Which of the following statements about the results of
thymectomy for myasthenia gravis
are true?
A. Patients with ocular symptoms experience clinical improvement in 90% of cases.
B. Clinical remission can be expected in 90% of cases.
C. The response rate to thymectomy for patients with generalized symptoms is 90%.
D. Patients with thymoma experience improvement in 75%.
E. Continued medical therapy is required in 75%.
Answer
All of the following are true of the treatment of myasthenia gravis except:
A. The transcervical approach to surgical thymectomy is less likely to benefit the patient with myasthenia gravis.
B. Corticosteroids result in improvement in 80% of patients.
C. Plasma exchange is associated with improvement in up to 90% of patients.
D. Medical therapy with Mestinon (pyridostigmine) is associated with remission in approximately 10% of patients.
E. Surgical thymectomy, regardless of the approach, is associated with improved remission and response rates as compared with medical therapy.
Answer
Which of the following is/are acceptable alternatives in the management of malignant pericardial effusion?
A. Pericardiocentesis.
B. Subxiphoid pericardiotomy (“pericardial window”).
C. Thoracotomy with pericardiectomy.
D. Instillation of tetracycline or bleomycin into the pericardial space.
E. Treatment of the underlying malignancy.
Answer
Which of the following statements about cardiac tamponade is/are correct?
A. At least 500 ml. of fluid must be present in the pericardium of an adult to cause symptoms of tamponade.
B. A drop in systemic blood pressure of greater than 20 mm. Hg during inspiration (pulsus paradoxus) is a finding specific to cardiac tamponade.
C. The vast majority of patients with cardiac tamponade demonstrate a low QRS voltage, nonspecific ST T-wave abnormalities, and electrical alternans (alternation of QRS amplitude) on the electrocardiogram.
D. In trauma victims with cardiac tamponade, the three components of “Beck's triad” (hypotension, elevated jugular venous pressure (JVP), and muffled heart sounds) are almost always present.
E. When the diagnosis is made, treatment must be instituted rapidly and may include pericardiocentesis, creation of a pericardial window, and identification and treatment of the underlying cause.
Answer
Which of the following statements about constrictive pericarditis is/are correct?
A. Most patients who develop constrictive pericarditis after cardiac operation present with symptoms within 6 months of the procedure.
B. Results of pericardiectomy for constrictive pericarditis are worse in patients who develop constriction after mediastinal irradiation.
C. Drainage of asymptomatic pericardial effusions arising from acute pericarditis is advised to prevent development of constrictive pericarditis.
D. If surgical treatment is planned for constrictive pericarditis it should involve total or complete pericardiectomy.
E. Echocardiography can usually make the diagnosis by imaging a thickened pericardium.
Answer
The relationship between small-cell and non-small cell lung cancers can be described by the following:
They differ by histology, clinical behavior and cell of origin
Of all lung cancers, approximately 80% are non-small cell and 20% are small cell
Both cell types are predictably responsive to chemotherapy
The International Staging System can be applied to both tumor types
The majority of non-small cell cancer patients vs. the minority of small cell cancer patients are candidates for pulmonary resection
Answer
A 62-year-old male smoker presents with right anterior chest pain. There is a 3 cm mass attached to the chest wall with radiographic evidence of rib erosion and positive cytology for non-small cell carcinoma. Which of the follow is/are true:
The patient is inoperable due to tumor size and chest wall involvement
Radiation therapy is the preferred initial treatment
Operative resection should be performed with en bloc removal of the tumor and adjacent chest wall as well as a mediastinal lymph node resection
Positive mediastinal nodes will have little effect on survival
The patient would be classified Stage IIIa
Answer
For the patient in the pervious question to become an operative candidate which of the following must be met?
