesis

Question 8

What does it mean when cytology is positive in a thoracentesis

Answer 8

The tumor is inoperable

Question 9

Used to obtain tissue for tumor diagnosis, negative result does not rule out diagnosis

Answer 9

CT-directed fine needle aspiration biopsy

Question 10

Necessary if needle biopsy fails, often is required

Answer 10

Open lung biopsy

Question 11

Exposes heart, pericardium, ascending aorta and pulmonary artery

Answer 11

Median sternotomy

Question 12

Exposes lung, esophagus, posterior mediastinum

Answer 12

Posterolateral thoracotomy

Question 13

Used for upper lobe biopsy and sympathectomy

Answer 13

Axillary thoracotomy

Question 14

Rapid exposure for patients with thoracic trauma

Answer 14

Anterolateral thoracotomy

Question 15

Minimally invasive procedure that allows avoidance of a thoracotomy. Useful for effusions, diffuse lung diseases, recurrent pneumos, pulmonary nodules

Answer 15

Video-assisted thoracic surgery

Question 16

Causes mediastinal shift away from air collection

Answer 16

Tension pneumothorax

Question 17

Process in which air escapes the lung parenchyma into the pleural space

Answer 17

Tension pneumothorax

Question 18

Complication of inadequately drained hemothorax

Answer 18

Empyema or fibrothorax

Requires thoracotomy and decortication

Question 19

Tx of tension pneumothorax

Answer 19

Needle decompression and chest tube with underwater seal (48 hrs) and suction (24 hrs)

Question 20

Tx for open pneumothorax

Answer 20

Cover the wound, thoracostomy tube

Question 21

Tx for hemothorax

Answer 21

IV resuscitation and thoracostomy tube

Question 22

Signs of cardiac tamponade

Answer 22

Hypotension and neck vein distension

Question 23

Tx for cardiac tamponade

Answer 23

Pericardiocentesis
Median sternotomy
or left anterior thoracotomy

Question 24

Tx for flail chest

Answer 24

Pain control (intercostal block or epidural narcotics)
Aggressive pulmonary toilet
possible mechanical ventilation

Question 25

Persistent lung collapse after chest tube, persistent air leak, massive progressive subcutaneous emphysema

Answer 25

Tracheobronchial disruption

Question 26

Used to diagnose tracheobronchial disruption

Answer 26

Bronchoscopy

Question 27

Widened mediastinum, indistinct aortic knob, tracheal deviation to the right, left plural effusion

Answer 27

Aortic disruption

Question 28

Used to diagnose aortic disruption

Answer 28

Aortogram

Question 29

Tx of aortic disruption

Answer 29

Interposition graft | w/ or w/o method of distal perfusion

Question 30

CXR shows evidence of stomach or colon in chest

Answer 30

Diaphragmatic disruption | radial tear begins at esophageal hiatus

Question 31

Tx for diaphragmatic disruption

Answer 31

NG tube Urgent transabdominal repair (adhesions to lung may form within 7-10 days)

Question 32

Signs of rapidly progressive mediastinitis

Answer 32

Esophageal disruption | requires drainage, primary closure

Question 33

New onset arrhythmia, myocardial rupture, ventricular septal rupture or left ventricular failure after trauma

Answer 33

Cardiac contusion

Question 34

Most common thoracic trauma causing edema, small airway obstruction

Answer 34

Pulmonary contusion

Question 35

Tx for pulmonary contusion

Answer 35

O2, fluid restriction, pain control, chest physiotherapy and possible chest tube

Question 36

``` Stridor, episodes of respiratory distress Dysphagia Barium shows extrinsic compression Bronchoscopy shows segmental compression Tx? ```

Answer 36

Vascular rings | Surgery divides smaller of two aortic arches

Question 37

Workup of a coin lesion on CXR starts with what

Answer 37

Seeking old CXR

Question 38

First noninvasive tests if lung cancer is suspected

Answer 38

Sputum cytology | CT scan