Thoracic Surgery
Thoracic Surgery covers lung, pleura, mediastinum, chest wall, esophagus, and trachea. The exam tests staging, pleural physiology, and emergency thoracic procedures.
Core rules
- Lung cancer: TNM staging with CT and PET-CT; mediastinal staging with EBUS or mediastinoscopy for suspicious nodes. Stage I–II is resectable; stage III is multimodality; stage IV is systemic.
- Solitary pulmonary nodule: compare old imaging, assess size and morphology; PET for solid nodules >8 mm.
- Pneumothorax: simple versus tension. Tension = hypotension + absent breath sounds + tracheal deviation; immediate needle decompression then chest tube.
- Pleural effusion: Light's criteria (pleural protein/serum >0.5, pleural LDH/serum >0.6, pleural LDH >2/3 upper limit) define exudate.
- Anterior mediastinal mass: thymoma, teratoma, thyroid, lymphoma.
Worked example: A 58-year-old has a 2.5 cm spiculated lung nodule, no nodes, and PET avidity. Reasoning: a suspicious solid nodule >8 mm warrants PET and tissue; if stage I, lobectomy with lymph node sampling is standard.
Traps: calling every pneumothorax tension; using Light's criteria incorrectly; assuming all mediastinal masses are thymoma; failing to stage before resection.