Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SESATS > General Thoracic 3.0 > Flashcards

General Thoracic 3.0 Flashcards

1
Q

2017 Lung Cancer Staging

T0 –

A

T0 – no primary tumor

T1a (mi) – Minimally invasive adenoma

T1a ss –superfical spreading in central airways (any size but confined to the tracheal or bronchial wall)

T1a Tumor =< 1cm

T1b tumor > 1 but =< 2 cm

T1c Tumor > 2 but =< 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lung Cancer 2017 Staging

T1a (mi) –

A

Lung Cancer 2017 Staging

T1a (mi) – Minimally invasive adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lung Cancer 2017 Staging

T1a ss

A

Lung Cancer 2017 Staging

T1a ss:

superfical spreading in central airways

(any size but confined to the tracheal or bronchial wall)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lung Cancer 2017 Staging

T1a

A

Lung Cancer 2017 Staging

T1a Tumor =< 2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lung Cancer 2017 Staging

T1b

A

tumor > 2, but =< 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lung Cancer 2017 Staging

T1c?

A

Tumor > 2 but =< 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACOSOG Z0050 trial

Trial purpose

Trial Conclusion

A

ACOSOG Z0050 trial (2011)

  • Examined the utility of PET for staging patents with potentially operable NSCLC
  • The authors concluded that their study validated that mediastinoscopy (prior to the widespread use of EBUS) is the gold standard for mediastinal staging when compared to the CT and/or PET interpretations.
  • Therefore: N2 disease should be confirmed pathologically.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Specificty of PET for N2/N3 disease ?

A

ACOSOG Z0050 trial (2011)

PET for N2/N3

Specificity: 84%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PPV of PET for mediastinal lymph nodes

A

ACOSOG Z0050 trial (2011)

The PPV (positive predictive value) of PET in that study was only 56%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Comparison of VATS vs. Thoracotomy
Mortality

A

No differences in mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Comparison of VATS vs. Thoracotomy

Respiratory issues:

A

Perioperative respiratory complications (12.2% vs. 7.6%, p=0.0001)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Comparison of VATS vs Thoracotomy

Atrial arrhythmia:

A

Comparison of VATS vs Thoracotomy

Atrial arrhythmia:

atrial arrhythmias (11.5% vs. 7.3%, p=0.0004) were higher in the thoracotomy group.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Comparison of VATS vs Thoracotomy

Lymph Node Status and Up Staging

Mediastinal and hilar lymph node staging

A

Mediastinal Lymph nodes

no difference in the number of mediastinal stations sampled or of upstaging of mediastinal nodes (5.0% with thoracotomy vs. 4.9% with VATS; p = 0.52).

Peribronchial lymph nodes

There was, however, a difference in the rates of hilar and peribronchial upstaging for N1 disease favoring thoracotomy (9.3% vs. 6.7%, p<0.001).

This was assumed to indicate variability in the completeness of hilar and peribronchial lymph node dissection during the VATS cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cameron’s Ulcers

A
  1. Patients with a type III hernia may have an associated unexplained anemia.
  2. Aetiology
    • The blood loss is from the stomach moving up and down through the hernia ring leading to irritation of the gastric mucosa and subsequent bleeding. This may or may not be seen on endoscopy. These erosions are referred to as Cameron’s erosions or Cameron’s ulcers.
  3. Epidemiology
    • It occurs in 20%-30% of patients with large type III hernias.
  4. Work up
    • A full investigation of other sources of gastrointestinal blood loss is warranted. This usually involves a colonoscopy and CT scan to rule out other causes of bleeding.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Incidence of Cameron’s ulcer

A
  1. Epidemiology
    1. It occurs in 20%-30% of patients with large type III hernias.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Quantification of AFB and B-HCG in young patient with anterior mediastinal mass

? how much is too high?

A

Any elevation of alpha-fetoprotein (αFP) and elevation of beta human chorionic gonadotropin(βhCG) elevation > 100 mIU/mL is diagnostic for a primary mediastinal nonseminomatous germ cell cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

IHC staining for germ cell tumors

ALK

A
  1. Eighty percent of seminomatous germ cell cancers stain positive for placental alkaline phosphatase, which is also diagnostic.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is more comminon

Seminoma or non-seminoma

A

Seminoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what has a better prognosis ? seminoma or non-seminoma

A

Seminoma - 5 year survival 80%

Non seminoma 50-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common malignant germ cell tumor in the mediastinum

A

Seminoma

###

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A.Seminoma

1.Epidemiology

  • Frequency of mediastinum
  • Gender prevlance
  • Age?

###

A
  • Most common malignant germ cell tumor in the mediastinum
  • Occurs almost exclusively in Males
  • 30’s – 40s

###

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Seminoma

Diagnosis

Lab and Imaging ?

###

A

a) Serum Tumor markers are slightly elevated.
b) CT: reveal characteristically large, homogenous math with smooth boaders
c) Eighty percent of seminomatous germ cell cancers stain positive for placental alkaline phosphatase, which is also diagnostic.

