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Fiser ABSITE Review + Decker + TrueLearn > Chapter 25 – Thoracic > Flashcards

Chapter 25 – Thoracic Flashcards

1
Q

What is the path of the azygos vein?

A

Runs along the right side and dumps into superior vena cava

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2
Q

What is the path of the thoracic duct?

A

Runs along the right side, crosses midline and dumps into left subclavian vein at junction with IJ

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3
Q

Which mainstem bronchi is longer?

A

Left

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4
Q

Which pulmonary artery is longer?

A

Right

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5
Q

Which nerve runs in anterior to hilum? Which runs posterior to hilum?

A

Anterior – phrenic; posterior – vagus

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6
Q

What percentage of total lung volume is the right lung volume? What is the left lung volume?

A

55%; 45%

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7
Q

What percent of the work is done by the diaphragm and quiet inspiration?

A

80%

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8
Q

What are the accessory muscles of respiration?

A

Sternocleidomastoid, levators, serratus posterior, scalenes

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9
Q

What is the function of type I pneumocyte? Type II pneumocytes?

A

Type I: gas exchange; type II: surfactant production

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10
Q

What is the purpose of pores of Kahn?

A

Direct air exchange between alveoli

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11
Q

How much pleural fluid is made in a day? Where is it cleared?

A

1-2 L produced by the parietal pleura, cleared by lymphatics in the visceral plural

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12
Q

What FEV1 is needed before surgery?

A

Greater than 0.8 or 40% of predicted value

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13
Q

What predicted DLCO is needed before surgery?

What is DLCO representative of?

A

Greater than 11 to 12 mL/min/mmHg CO, at least 50% of the predictive value

Represents carbon dioxide diffusion capacity

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14
Q

What value of pCO2 or CO2 is needed prior to resection?

A

pCO2 greater than 45, CO2 less than 50

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15
Q

Persistent air leak is most common after what operation?

A

Segmentectomy, wedge

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16
Q

Symptoms of lung cancer?

A

Asymptomatic with findings on routine chest x-ray, pneumonia, pain, weight loss

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17
Q

What is the most common cause of cancer related death in the United States?

A

Lung cancer

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18
Q

What aspect of lung cancer has the strongest influence on survival?

A

Nodal involvement

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19
Q

What is the single most common site of lung cancer metastasis?

A

Brain

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20
Q

How does lung cancer recurrence present? What percent of recurrences are within the first three years?

A

Most commonly appears as disseminated metastases; 80%

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21
Q

What is the overall five-year survival rate of lung cancer? With resection?

A

10%; 30%

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22
Q

Which stages of lung cancer are resectable?

A

Stage I and II

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23
Q

What is the most common lung cancer?

A

Adenocarcinoma

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24
Q

What percent of lung cancer is non-small cell carcinoma?

A

80%

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25
Q

What type of non-small cell carcinoma is associated with more peripheral lesions and distant metastases?

A

Adenocarcinoma

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26
Q

What type of non-small cell carcinoma is associated with local recurrence and more central lesions?

A

Squamous cell carcinoma

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27
Q

What percent of lung cancer is small cell carcinoma?

A

20%

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28
Q

What is the overall five-year survival rate for small cell carcinoma?

A

Very poor, less than 5% are candidates for surgery; 50%

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29
Q

What paraneoplastic syndrome is associated with squamous cell carcinoma?

What two are associated with small cell carcinoma? Which is most common?

A

Squamous cell – PTH related peptide

Small cell – ACTH (most common), ADH

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30
Q

What is the most malignant lung tumor?

A

Mesothelioma

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31
Q

Chemotherapy used for non-small cell carcinoma stage II or higher?

A

Carboplatin, Taxol

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32
Q

What chemotherapy is used for small cell lung cancer?

A

Cisplatin, etoposide

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33
Q

What findings would prompt use of mediastinoscopy?

A

Centrally located tumors, patients with suspicious adenopathy, ipsilateral and contralateral mediastinal nodes

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34
Q

What is the Chamberlain procedure?

A

Assesses aortopulmonary window nodes; mediastinoscopy through left second rib cartilage

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35
Q

What is a Pancoast tumor?

A

Tumor invades apex of chest wall and patients have Horner’s syndrome or ulnar nerve symptoms

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36
Q

Which cancers’ mets to the lung may be resected if isolated and not associated with any other systemic disease?

A

Colon, renal cell cancer, sarcoma, melanoma, ovarian or endometrial cancer

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37
Q

What are the characteristics of a carcinoid tumor?

A

Neuroendocrine tumor, central, 50% with symptoms

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38
Q

What is the five-year survival of a typical carcinoid? Atypical carcinoid?

A

90%, 60%

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39
Q

What bronchial adenomas are malignant?

