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Esophageal Cancer: Workup, Management, Postoperative Care

*Please take the quiz below the video to receive credit.

Objectives

Describe the incidence and mortality associated with esophageal cancer
Become familiar with the preoperative workup and various surgical treatment options available for esophageal cancer
Understand the expected postoperative course following esophagectomy
Identify early postoperative complications and describe how to appropriately manage them

Articles

Esophageal Carcinoma
Reducing Hospital Morbidity and Mortality Following Esophagectomy

Lecture

Quiz

Esophageal Cancer

Name*
First Last
1. Which of the following are risk factors for the development of esophageal cancer?*
- A. GERD
- B. Obesity
- C. Barrett’s Esophagus
- D. All of the above
2. Which of the following is NOT true regarding esophageal adenocarcinoma?*
- A. It is the most common type of esophageal cancer in the United States
- B. It is typically located at the GE function
- C. It is most commonly located in the mid to upper esophagus
- D. It has a strong association with Barrett’s esophagus
3. Which of the following is the most common post operative complication associated with esophagectomy?*
- A. Pneumonia
- B. Anastomotic leak
- C. Cancer reoccurrence
- D. DVT/PE
4. True or False, to perform an Ivor-Lewis esophagectomy, you start with the chest portion and then proceed with the abdominal portion of the case?*
- True
- False
5. Following esophagectomy, which of the following arteries will serve as the only blood supply to the gastric conduit?*
- A. Right gastric artery
- B. Left gastric artery
- C. Left gastroepiploic artery
- D. Right gastroepiploic artery
6. True or False, In the immediate postoperative period following esophagectomy, pressors should be avoided due to the limited blood supply to the conduit.*
- True
- False
7. What is the most likely reason patients may suffer from gatro-paresis post-operatively following esophagectomy?*
- A. Division of the vagus nerve
- B. Excessive tension on the stomach intraoperatively
- C. Now smaller size of the stomach due to use of the stomach to form the esophageal conduit
- D. Technical error in the operation
8. In a post-operative esophagectomy patient who develops severe sepsis, what possible life-threatening complication must be ruled out first as the cause?*
- A. Pneumonia
- B. Anastomotic leak
- C. Gastric conduit necrosis
- D. Bacteremia
9. True or False, An early T1 lesion may be treated with endoscopic therapies alone.*
- True
- False
10. When is the optimal time to preform esophagectomy following chemotherapy?*
- A. Chemotherapy should only be preformed after esophagectomy
- B. As soon as possible following completion of chemotherapy
- C. 4-8 weeks after completion of chemotherapy
- D. 3-6 months after completion of chemotherapy

Oncologic Emergencies

*Please take the quiz below the video to receive credit.

Objectives

Describe common oncologic emergencies and appropriate management strategies for each
Understand the criteria for neutropenic fever and the appropriate workup required

