Surg Block 3 Flashcards by brandon lovin

How many compartments are in the mediastinum?

Define Angle of Louis

Superior Anterior middle Posterior

Superior compartment line from T4 to sternomanubrial junction

How well did you know this?

Not at all

Perfectly

Utilizing the Burkell Classification, what structures are contained w/in the mediastinum compartments?

Anterior: Thymus Nodes Ascending Transverse Areolar

Middle: Heart Pericardium Trachea Hila Phrenic Areolar

Posterior: Sympathetic Vagus Esophagus Descending

How well did you know this?

Not at all

Perfectly

What is the fundamental unit of lung anatomy?

What are the homologous units of the lungs?

Bronchopulmonary segment

L: Lingular segment of upper lobe
R: middle lobe

How well did you know this?

Not at all

Perfectly

How many fissures are in the lungs?

Skin tests can be used for Dx what 3 thoracic dzs?

L: single oblique, upper/lower
R: major/oblique= upper/lower
minor/horizontal= upper/middle

TB Histo Coccidio

How well did you know this?

Not at all

Perfectly

Purpose of Endoscopy

Purpose of Bronchoscopy

Collect lung tissue; assess vocal cord mobility after suspected lung carcinomas induced voice change

Lymph node sample; obstructions, aspirations, foreign bodies

How well did you know this?

Not at all

Perfectly

What is the mainstay method to evaluate the mediastinum?

Where are samples gathered from for this mainstay method?

Cervical mediastinoscopy via incision above sternal notch

Paratracheal levels 2 and 4
Subcarinal level 7

How well did you know this?

Not at all

Perfectly

Define Chamberlain Procedure and its use

What is the alternate procedure to the Chamberlain?

Anterior mediastinotomy- node sampling via aortopulmonary window through interspace incision

Video assisted thoracoscopic surgery VATS

How well did you know this?

Not at all

Perfectly

How are pleural biopsies acquired?

What is the MC indication and additional benefit to use transthoracic needle biopsy of lungs?

Percutaneous needles
Open surgery
VATS

Solitary pulmonary nodule
Confirm presence of metastatic dz

How well did you know this?

Not at all

Perfectly

What procedure is the standard approach for open lung biopsy?

PTs eligibility for this type of procedure depends on their ability to ?

Thorascopy

Tolerant to single lung ventilation

How well did you know this?

Not at all

Perfectly

What type of lung sample is used for detecting lung cancer?

How are these samples acquired?

Sputum

Deep cough
Abrasion w/ brush
Bronchial wash

How well did you know this?

Not at all

Perfectly

Since CT is the cornerstone to evaluating chest pathology, why would an MRI be used instead?

Why would PET scan be used?

Cancer invasion
Pancoast tumors in sulcus

Staging and workup
More accurate than CT for detection of metastatic caner to nodes

How well did you know this?

Not at all

Perfectly

On CXR, ascending aorta should not project farther right than ?

An effusion of what size results in blunted costophrenic angles visible on ? angle?

R atrium

300mL
Frontal CXR

How well did you know this?

Not at all

Perfectly

Pleural effusions are sub-divided into ? or ? based on ?

Define the sub-types

Exudate/Transudate
Protein and LDH

Transudate- inc hydrostatic pressure/dec osmotic pressure
MC cause: CHF/L HF
Hypoalbumin
Cirrhosis
Nephrotic syndrome

Exudate- due to inflammation
MC cause- malignancy

How well did you know this?

Not at all

Perfectly

What is the characteristic CXR finding of pleural fluid?

How much fluid is needed to be visible on PA CXR?

How much is needed to be seen on lateral decubitus?

Meniscus sign

> 150mL

<50mL

How well did you know this?

Not at all

Perfectly

How much of a pleural effusion is needed for an attempted thoracentesis?

When pulmonary venous pressure exceeds ? a pleural effusion is formed

1cm thick

> 25mmHg

How well did you know this?

Not at all

Perfectly

What part of the lung is involved/spared during pulmonary edemas w/ ? characteristic finding?

Why is cephalization seen in CHF PTs unreliable?

Outer third spared
Lower zones involved w/ bat-wing appearance

Reqs upright image, most CHF PTs are supine

How well did you know this?

Not at all

Perfectly

What is a common characteristic in all forms of atelectasis?

What would be seen on CXR w/ atelectasis?

Loss of lung volume

Major/minor fissures shift toward atelectasis
Affected lung inc w/ density

How well did you know this?

Not at all

Perfectly

What is the first image of choice for suspected small pericardial effusions?

What are the 4 types of pneumothorax

Pericardial US

Simple- collapsed lung w/ no VS changes; Tx w/ lung expansion

Tension- VS changes, needle-d and thoracostomy

Open- penetrating/sucking wound

Closed- blunt trauma, intact chest wall

How well did you know this?

Not at all

Perfectly

How do tension pneumos lead to death?

What will be seen/heard on PE?

Thoracic pressure pushes heart chamber/vena cava leading to CV collapse

Dec sound/fremmitus
Tympany on affected side
JVD/deviation
Tachy/tachy
Hypoxic/hypocapnic

All spontaneous pneumothoraces are classified as ?

What is the MC cause of spot-pneumo?

