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General surgery > lungs > Flashcards

lungs Flashcards

1
Q

horners syndrome

A

miosis-constriction of pupil
anhidrosis- absence of sweating on face
ptysis-drooping of eyelid

all due damage of sympathetic nerves

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2
Q

fine tremor and flapping tremmor

A

fine- can be a side effect of b 2 agonist use (salbutamol)
flapping - asterixis sign which indicates co2 retention

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3
Q

pectus and carinatum

A

excavatium: caved in (funnel chest)
carinatum: sternum is pushing out (pigeon chest)

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4
Q

apex beat

A

Normal position is 5th intercostal space

Mid-clavicular line

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5
Q

where is apex of the lung found

A

supraclavicular fossa

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6
Q

when is the loudest sound heard when breathing

A

inspiration due to more turbulent air flow

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7
Q

adenocarcinoma

A

cancer that starts in the glands that line the inside of one of your organs. could be the lungs,breast etc. if in lungs its most often found in the outer parts of the lungs and grows more slowly than other types of lung cancers

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8
Q

techniques in the past for tb

A

induce a pneumothorax

thoracoplasty - break several ribs to make lungs deflate

phrenic nerve paralysis

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9
Q

types of lung resection

A

wedge - not anatomically based and is the smallest portion
segment - the smallest anatomical diviison of the lung
lobe
bilobectomy
sleeve resection - remove a lobe + part of main airway

pneumoectomy - entire lung

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10
Q

what determines if someone can have lung cancer surgery

A
  1. has the lung spread? is it containesd
  2. can the patient physically handle it are they physicallys strong enough
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11
Q

which type of resection has a higher reccurrence rate

A

wedge

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12
Q

decortication

A

surgical procedure to remove the fibrous tissue covering the lung to help them funcntion normally again done using thoracoscopy

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13
Q

causes of echinococcus

A

e. granulosis
e. multilocularis

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14
Q

symptoms of lung empyema

A

s.o.b ( pus is pressing agaiants the lung ) and chest pain PLEURITC
dry cough - cant cough it out as its oUTSIDE THE LUNG
VERY TOXIC APPEARNACE

night sweats
malais/fever

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15
Q

tx of lung empyema

A
  1. drain the pus like thorocostomy + AB;S
  2. VATS - minimally invasisve
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16
Q

what is thoroscopy uuslaly used for /associated with

A

PLEURAL DISEASES so it allows you to look inot the pleural space

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17
Q

pleurodesis

A

when you get rid of pleaural space- so no reaccumulaitng fluids

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18
Q

rf for lung empyema

A

infection like penumonia
having a lung absvess esp a peripheral one
thoracic surgery

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19
Q

rf for lung empyema

A

infection like penumonia
having a lung absvess
thoracic surgery
bronchopleural fistula

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20
Q

stages for empyema

A
  1. exudation - low celld , simple effusion
  2. fibrino purrulant - more cells, and wbc pMN
  3. oragnisation - fibroblasts

Evenutally causing the 2 layers to come into contact with each others whihc hsouldnt normally happen

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21
Q

why do people feel the ysmptoms of empyema most important

A

it prevents the lungs from expanding properley

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22
Q

classifcation of bronhcieactasis

A
  1. cylindrical/tublar
  2. varicose/mixed
  3. sacular
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23
Q

symptoms AND SIGNS OF BRONCHIACTASIS

A

cough- prodcutive - nb PURRULENT SPUTUM
loss of weight
fever
hempotysis- nb!

SIGNS:
clubbing - chronic
wheezing
Coarse inspiratory crepitations

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24
Q

pseudobronchieactatsis

A

REVERSIBLE dilation of bronchi so no need for surgical intervention because no permanent damage

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25
Q

what is the main mechanis of bronchieactasis

A

imparied mucus clearance

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26
Q

what happens to the bronchie in bronchieactatsis

A

you have permant dilation so the structure is now affected the elsatic and muscle layers

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27
Q

diagnoss

A

ct- gold standar
x ray - not reliable because changes may not be seen some lungs look normal but there is the ‘tram lines’
bronchoscopy - cant reach that far so not a routine

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28
Q

what part of the lung isi affectis in Bronhcieactais

A

bronchi and bronchioles

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29
Q

what are he maiwith n organisms patients are infected with in bronchiectasis

A

The main organisms patients are infected by include: Haemophilius Influenzae, Pseudomonas aeruginosa, Streptococcus Pneumoniae, Staphylococcus aureus.

