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SESATS > General Thoracic 2.0 > Flashcards

General Thoracic 2.0 Flashcards

1
Q

Lower esophageal sphincter

Normal and abnormal resing pressure amplitude

A

LES:

Normal pressure : 12 - 20 mmHg

Abnormal < 6

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2
Q

LES - normal and abnormal length

A

Normal length is 3-5 cm

Abnormal is < 2cm

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3
Q

Components of the DeMeester Score (6)

A

Data to calculate the score

  1. Presence of time pH<4
  2. percent supine pH< 4
  3. percent upright pH< 4
  4. Number of reflux episodes
  5. Number of reflux episodes > 5 min in duration
  6. Longest reflux episode
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4
Q

Demeester Score consistent with Reflux

A

score is >14.7
percent time pH < 4 is > 4%

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5
Q

Length of the cervical esophagus

what does this mean for surgical options for esophageal cancer ?

A

The cricopharyngeas is at 15cm from the incisors - the length of the cervial esophagus

For a tumor to be removed from here surgicall would require a pharyngolaryngoesophagectomy which high associated morbidity

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6
Q

Esohophageal anatomy

how far from the incisions to the thoracic inlet / sternal notch

A

20 CM

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7
Q

Esophogeal anatomy

how far from the incisors to the azygous Vein

A

25cm

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8
Q

Esophageal anatomy

How far from the incisors to inferior pulmonary vein

A

30 cm

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9
Q

Esophageal anatomy

How far from the incisors to the EGJ

A

40cm

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10
Q

Treatment of SCC of the cervical esophagus

A

Behave more like H&N cancers

Respond well to Radiation and Chemotherapy

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11
Q

pharyngolaryngoesophagectomy

A

would be needed for esophageal cancer of the cervical esophagus

Problems:

  • deforming
  • poor long-term outcomes
  • poor QOL
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12
Q

General Defenition of Barrett’s esophagus

A

squamocolumnar junction is cephalad to the GE junction
Adaptive reponse to esophageal mucosal injury from gastric acid or bile reflux

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13
Q

Barretts is found in what percent of patient with GERD

A

6-12%

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14
Q

Histology of Barretts esophagus

A

Columnar mucosae (intestinal metaplasia)

Goblet cells

Progressive disorganization of cells and glands above the GE junction

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15
Q

What percent of Barrett’s esophagus progress to adenocarcinoma ?

How higher fold of a risk is it ?

A

1%

30-120 fold higher risk

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16
Q

what percent of Barrett’s esophagus will progress to some form of dysplasia ?

A

5-10%

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17
Q

What percent of Barrett’s esophagus progress to LGD

A

15-25%

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18
Q

Barrett’s esophagus - what percent of patients will progress to HGD

A

5-10%

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19
Q

Barrett’s Esophagus

Management of patients with metaplasia wtihout dysplaisa

A

Endoscopy every 2-3 years with 4 quadrant biopsies at 2 cm intervals

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20
Q

Management of Barrets esophagus with Low grade dysplasia

A

4 quadrant biopsies at every 2cm

Every 6 months for 1 year

then annually if still LGD

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21
Q

Managements of barrets esophagus found to have high grade dysplasia

A

Confirm diagnosis with repeat endoscopy and two separate pathologists

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22
Q

treatment of patients with high grade dysplasia

A

Flat and unifocal:

  • may be treated with endoscopic techniques

Mutifocal ./ HGD with displasia associated lesion or masses (DALM) / long segments of dysplasia

  • Esophagectomy
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23
Q

Varriants of HGD that are indications for Esophagectomy

A
  • Mutifocal
  • HGD with displasia associated lesion or masses (DALM)
  • Long segments of dysplasia
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24
Q

Technic of PDT for Barrett’s esophagus

A

injection of photosentitizing ageng followed by tx with 630nm laser – causes ox rad dependent tissue necrosis

