THORACIC

Question 1

major points of VATS

Answer 1

Camera port
Fifth intercostal space mid axillary line

Working ports
Fourth or seven intercostal space

Question 2

Solitary pulmonary nodule if it is cancer what is the most common type expected

Answer 2

75% are NSCLC.

Question 3

Solitary pulmonary nodule what is most common benign diagnosis

Answer 3

80% are infectious granulomas.

Question 4

Solitary pulmonary nodule

Six important factors that significantly increase the likelihood of an SPN being cancer

Answer 4

(1) age > 60 years,
(2) tobacco history > 20 pack-years,
(3) prior history of cancer,
(4) size > 2 cm on chest x-ray or CT,
(5) the presence of spiculations on chest x-ray or CT,
(6) doubling size

Question 5

Solitary pulmonary nodule > 1 cm who have an intermediate probability are managed hwo

Answer 5

FDG-PET scan

to assess the need for surgical excision

versus

surveillance with serial CT scans.

Question 6

Solitary pulmonary nodule high clinical and/ or radiographic probability of cancer

Answer 6

undergo surgical excision

even without tissue (like whipple)

Question 7

For patients with stage 1a what is recommended treatement

Answer 7

This is ONLY I AAAA (all the other stage I get chemo)

lobectomy alone is recommended.

Question 8

For patients with stage 1 what is recommended treatement

Answer 8

stage 1 SCLC, lobectomy followed by platinum-based adjuvant chemotherapy is recommended.

Question 9

IIIb disease tx

Answer 9

no surgery

cisplantinum
and
xrt

Question 10

who gets preop chemo

Answer 10

IIIA

pancost tumor and ipsilateral node

Question 11

mass and ipsilateral node

Answer 11

mediastinoscopy
shows positive

this is stage IIIa - needs neoadjuvant

Question 12

mass and contralateral node

Answer 12

mediastinoscopy
shows positive

this is stage IIIb

no surgery

cisplantinum
and
xrt

Question 13

pulmonary function

Answer 13

FEV1

1.6 need for lobectomy

each lobe is about 20%

Can do functional reserve with V/Q.

Question 14

FEV1 needed for pneumontectomy

Answer 14

Greater than 2 L

Question 15

FEV1 needed for lobectomy

Answer 15

Greater than one 1.6 L

Question 16

FEV1 needed for wedge resection

Answer 16

Greater than 0.6 0.8

Question 17

Pre-op testing for considered long resection

Answer 17

PFTs
VQ scan predicted postop FEV1
ABG
CT pet - include liver and adrenals

If any nodes light-up:
medianstinoscopy

Question 18

Contraindications for surgery on lung cancer

Answer 18

T4
N3 - contralateral positive node

Post our predicted FEV1 less than 0.8

Malignant affusion

Extra thoracic metastasis (CAREFUL - may still go for care if isolated brain met!)

STC syndrome

Recurrent laryngeal your nerve involvement

Phrenic nerve paralysis

Great vessel involvement

Small cell lung cancer (these get chemoradiation)

Horner syndrome

Positive cervical lymph node

Tracheoesophageal fistula

Question 19

When is the pneumonectomy resection required

Answer 19

hilar lesion

Crosses the fishers and involves all lobes

Question 20

When should you do a Chamberlain procedure

Answer 20

Right-sided nodes

Left para tracheal nodes

Question 21

Hormones that long cancer Cancer secrete

Answer 21

squamous

PTH like hormones squamous

both squamous and calcium can affect the skin.

small cell

(SIADH) in small cell

“systemic therapy so systemic diuresis”

Question 22

Still go for cure in non-small cell lung cancer

Answer 22

IIIa
up to T3 (pericardium, chest wall, bronchus) N1 (ipsilateral)

T2 N2 (ipsilateral mediastiunm)

Question 23

Differential diagnosis of mediastinal tumor

Answer 23

Anterior:
Thymoma, teratoma, terrible lymphoma

Medial
Pericardial
Bronchogenic
Sarcoid

Posterior
Mesothelioma
Neurogenic
(the Esophageal duplication)
Germ cell tumor
Substernal thyroid
Sarcoidosis
Neurogenic humor

Question 24

What physical examinations do a mediastinal mask patient need

Answer 24

Testicles exam!

Heading and neck exam

Question 25

What laboratory studies does a mediastinal mass patient meet

Answer 25

Baby hCG
AFP
LDH

Metanephrines
TSH

Question 26

Treatment of mediastinal non-seminoma

Answer 26

Chemotherapy alone

Question 27

Treatment of mediastinal seminoma

Answer 27

Chemotherapy and XRT

Very do you sensitive

Question 28

Treatment of male genitalia

Answer 28

Wide local excision
XRT
Chemotherapy

Question 29

Treatment of thymoma

Answer 29

Preoperative plasmapheresis to remove anti-cholenergic receptor antibody

Steroids

Excision via MEDIAN sternotomy

Question 30

Thoracic duct course

Answer 30

Enters the chest via the aortic hiatus travels on the right side until T4/T5

Gaines into the common loans of the internal jugular and subclavian vein

cisterna chyli is at
L2
The cisterna chyli (or cysterna chyli, and etymologically more correct, receptaculum chyli) is a dilated sac at the lower end of the thoracic duct into which lymph from the intestinal trunk and two lumbar lymphatic trunks flow.

Question 31

What is the advantage of using thin barium besides for subtle leak

Answer 31

If concerned of aspiration (example: tracheoesophageal fistula) not harmful for aspiration

Question 32

Treatment for chylothorax / fistula

Answer 32

You can try medium chain triglycerides
TPN

If fail:
VATS ligation in the chest

Question 33

What strap muscle should be used to buttress your internal jugular repair or ligation

Answer 33

Cricothyroid muscle

Question 34

what are the strap muscles that are retracted during thyroidectomy

Answer 34

sternohyoid and sternothyroid

These may also be divided

Question 35

what side nodes does mediastinoscopy biopsy

Answer 35

Right

“Regular procedure equals right”

Question 36

Website node does Chamberlin procedure biopsy

Answer 36

Left

“left = sinister = Walt Chamberlain the left hand basketball player”

Question 37

Patient after retropharyngeal abscess drainage continues to have high fever in the ICU postop day five. They are sick and cannot get off the ventilator what is the next step

Answer 37

CT scan for food collection

Paratracheal

Right chest drainage

This is mediastinitis

Question 38

Patient after mandibular fracture in the chest tube output characters changed it is layering out in the container now

Answer 38

Thoracic duct injury

Send triglycerides
Cholesterol
Chylomicron
LDH
Lymphocytes

Nonfat diet versus
Medium medium chain triglycerides

NPO three weeks

Monitor chest tube output

Question 39

What test do you need after you’ve done a cardiac repair for penetrating heart injury

Answer 39

Echocardiogram

Make sure valve was not injured et cetera.