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ABSITE Review > ABSITE Review - Thoracic > Flashcards

ABSITE Review - Thoracic Flashcards

1
Q

Where is the azygos vein located and where it drains?

A

It is located in th eirght side and dumps into SVC

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2
Q

Where is the thoracic duct located and where it drains?

A

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

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3
Q

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

A

Phrenic nerve runs ANTERIOR to the hilum

Vagus nerve runs POSTERIOR to the hilum

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4
Q

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

A

Type I pneumocytes - gas exchange

Type II pneumocytes - surfactant production

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5
Q

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

A

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

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6
Q

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

A

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

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

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7
Q

What is the MC site of lung metastasis?

A

Brain

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8
Q

What is the MC type of lung cancer?

A

Adenocarcinoma (non-small cell)

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9
Q

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

A

Squamous cell - more central

Adenocarcinoma - more peripheral

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10
Q

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

A

Squamous cell carcinoma

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11
Q

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

A

Adenocarcinoma

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12
Q

Mention the paraneoplastic lung syndromes.

A

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

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13
Q

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

A

Mesothelioma - due to asbestos exposure

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14
Q

What is the role of mediastinoscopy?

A

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

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15
Q

What is the Pancoast tumor?

A

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

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16
Q

What is Horner’s syndrome?

A

Invasion of sympathetic chain –> ptosis, miosis, anhidrosis

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

What is the MC mediastinal tumor in adults and children?

A

Neurogenic tumors, usually in posterior mediastinum

20
Q

What are the common tumor per are of mediastinum?

A

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

21
Q

What is the 50% rule for thymomas?

A

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

22
Q

What is the MC variant of T-cell lymphoma?

A

Lymphoblastic

23
Q

What is the MC variant of Hodgkin’s lymphoma?

A

Nodular Sclerosing

24
Q

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

A

TRUE

25
Q

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

A

Adults - papilloma

Children - hemangioma

26
Q

What is the MC malignant tumor in the trachea?

A

Squamous cell carcinoma

27
Q

What is the MC late complication after tracheal surgery?

A

Granulation tissue formation

28
Q

What is the MC early complication after tracheal surgery?

A

Laryngeal edema

29
Q

What is the treatment for a tracheoesophageal fistula?

A

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

30
Q

What are the three phases of empyema?

A

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

31
Q

What is the MC site for lung absecesses?

A

Posterior segment of RUL and superior segment of RLL

32
Q

What are the MCC of chylothorax?

A

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

33
Q

What is the treatment for a chylothorax?

A

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

34
Q

What is massive hemoptysis?

A

> 600cc/24 hours

35
Q

What is the recurrence risk for spontaneous PTX?

A

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

36
Q

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

A

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

37
Q

When is surgery indicated for spontaneous PTX?

A

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

38
Q

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

A

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

39
Q

What is sequestration?

A

Lung tissue in lung not connected to bronchial tree

Receives blood supply from anomalous systemic arteries –> usually off thoracic aorta

40
Q

What are the 2 types of sequestration?

A

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

41
Q

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

A

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

42
Q

What is catamenial pneumothorax?

A

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

43
Q

What are the usual findings in tuberculosis?

A

Cacifications and caseating granulomas in lung apices

Ghon complex –> parenchymal lesion + enlarged hilar nodes

44
Q

What are the numbers classic of a exudative effusion?

A

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

45
Q

What is the MC benign and malignant chest wall tumor?

A

Benign - osteochondroma

Malignant - chondrosarcoma

ABSITE Review (32 decks)

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