Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Absite Review > The Surgical Review- Thoracic > Flashcards

The Surgical Review- Thoracic Flashcards

1
Q

Three zones of the lung?

A
  1. Conducting zone: first 16 divisions, ciliated epithelium + mucus secreting goblet cells
  2. Transitional zone: 17-19th division
  3. Respiratory zone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which type of alveolar cells produce surfactant and what is surfactant?

A

type II

dipalmitoyl phosphatidylcholine- reduces alveolar surface tension and prevents alveolar collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what components does spirometry measure?

A

Tidal volume (VT), vital capacity (VC), inspiratory reserve volume (IRV), and expiratory reserve volume (ERV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is tidal volume and what is a normal?

A

volume of air inspired or expired during normal breathing, ~7mL/kg in average adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is vital capacity?

A

the amount of air that can be expelled from the lungs during a maximal forced expiration after a maximal forced inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

using PFTs/spirometry, whats the difference between obstructive and restrictive lung disease?

A

Obstructive: FEV1/FVC ratio is decreased (

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the two vascular networks of the lung?

A
  1. Bronchial circulation- arising from the descending aorta, supplies the conducting zone of the lung and drains into pulmonary venous system
  2. Pulmonary circulation - arising from R ventricle, coats alveoli for gas exchange
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how do the pulmonary vessels differ from the systemic arterial supply?

A

thinner walls with less elastin and smooth muscle resulting in:

  1. lower pressure
  2. less resistance
  3. increased capacitance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the zones of the lung and relationships of PA, Pa, Pv

A

Zone I: PA > Pa > Pv, apex, alveolar dead space, no blood flow (ventilated but not perfused)
Zone II: Pa > PA > Pv, middle, pressure flow driven by difference between alveolar and arterial pressure
Zone III: Pa > Pv > PA, base of lung, pressure for flow is the difference between arterial and venous pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is ficks law of diffusion?

A

V gas = A x D x (P1-P2) /T

A= area available for diffusion, D = diffusion coefficient, P = pressure gradient, T = thickness of barrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the most common causes of hypoventilation seen in surgical population?

A
  1. Respiratory depression 2/2 general anesthesia or pain medications
  2. Respiratory mm dysfunction 2/2 paralytic meds
  3. Splinting secondary to pain
  4. Traumatic injuries ie flail chest
  5. Upper airway obstruction from tumor invasion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the key diagnostic feature of hypoventilation?

A

hypercarbia!! because PCO2 is inversely related to the volume of alveolar ventilation (halving alveolar ventilation results in a doubling of arterial PCO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are shunts?

A

lung that is perfused but not ventilated, can see in a-v fistulas, congenital defects etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the only cause of hypoxemia that does not improved with the administration of 100% oxygen?

A

shunts!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the most common pathologic organism in the lung?

A

mycobacterium TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

treatment of mycobacterium TB?

A

Isoniazid, Rifampin, ethambutol, pyrazinamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when do you operate in mycobacterium TB infections of lung? (6)

A
  1. positive sputum cx plus cavitary lung lesions after >5months of treatment with 2 or more drugs
  2. Severe/recurrent hemoptysis
  3. Bronchopulmonary fistula not responsive to chest tube
  4. persistent empyema
  5. a mass found in the area of the lung infected
  6. disease caused by mycobacterium avium intracellulare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

treatment of bronchiectasis?

A

antibiotics, cessation of smoking, pulmonary toilet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when is surgical intervention warranted in patients with lung abscess?

A

when a cavity larger than 2cm persists for longer than 8 weeks after antimicrobial therapy, or in setting of persistent bacteremia, hemoptysis, or neoplasm is suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the definition of massive hemoptysis?

A

greater than 500cc of blood loss from the lung over 24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what do u have to be worried about when doing an angiographic embolization of lung?

A

quadriplegia, as the bronchial circulation often contributes to the blood supply of the spinal cord

22
Q

most common lung mass benign

A

hamartoma

23
Q

how do u distinguish a hamartoma from a lung cancer?