###

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Seminoma

Treatment

A
  • Radiation therapy: traditionally the primary treatment.
  • Cisplatin-based chemotherapy is used for metastatic disease
  • Surgical resection is reserved for any residual disease that is manifested as the local growth of a residual mass.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Non-seminomatous germ cell tumors

Epidemiology

Age and gender

###

A

A.Non-seminomatous germ cell tumors

Epidemiology

a)most often in young men 20 to 30 years old

###

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Non-seminomatous germ cell tumors

pathologic subtypes

###

A

(1) yolk sac carcinoma
(2) embryonal carcinoma
(3) choriocarcinoma

###

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Most common side effects to Cisplatin

A

The most common side effects of cisplatin are:

nausea and vomiting

arthralgias

nephrotoxicity

sensory polyneuropathy

electrolyte abnormalities

(hypomagnesemia, hypocalcemia, hypokalemia), ototoxicity,

anemia and leukopenia (usual onset after 10 days, with nadir between 14-23 days, and recovery after 21-39 days).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bronchopleural Fistula

Epidemiology

  • incidence of bronchopleural fistula (BPF)following pneumonectomy: 0.8% to 15%?
A

Bronchopleural Fistula

Epidemiology

  • incidence of bronchopleural fistula (BPF)following pneumonectomy: 0.8% to 15%
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Bronchopleural Fistula

Risk factors?

A

Pneumonectomy

Neoplastic disease

Right >> Left

neoadjuvant chemotherapy or radiation

hypoalbuminemia

long residual bronchial stump

more severe chronic obstructive lung disease

the need for postoperative mechanical ventilation.

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

CTA findings consistent with chronic pulmonary HTN

A
  • A CT-determined main pulmonary artery diameter greater than 29 mm predicts PHTN with a sensitivity of 87% and specificity of 89%.
  • The specificity reaches 100% if additionally an artery-to-bronchial ratio greater than 1:1 is found at the segmental level in at least three lobes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stages of BOS

A

1 - 3

31
Q

Grade 1 BOS

A

10% reduction in FEV1

32
Q

Lung biopsy results consistent with BOS

A

intraluminal fibromyxoid granulation tissue and submucosal eosinophilic infiltrates

33
Q

You have sent a specimen after a lung biopsy. The fresh sample shows hyphae branching at right angles. The most likely diagnosis is

A
  1. mucormycosis
34
Q

In Blunt chest trauma with fractured ribs what factors are predictive of morality ?

A

A. The adverse outcome for flail chest patients correlates with:

a) Injury Severity Score
b) Associated injuries.

​

35
Q

In blunt chest trauma with fractured ribs: what impacts the length of stay (but not mortality)?

A

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

a) Age,
b) hemopneumothorax
c) mechanical support

​

36
Q

In blunt chest trauma with fractured ribs,

what does Injury Severity Score correlate with?

​

A

Mortality

37
Q

Recommendations for medical therapy for Mycobacterium Tb

A
  1. 2010 WHO recommendations:
    a) 2HZRE/4HR
    (1) 2 months of isoniazid (H) Pyrazinamide (Z), Rifmapin, Ethambutol (E)
    (2) 4 months of Isoniazid and rifampin
    (3) ethambutol is maintained in areas of high resistance

​

38
Q

Ranking of disease on LAS

A
  1. Rank of Favoring Diseases on LAS
    1. Highest
      1. End-stage fibrotic lung disease
      2. (e.g., idiopathic pulmonary fibrosis-IPF, usual interstitial pneumonitis-UIP)
    2. Middle:
      1. supportive lung disease (eg, CF, bronchiectasis)
    3. Least favored:

obstructive lung disease emphysema, alpha1 antitrypsin deficiency

39
Q

highest ranked primary lung diseases in LAS

A
  1. Rank of Favoring Diseases on LAS
    1. Highest
      1. End-stage fibrotic lung disease
      2. (e.g., idiopathic pulmonary fibrosis-IPF, usual interstitial pneumonitis-UIP)
        2.
40
Q

Middle ranked diseases on LAS

A

Middle:

supportive lung disease (eg, CF, bronchiectasis)

41
Q

Least favored lung diseases in LAS

A

​

Least favored:

obstructive lung disease emphysema, alpha1 antitrypsin deficiency

42
Q

Double vs single lung transplant for primary pulmonary htn

A

in older patients (>65 yrs) double lung transplantation has proven to be high risk, single lung transplantation for patients with moderate pulmonary hypertension (mean 35 mmHg) has equivalent outcomes.

43
Q

Proximal Acinar Emphysema -

typical anatomic location

A

Proximal acinar emphysema (centrilobular) typically located in the upper airways

44
Q

Proximal acinar emphysema

  • with what is it associated (etiology)
A

Smoking

Inflammatory lung conditions

45
Q

Pan acinar emphysema

typical anatomic location ?