These classically occur most often in ? PTs

Secondary

Ruptured subpleural bleb d/t inc pressure at lung apex of upper lob/superior lower lobe

Asthenic males w/ smoking Hx

Define Catamenial pneumothorax

What is the standard test for Dx pneumothoraxes?

Menstruation related pneumothorax

PA CXR w/ exhalation

How are the different types of pneumothoraxes Tx

All types can become persistent which then need ? Tx

Simple/Closed- thoracostomy
Tension- needle-d, thoracostomy
Open- valve, thoracostomy

Pleurodesis

What is the MC pleural problem?

Pleural effusions are the result of what 5 fluids

Pneumothorax

Sterile fluid
Malignant fluid
Pus
Chyle
Blood

Primary pleural tumors are uncommon but ? is common

What are the MC S/Sxs of pleural Dz

Pleural involvement w/ metastatic cancer

Pain Dyspnea

Where is pleural dz pain referred to ? and why? What movement during PE can produce typical pleuritic chest pain?

Somatic intercostal nerves in chest wall (cervical/costal) and phrenic nerve (diaphragm/mediastinal) leading to chest, back, shoulder pain Extension of visceral pleura

What are the 7 processes of pathophysiology behind a pleural effusion

Inc pulmonary vascular hydrostatic pressure Dec vascular colloid oncotic pressure Inc capillary permeability Dec intrapleural pressure Dec lymph drainage Transdiaphragm movement of abdominal fluids Rupture of vascular/lymph structures

What will be seen on PE of pleural effusion What will be seen if it's an advanced dz

``` Dec respiratory excursion Dec sounds Dull percussion Friction rubs Local tenderness ``` Contracted hemithroax w/ narrow intercostal spaces

How much fluid does it take to opacify an entire hemithorax? What imaging is ordered to evaluate ? types of pleural effusions Why would a interventional radiology get involved w/ these cases?

2000-2500mL CT- complex, loculated, recurrent Loculated pleural effusion Percutaneous drain placement

What underlying issues can leave mediastinum midline and not shift during development of pleural effusions?

Proximal bronchial obstruction causes atelectasis Mediastinum fixed from fibrosis/tumors Ipsilateral lung infiltrated by tumor Malignant mesothelioma is present

How much fluid is needed for thoracentesis analysis? What are the criteria for transudates What are the criteria for exudate?

20mL CHF/LF Protein <3g/ration <0.5 LDH <200/ratio <0.6 SpecGrav <1.016 Ca/Pneumonia

Transudates result from alterations in ? and is a ? Exudates result from alterations in ?

Hydrostatic pressure Ultrafiltrate of serum Inc pleural permeability

What is the best location for performing thoracentesis? What is required after completion of the procedure?

9th/10th intercostal space on mid-scapular line CXR

When chest tube output falls below ?mL, and lung re-expansion is verified, ? is the next step How are malignant effusions Tx

200mL/day Pleurodesis w/ Talc/Doxy Pallative: Re-expansion, pleural symphysis w/ 20-28F tube drainage x 48hrs Pleurodesis

What is the procedure of choice for Dx thoracic empyemas? How are they Tx

Thoracentesis Control infection Removal of fluids Sterilize/re-expand lung Eliminate underlying dz

How are hemothoraces Tx How are chylothoraxes Tx?

32-36F chest tube Re-expansion, pleural symphysis Chest tube/Pleurodesis Low fat diet

What is the MC cause of exudative pleural effusions? What type of effusion does a PE cause?

Malignancy Exudative effusion

# Define Pyothorax Define Parapneumonic empyema

Pus in pleural cavity Underlying suppurative lung dz causing pus in pleural cavity

What microbe is the MC cause of empyema This is one of the MC complications for ? PTs

Staph A Staph pneumonia in kids/adults

What Gram Neg microbes can cause empyema? What other microbes can?

E Coli Pseudomonas Klebsiella Pneumo Proteus Enterobacter aerogenes Salmonells

What fungi can cause empyema? What parasite can cause this?

Aserpgillus Coccidioides immitis Blastomyces Histo capsulatum E histolytica

What are the typical presenting complaints of PTs w/ empyema What is the most important non-invasive test for Dx and what is a pathognemonic finding? What is the procedure of choice for Dx?

``` Fever Pleuritic pain Dyspnea Hemoptysis Cough ``` Plain CXR- D-shaped density on posteriorlateral image Throacentesis

What procedure is done on all thoracic empyema PTs? Define pulmonary infiltrate What can cause this

Bronchoscopy- r/o endobronchial obstruction Consolidaiton; fluid in interstitial space ``` Pneumonia Pulmonary constitution Inhalation injury Sepsis ARDS- mediators, TRALI, rapid PTX expansion ```

How can pulmonary edema be reduced? What is the MC cause of pulmonary capillary leakage or ARDS?

Dec ECF space Dec hydrostatic pressure in capillary bed Inc plasma oncotic pressure Infection/inflammation distant from lungs

How is thoracic empyemas d/t abscesses Tx When are these PTs considered as surgical possibilities?

An/aerobic coverage x 4-6wks Percutaneous drainage ABX failure after 4-6wks Abscess >6cm Life threatening hemoptysis/empema/BPF Bronchial obstruction

If thoracic abscess is causing empyema, what is the preferred procedure? What is a common post-op issue?

Lobectomy Pnemonia