Surgery Thoracic

Question 1

most common presenting s/sx referred to thoracic surgeons

Answer 1

pulmonary neck masses or nodules, effusions

Question 2

what is ct guided aspiration biopsy

Answer 2

• local anes or mild iv anes
• on peripheral lesions about > 2 cm
• real time ct

Question 3

what is ct/mr angiography

Answer 3

• to assess vascular lesions

- lung av malformations, hemangiomas, sequestrations, fistulas between blood vessel and another hollow organ structure

Question 4

what is transthoracic needle aspiration biopsy

Answer 4

• not guided by real time ct bu ct images

- can also be uts guided

Question 5

complications in ttna and ctgab

Answer 5

pneumothorax, hemothorax, hemoptysis and hemorrhage, hematoma

Question 6

what is mediastinoscopy

Answer 6

• insert scope at suprasternal notch to access ln level 2, 4, 7
• must avoid innominate vein and great vessels

Question 7

mediastinoscopy is gold standard for

Answer 7

• central lesions
• hilar involvement
• obvious mediastinal involvement on radiographic examinations
• cases with positive gallium 67 scans of mediastinal nodes

Question 8

what is fiber optic bronchoscopy

Answer 8

• to visualize oropharynx, larynx, vocal cords, and tracheobronchial tree
• to obtain tissue samples for diagnosis
• to ligate and stop bleeding
• to do bronchial lavage in a patient with atelectasis
• under general anes / iv sedation with muscle relaxants

Question 9

indications for fob

Answer 9

• infection (increased secretions)
• atelectasis
• abnormal finding on imaging studies
• hemoptysis
• airway narrowing (stridor or noisy breathing)
• complement rigid bronchoscopy

Question 10

what is rigid bronchoscopy

Answer 10

• to visualize the oropharynx, larynx, vocal cords, and tracheobronchial tree
• for diagnosis and treatment
• under general anes / iv sedation with muscle relaxants

Question 11

indications for rigid bronchoscopy

Answer 11

• bleeding or hemorrhage
• foreign body extraction
• dilation of tracheal and bronchial strictures
• relief of airway obstruction
• insertion of stents
• pedia bronchoscopy
• tracheobronchial laser therapy

Question 12

what is endobranchial uts

Answer 12

• can determine depth of tracheobronchial tumor invasion
• guides access and evaluation of peritracheal and peribronchial ln biopsy
• can access ln 2 4 7 10 11 12

Question 13

what is electromagnetic navigation bronchoscopy

Answer 13

• uses electromagnetic to localize and guide endoscopic tools/catheters through tracheobronchial tree
• used to access and biopsy peripheral lesions and lymph nodes

Question 14

steps to enb

Answer 14

• ct scan to construct virtual 3d map using dicom data
• planning
• navigate, biopsy, localize

Question 15

t/f there is no difference between ebus-tbna and mediastinoscopy in staging nsclc

Answer 15

true

Question 16

diagnostic/therapeutic surgical procedures

Answer 16

• biopsy of superficial chest masses or cervical lns
• open thoracotomy
• anterior mediastinoscopy
• minimally invasive (vats/rats and thoracoscopy)

Question 17

indication for anterior mediastinoscopy (chamberlain procedure)

Answer 17

• anterioer mediastinal masses not accessible by mediastinoscopy or bronchoscopy
• need to do transverse incision on left or right 2nd intercostal cartilage

Question 18

uses of vats

Answer 18

• biopsy of nodules, masses, parietal pleura, ln
• evacuation of effusions or hemothorax
• resect bullae and blebs
• diagnostic or therapeutic
• needs general anes

Question 19

benefits of vats vs major resection over conventional surgery

Answer 19

• less pain
• better preservation of lung function
• better preservation of shoulder function
• shorter hospital stay
• cosmesis

Question 20

vat-able procedures

Answer 20

read

Question 21

what is rats

Answer 21

• for definitive excisions of anterior mediastinal masses, lobectomies, and esophageal surgeries
• not a diagnostic procedure, therapeutic

Question 22

advantage of rats vs vats

Answer 22

• 3d immersive view
• magnification up to 10x
• motion scaling with tremor filtration
• intuitive, more precise
• fulcrum is inside the chest cavity

Question 23

best modalities for specific pathologies

Answer 23

• pleural effusions: uts guided thoracentesis
• loculated effusion: vats or drainage procedure with uts guidance
• solitary pulmo nodule: vats with frozen section
• tension pneumothorax: emergency tube thoracostomy (no need for cxr)
• spontaneous pneumothorax secondary to ruptured bullae: vats