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30
Q

tx of bronchiactasis

A

conservative
1. expectorants such as hypetonic saline
2. AB’S in an excervation

surgical resection
- when conservative has failed
- patients with hemoptysis are

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31
Q

rf for bronchiactasis

A
  1. congenital such as CF, PCD
  2. Bronhcial pathology - tumour, foreign body
  3. post infectious - TB, pneumonia
  4. Allergic bronchopulmonary aspergillous
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32
Q

gold standard bronchiactasis

A

CT -

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32
Q

gold standard bronchiactasis

A

CT -

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33
Q

complications of bronchieactais

A

MASSIVE HEMPOTYSIS- medical emergency !!!!!!!
pneumonia and its consequences
brain absecss- rare
reistance to ab due to chronic use
secondary amyloudos due to chronic inflammation affecting the kidneys ( AA)

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34
Q

pathognomic bronchiactasis

A

signet ring cell

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35
Q

what are some elctrolyte distrubances we find in lung cancer

A

hypercalcemia is associated with small cell lung cancer and squamous cell cancer

hyponatremia - due to increase in ADH secretion

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36
Q

when is surgery indicated in lung cancer

A

for non small cell cancers from stage 1-3

37
Q

gold standard in lung cancer surgery

A

lobecttomy with LN disection

38
Q

IF someone has reached stage 4 what are the options

A

target therapy - mutations

immunotherapy target the defective immune checkonts

chemo

palliative

39
Q

types of non small cell

A
  1. adeno
  2. squamous
  3. mixed
  4. large cell carcinoma
40
Q

adenocarcinomas

A

most common
we see in non smokers

more peripherally located compared to squamous

gives early metastasis

41
Q

which type of cancer is associated with high metasissi to the brain

A

small cell so we have to do porphylactic cranial irradiation

42
Q

common sites of metatsis for lung cancer

A

BBL
bone brain liver and adrenals (hence why addisons can be a complication )

43
Q

pareneoplastic syndrome with lungs

A

ACTH - cushings syndrome

ADH- causing hyponatremia

Eaten lambert syndrome (immune system attacks the NMJ so similar to MG suggest SMALL CELL

44
Q

horners syndrome

A

pancoast tobias stumour the tumour compresses the brahcial plexus

ptosis
anhydosison
miosis
enopthalmos

as well as atrophy of the muscles of the arms cos brachial plexus

45
Q

what sort of complications can lung tumours cause

A

horners

SVC syndrome - facial swelling and distended neck veines

obstruction of lymphatics

46
Q

TNM of lung

A

t1 - contained within the visceral pleura has not yet invaded bronchus

t2 - now has invaded bronchi

t3- invoves chest wall or now paritetal pleura or phrenic nerve

t4- invaded the great vessels, or other mediastinal structures

47
Q

rf for lung cancer

A

smokers
passive smoking
occupational - asbestos, silica
organ transplanation - immunosuppresants and etc

48
Q

which tumour is associated with hyperparathyroidism

A

squamous hence hwy causes hypercalcemai

49
Q

signs with lung cancer

A

clubbing
hypertrophic osteoarthropathy
horners - if apical
anemia
atypical physical exam e.g stony dull for effusion , atelactasis,, absent breath sounds

paraneoplastic symptoms

50
Q

Non-metastatic manifestations

A

pain - invades pleura

dyspnea - invades airways

hemoptyiss- friable vessels in ariways

pneuomthorax

atelecatasis

51
Q

which cancer can present as cavities

A

squamous

52
Q

which type of cancer is mor elikely to cause pleaural effusions

A

obvs mesothelioma but also adenocarcinomas in comparison to tothers

53
Q

pemberton test

A

he diagnostic test for superior vena cava obstruction is called Pemberton’s test, where lifting the arms over the head for more than 1 minute will precipitate facial plethora and cyanosis.

