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IPAP > Surg Block 3 > Flashcards

Surg Block 3 Flashcards

1
Q

How many compartments are in the mediastinum?

Define Angle of Louis

A

Superior Anterior middle Posterior

Superior compartment line from T4 to sternomanubrial junction

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2
Q

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

A

Anterior: Thymus Nodes Ascending Transverse Areolar

Middle: Heart Pericardium Trachea Hila Phrenic Areolar

Posterior: Sympathetic Vagus Esophagus Descending

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3
Q

What is the fundamental unit of lung anatomy?

What are the homologous units of the lungs?

A

Bronchopulmonary segment

L: Lingular segment of upper lobe
R: middle lobe

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4
Q

How many fissures are in the lungs?

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

A

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

TB Histo Coccidio

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5
Q

Purpose of Endoscopy

Purpose of Bronchoscopy

A

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

Lymph node sample; obstructions, aspirations, foreign bodies

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6
Q

What is the mainstay method to evaluate the mediastinum?

Where are samples gathered from for this mainstay method?

A

Cervical mediastinoscopy via incision above sternal notch

Paratracheal levels 2 and 4
Subcarinal level 7

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7
Q

Define Chamberlain Procedure and its use

What is the alternate procedure to the Chamberlain?

A

Anterior mediastinotomy- node sampling via aortopulmonary window through interspace incision

Video assisted thoracoscopic surgery VATS

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8
Q

How are pleural biopsies acquired?

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

A

Percutaneous needles
Open surgery
VATS

Solitary pulmonary nodule
Confirm presence of metastatic dz

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9
Q

What procedure is the standard approach for open lung biopsy?

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

A

Thorascopy

Tolerant to single lung ventilation

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10
Q

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

How are these samples acquired?

A

Sputum

Deep cough
Abrasion w/ brush
Bronchial wash

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11
Q

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

Why would PET scan be used?

A

Cancer invasion
Pancoast tumors in sulcus

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

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12
Q

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

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

A

R atrium

300mL
Frontal CXR

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13
Q

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

Define the sub-types

A

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

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14
Q

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?

A

Meniscus sign

> 150mL

<50mL

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15
Q

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

When pulmonary venous pressure exceeds ? a pleural effusion is formed

A

1cm thick

> 25mmHg

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16
Q

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

Why is cephalization seen in CHF PTs unreliable?

A

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

Reqs upright image, most CHF PTs are supine

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17
Q

What is a common characteristic in all forms of atelectasis?

What would be seen on CXR w/ atelectasis?

A

Loss of lung volume

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

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18
Q

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

What are the 4 types of pneumothorax

A

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

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19
Q

How do tension pneumos lead to death?

What will be seen/heard on PE?

A

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

Dec sound/fremmitus
Tympany on affected side
JVD/deviation
Tachy/tachy
Hypoxic/hypocapnic
20
Q

All spontaneous pneumothoraces are classified as ?

What is the MC cause of spot-pneumo?

These classically occur most often in ? PTs

A

Secondary

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

Asthenic males w/ smoking Hx

21
Q

Define Catamenial pneumothorax

What is the standard test for Dx pneumothoraxes?

A

Menstruation related pneumothorax

PA CXR w/ exhalation

22
Q

How are the different types of pneumothoraxes Tx

All types can become persistent which then need ? Tx

A

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

Pleurodesis

23
Q

What is the MC pleural problem?

Pleural effusions are the result of what 5 fluids

A

Pneumothorax

Sterile fluid
Malignant fluid
Pus
Chyle
Blood
24
Q

Primary pleural tumors are uncommon but ? is common

What are the MC S/Sxs of pleural Dz

A

Pleural involvement w/ metastatic cancer

Pain Dyspnea

25
Q

Where is pleural dz pain referred to ? and why?

What movement during PE can produce typical pleuritic chest pain?

