True or false: chylothorax in older children is often spontaneous?

1.   ?    True
2.   ?    False

What type of delivery is associated with an increased incidence of spontaneous chylothorax in infants?

1.   ?    Vaginal
2.   ?    Cesarean
3.   ?    There is no such association

The mature thoracic duct shifts from right to left at about ___

1.   ?    T2
2.   ?    T5
3.   ?    T8

Which is not a recognized cause of chylothorax?

1.   ?    Tumor
2.   ?    SVC thrombosis
3.   ?    Prematurity
4.   ?    Lymphangiomatosis

What hiatus does the thoracic duct pass through?

1.   ?    None
2.   ?    Caval
3.   ?    Aortic
4.   ?    Esophageal

Where does the thoracic duct originate?

1.   ?    Junction of SVC and Left IJ
2.   ?    T5
3.   ?    T10
4.   ?    L2 - cysterna chyli

Where does the thoracic duct empty into the vascular system?

1.   ?    Junction of the left subclavian vein and the left internal jugular
2.   ?    Junction of azygous and SVC
3.   ?    Junction of the right subclavian vein and the left internal jugular

What cardiac operation is NOT particularly prone to chylothorax?

1.   ?    BT Shunt
2.   ?    PDA ligation
3.   ?    Arterial switch
4.   ?    Repair of aortic coarctation

What is the rate of peristalsis possible in the thoracic duct as a result of smooth muscle in the wall of the vessel?

1.   ?    50 - 200 ml/hr
2.   ?    150 - 400 ml/hr
3.   ?    20 ml/hr

The total protein content of the thoracic lymph is high or low?

1.   ?    Low (1 gm/dL)
2.   ?    High (5 gm/dL)

How often is classic thoracic duct anatomy seen in real life?

1.   ?    10%
2.   ?    30%
3.   ?    50%
4.   ?    80%

What is the fat content of chyle?

1.   ?    0.4 - 4 gm/dL
2.   ?    10 - 20 gm/dL
3.   ?    5.0 - 10 gm/dL
4.   ?    0.1 - 1 gm/dL

How much of the fat that is ingested is carried in the chyle of the thoracic duct?

1.   ?    25%
2.   ?    50%
3.   ?    75%
4.   ?    90%

Whch is not a recognized complication of chylothorax?

1.   ?    Malnutrition
2.   ?    Metabolic alkalosis
3.   ?    Hypoproteinemia
4.   ?    Immunodeficiency

What kind of fats are absorbed through the portal circulation?

1.   ?    Split fats
2.   ?    Large chain fatty acids
3.   ?    Short chain fatty acids

The usual treatment of chylothorax in the newborn is simple chest tube drainage, since the chance of spontaneous resolution is high?

1.   ?    True
2.   ?    False

Which is NOT an appropriate treatment of chylothorax?

1.   ?    Denver shunt if ligation fails
2.   ?    MCT or TPN for 2 - 3 weeks with chest tube drainage
3.   ?    Thoracoscopic fibrin glue injection for failure after 4 weeks of TPN
4.   ?    Thoracic duct ligation after preop administration of cream

Spontaneous resolution is uncommon in neonatal chylothorax - T or F?

1.   ?    True
2.   ?    False

What congenital heart problem is associated with rupture of subplueral lymphatics into the pleural cavity?

1.   ?    Tetralogy of Fallot
2.   ?    Totally anomalous pulmonary venous return
3.   ?    Eisenmenger's complex