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Thoracic > all of chest > Flashcards

all of chest Flashcards

1
Q

treatment of chylothorax

A

start with NPO and TPN; if unresponsive after 5-7 days of conservative management then surgical ligation of thoracic duct; lymphoscintigraphy and thoracic duct embolization for patients who are poor surgical candidates

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2
Q

most common cause of nontraumatic chylothorax

A

lymphoma

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3
Q

treatment of retained hemothorax

A

first line tx is VATS; intrapleural fibrinolytics are recommended 2nd line (after surgery) or for patients if risk of surgery is too great

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4
Q

most common cause of chronic or fibrosing mediastinitis

A

Histoplasma, commonly causes mediastinal granuloma

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5
Q

true or false. aggressive blood glucose management both intraoperatively and posteroperatively has serious impact on rates of deep sternal wound infections and subsequent development of mediastinitis in both diabetic and nondiabetic patients

A

true

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6
Q

factors predictive on PFTs of ability to tolerate pneumonectomy/pulmonary resection

A

predicted posteroperative diffusion capacity of lungs for carbon monoxide (DLCO) > 60%; predicted postop FEV1 > 60%

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7
Q

patients who smoke should quit for at least _____ before lung surgery

A

4 weeks

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8
Q

patients with PPO FEV1 or DLCO <30% before lung surgery should undergo:

A

formal preop cardiopulmonary exercise testing with measurement of maximal oxygen consumption

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9
Q

confirmation of superior vena cava syndrome on CT scan:

A

nonopacification of the SVC inferior to the site of obstruction as well as opacification of collateral venous structures in the chest including the azygous and right intercostal veins

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10
Q

surgical treatment of primary lung cancers

A

anatomic lobectomy with lymph node staging

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11
Q

what populations should undergo annual low dose CT chest for lung cancer surveillance:

A

patients 55-80 with 30 pack year smoking history who currently smoke or quit within the past 15 years

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12
Q

cell findings consistent with exudative effusion

A

low glucose, low pH, high LDH; blood tinge is more suggestive of malignancy whereas empyema fluid is purulent

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13
Q

risk of recurrence of sponanteous pneumothorax without operative intervention:

A

60%

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14
Q

malignant pleural effusion denotes stage ____ lung cancer

A

IV; M1a disease present and resection is not recommended in most cases

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15
Q

triglyceride level above 110 in CT fluid is diagnostic for:

A

chylothorax

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16
Q

best approach for access to the heart

A

median sternotomy

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17
Q

left posterolateral thoracotomy allows access to what?

A

left ventricle, descending aorta, and distal esophagus

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18
Q

right posterolateral thoracotomy allows access to what?

A

trachea, bilateral mainstem bronchi, proximal/mid esophagus

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19
Q

treatment of malignant SVC syndrome:

A

often an oncologic emergency due to rapid progression; treat with high dose radiation and chemo initially

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20
Q

Lights criteria for exudative effusion:

A

anyone of these - effusion protein/serum protein ratio of >0.5, effusion LDH/serum LDH ratio >0.6; effusion LDH >2/3 the upper limit of normal range of serum LDH

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21
Q

true or false: mediastinal lymphadenopathy (N2 disease) in a tumor of the superior sulcus is not contraindication to surgical resection

A

false

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22
Q

symptoms of SVC syndrome

A

SOB, facial plethora & cyanosis, headache, papilledema, R UE edema, altered sensorium; 80% due to external compression from mediastinal tumor

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23
Q

to proceed with pneumonectomy, the contralateral lung needs what FEV1?

A

800cc (0.8L)

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24
Q

absolute contraindications to oncologic lung resection for lung cancer:

A

N2 (mediastinal) or N3 (contralateral supraclaviular) nodal disease
>50% vertebral body involvement
brachial plexus involvement above T1 nerve
invasion of esophagus or tracha

25
Q

relative contraindications to oncologic lung rection for lung cancer:

A

N1 or N3 (ipsilateral supraclavicular) nodal disease
invasion of subclavian artery
<50% vertebral body involvement
intraforaminal extension
invasion of common carotid or vertebral artery

26
Q

features of pancoast tumor:

A

superior sulcus tumor; usually NSCLC near the thoracic inlet at the apex of the lung; commonly invade chest wall including the first through third ribs and vertebrae

27
Q

presentation of pancoast/superior sulcus tumor:

