General Thoracic 1

1. A 40 yo woman presents to your office after CT chest, obtained incidentally for trauma, demonstrates bilateral hilar adenopathy. She is otherwise feeling well and has no symptoms. The next best step is:

2. A 75-year-old male presents with an incidental 11mm solid lung nodule on a CT of the chest. The patient has 20 pack-year smoking history, however, reports no symptoms. What is the recommended approach according to American College of Chest Physicians (ACCP) guidelines?

3. During routine screening for lung cancer in a 69-year-old male, the LDCT revealed a new benign appearing peripheral solid nodule of 5 mm. What is the recommended next approach according to Lung-RADS guidelines?

4. A 65-year-old man undergoes a difficult left upper lobectomy following induction chemoradiation for N2+ IIIA NSCLC. Station 5 and 6 lymphadenectomy is particularly difficult. Post-operatively, what complication should the astute cardiothoracic resident be mindful of?

5. A patient is found to have a 5 mm part-solid nodule in the periphery of the right lower lobe that was identified incidentally on a CT scan performed after the patient was involved in a motor vehicle collision. The lesion is followed over time and grows to 1 cm over a 6-month interval. It is suspicious for lung cancer. A level 4R lymph node measures 1.2 cm in the short axis. PET-CT shows the nodule has an SUV max of 3.8. There are no FDG-avid lymph nodes. A transthoracic biopsy of the nodule reveals adenocarcinoma. FEV1 is 95% predicted and DLCO is 87% predicted. What is the next step in management?

6. Which of the following statements regarding the thoracic duct is true?

7. Which of the following statements regarding the thoracic duct is true?

8. Which of the following is true regarding adjuvant therapy for patients with early stage lung cancer?

9. A 74 year old female who is a current smoker presents to your office with fatigue, shortness of breath and worsening fatigue. Workup reveals she has a 5.4cm centrally located left lung mass. EBUS and transbronchial biopsy of the mass reveal N1 disease and small cell lung cancer, respectively. She is started on platinum-etoposide and atezolizumab. She is seen in clinic 3 months later at which time her lung mass is noted to be 2.1cm, no evidence of nodal involvement, limited disease. Which of the following is the most appropriate option for therapy?

10. A patient is diagnosed with a 4 cm lung cancer of the left upper lobe with invasion of the left main bronchus. You determine that he will require a left pneumonectomy in order to complete remove his cancer. His PFTs are notable for an FEV₁ of 95% predicted and DLCO of 92% predicted. A quantitative perfusion scan shows that the 67% of the perfusion is going to his right lung. An echocardiogram shows no evidence of pulmonary hypertension and he is otherwise healthy and has a good performance status. What is the next step in management?

11. A patient presents with a 2 cm peripheral lung cancer in the right upper lobe. PFTs show a FEV1 of 42% and DLCO of 54%. A cardiopulmonary exercise test shows a VO2max of 12.5 ml/kg/min. She has a good performance status. What is the next best step in management?

12. In what stage of development are type II pneumatocytes produced?

13. Esophageal atresia is often seen in combination with trachea-esophageal fistula. Which variant is most common?

14. You see a 45 year old male in your office presenting with a CT finding of a solid well circumscribed 9mm lesion in his left lower lobe periphery, without any other abnormal findings. CT guided biopsy reveals cells with 1 mitosis/ 2mm2. How should you manage this lesion?

15. A 75 male former heavy smoker is found incidentally to have a solid 7 mm nodule in the lingula of the left lung. If the first scan shows staiblity of the lesion, no further follow-up imaging is recommended.

16. The rationale for neoadjuvant therapy in clinical Stage IIIA lung cancer include which of the following:

17. All of the following are neurological paraneoplastic syndromes associated with lung cancer except

18. A 65-year old man with non-small cell lung cancer underwent right pneumonectomy and mediastinal lymph node dissection 2 months ago. He returns with complaints of a productive cough of reddish-brown watery sputum and fatigue for the past week. On further questioning, he states the hemoptysis occurs at night when he is lying down. A CXR done prior to the visit shows a drop in the air fluid level in the pneumonectomy space. The next best step is

19. A patient is diagnosed with a 4 cm lung cancer of the left upper lobe with invasion of the left main bronchus. You determine that he will require a left pneumonectomy in order to complete remove his cancer. His PFTs are notable for an FEV1 of 95% predicted and DLCO of 92% predicted. A quantitative perfusion scan shows that the 67% of the perfusion is going to his right lung. An echocardiogram shows no evidence of pulmonary hypertension and he is otherwise healthy and has a good performance status. What is the next step in management?

20. _____ sequestration subtype has its own pleura and is separate from the adjacent lung