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Surgery > Lung > Flashcards

Lung Flashcards

1
Q

How are the lungs divided?

A

Right lung: 3 lobes, ten segments

Left lung: 2 lobes, 9 segments

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2
Q

Aspiration of gastric contents or foreign bodies is more likely to affect which lung? Why?

A

RIght lung, especially superior segment or R lower lobe and posterior segment of R upper lobe. It’s bc the R main bronchus doesn’t curve as much as the L one.

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3
Q

What is the arterial supply to the lung?

A 
pulmonary artery
bronchial arteries (come from Ao and intercostal vessels)
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4
Q

What are the kinds of benign tumors of the lung?

A 
First: these are very rare.
squamous papilloma (HPV 6,11)
angioma
fibroma
leiomyoma
chondroma
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5
Q

HPE of benign lung tumors

A 
recurrent pneumonia
cough
hemoptysis
decreased breath sounds on affected side
other sx from postobstructive pneumonia (pneumonia that's distal to the bronchial obstruction)
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6
Q

Dx Eval of benign tumor

A

CXR- shows mass

there is often postobstructive pneumonia if the lesion narrows the bronchial lumen

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7
Q

Rx for angiomas

A

they frequently regress, so just observe

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8
Q

Rx for benign tumors

A

Surgical removal- relieves sx and establishes dx.

Partial lung resection or sleeve resection w re-anastomosis of bronchus or trachea.

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9
Q

What kind of benign lung ca has a high recurrence rate?

A

Squamous papillomatosis

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10
Q

What kind of lung tumors are usu not malignant but have “malignant potential”?

A

bronchial carcinoids (10% malignant)
adenoid cystic carcinoma
mucoepidermoid tumors
these are all rare

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11
Q

What kind of tumors cause paraneoplastic syndrome?

A

Carcinoid tumors

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12
Q

What kind of substances do carcinoid tumors release (which can cause paraneoplastic syndrome)?

A 
histamine
serotonin
VIP
gastrin
GH
insulin
glucagon
catecholamines
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13
Q

HPE for lung tumors w malignant potential

A

Cough, dyspnea, hemoptysis, recurrent pneumonia
Carcinoid syndrome (infrequent)
Respi compromise or decreased breath sounds
Carcinoid tumors- valvular heart dz w pulm stenosis, tricuspid regurg

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14
Q

Dx Eval for tumors w malignant potential

A

CXR- show lesion or post-obstructive pneumonia
Bronchoscopy for tsu dx and to see anatomy
CT is routine for pre-op planning

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15
Q

Rx for tumors w malignant potential

A

Resect.

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16
Q

What is carcinoid syndrome?

A

flushing, diarrhea, plus manifestations of specific hormone excess (dep on which hormone it is)

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17
Q

T/F more than 80% of lung cancers are smoking related

A

True.

Lung cancer is the leading cause of cancer death in the US.

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18
Q

Carcinogens that can cause lung cancer

A 
Smoking
Asbestos
Formaldehyde
Radon gas
Arsenic
Uranium
Chromates
Nickel
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19
Q

How is lung ca classified

A 
Small cell (20-25%)
Non-small cell (75-80%)
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20
Q

How is non-small cell lung ca classified?

A 
Non-small cell is 75-80% of all lung cancer.
It's divided into:
squamous cell carcinoma (30%)
adenocarcinoma (35%)
large cell carcinoma (10%)
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21
Q

Where is small cell cancer located?

A

Centrally.

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22
Q

T/F small cell lung cancer can be a/w paraneoplastic syndromes

A

True
5% of pts have SIADH
3-5% have Cushing’s (from too much ACTH)

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23
Q

Where does squamous cell cancer usu occur? What other sx is it a/w?

A

Occurs centrally

A.w sx of hypercalcemia, secondary to production of PTHrP

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24
Q

Where does adenocarcinoma usu occur?

A

At the periphery

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25
Q

What signals that the tumor is obstructing the airway?

A

worsening cough with increased sputum

hemoptysis

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26
Q

Persistent chest, back, shoulder pain in lung ca is related to…

A

nerve involvement or direct tumor invasion

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27
Q

What are the sx of lung cancer mets?

A

Bone pain, neurologic sx

fatigue, loss of appetite, weight loss.

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28
Q

HPE of lung cancer

A

Diminished breath sounds dt pneumonia or malignant pleural effusion
Supraclavicular lymphadenopathy
Hoarsenss- recurrent laryngeal nerve

29
Q

Why can Horner’s syndrom be present in lung ca?

A

Superior sulcus tumor causes neural compression –> ptosis, myosis, anhidrosis

30
Q

What is pancoast syndrome?

A

shoulder and arm pain on side with lung ca

31
Q

What is superior vena cava syndrome

A

obstruction of SVC by malignancy, eg compression of wall dt R upper lobe tumors

32
Q

Paralysis of the diaphragm indicates tumor involvement of which nerve?

A

Phrenic

33
Q

Dx Eval for lung cancer

A

CXR
CT of chest + liver and adrenals- to see tumor size, lymphadenopathy, pleural effusion, distant mets
Bone scan, brain imaging
PET for distant dz
Invasive testing usu reqd for definitive dx
Flexible bronchoscopy- tsu biopsy, bronchial washings
Transthroacic CT-guided FNbiopsy- tsu sampling
Mediastinoscopy w lymph node biopsy- for staging

34
Q

What size are T1 lesions?

