Questions 31-35 (CHEST) from most popular Indian entrance exam
Q31) Most common anterior mediastinal tumor is
b) Neurogenic tumors
c) Parathtyroid adenoma
d) Ectopic thyroid
Q 32. In pleura, true about malignant mesothelioma is
a) It is the most common primary malignancy of pleura
b) It is related to excessive exposure to manganese in 1980s
c) The patients are mostly asymptomatic and detected incidentally
d) on analysis of pleural effusion, it is transudative
Q 33. Not a true statement about thoracic outlet syndrome:
a) Elevation of arm causes occlusion of subclavian artery
b) T1 nerve supply is mainly compressed
c) There is altered sensorium in T1 nerve distribution
d) Embolism of subclavian artery may occur
Q34) In penetrating neck trauma, to help in the management, neck has been divided into zones. Great vessels of thoracic inlet are seen in
a) Zone 1
b) Zone II
c) Zone III
Q35. Not an Indication of Surgery in Asymptomatic Aortic Stenosis
a) Concomitant Coronary artery disease
b) Patients less than 50 years of age
c) Left ventricular dysfunction
d) Silent ischemia
Thymoma is the most common mediastinal tumor and most commonly seen in anterior mediastinum.Neurogenic tumors are the most common in posterior mediastinum.
Thyroid and parathyroids are usually seen in anterior mediastinum.
Neurogenic tumors such as schwannomas are most common in posterior mediastinum
REf:- Bailey 23rd page 868
Malignant mesothelioma is related to asbestos exposure and not manganese. It is the most common primary parital pleura tumor. The presenting symptoms are pain and breathlessness due to exudative pleural effusion and pain due to pleurisy.
Butchart staging system has been in use since 1976 which stages mesothelioma.
|Stage 1||Tumor confined within the “capsule” of the parietal pleura, i.e., involving only ipsilateral pleura, lung, pericardium, and diaphragm|
|Stage 4||Distant blood-borne metastasis|
Thoracic outlet syndrome is mainly caused by cervical rib and affects the territory of T1 distribution. Features like Raynaud Phenomenon, emboli and thrombosis from subclavian artery etc may occur.
Elevation of arm causes occlusion of subclavian vein and not artery. Collateral filling may also be seen.
Zone I includes the base of the neck and thoracic inlet.
It extends from the sternal notch and clavicles to the cricoid cartilage.
Zone I contains the following structures:
●Thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins)
●Proximal carotid arteries
●Apices of the lungs
Zone II cephalad from the cricoid cartilage to the angle of the mandible, and contains the following structures:
●Common carotid arteries
●Internal and external branches of carotid arteries
●Vagus and recurrent laryngeal nerves
Zone III (upper neck) includes the region above the angle of the mandible up to the base of the skull and contains the following structures:
●Distal portion of the internal carotid arteries
●Cranial nerves IX, X, XI, XII
Zone designation carries implications for management and prognosis. Zone I injuries can involve the mediastinum where vascular control can be difficult. Zone III vascular injuries, especially those more cephalad, can also pose a significant surgical challenge.
Indications for surgery in asymptomatic patients with severe aortic stenosis are
Patients with left ventricular dysfunction, concomitant coronary artery disease, in patients over 60–65 years, severe left ventricular hypertrophy, arrhythmias and silent ischaemia.
Also peak systolic gradient of >6.7 kPa (50 mmHg) with impaired ventricular function on dynamic testing is sufficient indication for aortic valve replacement
Ref: Bailey page 838