A 52-year-old alcoholic with fever and a cough productive of purulent sputum is found to have the opacity on chest film as shown (Fig. 62-15). The following is/are true statement(s):
The findings suggest a parapneumonic empyema
If pus is found on aspiration of the pleural space, a chest tube should be placed
If pus is found on aspiration, bronchoscopy is a necessary part of the patient’s evaluation
In this situation, rib resection for drainage is preferred to a large-bore chest tube
Decortication of the lung should be considered if the lung fails to expand within 4 weeks
Answer
The lesion was found on a 32-year-old male on a routine chest film required for his employment. Which of
the following is/are true?
The stippled calcification and intact cortex of the rib are characteristic of osteochondroma
The stippled calcification is characteristic of osteogenic sarcoma
If the lesion is osteogenic sarcoma, the optimal treatment is resection and radiation therapy
If the lesion is an osteochondroma, it need not be resected in this age group
The radiographic picture is typical for Ewing sarcoma
Answer
To resect a chondrosarcoma of the chest wall in a 42-year-old man, ribs 2–4 were removed, leaving a defect 8 x 8 cm. For reconstruction, the following is/are true:
If this were to be posterior, beneath the scapula, reconstruction would not be required
If this defect is anterior, the primary benefit of reconstruction is an improved cosmetic result
Whenever chest wall reconstruction is considered, it should be delayed 6–12 months to allow detection of recurrent tumor
If Marlex is used for reconstruction, no wound drainage tube is necessary
If PTFE is used for reconstruction, both pleural and wound tubes should be used
Answer
An upright chest film of a cachectic, homeless 47-year-old woman shows blunting of the right costophrenic angle. The following is/are true:
A lateral decubitus film should be obtained to confirm the presence of fluid rather than a CT scan
Tuberculous effusion can readily be identified by stain and culture of aspirated fluid
A pleural fluid glucose level lower than in the serum is diagnostic of empyema
Bloody pleural effusion in this patient is diagnostic of an underlying malignancy
Pleural fluid cytology report of lumphoma should be viewed with skepticism
Answer
Following shotgun wound of the chest wall, a 39-year-old woman desires reconstruction without a foreign-body prosthesis. Old incisions prohibit use of her rectus abdominus muscles. Considering chest wall muscles for reconstruction, the following is/are true statement(s):
- The pectoralis major muscle is available and innervated by the medial and lateral pectoral nerves so named because it describes their relationship to the pectoralis minor
The serratus anterior muscle is available since its absence has no functional significance
There is no serratus posterior muscle
The latissimus dorsi muscle is available and supplied by the thoracodorsal artery
- The latissimus dorsi is innervated by the thoracodorsal nerve with fibers from C6, C7 and C8
Answer
A 38-year-old man presents with facial and upper extremity edema, venous distention in the neck and arms and a cyanotic appearance. The following is/are true statement(s):
The most likely cause of the problem is mediastinal granulomatous disease
A venogram should be obtained to confirm the diagnosis
Mediastinoscopy for diagnosis is contraindicated
If a malignancy is identified, resection is indicated for palliation
If the etiology is benign disease, gradual improvement without operation is to be expected
Answer
A 39-year-old woman with hypertension and radicular chest wall pain was found to have the lesion seen on chest radiograph . The following is/are true statement(s):
The location of the lesion suggests a teratoma
High urinary vanillylmandelic acid levels would indicate that the lesion is a paraganglioma
If the lesion was seen on a film 5 years earlier, resection would not be indicated
A neurosurgical consultation should be obtained
Vasoactive intestinal polypeptide level elevation suggests a ganglioneuroma
Answer
Carbon monoxide diffusion capacity (DLCO) has been shown to correlate with:
A. The thickness of the alveolar lining membrane.
B. The permeability of the erythrocyte to carbon dioxide.
C. Pulmonary emboli.
D. Total alveolar-capillary capacity.
Answer
Which of the following screening tests are important for preoperative evaluation of pulmonary function?
A. History and physical examination.
B. Room air arterial blood gases.
C. Chest film.
D. Vital capacity and forced expiratory volume in 1 second (FEV 1).
E. Cardiopulmonary exercise testing.
Answer
The pulmonary circulation:
A. Is the only vascular system in which the veins do not have the same course as the arteries.
B. Has a direct connection of vein to adjacent lung tissue by connective tissue fibers, making the diameter of the tissue fibers dependent upon lung volume.
C. Supplies the metabolic needs of the alveoli.
D. All of the above.
Answer
Clearance of mucus produced in the tracheo-bronchial tree in chronic bronchitis secondary to smoking may:
A. Be hampered by the fact that the amount of mucus is increased by the number of mucus-producing cells at the expense of ciliated cells.
B. Be slowed if patients have decreased lung volume and are therefore unable to generate a vigorous cough that would cause an inflammatory process.
C. Cause a decrease in diffusion capacity and associated hypoxemia.
D. All of the above.
The bronchial circulation:
A. Is the blood supply to the conducting airways.
B. Drains into a peribronchial venous network that may expand considerably with conditions such as bronchiectasis and chronic obstructive pulmonary disease.
C. Is an especially important consideration in pulmonary transplantation.
D. All of the above.
