Thoracic Surgery
Core concepts
Understand thoracic anatomy, the mediastinal compartments, and the principles of lung isolation and one-lung ventilation. Know the evaluation of a solitary pulmonary nodule, lung cancer staging, and the indications for lobectomy versus wedge resection. Master the management of pleural effusion, empyema, pneumothorax, and chest tube principles. Understand esophageal surgery basics, including achalasia and esophageal cancer. Know the presentation of mediastinal masses and the risk of airway compression. Understand postoperative pulmonary complications and their prevention.
Traps in questions
Questions often test whether a chest tube is needed and when to use suction versus water seal. Distinguish spontaneous pneumothorax management in stable versus unstable patients. Another trap is assuming all lung nodules are malignant; size, growth, and risk factors guide workup. Watch for questions about the timing of surgery after pneumonitis and about preoperative pulmonary function thresholds.
Worked rule of thumb
For a chest tube, assess for air leak, drainage, and lung re-expansion. If a patient with a chest tube develops sudden respiratory distress, consider tension pneumothorax or tube obstruction and act immediately.
Exam strategy
Correlate anatomy with imaging. A widened mediastinum suggests vascular injury or mass; a pleural effusion suggests infection, malignancy, or heart failure.