A

<3 cm

35
Q

What are T2 lesions?

A

> 3 cm
or involve main bronchus >2cm from carina
or involve visceral pleura

36
Q

What are T3 lesions?

A 
Invade:
chest wall
diaphragm
mediastinal pleura
pericardium
main bronchus w/in 2cm of carina
37
Q

What are T4 lesions

A 
Invade:
heart
great vessels
mediastinum
trachea
esophagus
vertebral bodies
carina
or have malignant effusions or satellite tumors
38
Q

What are N1 lesions?

A

Pos nodes in ipsi peribronchial or hilar region

39
Q

What are N2 lesions?

A

pos nodes in ipsi mediastinal or subcarinal region

40
Q

N3 lesions?

A

mets either to contralateral nodes or ipsi scalene or supraclavicular regions

41
Q

Stage IA, Stage IB

A

1A: T1, N0, M0
1B: T2, N0, M0

42
Q

T/F M1 automatically means Stage IV

A

True. Can be any T, any N.

43
Q

T/F Surgery is rarely indicated for small cell lung cancer

A

True, bc it’s usu widely disseminated at the time of dx. Only very early stage are considered potentially resectable.

44
Q

Rx for small cell lung ca

A

Chemo- usu combo of cisplatin and etoposide

And radiation

45
Q

What is the Rx if pts respond well to therapy and have complete remission?

A

Prophylactic whole-brain radiation, to decrease chances of cerebral mets

46
Q

Rx for non-small cell lung cancer

A

Early stages- surgery followed by chemo

most commonly lobectomy

47
Q

T/F all patients who have completely resected lung ca should get chemo

A

True

48
Q

Chemo regimen for pts with resected lung ca

A

a platinum agent (cisplatin or carboplatin)
a nonplatinum agent (etoposide, irinotecan, paclitaxel, gemcitabine)
+Radiation if mediastinal lymph nodes involved

49
Q

Where is most mesothelioma found?

A

Visceral pleura

50
Q

Risk factors for mesothelioma

A

Asbestos (esp +smoking)

51
Q

HPE for mesothelioma

A 
chest pain from local extension
dyspnea secondary to pleural effusion
weight loss
unexplained night sweats
decrsd breath sounds on side of tumor dt pleural effusion
52
Q

Dx eval for mesothelioma

A

CXR- shows pleural effusion
Thoracocentesis- bloody fluid, cytology neg for malignancy
Thoracoscopy and pleural biopsy- do this if there is suggestive hx and recurent pleural effusion and no clear etiology (even if neg fluid cytology)

53
Q

Rx for mesothelioma

A

Pgx is poor
Early stg lesions may be resectable but req induction chemo followed by extrapleural pneumonectomy
If non-op: chemo + rad

54
Q

What is a simple pneumothorax?

A

Air enters the potential space bt the visceral and parietal pleura, so lung falls away from chest wall

55
Q

What is an open pneumothorax?

A

Defect in chest wall allows continuous air entry from outside

56
Q

What is tension pneumothorax?

A

Air enters the potential space but can’t escape- one-way valve going inward.
Prs increases, forcibly collapsing the lung, compressing mediastinal structures

57
Q

What pts get spontaneous pneumothorax?

A

young thin males
older pts w bullous emphysema
pts on mechanical ventiliation, esp if high prs
pts w infection or tumors
iatrogenic causes (thoracocentesis, needle biopsy, operative trauma)

58
Q

What infections can cause pneumothorax?

A

TB or Pneumocystic carinii

59
Q

HPE for pneumothorax

A 
Can be asx
Dyspnea, chest pain
Decreased breath sounds
Hyper resonance on affected side
If tension pneumo- tachycardia, hypotension, hypoxia, tracheal deviation
60
Q

Dx Eval for pneumothorax

A

upright CXR- no lung markings in affected area (usu apex). see visible line corresponding to visceral pleural surf of lung. if tracheal dev or mediastinal shift, it’s tension pneumo

61
Q

Rx for simple pneumothorax

A

if <20%, just observe as long as there is no size increase on serial CXR
otherwise, chest tube

62
Q

Rx for open pneumothorax

A

repair of deficit and tube thoracostomy

63
Q

Rx for tension pneumothorax

A

surgical emergency- immed needle thoracostomy in mid-clavicular line, 2nd IC space
Then tube thoracostomy after

64
Q

What is an empyema?

A

Infection within the pleural space

65
Q

What causes empyema?

A

pneumonia
lung abscess
post-op complication of thoracic surgery
esophageal perf

66
Q

What organisms cause empyema?

A 
Staph
Strep
Pseudomonas
Klebsiella
Ecoli
Proteus
Bacteroides
67
Q

HPE for empyema

A

Hx of prev pneumonia, thoracic surg, esophageal instrumentation
Fatigue, lethargy, shaking chills
Systemic illness
Fever
Decreased breath sounds at affected lung’s base

68
Q

Dx eval of empyema

A

WBC elevated
CXR- pleural effusion
Throacocentesis- aspiration of the pleural fluid shows exudate, high WBCs w PMN predominant, low pH, low glucose, high LDH. May see bacteria on gram stain/culture

69
Q

Rx for empyema

A

TUbe thoracostomy and abx

rarely, needle aspiration and abx are enough

Surgery (20 decks)

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