ABSITE ch 25 thoracic

1. Course of azygous vein; what it drains into

Right thorax along esophagus; drains into SVC

2. Course of thoracic duct

Right side, crosses at T5-7, dumps into LSC at junction of LIJ

3. Longest mainstem bronchus

Left

4. Longer main pulmonary artery trunk

Right

5. Nerve running anterior to lung hilum

Phrenic

6. Nerve running posterior to lung hilum

Vagus

7. Normal lung volume of right lung

55%

8. Normal lung volume of left lung

45%

9. Accessory respiratory muscles

SCM, scalenes, levators

10. Pnuemocytes important in gas exchange

Type I pneumocytes

11. Pneumocytes important in surfactant production

 Type II pneumocytes

12. Openings allowing direct exchange of air between alveoli

Pores of Kahn

13. Amount of pleural fluid produced per day

1-2L

14. Needed predicted postop FEV1 to justify lung resection

>0.8

15. Diagnostic test if FEV1 is lower than expected

VQ scan

16. Needed DLCO to justify lung resection

>11-12

17. Needed predicted postop FVC

>1.5L

18. Needed preop PCO2 and PO2

<45 and >50

19. Most common cause of cancer-related death in us

Lung cancer

20. Most common site of lung metastasis

Brain

21. Overall lung ca 5-year survival rate

10%

22. Most common type of lung cancer

 Adenocarcinoma

23. Primary types of non small cell cancer (2)

Squamous, adenocarcinoma

24. Cancer type found more often centrally

Squamous

25. Cancer type found more often peripherally

Adenocarcinoma

26. NSCLC with more common local recurrence

Squamous cell

27. NSCLC with more common distant metastasis

Adenocarcinoma

28. T staging for lung cancer

T1<3cm, T2>3cm, T3 invasion of chest wall, pericardium, diaphragm or <2cm

from carina, T4 invasion of mediastinum, esophagus, trachea, vertebra, heart,
malignant effusion

29. N staging for lung cancer

N1 ipsi hilar nodes, N2 ipsi mediastinal nodes, N3 contralateral nodes or

supraclav nodes

30. Type of cancer causing 20% of lung ca; typically neuroendocrine

Small cell

31. Treatment of SCLC

Chemotherapy and XRT

32. Paraneoplastic syndrome associated with squamous cell CA

PTH-related peptide
33. Paraneoplastic syndrome associated with SCLC

ACTH, ADH release

34. Most common paraneoplastic syndrome in SCLC

ACTH production

35. Lung tumor associated with asbestos

Mesothelioma

36. Standard chemotherapy in NSCLC

Carboplatin, taxol

37. Standard chemotherapy in SCLC

Cisplatin, etoposide

38. Tumors in which mediastinoscopy is used

Central, LN>0.8cm, subcarinal LN>1.0cm

39. Left sided structures when looking down a mediastinoscope

RLN, esophagus, aorta, main PA

40. Right sided structures when looking down a mediastinoscope

Azygous, SVC

41. Anterior structures when looking down a mediastinoscope

Innominate vein and artery, right PA

42. Surgical technique to assess aortopulmonary window nodes

Chamberlain procedure

43. Tumor invading the apex of the chest wall; often causes horner�s syndrome

Pancoast tumor
44. Cancer type that mimics pneumonia; grows along alveolar walls

Bronchialveolar carcinoma

45. Neuroendocrine tumor with 90% 5-year survival

Carcinoid

46. Malignant bronchial tumors (3)

Adenoid cystic adenoma, mucoepidermoid adenoma, mucous gland adenoma

47. Most common benign adult lung tumor

Hamartoma

48. Popcorn lesion on CT of chest

Hamartoma

49. Most common site for mediastinal tumors

Thymus

50. Tumors found in anterior mediastinum (4)

Thymoma, Tcell lymphoma, Teratoma, parathyroid adenoma

51. Tumors found in middle mediastinum (4)

Bronchiogenic cyst, pericardial cyst, enteric cyst, lymphoma

52. Structures found in middle mediastinum (3)

Heart, trachea, ascending aorta

53. Structures found in posterior mediastinum (2)

Esophagus, descending aorta

54. % of thymomas that are malignant

50
55. % of thymoma patients with myasthenia gravis

50

56. % of patients with myasthenia gravis with thymoma

10

57. % of patients with myasthenia gravis who get improvement with thymectomy

80

58. Most common form of lymphoma

Tcell

59. Most common form of Hodgkins lymphoma

Nodular sclerosing

60. Most common germ cell tumor in mediastinum

Seminoma

61. Cyst posterior to carina

Bronchiogenic cyst

62. Treatment of bronchigenic cyst

Resection

63. Cyst found at right costophrenic angle

Pericardial cyst

64. Most common neurogenic tumor

Neurolemoma

65. Neurogenic tumors that produce catecholamines

Paraganglioma
66. % of symptomatic mediastinal masses that are malignant

50

67. % of asymptomatic mediastinal masses that are benign

90

68. Most common benign tracheal tumors in adults

Papilloma

69. Most common benign tracheal tumor in children

Hemangioma

70. Most common malignant tracheal tumor

Squamous cell

71. Most common late complication after tracheal surgery

Granulation tissue

72. Treatment of laryngeal edema

Intubation, racemic epi, steroids

73. Potential treatments of postintubation stenosis (2)

Resection, laser ablation

74. Risk of tracheostomy, esp when below 3rd cricoid ring

Tracheoinnominate fistula

75. Most common area of lung abscess

Posterior segment of RUL, superior segment of RLL

76. Common cause of empyema

Pneumonia
77. First phase of empyema, lasts 0-24h

Exudative phase

78. Second phase of empyema, lasts 24-72 hours

Fibroproliferative phase

79. Third phase of empyema, >72h

Organized phase

80. Treatment of organized phase empyema

Decortication or Eloesser

81. Treatment of exudative and fibroproliferative phase of empyema

Chest tube, antibiotics

82. Lab tests that diagnose chylothorax

Lymphocytes and TAGs

83. Location where thoracic duct crosses from right to left

T5-7

84. Conservative therapy for chylothorax

Chest tube, octreotide, TPN (or low-fat diet)

85. Optimal location to ligate thoracic duct

Low in mediastinum

86. Most common source of massive hemoptysis

Bronchial arteries

87. Treatment of massive hemoptysis

Mainstem intubation of unaffected side, OR for lobectomy or pneumonectomy,

bronchial artery embolization
88. Recurrence risk of spontaneous PTX after first occurance

20%

89. Recurrence risk of spontaneous PTX after second occurance

60%

90. Recurrence risk of spontaneous PTX after third occurance

80%

91. Most common side of spontaneous PTX

Right

92. Treatment of multiple spontaneous PTX

Thoracoscopy, blebectomy, mechanical pleurodesis

93. Most common mediastinal cyst

Bronchiogenic cyst

94. Abnormal lung tissue not connected into bronchial system

Bronchiogenic cysts

95. Lung tissue not connected to bronchial vasculature

Sequestration

96. Treatment of pulmonary sequestration

Lobectomy

97. Solitary pulmonary nodule with h/o sarcoma or melanoma: new primary or met??

More likely to be met

98. Solitary pulmonary nodule with h/o breast or H&N cancer: new primary or met??

More likely to be new primary

99. Most likely cause of arrest after blunt trauma

Tension pneumothorax

100. Endometrial implants on visceral lung pleura that causes PTX in relation to
menstruation

Catamenial PTX

101. Treatment of residual hemothorax despite 2 well-placed chest tubes

Thoracoscopic drainage

102. Whiteout on CXR with mediastinal shift toward whiteout: dx and tx

Atelectasis: do bronch

103. Whiteout on CXR with mediastinal shift away from whiteout: dx and tx

Effusion: chest tube

104. Causes of bronchiectasis (3)

Infection, tumor, cystic fibrosis

105. Parenchymal lung lesion + enlarged hilar nodes in TB

Gohn complex

106. Noncaseating granulomas common in:

Sarcoidosis

107. Caseating granulomas common in:

TB

108. Protein level in exudate

>3

109. LDH pleural fluid:serum in exudate

>0.6
110. Glucose in exudate

Low

111. Treatment of recurrent pleural effusion

Mechanical pleurodesis

112. Treatment of malignant pleural effusions

Talc pleurodesis

113. Connections between pulmonary arteries and veins; common in Osler

Weber Rendu

AVMs

114. Tx of lung AVMs

Embolization

115. Most common benign chest wall tumor

Osteochondroma

116. Most common malignant chest wall tumor

Chondrosarcoma