Non- lung cancer thoracic surgery

Question 1

name 2 tracheal tumours

Answer 1

salivary gland tumours

squamous carcinoma

Question 2

benign lung tumours

Answer 2

Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas
Chondroma

Question 3

bronchogenic cysts

Answer 3

present from birth
cause symptoms by pressing on the trachea or oesophagus

belong to group of cysts known as foregut duplication cysts

most found next to trachea at corina

Question 4

other than surgery for cancer what other things can surgery be used for in the chest

Answer 4

tumour
infection
trauma

Question 5

describe swinging pyrexia

Answer 5

temperature of patient cyclically going up and down - can be characteristic of lung abscess

Question 6

main reasons for a lung abscess to arise? (5)

Answer 6

aspiration - foreign object inhaled into lung

previous/current pneumonia

PTE- pulmonary thromboembolism

lung cancer

septic emboli - infected embolism (pus formed)

Question 7

what is a lung abscess?

Answer 7

localised infection in the lung

can heal but doesn’t always - accumulation of macrophages, neutrophils and pus

Question 8

what might bacteria within pus produce within thoracic cavity

Answer 8

they might produce gas - you would see air-fluid level in CXR

Question 9

psoas abscess

Answer 9

abscess in psoas muscle in abdomen

Question 10

empyema thoracic may come about in what circumstances? (5)

Answer 10

post pneumonic - most commonly

post operative

oesophageal

upper abdominal related

post traumatic

Question 11

describe oesophageal cause of empyema thoracis

Answer 11

if oesophagus is obstructed and patient vomits then the oesophagus may rupture and the contents spill into either side of the pleural cavity (usually R). This can lead to empyema - pus in the pleural space

Question 12

treatment of empyema

Answer 12

try to operate weeks after the infection occurs to give it time to clear

however if ‘trapped lung’ arises then may have to undergo surgery. Trapped lung is when the infection prevents the lung from expanding

Question 13

what is removed in decortication surgery

Answer 13

the cortex (surface) of the lung in order that the lung will be able to expand

Question 14

What is thymoma?

Answer 14

a tumour of the thymus that tends to always be malignant (staged as mild - lethal

if fit for surgery then they will surgically remove it

Question 15

carcinoid tumours

Answer 15

atypical and typical

atypical - malignant, similar prognosis to lung cancer

typical - benign seen in adolescents, can often present as asthma, easy to remove

Question 16

hamartoma

Answer 16

usually benign

cells of the tumour are native to that area of the body e.g fat cells

removed due to uncertainty of malignant change or that they could be carcinoid

Question 17

neurofibroma tumours

Answer 17

benign,grow on nerves around the body

want to remove these as despite being benign, they can grow to great size and cause problems - they also become harder to remove as they get bigger

Question 18

NF1 - Neurofibromatosis type 1

Answer 18

autosomal dominant pattern of inheritance. Likely to develop neurofibroma

Question 19

primary pneumothorax

Answer 19

usually affects young people around adolescent age

tend to operate

Question 20

secondary pneumothorax

Answer 20

usually affects older people who may have diseased lungs

usually not operated on

Question 21

open pneumothorax?

Answer 21

hole in chest wall – air is sucked directly from atmosphere into chest – most commonly seen during surgery due to open wounds

Question 22

difference between recurrent and persistent pneumothorax

Answer 22

recurrent - 2nd/3rd/4th times of coming back after treated

persistent- constant, can’t really be fixed

Question 23

tension pneumothorax

Answer 23

the progressive build-up of air within the pleural space as air leaves during expiration but can’t get back in during inspiration

usually due to a lung laceration

Leads to total collapse of lung and mediastinum moves over

When both lungs totally collapse – death can occur in 5/10 minutes

Positive pressure ventilation may exacerbate this ‘one-way-valve’ effect.

Question 24

spontaneous haemopneumothorax

Answer 24

Sometimes if they’ve had previous pneumothorax new adhesions will have been made-
Adhesions have blood vessels so when lung collapses again it tears these adhesions and this can lead to bleeding

Question 25

what is boyle’s law

Answer 25

P1V1 = P2V2
the volume of a mass of gas is inversely proportional to its pressure

When the volume of the lungs changes, the pressure of the air in the lungs changes
when you breathe in the lungs expand and pressure in the lungs decrease

Question 26

what is bullous lung disease

Answer 26

bullae (can develop or be from birth) are blisters or pockets of dead air in the lung parenchyma
a bullous is more than 2cm in size

Question 27

giant bulla

Answer 27

can take up to half of the lung volume

sever pain when the lungs expand

Question 28

why might a person need a double lung transplant?

Answer 28

for example if they’ve had cystic fibrosis, infection might still spread to the other lung if only one side is removed.

Question 29

what is a chest drain commonly used for

Answer 29

It is used to remove the following from the intrathoracic space:-

air - pneumothorax
fluid - pleural effusion, blood
or pus - empyema