A

Adenoid cystic adenoma, mucoepidermoid adenoma, mucous gland adenoma

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40
Q

What is the spread of adenoid cystic adenoma?

A

Spread along perineural lymphatics, beyond endoluminal compartment; slow-growing, can get 10 year survival with incomplete resection

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41
Q

What is the most common benign adult lung tumor?

A

Hamartomas

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42
Q

What do hamartoma lesions look like on chest CT?

A

Have calcifications, appear as popcorn lesion

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43
Q

Do hamartomas require resection?

A

No; repeat chest CT in six months to confirm diagnosis

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44
Q

What is the most common mediastinal tumor in adults and children?

A

Neurogenic

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45
Q

What is the most common site for mediastinal tumor?

A

Anterior

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46
Q

What tumors can be found in the anterior mediastinum?

A

Lots of “Ts”:

  • Thymoma
  • Thyroid cancer
  • paraThyroid adenoma
  • T-cell lymphoma
  • Teratoma
47
Q

What is the number one anterior mediastinal mass in adults?

A

Thymoma

48
Q

What tumors can be found in the middle mediastinum?

A

Lots of cysts:

  • bronchiogenic cyst
  • pericardial cyst
  • enteric cyst
  • lymphoma
49
Q

What tumors can be found in the posterior mediastinum?

A

Enteric cyst, neurogenic tumor, lymphoma

50
Q

What percent of thymomas are malignant? What percent have symptoms? What percent are associated with myasthenia gravis?

A

50%, 50%, 50%

51
Q

What percent of patients with myasthenia gravis have thymomas?

A

10%

52
Q

Treatment of thymomas?

A

All require resection, anti-cholinesterase medications, plasmapheresis, steroids

53
Q

What is the most common type of lymphoma?

A

T cell non-Hodgkin’s lymphoma

54
Q

What type of Hodgkin’s lymphoma is most common?

A

Nodular sclerosing

55
Q

What is the treatment for lymphoma?

A

Chemo and radiation

56
Q

What is the most common germ cell tumor in the mediastinum? What is the most common malignant germ cell tumor in the mediastinum?

A

Teratoma, seminoma

57
Q

Treatment for germ cell tumors?

A

Resection and chemotherapy with radiation for seminomas

58
Q

What percent of nonseminoma tumors have elevated beta hCG and alpha-fetoprotein?

A

90%

59
Q

Where are bronchiogenic cysts? What is their treatment?

A

Posterior to carina, resection

60
Q

Where are pericardial cyst found? What is their treatment?

A

At right costophrenic angle, resection

61
Q

What is the most common neurogenic tumor? Treatment?

A

Neurolemmoma, resection

62
Q

Paragangliomas produce what?

A

Catecholamines

63
Q

Nerve sheath tumors are associated with what syndrome?

A

Von Recklinghausen’s

64
Q

What percent of symptomatic mediastinal masses are malignant?

A

50%

65
Q

What percent of asymptomatic mediastinal masses are benign?

A

90%

66
Q

What are benign tumors of the trachea in adults? children?

A

Adults – papilloma, children – hemangioma

67
Q

What are malignant tumors of the trachea?

A

Squamous cell carcinoma

68
Q

What is the most common early complication after tracheal surgery? Late?

A

Laryngeal edema; granulation tissue formation

69
Q

Where is post intubation stenosis?

A

At stoma site with tracheostomy, at cuff with ET tube

70
Q

Where does a tracheostomy need to be placed so as not to risk tracheoinnominate fistula?

A

Between the first and second tracheal rings, not lower than third rings

71
Q

Treatment for tracheoinnominate fistula?

A
  • overinflated balloon or stick your finger in the tracheotomy and compress the innominate
  • resect innominate and place graft
  • use new tracheostomy site
72
Q

Management of tracheoesophageal fistula?

A

Use large volume cuff below fistula, may need decompressing gastrostomy, tracheal resection, reanastomosis, sternohyoid flap

73
Q

Long abscesses are most commonly associated with what? What segment of the long are they most commonly in?

A

Aspiration; posterior segment of RUL and superior segment of RLL

74
Q

Treatment for lung abscess?

A

Antibiotic 95% successful, CT guided drain if that fails, surgery if drain fails or cannot rule out cancer

75
Q

What causes empyemas?

A

Secondary to pneumonia and subsequent parapneumonic effusion (staph, strep)

76
Q

Symptoms of empyema?

A

Pleuritic chest pain, fever, cough, SOB

77
Q

What will the pleural fluid show in empyema?

A

WBCs >500 cells/cc, bacteria, positive G stain

78
Q

3 phases of empyema?

A

Exudative (1st week), fibroproliferative phase (2nd week), Organized phase (3rd week)

79
Q

Treatment of empyema in the exudative phase?