A

presence of a fat density within the nodule seen on CT

24
Q

environmental toxins related to lung cancer? 3

A

asbestos, chromium, radon gas

25
Q

wht is the most common oncogene abnormality seen in NSCLC?

A

k-ras mutation

26
Q

what are the different types of NSCLC?

A
  1. Adenocarcinoma
  2. Squamous cell
  3. Large cell
27
Q

what are the common sites of metastases of NSCLC? 3

A
  1. Brain
  2. Adrenal Glands
  3. Bone
28
Q

when do you do a mediastinoscopy for lung cancer? 2

A
  1. Centrally located tumor

2. Mediastinal lymph nodes greater than 1.5cm

29
Q

treatment of stage I or II NSCLC?

A

surgical resection: lobectomy vs pneumonectomy

30
Q

how do you treat mediastinal lymph node disease in NSCLC? Stage IIIA

A

neoadjuvant chemotherapy or chemo/XRT followed by surgical rsxn

31
Q

management of stage IIIB NSCLC?

A

not surgical candidates (especially w contralateral or supraclavicular LN involvement)

32
Q

what is the best predictor of pts survival in NSCLC?

A

pathologic stage- more specifically, lymph node status

33
Q

mainstay treatment of small cell lung cancers?

A

systemic chemotherapy

34
Q

if a bronchial carcinoid is a functional one, what does it typically secrete?

A

serotonin

35
Q

treatment of bronchial carcinoids?

A

complete surgical resection

36
Q

what are the 3 bronchial adenomas?

A
  1. Adenoid cystic carcinoma
  2. Mucoepidermoid Carcinoma
  3. Mucous gland adenoma (benign)
37
Q

pathogenesis of adenoid cystic carcinomas? treatment?

A

arise from submucosal glands in the bronchi and trachea, tx: resection of the tumor + involved airway + XRT

38
Q

chest wall tumors arise from what type of tissue?

A

mesodermal origin: chondrosarcoma, fibrosarcoma, plasmacytoma, ewing sarcoma, osteosarcoma

39
Q

definitive treatment chest wall tumors?

A

if

40
Q

principle of en bloc resection of chest wall tumors?

A

complete resection with 4cm margins and one normal rib above and below the tumor

41
Q

definition of transudative pleural effusion? 2

A
  1. Specific gravity
42
Q

most common etiology of spontaneous pneumothorax?

A

rupture of apical blebs (or blebs in the superior segment of the lower lobe)

43
Q

when is surgical intervention mandated in spontaneous pneumothorax?6

A
  1. Persistent air leak (3-5 days)
  2. Massive air leak >24hrs
  3. Failure of lung to re-expand
  4. Hx of previous ptx
  5. Bilateral ptx
  6. large pulm bullae
44
Q

how do you identify a chylothorax?

A
  1. Cholesterol/triglyceride ratio of 110 mL/dL

in pleural fluid

45
Q

Identifying empyema by fluid levels of : 7

A
  1. pH 1,000
  2. WBC >15,000
  3. Protein >3g/dL
  4. Specific gravity >1.016
    + Gram stain
46
Q

most common organism of empyema?

A

staph aureus

47
Q

pleural malignancies most commonly present as metastases from what 4 cancers?

A
  1. Lung
  2. Breast
  3. Stomach
  4. Pancreatic
48
Q

what subtype of mesothelioma has a favorable prognosis?

A

epithelial

49
Q

Common paraneoplastic syndromes that accompany thymomas?

A
  1. Myasthenia Gravis
  2. Cushing syndrome
  3. Lupus
  4. Rheumatoid arthritis
  5. Pure red cell aplasia
  6. Hypercoagulopathy
50
Q

what is the most common cause of chylous ascites?

A

malignancy- specifically lymphoma

51
Q

where are the incisions in a transhiatal esophagectomy?

A

upper midline abdominal and left cervical incision

52
Q

what is the blood supply of the gastric conduit in esophagectomy?

A

right gastroepiploic

Absite Review (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions