Nms Surgery Thoracic And Cardiothoracic

Front 1

What are the chances that coin lesion on CXR is malignant?

Back 1

50% at 50. Under 50 chances decrease, over 50 chances increase

Front 2

What do benign lesions looks like vs malignant?

Back 2

Benign has smooth surfaces, malig has irregular or spiculated surfaces

Front 3

What are other benign lesions?

Back 3

Bulls' eyes, hamartomas which have popcorn appearance on CXR

Front 4

Which area of US are coin lesions common?

Back 4

SW US where coccidiomycosis is common and mid atlantic and OH valley where Histo occurs

Front 5

Most common mets to the lung are from?

Back 5

Colorectal, breast, renal

Front 6

If a lung lesion looks malignant what do you do?

Back 6

Get a CT to characterize lesions and to look for enlarged lymph nodes in mediastinum, then do CT guided needle biopsy

Front 7

What do you do if needle biopsy shows malig or indeterminate?

Back 7

Resection

Front 8

What do you do for lesion with cough and hemoptysis and mediastinal enlarged lymph node?

Back 8

Bronchoscopy for tissue diag and to determine location of lesion. and mediastinoscopy to det state of mediastinal LNs

Front 9

What doubling time favors benign status vs malignant status?

Back 9

If doubling time is <5wks or >465 days then it favors benign. If doubling time is 5 weeks to 280 days, favors malig

Front 10

What type of LC usually presents late and not amenable to resection?

Back 10

Small Cell Carcinoma

Front 11

Cure rate for stage I tumors w resection?

Back 11

70%

Front 12

Stage II LC 5 year survival?

Back 12

40-50%

Front 13

Surgical options for metastatic lesion involving mainstem bronchus

Back 13

Pneumonectomy (easier) or sleeve lobectomy (safer). Sleeves are not feasible if main pulmonary artery is invaded

Front 14

Perioperative death rate from pneumonectomy?

Back 14

5-10% especially in those over 70 and those with cardiac or obstructive airway dz

Front 15

At what stages can tumors be resected?

Back 15

Stages I and II

Front 16

At what stages are chemo and radiation the only treatments?

Back 16

Stages III and IV

Front 17

Ipsilateral hilar lymph nodes are what stage?

Back 17

Stage II

Front 18

Mediastinal LNs are what stage?

Back 18

Stage III

Front 19

Can a tumor undergo chemo and be downstaged and resected?

Back 19

Yes

Front 20

Imaging modality good for detecting lung cancer mets?

Back 20

PET scan

Front 21

Symptoms of Pancoast tumor?

Back 21

Horner's syndrome, pain in ulnar area of elbow and wrist

Front 22

How to verify superior sulcus tumor?

Back 22

CT, bronchoscopy, mediastinascopy, needle biopsy

Front 23

what are 5 year survivals for stage II, IIIa, and IIIb LC?

Back 23

44%, 22%, and <10%

Front 24

Tx of Pancoast tumor?

Back 24

1. Irradiation over the course of 6 wks then surgical resection of chest wall and lung

Front 25

In a young healthy patient with hemoptysis and atelectasis, what would be suspect?

Back 25

Bronchial adenoma that's obstructing a bronchus

Front 26

2 types of bronchial adenomas?

Back 26

1. Carcinoids (malignant potential if originated in small bowel)
2. Adenocystic carcinomas (invade locally)

Front 27

How to diagnose bronchial adenoma?

Back 27

Bronchoscopy with biopsy. careful cause they bleed.

Front 28

How to treat bronchial adenomas?

Back 28

Lobectomy. Usually curative.

Front 29

Carcinoid syndrome sxs?

Back 29

Flushing, diarrhea, wheezing from bronchospasm, Facial telangectasia, tricuspid regurg and pulmonary stenosis because serotonin increases collagen production in valves

Front 30

Differential diag for effusion?

Back 30

Cancer: bronchiogenic carcinoma, mesothelioma
Benign: CHF, viral/bact pna, empyema, TB

Front 31

How to diag an effusion?

Back 31

Thoracentesis and pleural biopsy. you can culture the fluid and examine histology of biopsy for malignancy

Front 32

Prognosis for mesothelioma?

Back 32

Terrible. Most dead within a year. Not responsive to chemo/rad.

