At the level of the carina, the pulmonary arteries lie anterior to the mainstem bronchi

and posterior to the aortic arch..

When performing a posterolateral thoracotomy, what chest wall muscles are usually
transected?
The latissimus dorsi and serratus anterior.
What laboratory values suggest that a pleural effusion is an exudate?
Pleural fluid/serum protein ratio greater than .! and pleural fluid/serum "#$ ratio
greater than .%.
What is the most common etiology of a spontaneous pneumothorax?
&upture of a pulmonary bleb.
What is the treatment for traumatic hemothorax?
'hest tube drainage. (f a persistent bloody effusion is present refractory to tube drainage
then )AT*/decortication is indicated to avoid lung encasement/atelectasis.
What is the treatment for empyema at the organi+ed phase?
)AT* decortication.
At what level do the vena cava, esophagus, thoracic duct, and aorta cross the
diaphragm?
)ena cava,T-
.sophagus,T/
Aorta 0 thoracic duct,/1
Which proto+oa is responsible for a diffuse interstitial pneumonitis in
immunocompromised patients?
Pneumocystis carinii.
What is the most common form of non2small2cell lung cancer in the 3nited *tates?
Adenocarcinoma.
What is the diagnostic standard for a solitary speculated new lung mass in a smo4er?
&esection. 'onsider a preoperative P.T scan to rule out metastasis. There is no role for
'T2guided biopsy in an acceptable ris4 surgical patient.
5ame some features of small cell lung cancer.
Associated with smo4ing in 67 of cases. 8etastasis present at the time of presentation
in %97. 5euroendocrine cellular origin with A'T$2 and A#$2secreting paraneoplastic
syndrome association.
What is the most common benign tumor of the lung?
$amartoma.
What are the most common primary malignant tumors of the chest wall?
8yeloma and chondrosarcoma.
What is the most common benign tumor of the chest wall?
:steochondroma.
Which lung neoplasm, in young to middle2aged patients, is often centrally located, is
usually endobronchial, and may present with obstructive symptoms or hemoptysis?
;ronchopulmonary carcinoid.
Prior to thoracotomy P<Ts are ordered on patients. The patients need certain <.)/=s to
ensure good outcome after procedure. What is the prethoracotomy P<T for
pneumonectomy/lobectomy/wedge?
Pneumonectomy,1"
"obectomy,/"
What is the feared complication when a patient develops chest pain, hemoptysis, and
fever after right upper lobectomy and a right2sided pulmonary consolidation?
&ight middle lobe torsion. ;ronchoscopy can confirm the diagnosis with a stenotic
&8" bronchus. Treatment is surgical detorsion and resection of any devitali+ed tissue.
Which lung cell histology is associated with hypercalcemia?
*>uamous cell carcinoma when the paraneoplastic syndrome with elevated PT$ occurs.
When is a lung cancer unresectable?
5?contralateral or subclavian or scalene involvement with respect to lymph nodes.
T@mediastinal, heart, great vessel, esophagus, trachea, vertebral, or effusion Amidline
maBor structuresC.
&esectablechest wall, pericardium, and diaphragm invasion.
What preoperative arterial blood gas AA;DC values imply an increased ris4 of
respiratory insufficiency following pulmonary resection?
P':1 greater than @! torr and Pa:1 less than ! torr.
What type of tumor should one thin4 of when a patient presents with ptosis, miosis, and
anhydrosis, and ulnar nerve inBury findings?
Pancost, invasion of the sympathetic chain/stellate ganglion inducing $orner=s
syndrome.
What is the treatment of choice for an isolated brain metastasis that otherwise appears to
have stage ( non2small2cell lung cancer?
&esection of the isolated brain metastasis followed by whole brain irradiation and
resection of the primary lung tumor.
What is the appropriate treatment for a superior sulcus APancoastC tumor?
&adiation followed by surgical resection or a definitive dose A%%! DyC of radiation.
When is a pneumonectomy re>uired for the resection of non2small2cell lung cancer?
When there is tumor invasion of the proximal mainstem bronchus or pulmonary arteries
or veins in patients without other contraindications to resection.