A

shoulder pain in c8 and t1 dermatomes, paresthesia and weakness in ulnar distribution, horner syndrome (ptosis, miosis, anhidrosis)

28
Q

treatment of pancoast/superior sulcus tumor:

A

chemorads upfront followed by en bloc resection if resectable

29
Q

most common benign tumor of the lung

A

hamartoma

30
Q

radiologic features of hamartomas:

A

well-circumscribed nodule with popcorn calcification

31
Q

most common tumors of posterior mediastinum:

A

neurogenic tumors

32
Q

features of squamous cell carcinoma of the lung:

A

usually centrally located and associated with PTH-related peptide production

33
Q

features of small cell lung cancer:

A

ADH and ACTH paraneoplastic syndromes

34
Q

diagnostic test of choice for suspected TEF in adults:

A

bronchoscopy

35
Q

true or false. in an upright patient, the lung apex will have the high V/Q ratio and the base will be low

A

true

36
Q

conditions that cause low V/Q ratios

A

asthma, pulmonary edema

37
Q

conditions that cause high V/Q ratios

A

PE and COPD

38
Q

what does V/Q ratio of zero indicate

A

loss of ventilation; known as shunting

39
Q

what does a V/Q ratio of infinity or undefined indicate

A

an area with ventilation but no perfusion, called dead space

40
Q

PFT findings that are contraindications to lung resection?

A

DLCO<40%, postop FVC<1.5L

41
Q

VO2 is a measure of ____. Optimal values are ___

A

measure of exercise tolerance; optimal values are >10-12 mL/min/kg

42
Q

if preop FEV1<0.8L this study can be performed to see if patient can still tolerate a lobectomy

A

V/Q scan; can resect if resected lobe has minimal contribution to FEV1

43
Q

type of pneumonia characterized by thick, bloody mucoid sputum

A

Klebsiella pneumonia (currant jelly sputum)

44
Q

common VAP organisms include:

A

Pseudomonas, Staph aureus, H. flu, Strep pneumo, Enterobacter cloacae

45
Q

True or false. Smaller chest tubes are not as effective as larger ones in evacuating blood from the pleural space.

A

False

46
Q

Chest tube placement should be avoided if less than ____cc of blood is in the pleural space.

A

300cc

47
Q

management of malignant chylothorax:

A

respond favorably to chemorads; duct ligation and embolization are usually ineffective

48
Q

True or false. Pulmonary metastatectomy improves overall survival in sarcoma patients with isolated pulmonary mets.

A

True

49
Q

Cause of spontaneous pneumomediastinum:

A

alveolar rupture with tracking along the bronchovascular bundle to the mediastinum

50
Q

Symptoms and treatment of spontaneous pneumomediastinum:

A

chest pain, SOB, neck pain/crepitus; fever is uncommon

CT shows diffuse pneumomediastinum without pleural effusion or fluid collections

treat with pain control and observation

51
Q

True or false. Surgical rib fracture fixation after blunt chest trauma reduces pulmonary morbidity, particularly incidence of pneumonia and duration of mechanical ventilation.

A

true

52
Q

What is milrinone’s mechanism of action and what is it commonly used to treat?

A

phosphodiesterase type III inhibitor that causes increased contractility in cardiogenic shock and induces pulmonary vasodilation in pulmonary hypertension; improves right ventricular function and pulmonary hemodynamics

53
Q

Normal aortic valve area:

A

3-4 cm squared

54
Q

Which patients with aortic stenosis should have valve replacement?

A

those that are symptomatic or who have a valve area <1cm squared

55
Q

What location is thoracentesis performed?

A

between the scapula and the mid axillary line (posterior axillary line), never below the 8th interspace; typically for large effusions it is performed 2-3 interspaces below the top margin of the effusion (as long as it is above 8); typically do in the sitting position leaning forward

56
Q

Signs and symptoms of post-pericardiotomy syndrome/post cardiac injury syndrome?

A

fever, pleuritic chest pain 1-3 weeks after injury (surgery/CABG or trauma), pericardial friction rub, elevated wbc, elevated esr, elevated crp; diffuse ST segment elevation with PR depression, pericardial effusion on echo

57
Q

Work up of post-pericardiotomy syndrome?

A

echo, EKG, labs and CXR

58
Q

Tx of post-pericardiotomy syndrome?

A

NSAIDS

Thoracic (1 decks)

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