Thoracic

Question 1

Best screening for lung cancer?

Answer 1

Low dose CT scan

Question 2

What is the gold standard for diagnosing lung cancer?

Answer 2

Tissue biopsy

Question 3

Why do we CT the abdomen when staging?

Answer 3

Because lung cancer often metastasizes to the adrenals

Question 4

Which staging test is very sensitive and specific?

Answer 4

PET scan

Question 5

Which mutations do we look for in NSCLC, specifically adenocarcinoma?

Answer 5

1) EGFR
2) EML4-ALK fusion

Question 6

What T stage would someone with pleural effusion be?

Answer 6

T4 (beyond surgery)

Question 7

What T stage would someone with a tumor limited to lobar bronchus be?

Answer 7

T1

Question 8

What T stage would someone with a tumor between >3 cm and <7 cm?

Answer 8

T2

Question 9

What T stage would someone with a tumor <2 cm distal from carina (no carinal inv.) be?

Answer 9

T3

Question 10

Which N stage would someone with ipsilateral peribronchial and/or ipsilateral hilar nodes involved be?

Answer 10

N1

Question 11

Which N stage would someone with ipsilateral mediastinal and/or subcarinal nodes involved be?

Answer 11

N2

Question 12

How do we treat lung cancer?

Answer 12

With multiple therapies

Question 13

Which stages are beyond surgery?

Answer 13

3b and 4

Question 14

What is the surgery we do?

Answer 14

Lobectomy + clear margin + lymph node sampling

Question 15

What are the factors affecting survival?

Answer 15

1) Tumor size
2) Visceral pleura involvement
3) Histological type of tumor

Question 16

Which is better: Squamous cell carcinoma or adenocarcinoma?

Answer 16

Squamous cell carcinoma

Question 17

When do we do a pneumonectomy?

Answer 17

1) Central cancers with hilar or fissure involvement
2) Peripheral cancers with extension across fissure and/or hilar or fissure lymph node
metastases

Question 18

Which procedures help symptoms of lung cancer besides surgery?

Answer 18

1) Pleural catheter to drain effusion
2) Pleurodesis
3) Airway stenting
4) Laser or removal of airway tumor

Question 19

What are some targeted agents for treatment of NSCLC with demonstrated activity?

Answer 19

1) VEGF inhibitors
2) EGFR inhibitors
3) Proteosome inhibitors

Question 20

What structures does a pancoast tumor invade?

Answer 20

1) Subclavian artery and vein
2) Brachial plexus

Question 21

How do you approach normal lung cancer?

Answer 21

Thoracotomy or VATS

Question 22

How do you approach pancoast tumors?

Answer 22

Anterior trans-cervical approach (Dartevelle)

Question 23

How do you treat pancoast tumors?

Answer 23

Concurrent chemo and radio therapy (CRT)

Question 24

What is empyema stage 2?

Answer 24

Emmpyema lasting more than 10 days and up to 4 weeks

Question 25

What are the characteristics of stage 3 empyema?

Answer 25

Ingrowth of fibroblasts and deposition of collagen

Question 26

What are the characteristics of stage 1 empyema?

Answer 26

Exudative, with swelling of the pleural membranes as a result of ↑ permeability of swollen membranes

Question 27

What are the characteristics of stage 2 empyema?

Answer 27

Fibropurulent with heavy fibrin deposits

Question 28

Most common causes of empyema?

Answer 28

1) Para-pneumonic effusion/infection secondary to pneumonia!!!
2) Post trauma
3) Post surgery
4) Subphrenic abscesses

Question 29

Which types of bacteria in pneumonia lead to a higher chance of developing empyema? IN ADULTS

Answer 29

1) Gram negatives (hospital and ventilator acquired pneumonia)
2) Anaerobes

Question 30

Which types of bacteria in pneumonia lead to a higher chance of developing empyema? IN CHILDREN

Answer 30

Staph aureus (Gram positive aerobic)

Question 31

How do we confirm empyema?

Answer 31

Thoracentesis

Question 32

Characteristics of empyema fluid?

Answer 32

1) Low pH (<7.2)
2) Low glucose (<40)
3) High LDH (>1000)
4) Positive gram stain
5) Positive cultures
6) High specific gravity
7) High protein level

Question 33

Difference between simple and complicated empyeme?

Answer 33

Simple has higher pH (>7.2)
Complicated (Frank pus) low glucose (<2.2) and pH (<7.2)

Question 34

Surgical therapy for empyema?

Answer 34

1) CT guided aspiration
2) Thoracotomy
3) VATS

Question 35

Management for empyema?

Answer 35

1) Antibiotics
2) Chest tube insertion (Stage 1 and 2)
3) Thoracotomy (Stage 3)
4) Obliteration of the empyema cavity
5) Intrapleural Fibrinolytic therapy (STK or Urokinase OR tPA)
6) Intrapleural DNase

Question 36

Which bacteria cause lung abscesses?

Answer 36

Anaerobes

Question 37

What is a must in lung abscesses?

Answer 37

Fibrooptic bronchoscopy