THORACIC

Question 1

What are two kinds of pleuritis?

Answer 1

1. Fibrinous (dry)
2. Serofibrinous (wet)

Question 2

What is the underlying mechanism behind pleural effusion?

Answer 2

Alteration in hydrostatic or oncotic pressure

Question 3

What is the term for collapsed airless alveoli?

Answer 3

Atelectasis

Question 4

What patient population are all at risk for hospital acquired pneumonia?

Answer 4

Postop patient who have received general anesthesia

Question 5

What is the difference between community acquired and hospital acquired pneumonia?

Answer 5

CAP: onset in community or within 2 days of hospitalization

HAP: onset after 2 days of hospitalization

Question 6

What are 6 risk factors for hospital acquired pneumonia?

Answer 6

1. Aspiration
2. Immunosuppression
3. Immobility
4. Intubation
5. Poor glycemic control
6. Failure to use aseptic technique

Question 7

What is the definition of a lung abscess?

Answer 7

Pus containing lesion of lung that results in tissue necrosis

Question 8

What are 2 possible causes of a lung abscess?

Answer 8

1. Infection
2. Infarction

Question 9

What are 4 complications of a lung abscess?

Answer 9

1. Chronic abscess
2. Bronchiectasis
3. Systemic spread
4. Fistula

Question 10

What are 2 treatments for lung abscess?

Answer 10

1. Bronchoscopy
2. 2-4 months of antibiotics

Question 11

Why is percutaneous drainage of a lung abscess not recommended?

Answer 11

High risk of pleural space contamination

Question 12

What are 2 kinds of lung cancer, which is most common, and how do they differ clinically?

Answer 12

1. Non-small cell lung cancer (most common)
2. Small cell lung cancer (grows faster but easier to treat)

Question 13

What is the term for a complication of lung cancer involving systemic manifestations including hormonal, dermatological, neuromuscular, vascular, hematological, and connective tissues?

Answer 13

Paraneoplastic syndrome

Question 14

What causes hypercalcemia associated with paraneoplastic syndrome?

Answer 14

Increased bone resorption

Question 15

What causes hyponatremia associated with paraneoplastic syndrome?

Answer 15

Tumor cells produce excess ADH, leading to SIADH and water retention

Question 16

What are 4 common surgeries performed for patients with lung cancer?

Answer 16

1. VATS
2. Wedge resection
3. Lobectomy/pneumonectomy
4. Sleeve resection

Question 17

What is the difference between open and closed pneumothorax?

Answer 17

Open: A puncture wound allows air to enter the chest

Closed: Air collects in the pleural space originating from the respiratory system

Question 18

What is the term for rapid accumulation of air in the pleural space, increasing intrapleural pressure and causing tension on the heart?

Answer 18

Tension pneumothorax

Question 19

What are 3 ways pneumothorax resolves?

Answer 19

1. Spontaneous
2. Large bore needle aspiration
3. Chest tube

Question 20

What is the primary goal of treatment in cases of rib fracture?

Answer 20

Promote chest/lung expansion

Question 21

What are 4 diagnostics or treatments that can be done with bronchoscopy?

Answer 21

1. Bronchial washing
2. Endobronchial ultrasound
3. Transbronchial needle aspiration
4. Unblock airway via laser/stent

Question 22

What must be monitored when a patient returns from bronchoscopy?

Answer 22

Return of gag reflex

Question 23

What are 2 indications for thoracentesis?

Answer 23

1. Pleural effusion
2. Empyema

Question 24

Where is thoracentesis usually performed?

Answer 24

Interventional radiology

Question 25

What 3 complications should be monitored for after thoracentesis?

Answer 25

1. Pneumothorax 2. Respiratory distress 3. Worsening pleural effusion

Question 26

What position should patients with a chest tube be kept in?

Answer 26

Semi-fowlers to make breathing easier

Question 27

What are 2 kinds of chest tube drainage systems?

Answer 27

Wet and dry suction

Question 28

What should be assessed for at the site of chest tube insertion?

Answer 28

Subcutaneous emphysema (aka crepitus)

Question 29

Why should dependent loops be avoided in chest tubes drainage tubing?

Answer 29

Can dramatically increase intrathoracic pressure, decreasing drainage

Question 30

What are 2 things never to do with a chest tube drainage system?

Answer 30

1. Strip/milk tubing (can increase pressure) 2. Clamp tubing (except right before removal)

Question 31

What does the level of water in the water seal chamber of the chest tube drainage system indicate?

Answer 31

Intrathoracic pressure

Question 32

If the water seal chamber stops tidaling, what are 2 things this could indicate?

Answer 32

1. Tube blockage 2. The patient's lung has re-expanded

Question 33

What should NOT be seen in the water seal chamber, and what would this indicate?

Answer 33

Continuous bubbling; this may indicate leakage

Question 34

Over time, we would expect the level of the water seal chamber to __________, signaling healing

Answer 34

Rise

Question 35

How is the chest tube collection chamber monitored?

Answer 35

1. q8h 2. Mark the level of drainage on the outside of the chamber with date, time, initials

Question 36

What kind of drainage should be reported to the HCP?

Answer 36

1. Bright red blood >100 ml/h 2. Excess pleural fluid >1-1.5 L 3. Cloudy

Question 37

What do we expect to see in the suction chamber of the chest tube drainage system?

Answer 37

Gentle continuous bubbling

Question 38

Is chest tube indicated for lobectomy, and why?

Answer 38

Yes, as the remaining lung will expand to fill the space of the lobe removed

Question 39

Is chest tube indicated for pneumonectomy, and why?

Answer 39

No, as serosanguineous fluid must fill the empty space of the lung removed

Question 40

What is the term for removal of a small, localized lesion that occupies only a small segment of lung?

Answer 40

Wedge resection

Question 41

What is the indication for thoracotomy?

Answer 41

Assess internal injury Perform surgery

Question 42

What are 2 kinds of thoracotomy?

Answer 42

1. Median sternotomy 2. Lateral thoracotomy

Question 43

What is the term for a procedure involving insertion of scope into the pleural space through an intercostal incision, and insertion of instruments through additional intercostal incisions?

Answer 43

Video assisted thorascopic surgery (VATS)

Question 44

Why is the ability to self monitor a requirement for lung transplant?

Answer 44

High risk of infection (esp by CMV)

Question 45

What is the most common cardiac complication after thoracic surgery?

Answer 45

Arrhythmia (esp a-fib)

Question 46

What does I-COUGH stand for?

Answer 46

Incentive spirometry Cough and deep breathe Oral care Up (Head of bed up) Get out of bed Have a conversation