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SURGERY CARDS > NMS Thoracic > Flashcards

NMS Thoracic Flashcards

1
Q

what are chances that coin lesion on CXR is malignant

A

50% at 50. under 50 chances decrease, over 50 chances increase

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2
Q

what do benign lesions look like vs. malignant

A

benign has smooth surfaces, malignant has irregular or spiculated surfaces

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3
Q

what are other benign lesions

A

Bulls’ eyes, hamartomas which have popcorn appearance on CXR

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4
Q

which area of U.S. are coin lesions common

A

SW U.S. where coccidiomycosis is common and mid-Atlantic and OH valley where Histo occurs

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5
Q

most common mets to the lung are from

A

colorectal, breast, liver

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6
Q

if a lung lesion looks malignant what do you do

A

get a CT to characterize lesions and to look for enlarged lymph nodes in mediastinum, then do CT-guided needle bx

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7
Q

what do you do for a lesion with cough and hemoptysis and mediastinal enlarged lymph node

A

bronchoscopy for tissue diagnosis and to determine location of lesion and mediastinoscopy to determine state of mediastinal LNs

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8
Q

what do you do if needle bx shows malignant or indeterminate (lung)?

A

resection

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9
Q

what doubling time favors benign status vs. malignant status

A

if doubling time is 465 days then it favors benign. if doubling time is 5 wks to 280 days, favors malignant

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10
Q

what type of lung cancer usually presents late and not amenable to resection

A

small cell carcinoma

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11
Q

cure rate for Stage I lung tumors w resection

A

70%

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12
Q

Stage II lung cancer 5y survival

A

40-50%

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13
Q

surgical options for metastatic lesion involving mainstem bronchus

A

pneumonectomy (easier) or sleeve lobectomy (safer). sleeves not feasible if mainstem pulmonary artery involved

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14
Q

perioperative death rate from pneumonectomy

A

5-10% especially in those over 70 and those with cardiac or obstructive airway dz

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15
Q

at what stages can lung tumors be resected

A

stages I and II

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16
Q

at what stages are chemo and radiation the only treatments

A

stages III and IV

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17
Q

ipsilateral hilar lymph nodes are what stage

A

stage II

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18
Q

mediastinal lymph nodes are what stage

A

stage III

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19
Q

can a tumor undergo chemo and be downstaged and resected (lung)

A

yes

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20
Q

imaging modality good for detecting lung cancer mets

A

PET scan

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21
Q

symptoms of Pancoast tumor

A

Horner’s syndrome, pain in ulnar area of elbow and wrist

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22
Q

how to verify superior sulcus tumor

A

CT, bronchoscopy, mediastinoscopy, needle bx

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23
Q

what are 5y survivals for stage II, IIIa, and IIIb lung cancer

A

stage II 44%
stage IIIA 22%
stage IIIB <10%

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24
Q

tx of pancoast tumor

A
  1. irradiation over course of 6 wks then

2. surgical resection of chest wall and lung

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25
Q

in young healthy pt with hemoptysis and atelectasis, what would be suspect

A

bronchial adenoma thats obstructing bronchus

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26
Q

2 types of bronchial adenomas

A
  1. carcinoids (malignant potential if originated in small bowel)
  2. adenocystic carcinomas (invade locally)
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27
Q

how to dx bronchial adenoma

A

bronchoscopy with bx, careful bc they bleed!

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28
Q

how to treat bronchial adenomas

A

lobectomy. usually curative

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29
Q

carcinoid syndrome sxs?

A

flushing, diarrhea, wheezing from bronchospasm, facial telangiectasia, tricuspid regurg and pulmonary stenosis bc serotonin increases collagen production in valves

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30
Q

ddx for effusion (pleural)

A

cancer: bronchogenic carcinoma, mesothelioma
benign: CHF, viral/bacterial pneumonia, empyema, TB

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31
Q

how to dx pleural effusion

A

thoracentesis and pleural bx. you can cx the fluid and examine histology of bx for malignancy.