Front 33

Only surgical tx for mesothelioma?

Back 33

Extrapleural pneumonectomy. Takes out lung, both visceral and parietal pleura, pericardium, and diaphragm at times

Front 34

Etiology of spontaneous pneumothorax?

Back 34

rupture of apical blebs, pleural cavity pressure becomes same as atm, causes lung collapse and trachea deviated to side of collapse

Front 35

Etiology of tension pneumo?

Back 35

penetrating trauma to the lungs, pleural tear that allows air only to go into pleural space, trachea deviates to contralateral side

Front 36

Tx of a pneumo?

Back 36

Chest tube

Front 37

What do you do if patient unresponsive to chest tube?

Back 37

Must investigate persistent air leaks from lung parenchyma with thoracoscope and surgical intervention

Front 38

How to treat persistent or recurrent pneumo?

Back 38

1. thoracoscopic excision of blebs and pleurodesis (pleural abrasion to adhere visceral and parietal pleura)

Front 39

What do you suspect with chest pain, cough, recurrent fever, and pleural effusion after a pneumonia treatment?

Back 39

Empyema

Front 40

Most common causes of empyema?

Back 40

S.pneumo
Staph and gram neg in hospitals
Anaerobes if aspiration suspected or alcoholism or recent operation

Front 41

How often are empyema culture neg?

Back 41

35% b/c of previous abx tx

Front 42

How to treat empyema?

Back 42

1. empiric abx
2. Chest tube for drainage

Front 43

What happens if you don't treat an empyema?

Back 43

1. exudative phase
2. fibropurulent stage (loculation of fluid pockets)
3. organizing stage (scarring and inflammatory tissue)

Front 44

How do you fix an untreated empyema?

Back 44

1. thoracotomy and decortication

Front 45

How to manage unstable angina?

Back 45

1. Admit and bed rest
2. Oxygen
3. Beta blockers, Nitro, ASA, heparin, morphine is questionable
4. Cardiac enzymes
5. Cath or thrombolysis if MI+

Front 46

3 major coronary arteries?

Back 46

1. RCA
2. LAD
3. Cx

(LAD and Cx from left main)

Front 47

what's an abnormal EF?

Back 47

<40-50%

Front 48

How to treat left main dz?

Back 48

Coronary artery bypass

Front 49

Alternative to bypass?

Back 49

PTCA with stents, danger of reobstruction

Front 50

Sources of bypass grafts?

Back 50

Internal mammary A has best patency, reversed greater saphenous V also used

Front 51

What solutions used to help performance of bypass?

Back 51

Cardioplegia solution, blood cardioplegia solution, hypothermia

Front 52

Operative mortality for bypass surgeries?

Back 52

3%, but less for low riskers

Front 53

Etiology of MVR?

Back 53

Myxomatous degeneration of MV. Thought to be due to ischemia of mitral value apparatus

Front 54

How is MVP different from MVR?

Back 54

Prolapse is eccentric closure and doesn't have to regurg. Common in young women, but in men it can be a sign of severe mitral valve dz.

Front 55

Etiologies of Mitral stenosis?

Back 55

Rh fever, Scarlet fever
you get inflammation of connective tissues, leaflets progressively fuse, LA pressure goes up, R heart enlargement, pulmonary htn

Front 56

Treatment of mitral valve dz?

Back 56

Can try to repair regurg by excision of redundant portion of leaflefts and reinforcing mitral annulus with annuloplasty ring, but can replace if not successful

Front 57

3 etiologies of aortic stenosis

Back 57

1. Congenital (bicuspid valve)
2. arteriosclerotic
3. deteriorative

Front 58

Aortic valve area less that what is severe stenosis?

Back 58

0.8cm sq

Front 59

Workup for aortic stenosis?

Back 59

1. Cardiac cath to det aortic valve size, pressure grad, vent function, check for CAD.
2. Carotid doppler to rule out internal carotid obstruction

Front 60

When do pts with aortic stenosis usually present?

Back 60

late in life. extreme risk for sudden death.

Front 61

Pros and cons of mech vs tissue valves

Back 61

Mech valves need anticoagulation b/c they are thrombogenic
Tissue valves nonthrombogenic but deteriorate. require replacement at 7 years.

