Chest Wall, Lung, and Mediastinum

Question 0

Unilateral absence of costal cartilages, pectoralis muscle and breast

Answer 0

Poland’s syndrome

Question 1

Exceedingly depressed sternum, most common chest wall deformity

Answer 1

Pectus excavatum

Question 2

Compression of neurovascular bundle (pain and paresthesia in neck, shouler, arm, hand)
Brachial plexus compression (often ulnar n parasthesia)
Uncommonly vascular compression

Answer 2

Thoracic outlet syndrome

Question 3

Etiology of thoracic outlet syndrome

Answer 3

Compression by fibromuscular bands, anterior scalene muscle, first rib or cervical ribs

Question 4

Tx for thoracic outlet syndrome

Answer 4

PT for 3-6 months

Supraclavicular scalenectomy, brachial plexus neurolysis, or first rib resection

Question 5

Tx of chest wall tumors

Answer 5

Wide excision

Reconstruction using autologous and/or prosthetic grafts

Question 6

Etiology of spontaneous pneumothorax

Answer 6

Subpleural bleb

Question 7

Tx of spontaneous pneumothorax

Answer 7

Chest tube

Stapling of blebs if recurrent or persistent air leak for 3-5 days, or hemopneumothorax

Question 8

Which pleural effusion is protein-rich and which is protein-poor

Answer 8

Rich: exudative
Poor: transudative

Question 9

Used to diagnose pleural empyema

Answer 9

Thoracentesis and culture

Question 10

If thoracentesis fails to resolve empyema

Answer 10

Intercostal tube

Thoracotomy, debridement, decortication

Question 11

Risk factor and location of malignant mesothelioma

Answer 11

Asbestos exposure, parietal pleura

Question 12

Etiology of lung abscess

Answer 12

Aspiration

Question 13

Tx for lung abscess

Answer 13

IV antibiotics (penicillin) 90% success
Transbronchial drainage via bronchoscopy
CT-directed catheter drainage
Surgery

Question 14

Caused by repeated pulmonary infections, excessive sputum production

Answer 14

Bronchiectasis

Do CT, antibiotics

Question 15

Popcorn-like calcification, no change for 2 yrs, well circumscribed on CT

Answer 15

Benign pulmonary nodule (coin lesion)

May still require biopsy

Question 16

Which paraneoplastic syndromes can be caused by small cell carcinoma

Answer 16

ACTH, SIADH, Lambert Eaton myasthenic syndrome

Question 17

Which paraneoplastic syndrome can be caused by squamous cell carcinoma of the lung

Answer 17

Hyperparathyroidism (PTHrP)

Question 18

Horner’s syndrome, brachial plexus involvement, vertebral collapse

Answer 18

Pancoast tumor

Question 19

Tx for bronchogenic carcinoma

Answer 19

Lobectomy

Extensive mediastinal lymph node involvement or surrounding tissue involvement may contraindicate

Question 20

Adjuvant therapy for non small cell carcinoma

Answer 20

Post lobectomy chemotherapy

Question 21

Adjuvant therapy for advanced local lung ca

Answer 21

Preoperative chemotherapy

Question 22

Which lung tumor is located peripherally

Answer 22

Adenocarcinoma

Most others are centrally

Question 23

Tx of small cell carcinoma

Answer 23

Chemotherapy and radiation

Question 24

Which are the most common tumors with mets to the lung (4)

Answer 24

Colorectal Breast Melanoma Renal

Question 25

Diagnostic study for congenital lesions of the trachea

Answer 25

Air tracheography (tomography) Bronchoscopy Angiography

Question 26

Tx of tracheal tumor

Answer 26

Preop antibiotics | Tracheal resection with end to end anastamosis

Question 27

Elevated beta HCG, AFP and mediastinal mass

Answer 27

Germ cell tumor Seminomas most common, radiosensitive and treated with resection Others respond to chemotherapy

Question 28

First thing done in workup of coin lesion

Answer 28

Seek old CXR

Question 29

Noninvasive tests done first when lung cancer suspected

Answer 29

Sputum culture | CT scan

Question 30

Tx small cell cancer of the lung

Answer 30

Chemotherapy and radiation only

Question 31

How is operability of lung cancer assessed

Answer 31

Predicted residual function after resection Measure FEV1, get V/Q scan for fractions and determine remainder

Question 32

What is lower limit for residual pulmonary function after pneumonectomy

Answer 32

800mL

Question 33

How is potential cure by resection assessed

Answer 33

Metastasis to carinal or mediastinal nodes, Mets to other lung or liver By CT, PET, or endobronchial ultrasound