Cf Ch 41-1 Thymoma And Myasthenia Gravis

Front 1

1. Best treatment for thymoma?

Back 1

a. Complete resection via median sternotomy.

Front 2

2. When should a thymectomy be AVOIDED for MG?

Back 2

a. During an acute crisis.

Front 3

3. Treatment of MG?

Back 3

a. Anticholinesterase drugs
b. Prednisone
c. Immunosuppressive drugs:
1. Azathioprine
2. Cyclophosphamide

Front 4

4. How should acute exacerbations or myasthenic crisis be treated?

Back 4

a. Medically and with plasmapheresis.

Front 5

5. What type of tumors are thymomas is considered?

Back 5

a. Anterior Mediastinal tumors

Front 6

6. Are thymomas malignant?

Back 6

a. They are considered borderline malignant because of the potential for local invasion in systemic spread.
b. Most are benign, although they can be malignant.

Front 7

7. In what percentage of patients with thymoma is myasthenia gravis identified?

Back 7

a. 30 to 50%

Front 8

8. What % of patients with MG have thymoma?

Back 8

a. 15%.

Front 9

9. Class I MG (Osserman classification for severity of myasthenia gravis)?

Back 9

a. Ocular involvement only (diplopia, ptosis)

Front 10

10. Class IIa MG (Osserman classification for severity of myasthenia gravis)?

Back 10

a. Generalized muscle weakness without respiratory impairment

Front 11

11. Class IIb MG (Osserman classification for severity of myasthenia gravis)?

Back 11

a. More bulbar manifestations than in class IIA.

Front 12

12. Class III MG (Osserman classification for severity of myasthenia gravis)?

Back 12

a. Rapid onset and progression of bulbar and generalized weakness including respiratory muscle weakness

Front 13

13. Class IV MG (Osserman classification for severity of myasthenia gravis)?

Back 13

a. Severe generalized weakness
b. Progressive myasthenic symptoms

Front 14

14. Class V MG (Osserman classification for severity of myasthenia gravis)?

Back 14

a. Muscle atrophy requiring mechanical ventilation

Front 15

15. With what type of Ach receptors is MG associated?

Back 15

a. Nicotinic postsynaptic receptors.

Front 16

16. Surgical outcomes for thymoma?

Back 16

a. At 5 years post resection, 25 to 30% of patients show complete remission of MG.
b. 35 to 60% had improvement in symptoms with a decrease in their medication requirement
c. 20% showed no change in status
d. 10 to 15% have a worsening of other symptoms

Front 17

17. Types of anterior mediastinal masses?

Back 17

1. Thymoma
2. Lymphoma
3. Germ cell tumor, teratoma, seminoma, non-seminoma
4. Parathyroid adenoma
5. Aberrant thyroid
6. Lipoma, hemangioma, Thymic cyst.

Front 18

18. Stage I thymoma description and treatment?

Back 18

a. Completely encapsulated, no invasion
b. Tx: surgical resection

Front 19

19. Stage II thymoma description and treatment?

Back 19

a. Macroscopic invasion to fat or pleura or microscopic invasion through capsule.
b. Tx: radical surgical resection

Front 20

20. Stage III thymoma description and treatment?

Back 20

a. Macroscopic invasion to radiation structure: Pericardium, great vessels, lung, or intrathoracic mets.
b. Tx: radical surgical resection and/or XRT.

Front 21

21. Stage IV thymoma description and treatment?

Back 21

a. Extrathoracic metastasis
b. Tx: chemotherapy, XRT .

Front 22

22. Diagnosis of thymoma?

Back 22

a. Surgical resection

Front 23

23. Treatment of thymoma?

Back 23

a. Surgical resection
b. Possible XRT
c. Chemotherapy

Front 24

24. Diagnosis of anterior mediastinal lymphoma?

Back 24

a. Open median sternotomy
b. Video assisted thoracoscopy if fine-needle aspiration biopsy is equivocal.

Front 25

25. Treatment of anterior mediastinal lymphoma?

Back 25

a. Chemotherapy or XRT, depending on cell type

Front 26

26. Diagnosis of anterior mediastinum germ cell tumor, teratoma, seminoma, non-seminoma?

Back 26

a. Surgical resection
b. PE
c. PE, positive β-HCG and α-fetoprotein.

Front 27

27. Treatment of anterior mediastinum germ cell tumor, teratoma, seminoma, non-seminoma?

Back 27

a. Surgical resection
b. XRT
c. Chemotherapy

Front 28

28. Diagnosis of Parathyroid adenoma?

Back 28

a. Hyperthyroidism
b. CT scan
c. Sestamibi scan

Front 29

29. Tx of Parathyroid adenoma?

Back 29

a. Surgical resection.

Front 30

30. Dx of aberrant thyroid?

Back 30

a. CT scan

Front 31

31. Tx of aberrant thyroid?

Back 31

a. Surgical resection if symptomatic.

Front 32

32. Dx of anterior mediastinal lipoma, haemangioma, or thymic cyst?

Back 32

a. CT scan
b. MRI

Front 33

33. Tx of anterior mediastinal lipoma, haemangioma, or thymic cyst?

Back 33

a. Surgical resection if symptomatic or to r/o malignancy

Front 34

34. Indications for biopsy of anterior mediastinal masses?

Back 34

a. Pts w/mediastinal masses are often referred for tissue diagnosis, but Fine-needle aspiration (FNA) is seldom helpful.

Front 35

35. Open resection can be performed directly for most are neurogenic tumours of mediastinum usually located?

Back 35

a. Posterior mediastinum.

Front 36

36. Where are thymomas of mediastinum usually located?

Back 36

a. Anterior mediastinum

Front 37

37. Where are teratomas of mediastinum usually located?

Back 37

a. Anterior mediastinum (and other germ cell tumours).

Front 38

38. What is thymoma staging primarily determined by?

Back 38

a. Is based on the pathologic and histologic characteristics of the tumor.

Front 39

39. What do anterior mediastinal masses often require for diagnosis and treatment?

Back 39

39. What do anterior mediastinal masses often require for diagnosis and treatment?

Front 40

40. How is the prognosis for thymoma determined?

Back 40

a. By proper staging and complete resection.