THORACIC Flashcards
Dx of chylothorax
Fluid triglyceride >110 mg /dL
If triglyceride level does not meet diagnostic criteria the presence of chlomicrons in pleural fluid would also make the dx
Also seen: predominance of lympocytes >70%
Where should incision be made for subxiphoid pericardial window
verticlal incision 5-8 cm long made over xiphoid toward abdomen and linea alba is incised
Incision for thoracotomy approach in establishing pericardial woindow is through?
inframammary skin. Rhis allows division of pectoralis muscle to expose pleural space and pericardium through intercostal space
MC tumor of anterior mediastinum
thymoma
MC tumor o fanterior mediastinal tumor in children
teratoma
MC posterior mediastinal tumor
Neurogenic tumor
What else do you need to check in a male who presents with a mediastinal mass
Scrotum (germ cell tumor)
MCC mediastinal adenopathy
Lymphoma
MC overall mediastinal tumor in adults and children
Neurogenic (posterior mediastinum)
MC malignant chest wall tumor
Chondrosarcoma
BiBx shows disorganized hypercellular cartilage and increased nuclear detail
Chondrosarcoma
Tx of chondosarcoma
Wide local excision
Standard tx for localized PAncoast tumor
Concurrent chemoXRT followed by resection
What paraneoplastic syndrome assoc with squamous cell lung CA
parathyroid hormone related paraneoplastic syndromes
NEedle decompression site for kids <15 years old
2nd intercosta lspace, midclavicular line
Needle decompression site for adutls
4th-5th intercostal space, anterior axillary line
MC long term sequelae seen in repair of TEF
reflux (30-60%)
Hypercalcemia is seen in which lung CA
SCC
Trousseau syndrome (migratorry thrombophlebitis) ius a/w which lung CA
adenoCA
T2 lung CA
Tumor 3-5 cm or tumor wich involvement of main bronchus, invading visceral pleura, a/w atelectasis or obstructive pneumonitis
N2 disease in lung CA
positive ipsilateral mediastinal lymph node
Which level nodes are localized superior to innominate artery
2
Which level nodes are localized inferior to innominate artery
4
Which nodal level are lateral to ligamentum arteriosum
level 5. these are subaoritc LN (Aortopulmonary window)
Accessible nodal station in EBUS
2,3, 4, 7, 10, 11 and even 12 sometimes
functional residual capacity is defined as
total lung capacity minus inspiratory capcacity
inspiratory capacity is defined as
inspiratory reserve volume + tidal volume
vital capacity is defined as
total lung capacity minus residual volume (total amount of air you can move!)
exudative effusions - lights criteria
pleural:serum fluid protein >0.5
pleural:serum fluid LDH >0.6
pleural fluid LDH > 2/3 upper limit of normal
pleural effusion must be larger than what to be detectable on CXR
300 mL
adverse effect of bleomycin
commonly used to treat lymphoma and germ cell tumor
PNA and eosinophilic hypersensitivity pneumonitis
life threatening interstitial fibrosis
MC fungi causing mucor
rhizopus, mucor, and rhizomucor
describe mucor fungi microscopically
broad irregularly branching WITHOUT regular septations
Describe aspergillus microscopically
narrower, regular branching, many septations
Mgmt of mucormycosis
aggressive surgical debridement of involved tissue, IV liposomal amphotericin B followed by posaconazole or isavuconazole
Anterior mediastinum boundaries
sternum (anterior) and great vessels and pericardium posterior
Boundaries of middle mediastinum
pericardium anterior and anterior surface of thoracic spine posterior
