Thoracic And Cardiothoracic 1

Question 0

Characteristic of a benign lung lesion versus malignant lesion on imaging?

Answer 0

Smooth surface versus irregular/spiculated surface

Question 1

Patient with coin lesion on x-ray – chance of malignancy?

Answer 1

50% at 50 years of age (more likely if older, less likely if younger)

Question 2

Likely diagnosis if lung imaging shows:

1. Calcifications
2. Bull’s-eye configuration
3. Popcorn appearance

Answer 2

1. Granulomas (Cancers rarely have calcium)
2. Benign
3. Hamartomas

Question 3

Noncancerous coin lesions are common where?

Answer 3

1. Southwest – coccidiomycoses

2. Ohio Valley – histoplasmosis

Question 4

Patient presents with coin lesion – work up?

Answer 4

#CT guided needle aspiration
#If malignant/indeterminant, resection

Question 5

60-year-old man with a 40 pack year smoking history presents with cough and hemoptysis. Absent breath sounds in the right lower chest. Normal labs. CXR shows 2 cm lesion in the right middle lobe and 2 cm lymph node at the take off from the right mainstem bronchus – next steps in the evaluation?

Answer 5

#Bronchoscopy to obtain tissue diagnosis
#Mediastinoscopy to examine lymph nodes

Question 6

Doubling time of solitary pulmonary nodule that suggests cancer? That disfavors cancer?

Answer 6

Five weeks to 280 days

Less than five weeks for over 465 days

Question 7

Likely diagnosis if pulmonary mess presents with:

1. Dental abscess or sinus
2. Concentric calcification
3. Thin-walled cavity with air fluid level
4. Chronic skin ulcers
5. Meningeal involvement
6. Mycetoma with air crescent sign
7. Well-defined border with slight lobulations
8. Adjacent to thickened pleura

Answer 7

1. Actinomycosis
2. Histoplasmosis
3. Coccidiomycosis
4. Blastomycosis
5. Cryptococcus
6. Aspergillus
7. Hamartoma
8. Round atelectasis

Question 8

55-year-old man with two PPD smoking history presents with hemoptysis and 10 pound weight loss. CXR shows 3.5 cm mass in right hilum. Bronchoscopy shows tumor in upper lobe bronchus. Mediastinoscopy is negative for lymph node metastasis. Histology shows undifferentiated squamous cell carcinoma. Stage? Management?

Answer 8

Stage I – no hilar metastasis

Exploratory thoracotomy and pneumonectomy because mass is centrally located

Question 9

Stages for lung cancer?

Answer 9

Stage I – no lymph node involvement
Stage II – intrapulmonary and/or hilar lymph node involvement
Stage IIIa – over 3 cm tumor involving ipsilateral hilar and mediastinal lymph nodes
Stage IIIB – involvement of mediastinum and ipsilateral/contralateral mediastinal, hilar, supraclavicular lymph nodes

Question 10

Treatment for stage I lung cancer?

Stage II lung cancer?

Stage III lung cancer?

Answer 10

Surgical resection

Surgical resection

Chemoradiation for surgical resection

Question 11

Pancoast tumor – originates where?

Work up?

Treatment?

Bad prognosis if?

Answer 11

Extreme apex of the long in the superior sulcus

CT scan, bronchoscopy, mediastinoscopy, needle Biopsy

Irradiation for six weeks, then surgical resection

Involvement of mediastinal nodes

Question 12

25-year-old woman presents with cough, SOB, hemoptysis. Non-smoker. CXR reveals partial collapse of right upper lobe. Likely diagnosis? Confirm with? Treatment?

Answer 12

Bronchial adenoma resulting in atelectasis

CT scan, bronchoscopy

Lobectomy

Question 13

Why is bronchial adenoma a misnomer? Types?

Answer 13

Have malignant potential

Carcinoid (Oat-cell carcinoma) versus adenocystic

Question 14

Danger in taking a biopsy of a bronchial adenoma?

Answer 14

Highly Vascular, tends to bleed

Question 15

65-year-old retired shipyard worker presents with chest pain and shortness of breath for three months. Absent breath sounds and dullness to percussion in right lung base. CXR reveals opacified right lower lung field with pleural effusion – likely diagnosis? differential? Confirm with?

Answer 15

Plural effusion in older patient is cancer until proven otherwise

#Bronchogenic carcinoma/mesothelioma
#Congestive heart failure
# viral/bacterial pneumonia
#Empyema or tuberculosis effusion

Thoracentesis and pleural biopsy

Question 16

Treatment for mesothelioma?

Answer 16

Only cure – extrapleural pneumonectomy (removal of lung, parietal/visceral Flora, +/- pericardium and diaphragm)

Question 17

Water-sealed chest tube mechanism?

Answer 17

Maintains negative pressure in plural space to create one-way valve drain air/fluid in lung

Question 18

Patient gets the chest tube – causes of persistent air leak?

Answer 18

#Incorrect tube placement
#leaks from lung parenchyma, large bleb, bronchi

Question 19

Patient with chest tube has persistent air leak – tube appropriately placed, leak from blend or bronchi ruled out – source of air leak? Management?

Answer 19

Thorascopic excision of blebs and and Pleurodesis (pleural abrasion)

Parenchyma – surgical intervention

Question 20

Mechanism of pleurodesis?

Answer 20

Irritates the visceral and parietal pleura, causing them to it here (preventing future pneumothorax)