Cardiothoracic Surgery and the Lung in Non-Malignant Situation

Question 1

What is Boerhaave syndrome?

Answer 1

A spontaneous perforation of the oesophagus that results from a sudden increase in intraoesophageal pressure combined with negative intrathoracic pressure (eg, severe straining or vomiting). It causes vomit to be discharged into the pleural cavity.

Question 2

Is it possible to decorticate the diaphragm?

Answer 2

No- it is fa too vascular

Question 3

Name the 5 different tumours that can affect the thymus

Answer 3

1. Thymoma
2. Thymolipoma
3. Thymic carcinoma
4. Carcinoid tumours of the thymus
5. Lymphoma

Question 4

What condition are thymus tumours linked to?

Answer 4

Myasthenia gravis

Question 5

What is Myasthenia gravis?

Answer 5

a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness.

Question 6

List the 7 different kinds of benign lung tumour

Answer 6

1. Hamartoma
2. Fibroma
3. Lipoma
4. Neural tumours
5. Papillomas
6. Chondroma
7. Carcinoid

Question 7

What defines a persistent pneumothorax?

Answer 7

one in which the chest drain continues to bubble for >7 days

Question 8

What are the surgical indications in pneumothorax?

Answer 8

Recurrence >2 episodes (either on the same side or on each side separately)

Persistence (>7 days is an indication for a talc pleurodesis).

Surgery can be carried out after the first episode of pneumothorax in special cases (e.g. the patient is a diver or in the army or if the patient undertakes international travel to areas where there is a lack of appropriate tertiary care

Question 9

What is a bulla?

Answer 9

A very large, abnormal airspace in the lung >2cm in diameter

Question 10

What is a bleb?

Answer 10

An abnormal airspace in the lung <2cm

Question 11

What happens to a bulla on a flight?

Answer 11

It doubles in size (can cause tearing of adhesions, pneumothorax or the tearing of the pulmonary veins causing an air embolism and a subsequent stroke)

Question 12

What is a bronchogenic cyst?

Answer 12

A cyst located around the trachea or the carina present from birth

Question 13

How are bulla removed?

Answer 13

Surgically

Question 14

What are the three conditions in which lung transplants are most commonly carried out?

Answer 14

• Cystic fibrosis
• Pulmonary fibrosis
• Emphysema

Question 15

Why must lung transplantation be bilateral in cycstic fibrosis patients?

Answer 15

If only unilateral, the new lug will be susceptible to infection from the diseased lung

Question 16

List the 5 qualifying criteria a patient must meet before they can have a lung transplant

Answer 16

• Age <65 years
• Not overweight or diabetic (due the administration of prednisolone which causes weight gain and will cause diabetics to lose control of their blood sugars)
• No renal failure
• No mental illness
• Good social support