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Surgery Block 2 Flashcards

1
Q

Skin tests can be used for Dx ?

What are the two types of Endoscopy and what are they used for?

A

TB Histo Coccidio

Laryngo: vocal cord mobility
Brncho: flex/rigid

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2
Q

How are mediastinum samples acquired

Define Chamberlain procedure

How are pleural biopsys done?

A

Mediastinoscopy, samples from 3 stations

Ant mediastinotomy biopsy
Alternate- videoscopic guidance

Percutaneous needle
Open surgery
VATS

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3
Q

Two types of lung biopsy

How are sputum samples acquired for analysis?

A

Needle- MC indicated for eval of SPN
Surgical- thoracoscopy for open lung biopsy

Deep cough
Abrasion-brush/wash

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4
Q

What image is the cornerstone of chest pathology

MRI has particular niche for evaluating ?

A

CT

Superior sulcus for pancoast tumors

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5
Q

What is the use of PET

Since this is more accurate than CT, what can it be used to detect?

A

Staging/work up Ca PT

Spread to mediastinal lymph nodes

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6
Q

What are the A-F of assessing CXRs

Define Infiltrate
Define Effusion

What is the infiltrate during pneumonia, edema or contusions?

A

Air Bones Cardiac silhouette Density Edema Foreign body

In: fluid in lung
Eff: fluid in pleural

Pneumo- pus
PulmEdema- serous
PulmCont- blood

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7
Q

? CXR sign indicates fluid

Pleural effusion is fluid located in ?

What procedure could be done to remove the effusion?

A

Meniscus

Chest, not lungs

Thoracentesis

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8
Q

Cavitation on CXR indicates ?

What if the cavitation has a thicker wall

How does this differ than thin walled cavitations?

A

TB Fungal infection

Abscess w/ fluid and inflammatory cells

COPD has blebs/bulla

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9
Q

Define Cephalization

Pulmonary edema w/ cephalization indicates ?

A

Fluid leaking into alveoli, begins near hila and spreads out/up

Bilateral perihilar infiltrates

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10
Q

If PT has diaphragmatic hernia, what procedure is done to decompress air in stomach prior to repair surgery?

Define atelectasis

A

NG tube suction

Air trapped in alveoli reabsorbed= collapsing alveoli, pulls tissue together

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11
Q

Define Simple PneumoThx and what is the urgent Tx

What does the PT have once the above definition changes

A

Collapse w/out change to VS
Expand lung

Tension- VS changes HOTN
Needle-D, Thoracostomy

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12
Q

What PT populations are at risk for Spot PTx

S/Sxs of PTx

What would be seen on PE?

A

SMELT C
Smoker Margan Emphysema Lung ca Thin CF

Pleuritic pain/dyspnea
Sev= cyanosis HOTN CV collapse

Tachy Tachy Deviation Dec sounds Hyper resonance

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13
Q

What would be seen on ABG results of PTx

What would the EKG show

A

Hypoxia, Hypercapnia

Axis deviation
Non spec ST change
T inversion

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14
Q

What is the standard test for PTx Dx

What can PTs do to make appearance more pronounced

Why would a CT be ordered

A

PA, Lat CXR

Exhale- inc contrast and collapse

Differentiate PTx from large bulla

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15
Q

How are PTx Tx

Any form can become persistent and then needs ?

A

Simple- thoracostomy
Tension- needle-d (emergent), thoracostomy (definitive)
Open- valve, thoracostomy
Closed- thoracostomy

Pleurodesis

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16
Q

What is the MC pleural problem

What types of pleural tumors are un/common?

A

PTx

Primary pleural
Metastatic Ca

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17
Q

The MC Sxs of pleural Dzs are ?

What type of referred pain do they have?