Extrathoracic metastases must be able to be controlled by another modality, e.g. radiotherapy
Tumor doubling time must exceed 40 days
If there is recurrence at the primary site, it must be treated before the metastatic disease
Even if effective systemic therapy is available, resection of metastases is preferred
If pulmonary reserve is marginal, resection of the maximal number of metastatic foci should be performed
Answer
Biopsy of the lesion in the previous question is reported as “bronchial carcinoid with no signs of atypia.” Which of the follow is/are true?
Sleeve resection of the bronchus would be appropriate
Lymph node biopsy at time of resection is unnecessary
Associated carcinoid syndrome is very unlikely
If carcinoid syndrome were found in a tumor this size, hepatic metastases would be likely
When bronchial carcinoid syndrome occurs, right-sided cardiac valves are affected
Answer
Following resection of a T1N1 squamous cell cancer in a 47-year-old male, the following is/are true:
There is a higher risk of local recurrence than with any other histologic type of non-small cell cancer
The greatest risk to the patient is a distant metastasis
Of all metastatic sites, liver is most likely
If the patient survives five years, there is a greater risk of a new lung cancer than recurrence
To improve survival, the patient should be considered for adjuvant chemotherapy
Answer
A 42-year-old woman with hemoptysis is seen to have a 2 cm mulberry appearing polypoid lesion in the left
mainstem bronchus suspicious for bronchial adenoma. The differential diagnosis includes which of the following:
Mucoepidermoid carcinoma
Plasma cell granuloma
Carcinoid tumor
Adenoid cystic carcinoma
Mucous gland adenoma
Answer
A 42-year-old man has a solitary “coin lesion” 2 cm in diameter in the area of the right upper lobe on a
routine chest radiograph. Which of the following is/are true?
A previous radiograph from five years prior showing the lesion to be 1.2 cm in diameter indicates malignancy
If a CT scan shows mediastinal adenopathy, mediastinoscopy is preferable to thoracotomy
In the absence of previous radiographs, the lesion should be followed by serial films at 6 month intervals
Calcification in a concentric or “popcorn” configuration denotes a benign lesion
Needle aspiration showing “chronic inflammatory cells” denotes a benign lesion
Answer
A 53-year-old woman who had a malignant tumor removed 2 years ago presents with a solitary lung nodule
1.5 cm in diameter. The following is/are true:
If the primary tumor originated in the breast, the lesion is most likely to represent a new primary lung cancer.
If the primary tumor was melanoma, the lesion is most likely to be metastatic
If the remainder of the lung fields are clear, a CT scan is unnecessary
If the primary tumor was in the GI tract, there is very little chance that the lesion is a new primary lung cancer
Fine needle aspiration should always be performed prior to resection of the lung lesion
Answer
A 61-year-old male presents with a painful mass 3.5 cm in diameter below the clavicle and attached to the chest wall. The following is/are true:
A CT scan is the best study to determine rib destruction
The lesion should be removed enbloc without biopsy to minimize the chances for local recurrence
The chances are approximately 40% that the lesion is metastatic
If it is metastatic, the most likely primary tumor is in the lung or pancreas
Fortunately, less than 50% of chest wall tumors are malignant
Answer
Concerning the sternum, the following is/are true:
The xiphoid process is the anterior border of the thoracic outlet
Gladiolus is the body of the sternum
The angle of Louis is at the level of the 2nd costal cartilage
The 11th rib is attached via costal cartilage to the xiphoid
The sterno-manubrial junction is at the level of T4 posteriorly
Answer
A 22-year-old woman recovering from a traumatic head injury is noted to have bright red bleeding when her
tracheostomy is suctioned. The following is/are true statement(s):
Antibiotics should be administered to treat the bronchitis
Deflation of the tracheal tube cuff is a useful diagnostic maneuver
If massive bleeding occurs, a finger should be used to compress the innominate artery against the sternum
Operative treatment of a tracheoinnominate fistula includes resection and prosthetic replacement of the innominate artery
Tracheal resection is usually required for a tracheoinnominate fistula to prevent recurrence
Answer
adenocarcinoma, the following is/are true:
