ABSITE Review - Thoracic

Question 1

Where is the azygos vein located and where it drains?

Answer 1

It is located in th eirght side and dumps into SVC

Question 2

Where is the thoracic duct located and where it drains?

Answer 2

It runs along the right side, crosses midline, and dumps into Left subclavian vein at junction with IJ vein. Crosses at T4-5.

Question 3

Where runs the vagus and phrenic nerve in relation to the hilum?

Answer 3

Phrenic nerve runs ANTERIOR to the hilum

Vagus nerve runs POSTERIOR to the hilum

Question 4

What is the function of the Type I and II pneumocytes?

Answer 4

Type I pneumocytes - gas exchange

Type II pneumocytes - surfactant production

Question 5

What are the needed postop FEV1, DLCO, FVC values?

Answer 5

FEV1 > 0.8 (or at least 40% of the predicted value)
DLCO > 11-12 mL/min/mmHg CO (at least 50%)
FVC > 1.5L

Question 6

When lung resection is not possible, using the preop pCO2 and VO2?

Answer 6

No resection if preop pCO2 > 45 or pO2 < 50 at rest

No resection if preop VO2 max < 10 mL/min/kg

Question 7

What is the MC site of lung metastasis?

Answer 7

Brain

Question 8

What is the MC type of lung cancer?

Answer 8

Adenocarcinoma (non-small cell)

Question 9

In terms of location, where is most likely to find lung adenocarcinoma vs squamous cell cancer?

Answer 9

Squamous cell - more central

Adenocarcinoma - more peripheral

Question 10

In terms of lung adenocarcinoma and squamous cell cancer, which has increased risk of local recurrence?

Answer 10

Squamous cell carcinoma

Question 11

In terms of lung adenocarcinoma and squamous cell cancer, which has increased risk of distant metastases?

Answer 11

Adenocarcinoma

Question 12

Mention the paraneoplastic lung syndromes.

Answer 12

Squamous cell - PTH-related peptide
Small cell CA - ACTH, ADH
Small cell ACTH - MC paraneoplastic syndrome

Question 13

What is the most malignant lung tumor? What is the cause?

Answer 13

Mesothelioma - due to asbestos exposure

Question 14

What is the role of mediastinoscopy?

Answer 14

Use for centrally located tumors and patients with suspicious adenopathy (>0.8cm or subcarinal >1.0cm) on chest CT

Question 15

What is the Pancoast tumor?

Answer 15

Tumor invades apex of chest wall and patients have Horner’s syndrome.

Question 16

What is Horner’s syndrome?

Answer 16

Invasion of sympathetic chain –> ptosis, miosis, anhidrosis

Question 17

What is the next step when a coin lesion is found?

Answer 17

Follow up if no growth in 2 years, smoth contour suggests benign disease

Question 18

What is the MC benign adult lung tumor? What are theusua CT findings?

Answer 18

Hamartomas - Have calcifications and can appear as a popcorn lesion on chest CT.

Question 19

What is the MC mediastinal tumor in adults and children?

Answer 19

Neurogenic tumors, usually in posterior mediastinum

Question 20

What are the common tumor per are of mediastinum?

Answer 20

Anterior - T’s –> thymoma, thyroid cancer or goiter, T-cell lymphoma, Teratoma, Parathyroid adenomas
Middle - Bronchiogenic cysts, pericardial cysts, enteric cysts, lymphoma
Posterior - enteric cysts, neurogenic tumors, lymphoma

Question 21

What is the 50% rule for thymomas?

Answer 21

50% of thymomas are malignant
50% of patients with thymomas have symptoms
50% of patients with thymomas have myasthenia gravis
10% of patients with myasthenia gravis have thymomas
All thymomas require resection

Question 22

What is the MC variant of T-cell lymphoma?

Answer 22

Lymphoblastic

Question 23

What is the MC variant of Hodgkin’s lymphoma?