How does pain originate in visceral pleura

A

Pain
Dyspnea

Back/shoulder from somatic intercostals

Pleuritic pain, visceral pleura insensate

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18
Q

What are the 7 reasons pleural effusions accumulate

A

Inc hydrostatic press

Dec colloid press

Inc capillary membrane

Dec intrapleural press

Dec lymph drainage

Trandiaphragm movement of abd fluids

Ruptured vascular/lymph structure

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19
Q

How do pleural effusions present

What anatomical/structural change occurs in advanced stages

A 
Dec excursion
Dec sounds
Dull
Friction rub
Local tenderness

Contraction of hemithorax

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20
Q

How much fluid does it take to blunct costaphrenic angles on CXR

How much does it take to opacify the entire hemithorax?

A

300-500mL

2-2500mL

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21
Q

Why would a CT be ordered for pleural effusions

Why would interventional radiology be ordered

A

Complex Loculated Recurrent

Loculated effusions
Percutaneous drain placement w/ CT guidance

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22
Q

How are pleural effusions Dx

A

Throcentesis- 20mL
Protein LDH Total/Diff cell count
Glucose pH Cytology Gram w/ culture

23
Q

What causes transudates
What causes exudates

What type of lab results are seen

A 
CHF LF (not Ca)
Ca Pneumonia

Dec total protein
Dec LDH
SpecGrav <1.016

24
Q

What are the two MC pleurodesis agents used

How are effusions Tx

A

Talc
Doxycycline

Malignant: palliative, expand lung/pleural symphysis
Chest tube 20-28F and drainage

Empyema: procedure of choice for Dx= thoracentesis

Hemothoraces- 32-36F closed drainage

Chylothorax- similar to malignant, low fat diet initiated

25
Q

What is the MC organism causing empyema and the average number of species isolated is ?

This is also the MC complication of ? in adults and kids

What Gram-neg can be seen here too

A

Staph
3.2/PT

Staph pneumonias

E Coli
Pseudomonas

26
Q

If fungus is found in thoracic empyema, what can cause it?

What parasites can cause it?

A

Blasto Aspergillus Coccidio Histo

E Hystolytica

27
Q

Mhoracic empyema causes a mediastinal shift to ?

What procedure should be performed?

What is the procedure of choice for Dx

A

Affected side w/ D-shaped density

Bronchoscopy

Thoracentesis
Total protein >3g= exudate

28
Q

Pulmonary infiltrates can cause ? issues

How are thoracic empyemas Tx

A

Sepsis ARDS Pneumonia Pulm contusion Inhalation injury

Abscess= ABX w/ drainage
Emyema= thoracoscopic/open lobectomy removal and sterilization
29
Q

What is the MC cause of cancer related deaths of men and women in US

Smoking cessation dec risk after ?yrs of quitting

Previous smokers reach almost no risk after ? of no smoking

A

Lung Ca

6yrs

15yrs

30
Q

What are the types of lung cancers seen

What types of Cas are more likely to be central or peripheral

A

Squamous Large Adeno
Small cell- non-small cell
Bronchial gland adenomas/carcinoid

Small cell- central
Adeno- peripheral

31
Q

How do central tumors present

How do peripheral tumors present

Give two examples of peripheral tumors

A

Hemoptysis Pain Pneumonia

Pain Pleural effusion Pulmonary abscess

Horners- PIA
Pancoast- ____

32
Q

How do neoplasms present if they touch bronchus, mass, narrowed bronchus or mid parenchyma from bronchus

How do paraneoplastic syndromes present

A

Cough/hemoptysis
Wall pain
Atelectasis
Hemoptysis

Produce/deplete hormones=
Clubbing
Hypertrophic osteoarthropathy

33
Q

How do non small Ca present

How do small cell present

How do adrenal insufficiency present

A

PTH-like production= HyperCa

ADH like= SIAD, MAH, ACTH

Fatigue, Na craving Weight loss E+ imbalance HypoNa HyperK

34
Q

How does Panocast present

A

Brachial impingement
Ulnar compression
Cervical lymph strain
SVC

Horners

SVC syndrome- worse laying/flat

35
Q

How are neoplasms of lung Dx

A 
CXR
CT
SAP
FDG PET
Thoracentesis/scopy
36
Q

What are the characteristics of benign/malignant neoplasms of lung

A 
Benign= 
<2cm 
Stable x 24mon
Concentric calcification
Smooth border
Solitary
Malignant= 
>2cm
Inc/Unstable x 24mon
Irregular calcification
Spiculated border
Multiples
37
Q