A

Chest tube, abx

80
Q

Treatment of empyema in fibroproliferative phase?

A

Chest tube, abx

81
Q

Treatment of empyema in organized phase?

A

Likely decortication; fibrous peel around lung, Eloesser flap, chronic chest tube gradually pulled out

82
Q

What is an Eloesser flap?

A

Direct opening to external environment

83
Q

Chylothorax fluid characteristics?

A

Milky white; high lymphocytes and TAGs (>110), Sudan red stains fat

84
Q

What is the cause of chylothorax?

A

50% trauma/iatrogenic injury to thoracic duct, 50% tumor (lymphoma most common)

85
Q

What level injury causes left sided chylothorax? Right sided?

A

Thoracic duct injury:

  • Left: above T5-6
  • Right: below T5-6
86
Q

Treatment for chylothorax?

A

3-4wk conservative: CTb, octreotide, low-fat diet or TPN; if fails: surgery with ligation of thoracic duct on R. low in mediastinum

87
Q

What is considered massive hemoptysis?

A

>600cc/24h

88
Q

What is the bleeding from in massive hemoptysis?

A

High pressure bronchial arteries

89
Q

What is the most common etiology of massive hemoptysis?

A

Most commonly secondary to infection, mycetoma most common

90
Q

Treatment of massive hemoptysis?

A
  • place bleeding side down
  • rigid bronch
  • mainstem intubation to side opposite bleeding
  • OR for lobectomy or pneumonectomy
  • bronchial artery embolization if not good for OR
91
Q

What is the recurrence risk of spontaneous pneumothorax after 1st? 2nd? 3rd?

A

1st: 20%, 2nd: 60%, 3rd: 80%

92
Q

Treatment for spontaneous pneumothorax?

When is surgical intervention warranted?

A

Chest tube

Surgery for recurrence, large blebs on CT, air leak >7d, nonreexpansion

93
Q

What does surgery for spontaneous pneumothorax entail?

A

Thoracoscopy, apical blebectomy, mechanical pleurodesis

94
Q

What are bronchiogenic cysts?

A

Abnormal lung tissue outside lung; did not get connected to bronchial system

95
Q

Where does sequestered lung tissue get its blood supply?

A

From anomalous systemic arteries, usually off of thoracic aorta; can also come from abdominal aorta through inferior pulmonary ligament

96
Q

Who is extralobar sequestration more common in?

A

Children; more likely to have systemic venous drainage

97
Q

Who is intralobar sequestration more common in?

A

Adults; more likely to have pulmonary vein drainage

98
Q

Treatment for sequestration?

A

Lobectomy

99
Q

What is the etiology of a solitary pulmonary nodule with history of previous sarcoma/melanoma? Head, neck, breast? GI, GU?

A

Sarcoma/melanoma: more likely metastases

Head, neck, breast: more likely primary lung cancer

G.I./GU: can be metastases or primary

100
Q

What condition is most likely to cause arrest after blunt trauma due to impaired venous return?

A

Tension pneumothorax

101
Q

What is a catamenial pneumothorax and what is it caused by?

A

Occurs in temporal relation to menstruation, caused by endometrial implants in the visceral lung pleura

102
Q

What are bronchioliths usually caused by?

A

Secondary to infection

103
Q

When does mediastinitis usually occur?

A

After cardiac surgery

104
Q

What causes white out on chest x-ray with midline shift toward white out? Midline shift away from white out? No shift?

A

Toward whiteout: collapse from obstruction, need bronchoscopy to remove plug

Away: effusion, place chest tube

No shift: possibly contusion w/ trauma hx; CT to figure out

105
Q

What are the characteristics of tuberculosis lung disease?

A

Long apices, calcifications, caseating granulomas

106
Q

What is a Gohn complex?

A

Parenchymal lesions plus enlarged hilar lymph nodes

107
Q

What are characteristics of exudative effusions on cytology?

A

Protein greater than 3, SG greater than 1.016, LDH ratio (plural fluid to serum) greater than 0.6, low glucose

108
Q

What is the treatment for recurrent pleural effusions?

A

Mechanical pleurodesis, talc pleurodesis for malignant effusions

109
Q

What are airway fires usually caused by? What is the treatment?

A

Associated with the laser; stop gas flow, remove ET tube, re-intubate for 24 hours, bronchoscopy

110
Q

What are AVMs? Where are they located in the lung?

A

Connections between the pulmonary arteries and pulmonary veins, usually in lower lobes

111
Q

What are symptoms of AVMs? What is the treatment?

A

Hemoptysis, SOB, neurologic event; embolization

112
Q

What is the most common benign chest wall tumor?

A

Osteochondroma

113
Q

What is the most common malignant tumor of the chest wall?

A

Chondrosarcoma

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