Articles

Oncologic Emergencies
A review in the treatment of oncologic emergencies

Lecture

Quiz

Oncology Emergencies Quiz

Name*
First Last
1. Which of the following is true regarding spinal cord compression in cancer?*
- a. It may be associated with autonomic dysfunction as well including urinary retention or constipation
- b. Sensory deficits are less common than motor deficits
- c. It is most commonly associated with lung cancer, breast cancer, and prostate cancer.
- d. 20% of cases are the initial manifestation of malignancy
- e. All of the above are true
2. What is the gold standard diagnostic imaging for spinal cord compression?*
- a. MRI
- b. CT scan
- c. X-ray
- d. Bone scan
3. What is the preferred treatment for spinal cord compression related to cancer?*
- a. Chemotherapy
- b. Symptom management and aggressive PT
- c. Surgery alone
- d. Combination of high dose steroid taper for pain management, radiation, and surgery
4. What is the definition of neutropenic fever?*
- a. Neutropenia with ANC <500 or ANC <1000 with anticipation to decrease to 38.3 X1, or >38.0 for one hour
- b. Neutropenia with ANC 48hrs and Fever of 38.5
- c. Neutropenia with ANC <500 or ANC <1000 with anticipated decrease to less than 500 within 24 hours and fever of 38 or greater
- d. None of the above
5. Which of the following is true regarding neutropenic fever?*
- a. The majority of infections involve gram negative bacteria
- b. A source is only identified approximately 20-30% of the time
- c. All patients with neutropenic fever must have a lumbar puncture performed as a part of their diagnostic work up
- d. A MASCC score of >21 is high risk for medical complications and should prompt admission for IV antibiotics
6. In a patient presenting with neutropenic fever, which of the following situations should vancomycin be given in addition to gram negative antipseudomonal coverage?*
- a. Hemodynamic instability in sepsis
- b. Suspected catheter infection
- c. History of colonization with MRSA
- d. Radiographic evidence of pneumonia
- e. All of the above situations require vancomycin administration
7. Which of the following metabolic derangements is not included in tumor lysis syndrome?*
- a. Hyperkalemia
- b. Hyperphosphatemia
- c. Hypercalcemia
- d. Hyperuricemia
8. What is the best preventative treatment for tumor lysis syndrome?*
- a. Allopurinol 48hrs prior to chemotherapy in combination IV fluids
- b. High dose steroids in combination with IV fluids
- c. Antibiotics
- d. Early renal replacement therapy
9. Which of the following may contribute to hypercalcemia?*
- a. Low phosphorus
- b. Thiazide diuretics
- c. Enteral calcium supplementation (tube feeds, supplements)
- d. A and C
- e. All of the above
10. What is the treatment of hyperviscosity syndrome?*
- a. High dose steroids
- b. Emergent start of chemotherapy
- c. RBC transfusion
- d. Emergent plasmapheresis

Immunologic Causes of Allograft Dysfunction after Lung Transplantation

*Please take the quiz below the video to receive credit.

Objectives

Identify the criteria for lung transplantation
Recognize clinical manifestations for the different types of graft rejection
Describe treatment for patients with lung transplantation rejection

Articles

Course of Illness after the Onset of Chronic Rejection in Lung Transplant RecipientsCourse of Illness after the Onset of Chronic Rejection in Lung Transplant Recipients
Prevention of chronic rejection after lung transplantation

Lecture

Quiz

Allograft Dysfunction Quiz

Name*
First Last
1. The first successful heart-lung transplantation occurred in?*
- a. 1964
- b. 1971
- c. 1981
- d. 1987
2. Patients with pulmonary arterial hypertension who require lung transplantation are those who*
- a. Have disease progression on maximal medical therapy
- b. 6-minute walk test less than 350 m
- c. Cardiac index below 2L/min
- d. Right atrial pressure above 15mmHg
- e. All the above
3. What type of rejection occurs within the first 72 hours of transplantation?*
- a. Hyperacute rejection
- b. Primary graft dysfunction
- c. Acute Rejection
- d. Chronic allograft dysfunction
4. The incidence of primary graft dysfunction is*
- a. Less than 1%
- b. 5-10%
- c. 20-30%
- d. 10-35%
5. Which of the following is NOT a risk factor for developing primary graft dysfunction?*
- a. White Race
- b. Smoking history
- c. Greater than age 45
- d. Obesity
6. True or False: Acute rejection is driven by recognition of donor antigens by recipient lymphocytes as nonself.*
- True
- False
7. Which of the following is used in the management of hyperacute rejection?*
- a. High dose steroids
- b. Plasmapheresis
- c. IVIG
- d. Rituximab/bortezomib
- e. All the above
9. mTor inhibitors aren’t used often in lung transplantations during the first 6 months due to*
- a. Anastomosis dehiscence
- b. Pneumonitis
- c. A & B
- d. None of the above
10. True or False: I have watched the video in its entirety and have not received help while answering the post-lecture questions*
- True
- False

Critical Care Management for the Lung Transplant Recipient

*Please take the quiz below the video to receive credit.