#oes resecting thymus in myasthenia improve symptoms?
Ees. 67 of patients improve. /7 of patients with myasthenia gravis A8DC have a
thymomaF however, one does not need a thymoma for symptoms of 8D to improve.
What is the preferred techni>ue for resection of metastases to the lung?
Wedge resection.
What is the appropriate treatment of a right upper lobe non2small2cell lung cancer
involving the orifice of the right upper lobe but not extending into the bronchus
intermedius or involving regional lymph nodes?
&ight upper lobectomy with anastomosis of the bronchus intermedius to the mainstem
bronchus.
What is the preferred therapy for patients with superior vena cava syndrome caused by
non2small2cell lung cancer?
&adiation therapy.
What are the current indications for surgical resection of pulmonary tuberculosis?
Persistent or recurrent infection despite ade>uate multidrug therapy, massive or
recurrent hemoptysis, inability to exclude carcinoma, and bronchopleural fistula
unresponsive to tube thoracostomy.
What is the best initial method for locali+ing hemoptysis in a patient who is actively
bleeding?
;ronchoscopy.
What is the definitive treatment for a persistent bronchocutaneous fistula % wee4s after
penetrating trauma?
'ontrol of associated pleural infection and muscle flap coverage of the involved
bronchus.
What is the treatment for malignant effusion with shortness of breath?
)AT* with pleurodesis. :ther less efficacious palliations are repeated thoracentesis,
chest tube drainage, and percutaneous chemical pleurodesis with talc or bleomycin.
What type of bronchopulmonary se>uestration has a distinct pleural investment, no
communication with the tracheobronchial tree, an arterial supply derived from small
systemic arteries, and systemic venous drainage?
.xtralobar se>uestration. (ntralobar se>uestration has pulmonary venous return and a
bronchial attachment to the pulmonary tree. &ecurrent pneumonia is the most common
presentation for intralobar se>uestration and asymptomatic lung mass the most common
for extralobar. Treatment is surgical resection with attention to anomalous pulmonary
artery origins.
What is the initial bedside therapy for an acute bronchopleural fistula following
pneumonectomy?
Turn the patient operated side down to prevent aspiration of pleural fluid into the
contralateral lung and tube thoracostomy.
What fungus produces a granulomatous tissue reaction and can cause the triad of
pneumonitis, erythema nodosum, and arthralgias 4nown as valley fever?
'occidioidomycosis.
A chest G2ray of a smo4er reveals a popcorn lesion. This slow growing tumor is needle
biopsied AsensitiveC. What is the diagnosis?
$amartoma.
What are the disadvantages associated with treating a pneumothorax with catheter
aspiration alone?
(t is difficult to evacuate the entire pneumothorax, and it is not applicable in patients
with an active air lea4.
What complications are seen from chest tubes placed too low on the chest wall?
(nBury to the diaphragm or abdominal viscera.
What are the indications for surgical treatment of a chylothorax?
<ailure of nonoperative therapy after 9 to /@ days, continued drainage of more that /!
m"/d in adults, persistent electrolyte abnormalities, and/or malnutrition.
(f during the operative treatment of a chylothorax, the site of lea4age cannot be
identified, what definitive procedure should be performed?
"igation of the thoracic duct at the diaphragm.
What is the most common location of the thoracic duct at the level of the diaphragm?
;etween the aorta and the vertebral bodies.
What volume of pleural fluid is needed to obliterate the costophrenic angle on chest G2
ray?
1! m".
A man receives a stab to his lower nec4/chest at the Bunction of " (H and subclavian. A
chest tube is placed, revealing mil4y white fluid. What is the treatment of this inBury?
'hest tube drainage and 5P: I 1 wee4s. (f this does not resolve then thoracotomy and
thoracic duct ligation.
What is the most common metastatic tumor to produce a malignant pleural effusion?
;reast cancer.
What is the treatment for recurrent spontaneous pneumothorax?
)AT* with pleurodesis.
What are the clinical features of traumatic tracheobronchial disruption?
