Pulmonary

Question 1

What is the most frequent benign solid tumor of the lung?

What is classic CXR appearance?

Answer 1

1. hamartoma

2. “popcorn” calcifications

Question 2

Diagnostic procedure for pulmonary hamartoma?

Indication for resection?

Answer 2

1. CT guided needle biopsy

2. any radiographic doubt or enlargement -> wedge resection.

Question 3

Pulmonary AV malvormation?
Detection?
Work-up?
Treatment?

Answer 3

Any density should be considered for possibility of AV malformation
chest CTA.
Not usually a surgical lesion; can be treated with embolization or coils, radiologically.

Question 4

Spontaneous pneumothorax with persistent air leak (> 4 days) what do you do? (after chest tube)

Answer 4

Get CT chest to identify blebs.
Should have resection of apical cysts/blebs and pleurectomy.
Any recurrent pneumothorax should have definitive treatment as well

Question 5

Light criteria for Effusion vs exudate?

which get chest tube v. aspiration?

Answer 5

Specific gravity > 1.016 Protein > 3.0

Exudates generally require chest tube evacuation. Effusions may be managed by aspiration.

Question 6

How do you manage a malignant pleural effusion?

Answer 6

Tap for the diagnosis.
Trial of tube drainage.
Perform sclerosis for recurence

Question 7

What percentage of lung cancer is small cell?

What is the treatment?

Answer 7

20% small cell

Rx with chemo and RT

Question 8

What are stage I and II lung cancer?

Answer 8

Stage I (TI, T2, N0), tumors without chest wall extension, more than 2 cm from carina. • No nodal mets
Stage II (T1, T2, N1) 
primary as in stage I. • Nodal mets only: peribronchial or ipsilateral hilum (N1)

Question 9

What are criteria for Stage III lung cancer?

Answer 9

IIIa (T1-4 N1-2) is surgical, and includes tumors abutting chest wall and even locally invading chest wall or pericardium (but not through pericardium)
IIIb, is not surgical (N3 disease – contralateral nodes, scalene nodes) or mediastinal tumor growth (T4) or positive malignant effusion.

Question 10

What is five year survival by stage for Lung Cancer?
I
II
IIIA
IIIB
IV

Answer 10

I  70-80%  
II 40% 
 IIIA  25% 
 IIIB  5%  
IV  5%

Question 11

Lung Cancer with Horner Syndrome?

Answer 11

Apical Tumor

Question 12

Lung Cancer with Hoarseness?

Answer 12

L sided tumor invading recurrent nerve

Question 13

Lung cancer with Gynecomastia?

Answer 13

estrogen secreting tumor

Question 14

Lung cancer with hyponatremia?

Answer 14

small cell carcinoma

Question 15

lung cancer with cushing syndrome?

Answer 15

small cell carcinoma

Question 16

lung cancer with hypercalcemia?

Answer 16

squamous cell cancer

Question 17

What are PFT criteria for lung resection?

Answer 17

“High risk” for resection: FEV1, less than 800 cc – unacceptable; FEV, 800-1000 cc – likely will need initial postop vent; PCO2 > 50 also a grave concern

Question 18

Should you ever do a RUL and RL lobectomy?

Answer 18

No, middle at too high risk for torsion

Question 19

Give three agents used for pleural sclerosis

Answer 19

Bleomycin
Doxycycline
Quinine

Question 20

What are the stages of empyema?

Answer 20

Exudative < 7 days
Fibropurulent 7–14 days
Organized > 14 days

Question 21

What are the operations for empyema based on stage?

Answer 21

Surgical Treatment
Exudative stage—Thoracentesis (usually prior to CT
placement)
Chest tube drainage + Abx
Fibropurulent stage—VATS exploration/pleurodesis
(pleural biopsy/cytology if suspect
malignancy) or limited
thoracotomy
Organized stage—VATS decortication
Open decortication
Rib resection and Eloesser flap (skin
sutured to parietal pleura)→ used in
high risk pt!

Question 22

What per cent of solitary pulmonary nodules are cancer overall?

Answer 22

5%