3 - Thoracic Surgery

Question 1

Stepwise approach to radiograph?

Answer 1

Adequacy
Bones
Cardiac silhouette
Density
Edema
Foreign bodies

Question 2

Infiltrate

Answer 2

Fluid in the lung

Question 3

Effusion

Answer 3

Fluid in the pleural space

Question 4

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

Answer 4

Pus

Question 5

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

Answer 5

Serous

Question 6

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

Answer 6

Blood

Question 7

Cavitation can be seen with what kinds of diseases?

Answer 7

TB

Fungal infection

Question 8

What are blebs or bulla?

Answer 8

Thin-walled, contain air

Question 9

Describe lung abscesses

Answer 9

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

Question 10

Describe the presentation on CXR for pulmonary edema

Answer 10

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

cephalization

Bilateral perihilar infiltrates

Question 11

Procedure to remove fluid of pleural effusion?

Answer 11

Thoracentesis

Question 12

How will diaphragmatic hernia look?

Answer 12

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

Question 13

Describe atelectasis

Answer 13

Collapsed alveoli

Question 14

Cardiomegaly

Answer 14

Heart greater than 50% of the width of the chest

Possibly displaced PMI (left)

Question 15

What causes Transudative fluid?

Answer 15

Increased vascular permeability or low osmotic pressure

CHF, liver failure

Question 16

What causes Exudative fluid?

Answer 16

Usually inflammatory

CA, pneumonia

Question 17

Thoracentesis

Answer 17

Needle drainage of pleural effusion

Question 18

Thoracostomy

Answer 18

Chest tube

“S” in thoracostomy - Suck the fluid out

Question 19

Pleurodesis

Answer 19

Used to scar the lining of the lung

Used in people that have recurrent effusions

ABX and cautery

Question 20

Simple pneumo

Answer 20

“Collapsed” lung - with no change in vitals

Urgent txt to expand lung

Question 21

Tension pneumo

Answer 21

Vital sign changes

Needle decompression then thoracostomy

Question 22

Open pneumo

Answer 22

Penetrating

Sucking chest wound

Question 23

Closed pneumo

Answer 23

Blunt trauma

Intact chest wall

Question 24

Causes of spontaneous pneumo

Answer 24

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

Question 25

Causes of traumatic pneumo

Answer 25

Blunt chest trauma Penetrating trauma Barotrauma Thoracic procedures

Question 26

Txt for pneumo

Answer 26

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

Question 27

Causes of pulmonary infiltrates and consolidation

Answer 27

``` Pneumonia Pulmonary contusion Inhalation injury Sepsis ARDS ```

Question 28

Txt for pulmonary infiltrates

Answer 28

ABX Antifungals Ventilatory support Aggressive pulm toilet

Question 29

Lung masses that are touching bronchus can lead to

Answer 29

Cough / hemoptysis

Question 30

Lung mass in pleura can lead to:

Answer 30

Chest wall pain

Question 31

Lung masses that cause narrowing of the bronchus can lead to

Answer 31

Atelectasis

Question 32

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

Answer 32

Hemoptysis

Question 33

NSCLC leads to what paraneoplastic syndrome?

Answer 33

Hypercalcemia PTH-like substance is produced Metastasis to the bone

Question 34

Small cell lung cancer leads to what paraneoplastic syndrome?

Answer 34

ADH like substance SIADH -> low serum Na MSH production -> hyperpigmentation ACTH production -> increased cortisol -> Cushings -> glucose intolerance

Question 35

Pancoast tumor leads to what paraneoplastic syndrome?

Answer 35

Brachial plexus, cervical lymph chain Ulnar nerve compression Horner’s triad SVC syndrome

Question 36

Tissue dx of lung masses

Answer 36

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

Question 37

Percutaneous trans-thoracic biopsy

Answer 37

CT or fluoro guided - through chest wall

Question 38

MC primary types of lung CA

Answer 38

Adenocarcinoma Squamous cell carcinoma - often central

Question 39

Common sites of metastasis

Answer 39

Lung Liver Bone Brain

Question 40

80% of solitary nodules are:

Answer 40

Infectious granulomas TB or fungal infx

Question 41

Benign lung masses

Answer 41

``` Less than 2cm Stable over 24 mos Concentric calcification Smooth border Solitary lesion ```

Question 42

Malignant lung masses

Answer 42

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

Question 43

Unresectable

Answer 43

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

Question 44

Inoperable

Answer 44

Unstable pt due to comorbidities

Question 45

Cancer staging

Answer 45

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

Question 46

are you pleural effusion?

Answer 46

Cause i cant breath when youre around