Persistent pneumothorax despite good functioning chest tubes. #iagnosis and extent of
inBury are confirmed with bronchoscopy. *elective intubation of the opposite bronchus
can tempori+e the pneumothorax..
What is the initial management of refractory malignant pleural effusions not relieved by
chemotherapy or radiation of the primary tumor?
Thoracostomy tube drainage followed by talc or chemical pleurodesis.
A tall thin male presents with *:;. A 'G& reveals a pneumothorax. What are the
chances it will recur? And what should be done on recurrence?
!7 of spontaneous pneumothorax will recur. *urgery is indicated for persistent air lea4
or recurrence 2 thoracoscopy with pleurodesis and prn parenchymal stapling.
When should patients with 8D undergo thymectomy?
As soon as possible after the development of generali+ed wea4ness.
What clinical syndromes are associated with thymoma?
8D, .atonJ"ambert syndrome, red cell hypoplasia, and *Bogren=s syndrome.
What options remain for a persistent empyema cavity that cannot be sterili+ed by open
drainage or irrigation?
#ecortication, obliteration of the pleural space using muscle flaps or omentum,
thoracoplasty, or the 'laggett procedure.
What is the diagnostic paradigm and treatment for a traumatic chylothorax?
#iagnosis is confirmed upon fluid analysis of thoracostomy drainage. <luid has high
chylomycron and TD levels with a mil4y, odorless fluid. Treat for / to /@ days with
chest tube drainage, 5P:, and TP5. (f output is still high AK! cc/dC exploration with
duct ligation at the site of inBury is indicated. (sosulfan blue can help identify lea4 site. (f
no lea4 site is found then ligation of the duct at the aortic hiatus is indicated. <or large
chylous effusions refractory to chest tube drainage, decortication is indicated. (n cases of
tension chylothorax after pneumonectomy, emergent drainage with surgical thoracic
duct ligation is indicated.
What conditions are consistently associated with pectus excavatum?
8arfan=s syndrome, mitral valve prolapse, and scoliosis.
What is the most common cause of *)' syndrome shortly after right pneumonectomy?
'ardiac herniation secondary to atrial torsion through a pericardial defect. $ypotension,
tachycardia, distended nec4 veins, and a displaced heart on 'G& are the hallmar4s. &e2
exploration and atrial detorsion with pericardial repair is re>uired.
What is the differential diagnosis for anterior mediastinal masses?
Thyroid, lymphoma, teratoma, thymoma, and 8orgagni AanteriorC diaphragmatic hernia.
What is the differential diagnosis for middle mediastinal masses?
;ronchogenic cysts, atrial myxoma, esophageal leiomyoma/carcinoma, and adenopathy.
What is the differential diagnosis for posterior mediastinal masses?
5eurogenic tumor, thoracic aneurysm, and vertebral tumor.
What is the surgical approach for a symptomatic substernal goiter?
'ervical incision. The thyroid tissue is typically easily extracted from the substernal
space.
When postoperative infection is excluded, what etiology is responsible for
approximately 67 of cases of acute mediastinitis?
.sophageal perforation.
A thin man with lung cancer presents with facial swelling and H)# and *:;. What is
the treatment?
*)' syndrome,most commonly caused by lung cancer. (t is treated initially by
radiation therapy.
Through what type of incision are masses located in the middle or posterior
mediastinum best resected?
Through a posterolateral thoracotomy.
#ifferentiate between benign and malignant germ cell tumors of the mediastinum.
;enign tumors are mature teratomas and dermoid cystsF they secrete no tumor mar4ers
and have well2differentiated tissues. 8alignant tumors include seminomas and
nonseminomatous germ cell tumors. *eminomas secrete beta $'D and are chemo/G&T
sensitive. 5onseminomatous germ cell tumors secrete A<T, are the most aggressive, and
have a less predictable response to chemo/G&T,resection, when anatomically feasible,
is recommended.
#escribe the clinical features of mediastinal lymphoma.
8ultiple discrete masses are seen on 'T scan in conBunction with systemic symptoms of
malaise, fevers, and sweats. Additional lymphoma outside of the mediastinum is
typically observed when sought.