A

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

Extension of visceral pleura

26
Q

What are the 7 processes of pathophysiology behind a pleural effusion

A

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

27
Q

What will be seen on PE of pleural effusion

What will be seen if it’s an advanced dz

A 
Dec respiratory excursion
Dec sounds
Dull percussion
Friction rubs
Local tenderness

Contracted hemithroax w/ narrow intercostal spaces

28
Q

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?

A

2000-2500mL

CT- complex, loculated, recurrent

Loculated pleural effusion
Percutaneous drain placement

29
Q

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

A

Proximal bronchial obstruction causes atelectasis

Mediastinum fixed from fibrosis/tumors

Ipsilateral lung infiltrated by tumor

Malignant mesothelioma is present

30
Q

How much fluid is needed for thoracentesis analysis?

What are the criteria for transudates

What are the criteria for exudate?

A

20mL

CHF/LF
Protein <3g/ration <0.5
LDH <200/ratio <0.6
SpecGrav <1.016

Ca/Pneumonia

31
Q

Transudates result from alterations in ? and is a ?

Exudates result from alterations in ?

A

Hydrostatic pressure
Ultrafiltrate of serum

Inc pleural permeability

32
Q

What is the best location for performing thoracentesis?

What is required after completion of the procedure?

A

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

CXR

33
Q

When chest tube output falls below ?mL, and lung re-expansion is verified, ? is the next step

How are malignant effusions Tx

A

200mL/day
Pleurodesis w/ Talc/Doxy

Pallative:
Re-expansion, pleural symphysis w/ 20-28F tube drainage x 48hrs
Pleurodesis

34
Q

What is the procedure of choice for Dx thoracic empyemas?

How are they Tx

A

Thoracentesis

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

35
Q

How are hemothoraces Tx

How are chylothoraxes Tx?

A

32-36F chest tube

Re-expansion, pleural symphysis
Chest tube/Pleurodesis
Low fat diet

36
Q

What is the MC cause of exudative pleural effusions?

What type of effusion does a PE cause?

A

Malignancy

Exudative effusion

37
Q

Define Pyothorax

Define Parapneumonic empyema

A

Pus in pleural cavity

Underlying suppurative lung dz causing pus in pleural cavity

38
Q

What microbe is the MC cause of empyema

This is one of the MC complications for ? PTs

A

Staph A

Staph pneumonia in kids/adults

39
Q

What Gram Neg microbes can cause empyema?

What other microbes can?

A

E Coli
Pseudomonas

Klebsiella Pneumo
Proteus
Enterobacter aerogenes
Salmonells

40
Q

What fungi can cause empyema?

What parasite can cause this?

A

Aserpgillus
Coccidioides immitis
Blastomyces
Histo capsulatum

E histolytica

41
Q

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?

A 
Fever
Pleuritic pain
Dyspnea
Hemoptysis
Cough

Plain CXR- D-shaped density on posteriorlateral image

Throacentesis

42
Q

What procedure is done on all thoracic empyema PTs?

Define pulmonary infiltrate

What can cause this

A

Bronchoscopy- r/o endobronchial obstruction

Consolidaiton; fluid in interstitial space

Pneumonia
Pulmonary constitution
Inhalation injury
Sepsis
ARDS- mediators, TRALI, rapid PTX expansion
43
Q

How can pulmonary edema be reduced?

What is the MC cause of pulmonary capillary leakage or ARDS?

A

Dec ECF space
Dec hydrostatic pressure in capillary bed
Inc plasma oncotic pressure

Infection/inflammation distant from lungs

44
Q

How is thoracic empyemas d/t abscesses Tx

When are these PTs considered as surgical possibilities?

A

An/aerobic coverage x 4-6wks
Percutaneous drainage

ABX failure after 4-6wks
Abscess >6cm
Life threatening hemoptysis/empema/BPF
Bronchial obstruction

45
Q

If thoracic abscess is causing empyema, what is the preferred procedure?

What is a common post-op issue?

A

Lobectomy

Pnemonia

IPAP (212 decks)

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