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32
Q

prognosis for mesothelioma

A

terrible. most die within a year. not responsive to chemo/radiation.
:(

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33
Q

only surgical tx for mesothelioma

A

extrapleural pneumonectomy. takes out lung, both visceral and parietal pleura, pericardium, and diaphragm at times.

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34
Q

etiology of spontaneous pneumothorax

A

rupture of apical blebs, pleural cavity pressure becomes same as atm, causing lung collapse and trachea deviated to side of collapse

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35
Q

etiology of tension pneumothorax

A

penetrating trauma to the lungs, pleural tear that allows air only to go into the pleural space, trachea deviates to contralateral side

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36
Q

tx of a pneumo

A

chest tube

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37
Q

what do you do if a patient is unresponsive to chest tube s/p pneumothorax

A

must investigate persistent air leaks from lung parenchyma with thoracoscope and surgical intervention

38
Q

how to treat persistent or recurrent pneumo

A
  1. thoracoscopic excision of blebs and pleurodesis (pleural abrasion to adhere visceral and parietal pleura)
39
Q

what do you suspect with chest pain, cough, recurrent fever, and pleural effusion after a pneumonia treatment

A

Empyema!

40
Q

most common causes of empyema

A

s.pneumo, staph and gram neg in hospitals; anaerobes if aspiration suspected or alcoholism or recent operation

41
Q

how often empyema culture neg

A

35% bc of previous abx tx

42
Q

how to treat empyema

A
  1. empiric abx

2. chest tube for drainage

43
Q

what happens if you dont treat an empyema

A
  1. exudative phase
  2. fibropurulent stage (loculation of fluid pockets)
  3. organizing stage (scarring and inflammatory tissue)
44
Q

how do you fix an untreated empyema

A

thoracotomy and decortication

45
Q

how to manage unstable angina

A
  1. admit and bed rest
  2. oxygen
  3. beta blockers, nitro, ASA, heparin, morphine is questionable
  4. cardiac enzymes
  5. cath or thrombolysis if MI+
46
Q

3 major coronary arteries

A
  1. RCA
  2. LAD
  3. Circumflex

(LAD and Circumflex from left main)

47
Q

whats an abnormal EF

A

<55% (she said 40-50%)

48
Q

how to treat left main dz

A

coronary artery bypass

49
Q

alternative to bypass?

A

PTCA with stents, danger of reobstruction

50
Q

sources of bypass grafts

A

internal mammary artery has best patency, reversed greater saphenous vein also used

51
Q

what solutions used to help performance of bypass

A

cardioplegia solution, blood cardioplegia solution, hypothermia

52
Q

operative mortality for bypass surgeries

A

3%, but less for low riskers

53
Q

etiology of MVR

A

myxomatous degeneration of mitral valve; thought to be due to ischemia of mitral valve apparatus

54
Q

how is MVP different from MVR

A

prolapse is eccentric closure and doesnt have to regurg!

common in young women, but in men it can be sign of severe mitral valve dz.

55
Q

etiologies of mitral stenosis

A

rheumatic fever, scarlet fever. you get inflammation of connective tissues, leaflets progressively fuse, LA pressure goes up, R heart enlargement, pulmonary htn

56
Q

treatment of mitral valve dz

A

can try to repair regurg by excision of redundant portion of leaflets and reinforcing mitral annulus with annuloplasty ring, but can replace if not successful

57
Q

3 etiologies of aortic stenosis

A
  1. congenital (bicuspid valve)
  2. arteriosclerotic
  3. deteriorative
58
Q

aortic valve area less than what is severe stenosis

A

0.8 cm sq

59
Q

workup for aortic stenosis

A
  1. cardiac cath to detect aortic valve size, pressure gradient, ventricular function, check for CAD
  2. carotid doppler to rule out internal carotid obstruction
60
Q

when do pts with aortic stenosis usually present

A

late in life. extreme risk for sudden death

61
Q

pros and cons of mechanical vs. tissue valves

A

mechanical valves need anticoagulation bc theyre thrombogenic; tissue valves nonthrombogenic but deteriorate. require replacement at 7 yrs

62
Q

what can give you dilated cardiomyopathy if you’ve got normal coronary arteries

A

post-respiratory illness, etiology unclear

wtf??

