Surgery Block 2 Flashcards
Classically, what are the 3 compartments of the mediastinum?
What angle is formed here and by ? structures?
Superior Anterior Posterior
T4 to Sternomanubral Junction= Angle of Louis
What are the 3 compartments of the mediastinum and what is located in them according to the Burkell classification?
Anterior:
Areolar Transverse Great Nodes Ascending Thymus
Middle: Phrenic Hila Areolar Trachea Pericardium Heart
Posterior: Sympathetic Vagus Esophagus Nodes Ducts Descending
What is the fundamental unit of lung anatomy?
How many lobes does each lung have?
What lung segments are homologous to each other?
Bronchopulmonary segment
R: Upper Middle Lower
L: Upper Lower
L upper lobe lingular segment = R middle lobe
How many fissures are in the right lung?
R:
Minor/horizontal divides middle from upper
Major/oblique divides upper/middle from lower
L:
Oblique separates upper/lower lobes
Skin tests can be used for Dx of ? lung issues
What are the two types of endoscopy and their use?
TB Histo Coccidio
Laryngo- assess vocal cord mobility after change in voice d/t suspected lung carcinoma
Broncho- flex/rigid
What procedure is the mainstay of evaluation of the mediastinum?
Define Chamberlain procedure and it’s alternate?
Cervical mediastinoscopy: 3 sample collection: paratracheal 2/7, subcarinal 7
Anterior mediastinomy to sample nodes/biopsy tissue in aortopulmonary window.
Video Assisted Thorascopic Surgery
What are the 3 methods to collect a pleural biopsy?
Where is the incision for mediastinoscopy?
Where is the incision for Chamberlin procedure?
Percutaneous needle
Open surgery
VATS
Above sternal notch
2-3rd interspace
What is the MC indication and secondary indication to use transthoracic needle biopsy of the lung?
What is the standard approach for a surgical biopsy but w/ ? caveat?
Eval solitary pulm nodule
Confirm metastatic Dz
Thoracoscopy
Single lung ventilation
Cytology of ? can be used for detecting lung Ca
What is the cornerstone of chest pathology evaluation?
Sputum from abrasions
CT
What niche does MRI have in evaluating thoracic structures?
MRI is used in this niche to evaluate for involvement of ?
Superior sulcus (Pancoast) tumors
Brachial plexus
Subclavian vessel
Bony chest wall
Where does PET use fall into thoracic malignancy?
PETs are more accurate than CTs to detect ?
Staging/work up
Spread to mediastinal nodes
Define Infiltrate
Define Effusion
Fluid in lung
Fluid in pleural space
PTs w/ pneumonia, fluid in the infiltrate is ?
PTs w/ pulmonary edema, fluid in infiltrate is ?
PTs w/ pulmonary contusion, fluid in infiltrate is ?
Pus
Serous
Blood
Pleural effusions are divided into ? or ? depending on?
Where are each ones more likely to develop/form?
Exudate/Transudate
Protein/LDH
Transudates: inc capillary hydrostatic pressure/dec osmotic pressure
Exudates: inflammation
Transudates are MC caused by or can be created d/t ? underlying processes?
Exudate pleural effusions are MC caused by ? or can be due to ?
CHF (L sided failure)
Hypoalbumin
Cirrhosis
Nephrotic syndrome
Malignancy
Empyema is classified as ? type of effusion?
This classification can include ? other types of effusions
Exudate
Hemothorax- Hct +50%
Chylothorax- inc TG/cholesterol
What structures carry contents for a chylothorax to develop?
Where does it begin/end?
Thoracic duct, carries chyle from intestine to blood
Cisterna chyli (L2) to L-subclavian/jugular vein
? sign on CXR indicates fluid in chest cavity?
How can the fluid be removed?
Meniscus sign
Thoracentesis
Chest tube
? forms the interlobar fissures?
Space between visceral and parietal pleura is a potential space normally holding ? mL of fluid
Enfolds of visceral pleura
2-5mL
How much fluid is needed to blunt intercostal angles or whole hemithorax on frontal views?
Because of the natural elastic recoil of lungs, pleural fluid appears to be ? than reality
> 300mL- angles
2L- hemi
Higher on lateral margin than medially= meniscus sign
Pleural effusion must be larger than __mL to be detectable on standard upright AP CXR?
? PT position is used to detect smaller effusions of ? size
How much is needed to be accessible for thoracentesis?
> 150mL
Lateral decubitus; <50mL
1cm thick
? physiological process occurs in order for a pulmonary edema to occur?
What CXR appearance does this cause?
Pulm venous pressure >25mmHg
Bat wing appearance
Cephalization is only beneficial once ? has been verified?
Difference in appearance of a lung abscess and a COPD bleb/bulla?
Certain PT was upright during x-ray
Abscess: thick w/ fluid
Bleb: thin w/ air
Pulmonary edema starts by filling ? seen on CXR
What is common in all forms of atelectasis?
Large vessels in hilum
Dec volume, inc density