Objectives

List the indications and contraindications for lung transplantation
Identify pathogenesis for common presentations of graft dysfunction
Formulate plan of action for common causes of graft dysfunction

Articles

Lung transplantation: indications and contraindications
Lung Transplantation in Idiopathic Pulmonary Fibrosis

Lecture

Quiz

Lung Transplant Quiz

Name*
First Last
1. What percent of lung donations result from traumas?*
- a. 10-20%
- b. 30-40%
- c. 50-60%
- d. 70-80%
2. What is the age cut off for bilateral lung transplant in a patient with emphysema?*
- a. 45
- b. 50
- c. 55
- d. 60
3. True or False: Intra-op lung transplant surgery patients are typically given low volumes of fluid resuscitation (“ran dry”).*
- True
- False
4. Which of the following are the best initial assessment tools to assess graft function?*
- a. Arterial blood gas
- b. CT Scan
- c. Chest X-ray
- d. A and C
5. Which of the following is a reason for early tracheostomy in patients with a lung transplant?*
- a. Patient comfort
- b. Continued access to anastomoses sites
- c. Easier participation in physical and occupational therapy
- d. All the above
6. True or false: Due to tissue ischemia after surgery, it is normal to see tissue sloughing distal to the anastomoses site when performing a bronchoscopy.*
- True
- False
7. Which of the following is NOT an indication for bronchoscopy after lung transplant surgery?*
- a. Concerns for torsion
- b. Infection surveillance
- c. Biopsy for rejection/infection
- d. Therapeutic to relieve secretions
- e. All the above are indications for bronchoscopy
8. Which of the following is NOT a cause of primary graft disfunction?*
- a. Cold/warm ischemia time
- b. Infection of graft
- c. Organ manipulation
- d. Removal from natural blood supply
9. True or False: Recipients of lung transplants are at high risk of aspiration post op therefore it is highly recommended that speech and swallow exams are completed prior to PO intake.*
- True
- False
10. True or False: I have watched the lecture in its entirety and have not received help in answering the post video questionnaire.*
- True
- False

Lung Resection

*Please take the quiz below the video to receive credit.

Objectives

Identify patients who are appropriate candidates for lung resection
Formulate an appropriate plan of care for the post lung resection patient
Recognize common post-operative complications associated with lung resections

Articles

Surgical Management of Lung Cancer
Postoperative Care and Complications After Thoracic Surgery

Lecture

Quiz

Lung Resection

Name*
First Last
1. True or False: Extubation of thoracic patients in OR is always preferable.*
- True
- False
2. True or False: Optimal technique for removing a chest tube after pulmonary resection is after full exhalation.*
- True
- False
3. Which of the following is NOT a risk factor for developing a VTE in a thoracic surgical patient?*
- a) Cancer
- b) Older than 60 years old
- c) Procedure > 90 mins
- d) Central venous catheterization
- e) All the above are risk factors
4. The mortality rate associated with VTE at 3 months is as high as*
- a) 3%
- b) 5%
- c) 17%
- d) 25%
5. Which of the following is the typical perioperative antibiotic given to thoracic patients?*
- a) Ancef
- b) Vancomycin
- c) Cefepime
- d) Ampicillin
6. Which of the following is NOT true regarding post of medication management of lung resection patients?*
- a) Restart beta-blockers immediately
- b) Discontinue prophylactic antibiotics within 24 hrs
- c) Continue stress ulcer prophylaxis in high risk patients
- d) Restart all home antihypertensives immediately
7. All of the following should be restarted immediately post-op if possible EXCEPT?*
- a) Out of bed as early as possible
- b) Encourage incentive spirometry
- c) Chest physiotherapy
- d) All the above should be restarted immediately
8. Which of the following perpetrate post-pneumonectomy pulmonary edema?*
- a) Changes in pulmonary endothelial permeability
- b) Disruption of lymphatic drainage
- c) Multiple blood transfusions
- d) Intra-op volume resuscitation
- e) All the above
9. True or False: Post-pneumonectomy syndrome is most common after left pneumonectomy.*
- True
- False
10. True or False: I have watched the lecture in its entirety and have not received help in answering the post video questionnaire.*
- True
- False

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm Presentation Slides

Extra-Corporeal Membrane Oxygenation (ECMO)

Department of Anesthesiology

College of Medicine

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