ABSITE Review - Thoracic Flashcards
Where is the azygos vein located and where it drains?
It is located in th eirght side and dumps into SVC
Where is the thoracic duct located and where it drains?
It runs along the right side, crosses midline, and dumps into Left subclavian vein at junction with IJ vein. Crosses at T4-5.
Where runs the vagus and phrenic nerve in relation to the hilum?
Phrenic nerve runs ANTERIOR to the hilum
Vagus nerve runs POSTERIOR to the hilum
What is the function of the Type I and II pneumocytes?
Type I pneumocytes - gas exchange
Type II pneumocytes - surfactant production
What are the needed postop FEV1, DLCO, FVC values?
FEV1 > 0.8 (or at least 40% of the predicted value)
DLCO > 11-12 mL/min/mmHg CO (at least 50%)
FVC > 1.5L
When lung resection is not possible, using the preop pCO2 and VO2?
No resection if preop pCO2 > 45 or pO2 < 50 at rest
No resection if preop VO2 max < 10 mL/min/kg
What is the MC site of lung metastasis?
Brain
What is the MC type of lung cancer?
Adenocarcinoma (non-small cell)
In terms of location, where is most likely to find lung adenocarcinoma vs squamous cell cancer?
Squamous cell - more central
Adenocarcinoma - more peripheral
In terms of lung adenocarcinoma and squamous cell cancer, which has increased risk of local recurrence?
Squamous cell carcinoma
In terms of lung adenocarcinoma and squamous cell cancer, which has increased risk of distant metastases?
Adenocarcinoma
Mention the paraneoplastic lung syndromes.
Squamous cell - PTH-related peptide
Small cell CA - ACTH, ADH
Small cell ACTH - MC paraneoplastic syndrome
What is the most malignant lung tumor? What is the cause?
Mesothelioma - due to asbestos exposure
What is the role of mediastinoscopy?
Use for centrally located tumors and patients with suspicious adenopathy (>0.8cm or subcarinal >1.0cm) on chest CT
What is the Pancoast tumor?
Tumor invades apex of chest wall and patients have Horner’s syndrome.
What is Horner’s syndrome?
Invasion of sympathetic chain –> ptosis, miosis, anhidrosis
What is the next step when a coin lesion is found?
Follow up if no growth in 2 years, smoth contour suggests benign disease
What is the MC benign adult lung tumor? What are theusua CT findings?
Hamartomas - Have calcifications and can appear as a popcorn lesion on chest CT.
What is the MC mediastinal tumor in adults and children?
Neurogenic tumors, usually in posterior mediastinum
What are the common tumor per are of mediastinum?
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
What is the 50% rule for thymomas?
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
What is the MC variant of T-cell lymphoma?
Lymphoblastic
What is the MC variant of Hodgkin’s lymphoma?
Nodular Sclerosing
T/F: The MC neurogenic tumor in the mediastinum is the neurolemmoma.
TRUE
What is the MC benign tumor in the trachea in adults and children?
Adults - papilloma
Children - hemangioma
What is the MC malignant tumor in the trachea?
Squamous cell carcinoma
What is the MC late complication after tracheal surgery?
Granulation tissue formation
What is the MC early complication after tracheal surgery?
Laryngeal edema
What is the treatment for a tracheoesophageal fistula?
Use large volume cuff below fistula
May need decompressing gastrostomy
Tracheal resection, reanastomosis, sternohyoid flap
What are the three phases of empyema?
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
What is the MC site for lung absecesses?
Posterior segment of RUL and superior segment of RLL
What are the MCC of chylothorax?
50% 2ary to trauma or iatrogenic
50% 2ary to tumor (lymphoma MC)
Injury above T5-6 –> L-sided
Injury below T5-6 –> R-sided
What is the treatment for a chylothorax?
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
What is massive hemoptysis?
> 600cc/24 hours
What is the recurrence risk for spontaneous PTX?
Recurrence risk after 1st PTX 20%, after 2nd PTX 60%, after 3rd PTX 80%
What is the MCC of a spontaneous PTX? Where it is more common?
Results from rupture of a bleb in the apex of the upper lobe of the lung. More common on the right.
When is surgery indicated for spontaneous PTX?
Reccurence, large blebs on CT scan, air leak > 7 days, nonreexpansion, high risk profession (airline pilot, diver, mountain climber)
What is a bronchogenic cyst and where it is mos commonly located?
Abnormal lung tissue outside the lung; did not get connected to bronchial system
Usually posterior to the carina
What is sequestration?
Lung tissue in lung not connected to bronchial tree
Receives blood supply from anomalous systemic arteries –> usually off thoracic aorta
What are the 2 types of sequestration?
Extralobar - more common in children; more likely to have systemic venous drainage
Intralobar - more common in adults; more likely to have pulmonary vein drainage
If you find a solitary nodule in a patient withpast history of previous cancer, what is it: primary or metastatic?
Sarcoma/melanoma - more likely metastatic
Head/neck/breast - more likely primary lung CA
GI/GU - metastases or primary
What is catamenial pneumothorax?
Occurs in temporal relation with menstruation. Caused by endometrial implants in the visceral lung pleura.
What are the usual findings in tuberculosis?
Cacifications and caseating granulomas in lung apices
Ghon complex –> parenchymal lesion + enlarged hilar nodes
What are the numbers classic of a exudative effusion?
WBC > 1000, pH < 7.45, PF/serum protein > 0.5, PF/serum LDH > 0.6, sp gravity >1.016, low glucose
What is the MC benign and malignant chest wall tumor?
Benign - osteochondroma
Malignant - chondrosarcoma