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25
Q

Complications of Photodynamic therapy

A

30% esophageal stricture rate

10% sunburn dysphagia

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26
Q

Key limitations of photodynamic therapy

A

Depth of penetration is limited to the submucosa

Invasive cancers are inadequately treated

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27
Q

RFA treatment of Barrett’s esophagus

A

Ablates the tumor to the level of the muscularis mucosa

Does not provide intact histology architechture

28
Q

EGFR targeted drugs:

A

EGFR targeted drugs:

  • Erotinib
  • Afatinib
  • Crizotinib
  • Certinib
  • Gefitinib
29
Q

what Genes should be looked for in squamous cell lung cancer in non-smokers

A

EGFR and ALK

30
Q

Lung cancer

Which patients should be offered up front surgery

A

Stage 1 and II

31
Q

Lung Cancer

For which patients should one recieve adjuvant based chemotherapy:

A

Stage IIA and IIB

32
Q

Lung cancer

TNM of patients who should get adjuvant chemotherapy

A

IIA : T1, T2a, N1 ; T2bN0

IIB: T2b N1, T3 N0

33
Q

patients who should recive neoadjuvant radiochemotherapy

A
  1. IIIA (N2) positive lung cancer
    • This is : T1-T2a N2 disease
  2. Best for non-bulky disease (<3cm)
34
Q

Lung cancer

Next step in treatment

for patients who have recieved neoadjuvant chemotherapy ?

A

Patients in whom an R0 ressection can be performed with a lobectomy

Pneumonectomy does not provide a survival advantage

35
Q

Lung cancer

survival of patients who have recieved neoadjuvant therapy

5 year survival of lobectomy vs omm

A
  1. 5 year survival benefit to the lobectomy group vs OMM (36 vs 18%)
36
Q

Eosinophilic esophagitis

Epidemiology

  • Age
  • Ethnic
A
  1. Typical Age at presentation:
    1. It can occur in all ages
    2. typically presents in the third or fourth decade.
  2. Ethnic predisposition
    1. has predominance in non-Hispanic males
37
Q

How to make the diagnosis of Eosinphilic Esophagitis

A
  1. Currently, the only reliable diagnostic method is endoscopy with biopsy, and sampling both the proximal and distal esophagus is recommended.
  2. Endoscopic findings include nonspecific inflammatory changes, and “rings” and/or “corrugations” are present in most patients (see figure).
38
Q

Histologic diagnosis of eosinphilic esophagitis

A
  1. >= 15 eos /HPF in the squamous mucosa of the esophagus
  2. Biopsies of the mucosa of the gastric antrum or duodenum should *not* show similar findings.
39
Q

Eosinophilic esophagitis

Rx

A
  1. Swallowed topical fluticasone or budesonide
  2. oral systemic prednisone
  3. dietary elimination of food antigens
40
Q

number of lung segments

A

18

41
Q

Domperidone

A

Domperidone

Dopamine antagonist (can cause lactation)

used outside theUS as a prokinetic pharmacotherapy for reflux. I

augments muscle contractions in the esophagus, stomach, and intestines.

Domperidone passes into breast milk in small amounts.

42
Q

what causes a forshortened esophagus

A

Reflux with a reultant inflammatory reaction to the lamina propriata

leads to a forshortened esophagus and may lead to a type III hernia

43
Q

Esophagus;

varriations of High Grade Dysplasia to consider in reccomending treatment

A

Endoscopic:

  • Flat and unifocal:

Esophagecomy :

  • Mutifocal .
  • HGD with displasia associated lesion or masses (DALM)
  • Long segments of dysplasia
44
Q

esophagus with a ‘corkscrew’ appearance

A

Diffuse esophageal spasm

45
Q

​esophagus with a ‘rosary bead’ appearance

A

Diffuse esophageal spasm

46
Q

Diffuse esophageal spasm

  1. Pathology/Pathophysiology :
A

Diffuse esophageal spasm

  1. Pathology/Pathophysiology :
    1. Degenerative changes in the vagus
    2. Muscle hypertrophy
    3. Simultaneous contractions in the esophagus leading to a ‘corkscrew’ or ‘rosary bead’ appearance
    4. Epiphrenic diverticulum
47
Q