63
Q

prognosis for dilated cardiomyopathy

A

1/3 get better, 1/3 stay the same, 1/3 get worse

64
Q

tx for dilated cardiomyopathy

A

steroids, diuretics, immunosuppressives, beta blockers, transplant

65
Q

prognosis with transplant

A

immediate survival >90%
survival at 1 yr 85-90%
survival at 2 yrs 75%

66
Q

immunosuppressives for transplants

A

cyclosporine, tacrolimus

67
Q

most deaths from transplants happen from what

A

infection from immunosuppressive drugs and accelerated coronary atherosclerosis as a form of chronic rejection

68
Q

what do we suspect with regurgitated undigested food and dysphagia

A

Zenker’s diverticulum or pharyngeal diverticulum

69
Q

etiology of pharyngeal diverticulum

A

abnormal uncoordinated constriction of cricopharyngeal muscle during swallow results in outpouching bw lower pharyngeal constrictor and cricopharyngeal muscle

70
Q

where else can a pulsion diverticulum occur

A

distal esophagogastric junction: epiphrenic diverticulum. food can regurgitate and can be aspirated.

71
Q

tx for pharyngeal diverticulum

A
  1. excision if diverticulum is large

2. transect cricopharyngeal muscle to relax esophageal entrance and prevent uncontrolled contraction

72
Q

tx for epiphrenic diverticulum

A

esophageal myotomy at esophageal gastric junction

73
Q

sxs and etiology of achalasia

A

dysphagia, WL due to poor peristalsis of body of esophagus and failure of LES to relax. loss of smooth muscle ganglionic cells of Auerbach plexus

74
Q

how to dx achalasia

A

barium swallow

75
Q

associated conditions w achalasia

A

emotional stress, physical trauma, WL, Chagas

76
Q

tx for achalasia

A

Heller myotomy or pneumatic dilation. maybe Ca channel blockers

77
Q

types of cancers in different areas of esophagus

A

top 2/3 is squamous cell carcinoma, bottom 1/3 adenocarcinoma

78
Q

esophageal cancer a/w what

A

alcohol, tobacco, Barrett’s (40x w severe dysplasia)

79
Q

how do you stage esophageal cancer

A

endoscopic ultrasound for wall penetration and LN spread. CT abdomen and chest for celiac node involvement. mediastinal or celiac node mets automatically stage III and incurable.

80
Q

complication with middle third esophageal cancers

A

invasion of tracheobronchial tree

81
Q

tx for esophageal ca

A

stage I (just to submucosa) can be resected but not in upper third of esophagus. Stage II and beyond is chemoradiation. but you can downstage then try to resect

82
Q

two types of esophagectomies and types of incisions

A

transhiatal (cervical and upper abdominal incision). we want the anastomosis at the cervical area for easy access in case of complications

83
Q

what do we do after an esophagectomy anastomosis

A

pyloroplasty to prevent gastric outlet obstruction

84
Q

why would a person with esophageal cancer have constant cough

A

tracheoesophageal fistula from tumor invasion

85
Q

palliative methods for esophageal cancer

A

esophageal stent, gastrostomy tube, radiation, palliative resection, supportive care

86
Q

what type of tumor a/w weakness and double vision (in thorax/mediastinum)

A

thymoma a/w Myasthenia gravis

87
Q

lymphoma tx

A

rad + chemo

88
Q

common tumors of anterosuperior mediastinum

A

thymomas, lymphomas, germ cell tumors

89
Q

common tumors of middle mediastinum

A

cysts (bronchiogenic/pericardial), lymphomas, mesenchymal

90
Q

common tumors of posterior mediastinum

A

neurogenic neurilemomas from nerves and nerve sheaths

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