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Senior - Surgery 2 > 3 - Thoracic Surgery > Flashcards

3 - Thoracic Surgery Flashcards

1
Q

Stepwise approach to radiograph?

A 
Adequacy
Bones
Cardiac silhouette
Density
Edema
Foreign bodies
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2
Q

Infiltrate

A

Fluid in the lung

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3
Q

Effusion

A

Fluid in the pleural space

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4
Q

If the pt has pneumonia, what is the fluid in the infiltrate?

A

Pus

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5
Q

If the patient has pulmonary edema, the fluid in the infiltrate is:

A

Serous

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6
Q

If the patient has pulmonary contusion, the fluid in the infiltrate is:

A

Blood

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7
Q

Cavitation can be seen with what kinds of diseases?

A

TB

Fungal infection

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8
Q

What are blebs or bulla?

A

Thin-walled, contain air

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9
Q

Describe lung abscesses

A

Thick-walled cavity, contains fluid, inflammatory cells and organisms

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10
Q

Describe the presentation on CXR for pulmonary edema

A

Fluid “leaks” from the vessels into alveoli and lung tissues

cephalization

Bilateral perihilar infiltrates

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11
Q

Procedure to remove fluid of pleural effusion?

A

Thoracentesis

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12
Q

How will diaphragmatic hernia look?

A

No lung markings in the lower left lung field

Mediastinum is shifted to the right

Diaphragm is ruptured

Stomach is in left chest

Stomach is full of air

Needs surgery

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13
Q

Describe atelectasis

A

Collapsed alveoli

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14
Q

Cardiomegaly

A

Heart greater than 50% of the width of the chest

Possibly displaced PMI (left)

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15
Q

What causes Transudative fluid?

A

Increased vascular permeability or low osmotic pressure

CHF, liver failure

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16
Q

What causes Exudative fluid?

A

Usually inflammatory

CA, pneumonia

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17
Q

Thoracentesis

A

Needle drainage of pleural effusion

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18
Q

Thoracostomy

A

Chest tube

“S” in thoracostomy - Suck the fluid out

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19
Q

Pleurodesis

A

Used to scar the lining of the lung

Used in people that have recurrent effusions

ABX and cautery

20
Q

Simple pneumo

A

“Collapsed” lung - with no change in vitals

Urgent txt to expand lung

21
Q

Tension pneumo

A

Vital sign changes

Needle decompression then thoracostomy

22
Q

Open pneumo

A

Penetrating

Sucking chest wound

23
Q

Closed pneumo

A

Blunt trauma

Intact chest wall

24
Q

Causes of spontaneous pneumo

A 
Smoker
Marfan’s
Thin build
Emphysema / blebs
CF
Lung CA
25
Q

Causes of traumatic pneumo

A

Blunt chest trauma
Penetrating trauma
Barotrauma
Thoracic procedures

26
Q

Txt for pneumo

A

Simple - thoracostomy
Tension - needle decomp
Open - one-way valve (chest seal), then thoracostomy
Closed - thoracostomy

27
Q

Causes of pulmonary infiltrates and consolidation

A 
Pneumonia
Pulmonary contusion 
Inhalation injury
Sepsis
ARDS
28
Q

Txt for pulmonary infiltrates

A

ABX
Antifungals
Ventilatory support
Aggressive pulm toilet

29
Q

Lung masses that are touching bronchus can lead to

A

Cough / hemoptysis

30
Q

Lung mass in pleura can lead to:

A

Chest wall pain

31
Q

Lung masses that cause narrowing of the bronchus can lead to

A

Atelectasis

32
Q

Lung masses in the mid parenchyma away from bronchus can lead to

A

Hemoptysis

33
Q

NSCLC leads to what paraneoplastic syndrome?

A

Hypercalcemia
PTH-like substance is produced
Metastasis to the bone

34
Q

Small cell lung cancer leads to what paraneoplastic syndrome?

A

ADH like substance

SIADH -> low serum Na

MSH production -> hyperpigmentation

ACTH production -> increased cortisol -> Cushings -> glucose intolerance

35
Q

Pancoast tumor leads to what paraneoplastic syndrome?

A

Brachial plexus, cervical lymph chain

Ulnar nerve compression

Horner’s triad

SVC syndrome

36
Q

Tissue dx of lung masses

A

Bronchio-alveolar lavage - inject saline, aspirate out and send for cytology

Trans-bronchial bioppsy - biopsy through bronchial wall

Endobronchial ultrasound — FNA of mediastinal nodes / mass

37
Q

Percutaneous trans-thoracic biopsy

A

CT or fluoro guided - through chest wall

38
Q

MC primary types of lung CA

A

Adenocarcinoma

Squamous cell carcinoma - often central

39
Q

Common sites of metastasis

A

Lung
Liver
Bone
Brain

40
Q

80% of solitary nodules are:

A

Infectious granulomas

TB or fungal infx

41
Q

Benign lung masses

A 
Less than 2cm
Stable over 24 mos
Concentric calcification
Smooth border
Solitary lesion
42
Q

Malignant lung masses

A 
More than 2cm
Increased or unstable over 24 mos
Irregular calcifications
Spiculated border
Multiple lesions
43
Q

Unresectable

A

Tumor has invaded vital structures - can’t cut it out

44
Q

Inoperable

A

Unstable pt due to comorbidities

45
Q

Cancer staging

A

T - tumor size (cm)
N - nodal involvement
M - metastasis (y/n)

46
Q

are you pleural effusion?

A

Cause i cant breath when youre around

Senior - Surgery 2 (9 decks)

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