Answer 23

Nodular Sclerosing

Question 24

T/F: The MC neurogenic tumor in the mediastinum is the neurolemmoma.

Answer 24

TRUE

Question 25

What is the MC benign tumor in the trachea in adults and children?

Answer 25

Adults - papilloma | Children - hemangioma

Question 26

What is the MC malignant tumor in the trachea?

Answer 26

Squamous cell carcinoma

Question 27

What is the MC late complication after tracheal surgery?

Answer 27

Granulation tissue formation

Question 28

What is the MC early complication after tracheal surgery?

Answer 28

Laryngeal edema

Question 29

What is the treatment for a tracheoesophageal fistula?

Answer 29

Use large volume cuff below fistula May need decompressing gastrostomy Tracheal resection, reanastomosis, sternohyoid flap

Question 30

What are the three phases of empyema?

Answer 30

1st week - Exudative phase - Tx: chest tube, antibiotics 2nd week - Fibroproliferative phase - Tx: chest tube, antibiotics 3rd week - Organized phase - Tx: likely need decortication, fibrous peel occurs around lung

Question 31

What is the MC site for lung absecesses?

Answer 31

Posterior segment of RUL and superior segment of RLL

Question 32

What are the MCC of chylothorax?

Answer 32

50% 2ary to trauma or iatrogenic 50% 2ary to tumor (lymphoma MC) Injury above T5-6 --> L-sided Injury below T5-6 --> R-sided

Question 33

What is the treatment for a chylothorax?

Answer 33

3-4 weeks of conservative mgmt (chest tube, octreotide, low-fat diet or TPN) if fails, surgery with ligation of thoracic duct on right side low in mediastinum (80% succesful) if malignant causes, can perform mechanical or talc pleurodesis

Question 34

What is massive hemoptysis?

Answer 34

>600cc/24 hours

Question 35

What is the recurrence risk for spontaneous PTX?

Answer 35

Recurrence risk after 1st PTX 20%, after 2nd PTX 60%, after 3rd PTX 80%

Question 36

What is the MCC of a spontaneous PTX? Where it is more common?

Answer 36

Results from rupture of a bleb in the apex of the upper lobe of the lung. More common on the right.

Question 37

When is surgery indicated for spontaneous PTX?

Answer 37

Reccurence, large blebs on CT scan, air leak > 7 days, nonreexpansion, high risk profession (airline pilot, diver, mountain climber)

Question 38

What is a bronchogenic cyst and where it is mos commonly located?

Answer 38

Abnormal lung tissue outside the lung; did not get connected to bronchial system Usually posterior to the carina

Question 39

What is sequestration?

Answer 39

Lung tissue in lung not connected to bronchial tree | Receives blood supply from anomalous systemic arteries --> usually off thoracic aorta

Question 40

What are the 2 types of sequestration?

Answer 40

Extralobar - more common in children; more likely to have systemic venous drainage Intralobar - more common in adults; more likely to have pulmonary vein drainage

Question 41

If you find a solitary nodule in a patient withpast history of previous cancer, what is it: primary or metastatic?

Answer 41

Sarcoma/melanoma - more likely metastatic Head/neck/breast - more likely primary lung CA GI/GU - metastases or primary

Question 42

What is catamenial pneumothorax?

Answer 42

Occurs in temporal relation with menstruation. Caused by endometrial implants in the visceral lung pleura.

Question 43

What are the usual findings in tuberculosis?

Answer 43

Cacifications and caseating granulomas in lung apices | Ghon complex --> parenchymal lesion + enlarged hilar nodes

Question 44

What are the numbers classic of a exudative effusion?

Answer 44

WBC > 1000, pH < 7.45, PF/serum protein > 0.5, PF/serum LDH > 0.6, sp gravity >1.016, low glucose

Question 45

What is the MC benign and malignant chest wall tumor?

Answer 45

Benign - osteochondroma | Malignant - chondrosarcoma