Thoracic/Pulmonary

Question 1

Primary lung cancer types

Answer 1

Small-cell lung carcinoma (SCLC)

Non small-cell lung carcinoma (NSCLC)

Question 2

Most common symptom of lung cancer?

Answer 2

persistent cough

10% percent asymptomatic

Question 3

56M w/ shoulder pain, paresthesia and weakness within an ulnar distribution, and Horner syndrome, tobacco use and mass… what is the likely type of cancer?

Answer 3

For this Pancoast tumor (superior sulcus tumor), the most common type is
non-small cell lung cancer (NSCLC)

Question 4

What are ABSOLUTE contraindications for surgery for a pancoast tumor?

Answer 4

• Distant mets
• N2 (mediastinal) or N3 (contralateral suparaclavicular nodal disease)
• > 50% vertebral body involvement
• Brachial plexus involvement above T1 nerve
• Invasion of esophagus/trachea

Question 5

What are relative contraindications for surgery for a pancoast tumor?

Answer 5

• N1 or N3 disease (ipsilateral supraclavicular)
• Invasion of subclavian artery
• < 50% vertebral body involvement
• Intra-foraminal extension
• Invasion of common carotid or vertebral artery

Question 6

When is surgery performed for a pancoast tumor if the patient is an appropriate candidate?

Answer 6

Surgery is performed 3 to 5 weeks AFTER induction of CHEMORADIATION (if the patient is an appropriate surgical candidate)

• Involves en bloc resection of tumor/chest wall, paravertebral sympathetic chain, stellate ganglion, lower trunks of brachial plexus, subclavian artery or portions of thoracic vertebrae

Question 7

Patients with asthma and pulmonary edema will have high or low V/Q ratio?

Answer 7

low V/Q ratio

Question 8

Patients with PE and COPD will have high or low V/Q ratio?

Answer 8

high V/Q ratio

Question 9

V/Q ratio = 0. What is this phenomenon

Answer 9

shunting

Question 10

Patient sitting upright. What part of the lung has highest and lowest V/Q ratio?

Answer 10

highest = upper lung

lowest = lung bases