Surgery Block 2 Flashcards by brandon lovin

Skin tests can be used for Dx ?

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

TB Histo Coccidio

Laryngo: vocal cord mobility
Brncho: flex/rigid

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How are mediastinum samples acquired

Define Chamberlain procedure

How are pleural biopsys done?

Mediastinoscopy, samples from 3 stations

Ant mediastinotomy biopsy
Alternate- videoscopic guidance

Percutaneous needle
Open surgery
VATS

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Two types of lung biopsy

How are sputum samples acquired for analysis?

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

Deep cough
Abrasion-brush/wash

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What image is the cornerstone of chest pathology

MRI has particular niche for evaluating ?

Superior sulcus for pancoast tumors

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What is the use of PET

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

Staging/work up Ca PT

Spread to mediastinal lymph nodes

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What are the A-F of assessing CXRs

Define Infiltrate
Define Effusion

What is the infiltrate during pneumonia, edema or contusions?

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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? CXR sign indicates fluid

Pleural effusion is fluid located in ?

What procedure could be done to remove the effusion?

Meniscus

Chest, not lungs

Thoracentesis

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Cavitation on CXR indicates ?

What if the cavitation has a thicker wall

How does this differ than thin walled cavitations?

TB Fungal infection

Abscess w/ fluid and inflammatory cells

COPD has blebs/bulla

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Define Cephalization

Pulmonary edema w/ cephalization indicates ?

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

Bilateral perihilar infiltrates

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

Define atelectasis

NG tube suction

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

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Define Simple PneumoThx and what is the urgent Tx

What does the PT have once the above definition changes

Collapse w/out change to VS
Expand lung

Tension- VS changes HOTN
Needle-D, Thoracostomy

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What PT populations are at risk for Spot PTx

S/Sxs of PTx

What would be seen on PE?

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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What would be seen on ABG results of PTx

What would the EKG show

Hypoxia, Hypercapnia

Axis deviation
Non spec ST change
T inversion

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What is the standard test for PTx Dx

What can PTs do to make appearance more pronounced

Why would a CT be ordered

PA, Lat CXR

Exhale- inc contrast and collapse

Differentiate PTx from large bulla

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How are PTx Tx

Any form can become persistent and then needs ?

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

Pleurodesis

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What is the MC pleural problem

What types of pleural tumors are un/common?

PTx

Primary pleural
Metastatic Ca

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The MC Sxs of pleural Dzs are ?

What type of referred pain do they have?

How does pain originate in visceral pleura

Pain
Dyspnea

Back/shoulder from somatic intercostals

Pleuritic pain, visceral pleura insensate

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What are the 7 reasons pleural effusions accumulate

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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How do pleural effusions present

What anatomical/structural change occurs in advanced stages

Dec excursion
Dec sounds
Dull
Friction rub
Local tenderness

Contraction of hemithorax

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

How much does it take to opacify the entire hemithorax?

300-500mL

2-2500mL

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Why would a CT be ordered for pleural effusions

Why would interventional radiology be ordered

Complex Loculated Recurrent

Loculated effusions
Percutaneous drain placement w/ CT guidance

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How are pleural effusions Dx

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

What causes transudates
What causes exudates

What type of lab results are seen

CHF LF (not Ca)
Ca Pneumonia

Dec total protein
Dec LDH
SpecGrav <1.016

What are the two MC pleurodesis agents used

How are effusions Tx

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

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

Staph 3.2/PT Staph pneumonias E Coli Pseudomonas

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

Blasto Aspergillus Coccidio Histo E Hystolytica

Mhoracic empyema causes a mediastinal shift to ? What procedure should be performed? What is the procedure of choice for Dx

Affected side w/ D-shaped density Bronchoscopy Thoracentesis Total protein >3g= exudate

Pulmonary infiltrates can cause ? issues How are thoracic empyemas Tx

Sepsis ARDS Pneumonia Pulm contusion Inhalation injury ``` Abscess= ABX w/ drainage Emyema= thoracoscopic/open lobectomy removal and sterilization ```

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

Lung Ca 6yrs 15yrs

What are the types of lung cancers seen What types of Cas are more likely to be central or peripheral

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

How do central tumors present How do peripheral tumors present Give two examples of peripheral tumors

Hemoptysis Pain Pneumonia Pain Pleural effusion Pulmonary abscess Horners- PIA Pancoast- ____

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

Cough/hemoptysis Wall pain Atelectasis Hemoptysis Produce/deplete hormones= Clubbing Hypertrophic osteoarthropathy

How do non small Ca present How do small cell present How do adrenal insufficiency present

PTH-like production= HyperCa ADH like= SIAD, MAH, ACTH Fatigue, Na craving Weight loss E+ imbalance HypoNa HyperK

How does Panocast present

Brachial impingement Ulnar compression Cervical lymph strain SVC Horners SVC syndrome- worse laying/flat

How are neoplasms of lung Dx

``` CXR CT SAP FDG PET Thoracentesis/scopy ```

What are the characteristics of benign/malignant neoplasms of lung

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

How are lung neoplasms tissue Dx

Sputum cytology Bronchoscopy Percutaneous/Tran-T biopsy Wedge biopsy

# Define Unresectable Define Inoperable

Tumor invaded vital structures, not removeable Unstable PT due to comorbidities

How are lung neoplasms PTs assessed Pre-Op

Cardiopulm reserve | Most accurate factor

How are lung neoplasms Tx

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

How are lung neoplasms staged 3 layers of a artery

T- tumor size N- nodal involvement M- etastasis Intima Media Adventitia

What are the two MC causes of arterial aneurysms What causes psudoaneurysms? Pseudoaneurysm can present as ?

Atherosclerosis HTN Puncture/lacerated artery Pulsatile hematoma

What are the 3 subtypes of pseudoaneurysms What is the MC cause

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

What physics law applies to AAA These become at ? size? What PE finding indicates the need for urgent surgery

Laplace 5cm Extreme tenderness

What are the S/Sxs of a ruptured AAA How is it Dx

Gray Turner sign HOTN TTP flank/back pain Dec fem pulse Seen on x-ray Confrimed w/ US- LRA? Ruprture Dx w/ CT

What is the name of the procedure done prior to an AAA repair for assessment/planning When are these indicated for repair?

Aortogram- contrasted x-ray but nephrotoxic Elective >5.5cm Sx= emergent Growth >1cm/yr

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

Open Endovascular stent- endovascular aneurysm repair Bolus isotonic fluids

What complications can occur out of AAAs? What are 3 etiolgies of aortic transection?

Mycotic aneurysm Fistula w/ IVC= CHF Fistula w/ GI= GI bleed Blue toe syndrome Auto crash Motorcycle crash Fall from height

Where do aortic transections usually occur? PTs can survive if ? structure holds? What would be seen on CXR?

Distal to subclavian artery Adventitia holds CXR- wide mediastinum

What is the most reliable test for aortic transections? When is repair preferred? What can be done to dec forces on site of injury?

CT angiography Delayed- tight BP control and hemodynamically stable BBs then dilators

What are the two Tx methods for repairing aortic transections What is the MC catastrophic event of the aorta

Endovascular repair w/ graft Open repair Aortic dissection

What are the two classifications of aortic dissections? What type is more likely to rupture?

DeBakey Stanford Stanford type A, rupture in ascending aorta

How does aortic dissection present What findings may be seen on PE?

Male >60y/o Sharp tearing pain to back Hx of HTN surgery cocaine Pulse different between arms Diastolic aortic regurgitation

How are aortic dissections Dx Nearly all PTs present w/ ? trifecta of Sxs?

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