How are lung neoplasms tissue Dx

A

Sputum cytology
Bronchoscopy
Percutaneous/Tran-T biopsy
Wedge biopsy

38
Q

Define Unresectable

Define Inoperable

A

Tumor invaded vital structures, not removeable

Unstable PT due to comorbidities

39
Q

How are lung neoplasms PTs assessed Pre-Op

A

Cardiopulm reserve

Most accurate factor

40
Q

How are lung neoplasms Tx

A

Observe
Conserve/support- steroid ABX throracentesis
Excistion
Chemo/Rad

41
Q

How are lung neoplasms staged

3 layers of a artery

A

T- tumor size
N- nodal involvement
M- etastasis

Intima Media Adventitia

42
Q

What are the two MC causes of arterial aneurysms

What causes psudoaneurysms?

Pseudoaneurysm can present as ?

A

Atherosclerosis
HTN

Puncture/lacerated artery

Pulsatile hematoma

43
Q

What are the 3 subtypes of pseudoaneurysms

What is the MC cause

A

Saccular- outpouch of wall
Fusifrom- diffuse
Mycotic- Staphylococcus infection

Trauma

44
Q

What physics law applies to AAA

These become at ? size?

What PE finding indicates the need for urgent surgery

A

Laplace

5cm

Extreme tenderness

45
Q

What are the S/Sxs of a ruptured AAA

How is it Dx

A

Gray Turner sign
HOTN
TTP flank/back pain
Dec fem pulse

Seen on x-ray
Confrimed w/ US- LRA?
Ruprture Dx w/ CT

46
Q

What is the name of the procedure done prior to an AAA repair for assessment/planning

When are these indicated for repair?

A

Aortogram- contrasted x-ray but nephrotoxic

Elective >5.5cm
Sx= emergent
Growth >1cm/yr

47
Q

How are AAA Tx

Post aorto-bifemoral bypass PT w/ dec urine output to 30mL, what is the next step?

A

Open
Endovascular stent- endovascular aneurysm repair

Bolus isotonic fluids

48
Q

What complications can occur out of AAAs?

What are 3 etiolgies of aortic transection?

A

Mycotic aneurysm
Fistula w/ IVC= CHF
Fistula w/ GI= GI bleed
Blue toe syndrome

Auto crash
Motorcycle crash
Fall from height

49
Q

Where do aortic transections usually occur?

PTs can survive if ? structure holds?

What would be seen on CXR?

A

Distal to subclavian artery

Adventitia holds

CXR- wide mediastinum

50
Q

What is the most reliable test for aortic transections?

When is repair preferred?

What can be done to dec forces on site of injury?

A

CT angiography

Delayed- tight BP control and hemodynamically stable

BBs then dilators

51
Q

What are the two Tx methods for repairing aortic transections

What is the MC catastrophic event of the aorta

A

Endovascular repair w/ graft
Open repair

Aortic dissection

52
Q

What are the two classifications of aortic dissections?

What type is more likely to rupture?

A

DeBakey
Stanford

Stanford type A, rupture in ascending aorta

53
Q

How does aortic dissection present

What findings may be seen on PE?

A

Male >60y/o
Sharp tearing pain to back
Hx of HTN surgery cocaine

Pulse different between arms
Diastolic aortic regurgitation

54
Q

How are aortic dissections Dx

Nearly all PTs present w/ ? trifecta of Sxs?

A

EKG to r/o MI/PE
CXR- wide mediastinum, pulm edema, pleural effusion
CT- standard image modality
TEE

Abrupt onset of tearing
Pulse deficit >20mmHg
Wide mediastinum on CXR

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