A

typically located in the lower lung zones

46
Q

Pan-acinar emphysema

with what disease states is it associated?

A

associated with

alpha-1-at deficiency

PI deficiency

47
Q

Distal acinar emphysema

A

Sub pleural fibrosis

Nearly everyone will get

48
Q

Study design of the NETT 2003 study

A

randomized patients into either

  • OMM + Pulmonary rehab
  • or*
  • LVRS
49
Q

Inclusion criteria in the NETT trial

A
  • Inclusion criteria:
    1. FEV1 < 45%
      • Pt with FEV1<20% with either (a) homogeneous lung disease distribution or (b) DLCO < 20% were excluded
    2. pCO2 < 60 and PO2> 45
    3. 4 months of smoking cessation
50
Q

Exclusion criteria for the NETT trial

A
  • Exclusion criteria –
    • Pt with FEV1<20% with either (a) homogeneous lung disease distribution or (b) DLCO < 20% were excluded
    • PAH (mean > 35)
    • O2 requirement > 6L
    • Pulmonary nodule requiring surgery
51
Q

NETT Trial results for

Upper lobe predominant

High Exercise capacity

A

No improvement in Survival

Improved QOL

52
Q

NETT Trial Results

Upper Lobe predominant

Low exercise Capacity

A

50% decrease in 2 year mortality

53
Q

NETT Trial Results

Lower Lobe predominant

High exercise capacity

A

2x increase in mortality

54
Q

NETT Trial Results for

Lower Lobe predominant

Low exercise capacity

A

No improvement in survival

No improvement in QOL (although still better than OMM)

55
Q

Nett trial criteria for low exercise capacity

A

Women < 25 Watts

Men < 40 Watts

56
Q

How long should one be off of PPI’s and h2 blockers before having PH monitoring?

A

7 days off of PPI

48 hours off of H2 blocker

57
Q

Thymoma Masaoka Stage I

A

Macroscopically encapsulated with no microscopically detectable capsular invasion

58
Q

Thymoma Masaoka Stage II

A

Macroscopic invasion of the fatty tissue or Mediastinal pleura

or

Microscopic invasion into the capsule

59
Q

Thymoma Masaoka Stage III

A

Macroscopic invasion of structures

(pericardium, great vessels, lung)

60
Q

Thymoma Masaoka Stage IVA

A

Pleural or pericardial dissemination

61
Q

Thymoma Masaoka Stage IVb

A

Lymphogenous or hematogenous spread

62
Q

Epidemiology association between

  • Lymphangiomyomatosis

and

  • Tuberous sclerosis
A
  • 1% of patients with LAM have tuberous sclerosis complex;
  • 30-40% of adult women with tuberous sclerosis have LAM
63
Q

Esophageal cancer- N- Stage

N0:

A

Esophageal cancer- N- Stage

N0: no lymph nodes

64
Q

Esophageal cancer-N- Stage

N1:

A

Esophageal cancer-N- Stage

N1: 1 or 2 lymph nodes

65
Q

Esophageal cancer- N- Stage

N2:

A

Esophageal cancer- N- Stage

N2: 3 to 6 lymph nodes

66
Q

Esophageal cancer- N- Stage

N3:

A

Esophageal cancer- N- Stage

N3: 7 or more regional lymph nodes are involved

67
Q

ZOO60 TRIAL

A

ZOO60 TRIAL To clarify the role of FDG-PET in staging potentially resectable esophageal cancer, Z0060 to determine if FDG-PET could detect metastatic lesions that would preclude esophageal resection in patients believed to be surgical candidates after standard imaging procedures.

  • PET scan identified M1 disease in 4.8% of cases and N1 nodal disease in 31% of the patients.
  • named packets of nodal material by the surgeon resulted in 16 ± 9 nodes per case, as opposed to 10 ± 8 nodes for routine processing by the pathology team (P <0.001).
68
Q

Predictive values of lymph nodes

A

Recent analysis demonstrated that number of regional lymph nodes containing metastases (positive nodes)

  • is the most important prognostic factor in resectable esophageal cancers.
  • also predictive of distant metastases,
  • survival of patients with 9 or more positive nodes is equivalent to that of patients with the distant metastatic disease.
69
Q

iHC markers for squamous cell cencer

A
  1. IHC P40 (p63, CK 5/6)
70
Q
A
71
Q

IHC to ddx meso and andeno ca of the lung

A
  • Calretinin, cytokeratin 6/5 (or WT-1): both + for mesothelioma and negative for adeno)
  • CEA and MOC-31 (or BEP-EP4, BG-8): + for adeno and negative for meso
72
Q

EGFR

Lung tumor associated

phenotype

A

Adenocarcinoma

typically in non-smoking asians

73
Q

What is Ludwigs Angina ?

A

Necrotizing crevical myofascitis

74
Q

thoracic surgical treatment of Ludwig Angina

A

Radical debridment .\

May require a sternotomy

SESATS (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions