Thoracic Flashcards
Describe the course of the thoracic duct.
- cisterna chyli at L2
- crosses from right to left at T5
- empties into the junction of the L IJ and subclavian
Where does the azygous drain?
the SVC
Where does the phrenic nerve run in relation to the mediastinum?
anterior (the vagus runs posterior)
What are the functions of type I and II pneumocytes?
- 1: gas exchange
- 2: surfactant
What is the main component of surfactant?
phosphatidylcholine
What is the best PFT for predicting post-op complications?
FEV1 (want it > 80%)
What is the next step if a patient planned for pulmonary resection has a diminished FEV1 on pre-op testing?
V/Q scan to evaluate the contribution of the potentially resected lung parenhyma
What are the FEV1 and DLCO cutoffs for lung resection?
- FEV1 > 80% predicted
- DLCO > 40% predicted
What are light’s criteria?
- pleural to serum protein > .5
- pleural to serum LDH > .6
- pleural LDH > ⅔ upper limit of normal
How is a chylothorax diagnosed?
with pleural fluid triglyceride level > 110 mg/dL (stains positive for Sudan red)
What is the treatment for chyle leak?
low fat, medium-chain fatty acid diet (no long-chains)
What are the indications for operative intervention in someone with a spontaneous pneumothorax?
- air leak > 4 days
- recurrence
- high risk profession
- long travel to health care
What is the most common cause of mediastinal adenopathy?
lymphoma
What is the most common overall type of mediastinal tumor?
neurogenic (posterior)
What is the most common site of a mediastinal tumor?
anterior
What is the differential for an anterior mediastinal mass?
- thymoma
- teratoma
- terrible lymphoma
- thyroid tissue
What is the relationship between thymomas and myasthenia graves?
- 50% of those with thymomas have MG
- 10% of those with MG have thymomas
- 80% of those with MG improve with thymectomy
What is the most common cause of SVC syndrome?
small cell lung cancer
What is the treatment for SVC syndrome?
steroids, AC, and emergent radiation
Who should have lung screening?
annual low dose CT scan for those 55-80 with more than 30 pack year history who have smoked in the past 15 years
What is the strongest prognostic indicator for lung cancer?
lymph node involvement
What is the most common site of metastasis for lung cancer?
the brain
What paraneoplastic syndromes are lung cancer associated with?
- squamous cell (PTHrP)
- small cell (ACTH and ADH)
How is lung cancer staged?
- T1: less than 3cm
- T2: 3-5 cm
- T3 5-7 cm or invading the chest wall/pericardium
- T4: > 7cm or invading the mediastinum
- N3: supraclavicular node