54
Q

what does a tension pneumothorax ultimately lead to

A

obstructive shock

55
Q

physicla exam penumonthoaax

A

weak vesicular breathing on affected side

diminished breath sounds

distended veins

hyperresonance

The vocal resonance (or tactile vocal fremitus) is reduced on the affected side. ( sound travels faster in less air )

reduced expansion

56
Q

MOST COMMON CAUSE OF SPONANTOEUS PRIMERY

A

rupture of apical subpleaural bleb- NOVY

57
Q

MOST COMMON CAUSE OF SPONANTOEUS secondary

A

rupture of a bulla (which usually occure as a result of detsruction of the walls of the alveoli as seen in COPD

58
Q

small pneumorthroax

A

visceral pleura is less than 3 cm from chest well

or on radiology there is less than 2-3 cm distance between P + V pleaure

59
Q

bleb

A

collection of air subpleaurally
- less than

60
Q

what causes blebs and locaation

A

the alveoli rupture and the air gets trapepd

mostly apex of lungs or apex of lower lobes

61
Q

Five most common complications of a spontaneous pneumothorax- novvy

A
  1. tension
  2. pneumomediastimu
  3. hemopneumorhorax
    4.bilateral pneumothoad
  4. recurrence after inital tx
62
Q

surgical tx of spontanous primary pneumorthorax - novvy

A

rescet the blebs/bullae

pleuroectomy to remove the pleuarl space so you obliterate the pleural space

63
Q

surgical tx of spontanous primary pneumorthorax - novvy

A

rescet the blebs/bullae

pleuroectomy to remove the pleuarl space so you obliterate the pleural space

64
Q

PHYSICAL FINDINGS OF PLEURAL EMPYEMA

A

dullness to percussion
decreased chest expansion on affected side
decreased breath sounds

64
Q

PHYSICAL FINDINGS OF PLEURAL EMPYEMA

A

dullness to percussion
decreased chest expansion on affected side
decreased breath sounds

65
Q

chylothorax

A

is lymphaitc fluid and emulsified fat its quite rare and caused by malignancy and trauma

66
Q

histological types of mesothelioma

A

epithelioid
sarcomatoid
mixed

66
Q

histological types of mesothelioma

A

epithelioid
sarcomatoid
mixed

67
Q

malignant pleural effusion - novvy

A

an effusion that contains malignant cells

68
Q

fibrohemothroax - novvy

A

fibrous tissue in the pleural space, usually found as a complication of clotted hemothorax, chronic empyema or tb

69
Q

pleural fluid exudate

transudate

A

ex- from inflammation , more cells, more specific gravity

trans- heart failure, kidney failure

70
Q

Most common benign plural tumour

A

solitary fibrous tumour

71
Q

lights criteria

A

to determine if pleural effusion is transudate or exudate

it looks at your protein levels and LDH levels

72
Q

trapped lung

A

failure of the lung to re-expand after thoracentesis

72
Q

trapped lung

A

failure of the lung to re-expand after thoracentesis

73
Q

tx of malignant pleural mesothelioma

A

chemo, radio, extrapleural pneumonectomy

74
Q

signs of advance local cancer - NOVY

A

hoarseness of voice
pleural effusions
pericardial
SVC syndrome
pancoast

75
Q

anothy name for pancoast tumour- novs

A

superior sulcus tumour

76
Q

most common bening lesion of lung

A

hamartoma

77
Q

3 indications for palliative resection - NOVY

A

1.an unresolving lung abscess
2, massive hemoptysis
3. painful invasion of chest wall

78
Q

TYPES OF SMALL CELL- novyy

tx

A
  1. limited - limited to one hemithroax and ipsilateral ln and supraclavicular TX chemo, radio and prophylactic cranial
  2. extensive - metastasi outside the hemithorax
    tx - just chemo
79
Q

which sympto m of lung cancer is frequently overlooked i

A

cough

80
Q

mcqs women which place die from lung cancer

A

1

81
Q

primary lung abscess

A

no previou sunderlying lung pathology or currently infected with pneumonia

82
Q

secondary

A

have a disease which makes it easier for them to have an abscess, or obstructive symptoms or they are immunocompimised

83
Q

acute

subacute

chronic abscess

A

<6 weeks

6-12 weeks

> 12 weeks

84
Q

what could have caused a abcess

A

infection of the lung

hematogenous spread i.e right sided endocarditis,

BRONCHIAL OBSTRUTCION-NB
aspiration

alcoholics

84
Q

what could have caused a abcess

A

infection of the lung

hematogenous spread i.e right sided endocarditis,

BRONCHIAL OBSTRUTCION-NB
aspiration

alcoholics

85
Q

compplications of lung abscess

A

rupture
bronchopleural fistula
pneumothroax
can casue a brain absess
internal hemmorgae

86
Q

which complication of abscess is needed for emergency surgery

A

Massive bleeding in thorax
b. Formation of fistulas
c. In cases of empyema

87
Q

what causes a bronchopleural fistual

A

rupture of lung abscess

the erosion of a bronchus by carcinoma

post operative on lungs

General surgery (5 decks)

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