Esophageal condition

clinical history related to anxiety or psychiatric disorders

A

Diffuse esophageal spasm

48
Q

Diffuse esophageal spasm

  1. Presentation:
A

Diffuse esophageal spasm

  1. Presentation:
    1. Substernal atypical pain
    2. Similar to anxiety and angina
    3. High association with psychiatric disorders
49
Q

Diffuse esophageal spasm

Manometry

A

Manometry

LES: normal or hypertensive, normal relaxation

High amplitude esophageal contraction

50
Q

Treatment of DES

A
  1. Rx:
    1. Nitrates and CBB- tried for symptom relief but infrequent success
    2. Endoscopic botox to LES relieves dysphagia
    3. Long Esophageal myotomy – refractory cases
51
Q
  • Tarceva
A
  • Erotinib (Tarceva) - EGFR blocker
52
Q

What type of mutation is EGFR mutation when related to lung cancer

A

Driver mutation

53
Q

What trials evaluated tarceva

A

Tarceva = Erolotinib = EGFR blocker

  1. BR-21
  2. EUROTAC
54
Q

Br - 21

A

Trial evaluating tarceva (Erotonib)

Evaluated Erlotonib in NSCLCA

Erlotonib vs placebo

55
Q

EUROTAC

A

Clinical trial evaluating Tarceva (Erolotonib)

Erotinib vs standard chemo

improved disease free survival

56
Q

Iressa

A
  • EGFR blocker
  • Gefitinib (Iressa)
    • Initially removed by FDA in 2003 for lack of efficacy
    • TRANSCOG – efficacy of Irressa in Esophageal Cancer
    • 2015 FDA approved it for the use of NSCLC
57
Q

Pseudoachalsia

what is it?

consequently, what is the best diagnostic strategy ?

A

Pseudoachalsia

Behaves like achalsia from a manometric findings, but there is no loss of the myenteric plexus.

EUS with Bx is the best diagnostic modality

58
Q

Esophageal cancer

  • sub types of T4 disease
A
  • T4a tumors are resectable cancers invading adjacent structures such as pleura, pericardium, or diaphragm.
  • T4b are unresectable cancers invading other adjacent structures, such as aorta, vertebral body, or trachea.
59
Q

Esophageal cancer - what is A regional lymph node:

A

A regional lymph node:

has been redefined to include any paraesophageal lymph node extending between cervical nodes and celiac nodes.

Supraclavicular nodes are M1

celiac nodes are considered regional

60
Q

Esophageal cancer

what stage are supraclavicular lymph nodes?

A

Supraclavicular nodes are M1

celiac nodes are considered regional

61
Q

esophageal lung cancer

what station are celicac lymph nodes?

A

Supraclavicular nodes are M1

celiac nodes are considered regional

62
Q

Blunt chest trauma

factors that impact mortality

Factors that impact the length of stay

A

A. Adverse outcome for flail chest patients correlates with:

a) Injury Severity Score
b) Associated injuries.

B. Length of Hospitalization (But not Mortality) is dependent on:

a) Age,
b) hemopneumothorax
c) mechanical support

​

63
Q

how long can it take for Myasthenia gravis symptoms to improve after thymectomy

A

up to two years

64
Q

what type of myasthenia gravis tends to not improve after thymectomy

A

Some reports suggest that non-thymomatous myasthenia patients with antibodies to muscle-specific tyrosine kinase (MuSK) tend not to benefit from thymectomy.

65
Q

Most common causes of idiopathic phrenic nerve paralysis and what does that mean for surgery?

A

Idiopathic phrenic nerve paralysis, possibly due to viral infection or associated with acute brachial plexus neuritis (neuralgic amyotrophy, Parsonage-Turner syndrome) tends to resolve over time.

Surgery (diaphragm plication) should be delayed at least 18-24 months to allow for potential spontaneous resolution.

66
Q

PFT improvements with diaphragm plication

A

Dynamic values tend to get better because aggregate diaphragm strength and muscle recruitment both improve. Residual volume, however, is not altered.

SESATS (12 decks)

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