Front 62

What can give you dilated cardiomyopathy if you've got normal coronary arteries?

Back 62

post-respiratory illness. etiology unclear.

Front 63

prognosis for dilated cardiomyopathy?

Back 63

1/3 get better, 1/3 stay the same, 1/3 get worse

Front 64

Tx for dilated cardiomyopathy?

Back 64

steroids, diuretics, immunosuppressives, beta blockers, transplant

Front 65

Prognosis with transplant?

Back 65

Immediate survival >90%
Survival @ 1 year is 85-90%
Survival @ 2 years is 75%

Front 66

Immunosuppressives for transplants?

Back 66

Cyclosporine, tacrolimus

Front 67

Most deaths from transplants happen from what?

Back 67

infection from immunosuppressive drugs and accelerated coronary atherosclerosis as a form of chronic rejection

Front 68

What do we suspect with regurgitated undigested food and dysphagia?

Back 68

Zenker's diverticulum or pharyngeal diverticulum

Front 69

Etiology of pharyngeal diverticulum?

Back 69

Abnormal uncoordinated constriction of cricopharyngeal muscle during swallow results in outpouching between lower pharyngeal constrictor and cricopharyngeal muscle

Front 70

Where else can a pulsion diverticulum occur?

Back 70

distal esophagogastric junction: epiphrenic diverticulum. food can regurgitate and can be aspirated

Front 71

tx for pharyngeal divert?

Back 71

1. Excision if diverticulum is large
2. trasect cricopharyngeal muscle to relax esophageal entrance and prevent uncontrolled contraction

Front 72

Tx for epiphrenic divert?

Back 72

Esophageal myotomy at esophageal gastric junc

Front 73

Sxs and etiology of achalasia?

Back 73

dysphagia, WL due to poor peristalsis of body of esophagus and failure of LES to relax. Loss of smooth muscle ganglionic cells of Auerbach plexus

Front 74

How to diagnose achalasia?

Back 74

barium swallow

Front 75

Associated conditions with achalasia?

Back 75

Emotional stress, physical trauma, WL, Chagas

Front 76

Tx for achalasia?

Back 76

Heller myotomy or pneumatic dilation. Maybe Ca blockers

Front 77

Types of cancers in different areas of esophagus?

Back 77

top 2/3 is squamous cell carcinoma, bottom 1/3 adenocarcinoma

Front 78

Esophageal cancer assoc w/ what?

Back 78

Alcohol, tobacco, Barrett's (40x w/ severe dysplasia)

Front 79

How do you stage esophageal cancer?

Back 79

Endoscopic US for wall penetration and LN spread. CT abd and chest for celiac node involvement. Mediastinal or celiac node mets automatically stage III and incurable

Front 80

Complication with middle third esophageal cancers?

Back 80

invasion of trachebronchial tree

Front 81

Tx for esophageal ca?

Back 81

Depends on stage and location.
Stage I (just to submucosa) can be resected but not in upper third of esophagus. Stage II and beyond is chemoradiation. But you can downstage then try to resect.

Front 82

Two types of esophagectomies and types of incisions?

Back 82

Formal (upper abd and thorax incision)
Transhiatal (cervical and upper abd incision)
We want the anastamosis at the cervical area for easy access in case of complications

Front 83

What do we do after an esophagectomy anastamosis?

Back 83

Pyloroplasty to prevent gastric outlet obstruction

Front 84

Why would a person with esophageal ca have constant cough?

Back 84

Tracheoesophageal fistula from tumor invasion

Front 85

Palliative methods for esophageal ca?

Back 85

Esophageal stent, gastrostomy tube, radiation, pall resection, supportive care

Front 86

What type of tumor assoc w/ weakness and double vision?

Back 86

Thymoma assoc w Myasthenia gravis

Front 87

Lymphoma tx?

Back 87

Rad + chemo

Front 88

Common tumors of anterosuperior mediastinum?

Back 88

Thymomas, Lymphomas, Germ cell tumors

Front 89

Common tumors of middle mediastinum?

Back 89

Cysts (bronchiogenic/pericardial), lymphomas, Mesenchymal

Front 90

Common tumors of posterior mediastinum?

Back 90

Neurogenic neurilemomas from nerves and nerve sheaths