Thoracic Flashcards
This disease is progressive, irreversivble condition resulting in diminished lung compacity
COPD
Chest tubes must be connected to an open drainage system that is kept above chest level
False(below)
Lung scans are useful in identifying
Pulmonary edema
Embilosm
COPD
What are used as hemostatic agents in a thoracic case
Bone wax
Avitene
Gel foam
may be taken upon completion of thoracic procedure to asses lung re-expansion
PA and Lateral Xrays
right hemispheres of the lung consists of how many lobes
3
the rigid bronchoscopes is used to
remove foreign body
this incision is used for surgery involving the lower portion of the esophagus and upper abdomen
thoracoabdominal
what position is used to provide access to anterior lung surfaces and mediastinal structures
supine
prognosis of patient who had thoracic surgery because of cancer depends on
stage, location and type
for lung transplant the patient may be directly transported to PACU to be closely monitored
true
most thoracic procedures are performed under local anesthia
false
may thoracic procedures require the patient to be placed in what position
lateral
which is/are a post operative complication of thoracic surgery
PE
Hemorrhage
mediastinal shift
most thoracic procedures are performed under what anesthia
general
positioning for posterolateral thoracotomy approach
lateral
position used for median sternotomy approach
supine
which of the following is NOT a change in pressure of fluid in the respiratory system? atelectasis pulmonary edema emphysema pneumothorax
emphsyema
where does the respiratory begin
nose
what is a pnuemothorax? how is it corrected?
lung deflation
chest tube
which way does the diaphragm move during inspiration and expiration
down
up
list the common diagnostic tools used for thoracic pathology
CT scan
Xray
bronchoscope
what is a bleb
fluid filled cyst or sac
how are chest tubes secured
silk suture
list the 3 types of bronchoscopy specimens
washing
brushing
biopsies
what is decortication
removal fibrinous deposits on visceral pleura of lung
what is thoracic outlet syndrome
compression of subclavian vessels and brachial plexus nerve complex
what is the membrane that surrounds the lungs? which layer is closest to the lungs
pleural
parietal and visceral pleura
how many lobes does each lung have
right 3
left 2
what is the primary function of the lungs
process of gas exchange called respiration
what is the name of the smallest structure of the lungs, where gasexchange occurs
bronchi
what is needed in the pleural cavity to keep the lungs inflated
negative pressure
what is the hilum
root of lung
what is being visualized in each of the following
bronchoscopy
mediastinoscopy
thoracoscopy
larynx
mediastium
thorax
what are the 2 functions of a chest tube
establish negative pressure
drain fluid
what 3 mechanisms are used to reestablish negative pressure in the pleural cavity when a chest tube is used
gravity below chest
PEP
what can be done to decrease postop pain for the thoracotomy patient, why is pain control important
epedural catheter
decrease respiratory effort
what is pnuemonectomy
removal lung/partial
what is lobectomy
removal lobe of an organ
what is wedge resection
removal cancerous lung diagnosis
what is empyema? what can be done to treat it
collection pus in cavity
insert needle into pleural space
what carries deoxygenated blood to the lungs
pulmonary artery
what is the functional unit of the respiratory system exchanges o2 andCO2
alveoli
what is the landmark for ETT tube placement - bifuracation of bronchi
carina
what is a C-shaped ring
Trachea
what is the muscle of respiration phrenic nerve
diaphragm
what lines the cavity with fluid to prevent friction
parietal pleura
how many true ribs are there
7
what covers the organs
visceral pleura
damage to this can cause diaphragmatic paralysis
phrenic
what carries oxygenated blood to atrium
pulmonary vein
what is concave medial side of each lung
hilum
what 5 ribs are attached and floating
false ribs
what is used to determine pulmonary embolism
angiogram
is bronchoscopy strictly a diagnostic procedure, explain
no, can provide visual diagnosis remove foreign body
what does VAT stand for
video assisted thoracico surgery
what is a pectus excavatum, what implant is used
congenital deformity of chest funnel shaped
pectus bar inserted
what are the signs and symptoms of pulmonary embolism
chronic hypertension
heart failure
chronic cough
what can be used to find the plaque if needed
fiberoptic endoscope
define empyema, what procedure can be done to restore to normal lung function
blood or pus from chest injury
decortation of lung to restore to normal
when the lung is incised how is the anastomosis checked for leaks
irrigation to look for bubbles
name 4 specific thoracic instruments used during a thoracic procedure
rib shears
rasp
doyen
bailey rib retractor
during a donor lung transplant what is used to preserve the donor lung, what must the patient do to preserve the lung tissue postop
collins solution
deep breathing excersie
physical therapy
blood test
which of the following tunica is NOT park of the structure of an artery
adventitia, media, intima, vaginalis
vaginalis
what is the largest artery in the body
aorta
which vessels are responsible for the exchange of oxygen and metablic waste
capillaries
which part of the artery is responsible for vasoconstriction and vasodilation
tunica media
what is only found in veins
valves
which diagnostic study is considered the gold standard for evaluation of vascular disease
angiography
what are the serrations of debakey and cooley vascular instruments considered to be
atramatic
how far beyond the atherosclerotic lesion should a balloon angioplasty reach
1-2cm
where is the balloon dilator inserted percutaneoulsy in coronary artery angioplasty
femoral artery
what are urokinase and streptokinase used for in vascular pathology
lysis of embolus
what is the name of the frequently used balloon embolectomy catheter
fogarty
TIAs are treated surgically by
carotid endarterectomy
javid and argyle are examples of which type of device used in select vascular procedures
shunts
11 blade, potts-smith, small bore suction and insertion of fogarty cath. is the sequence for
arteritomy for embolectomy
what would be used to suture a graft to an artery
running 5-, 6-0 non absorbable suture
PT with end stage renal failure may have what procedures to create access for dialysis
arteriovenous fistula and shunt
serious condition that occurs when a blood clot forms in a vein located deep inside your body
deep vein thrombosis
a blood clot that travels to the lng
pulmonary embolus
hemorrhage, ulceration, and cellulitis are possible complications of
varicose veins
what are the prep borders for a unilateral vein stripping procedure
toes to groin circumferentially
what is the longest vein in the body
saphenous
balloon angioplasty performed in the cardiac catheterization lab is used to treat
atherosclerotic thickening
peripheral vessel angioplasty stents may be made of all of the following except
ceramic
wnat are vessel loops and umbilical tapes commonly used for in vascular cases
retraction
condition that manifests by deep aching pain in the lower extremity during rest periods
claudication
what is the best choice for distal bypass graft in the lower extremity
saphenous vein
double llumened vascular device for administration of chemo, antibiotic tx and IV fluids
groshong
11 blade and forward angle or reverse angle potts smith scissors are used for
arteriotomy
the atheromatous core removed from the carotid artery during endarterectomy is known as
plaque
what are the operative mortality rates of patients with ruptured AAA and shock
> 80%
what are the operative mortality rates of patients with unruptured AAA and elective repair
2-3%
diagnostic study provides the most detailed information for surgical planning in AAA repair
aortogram
what is the specimen in an AAA procedure
thrombus and plaque
what is done with the aneurysm sac in AAA repair
anterior wall suture over the proximal graft
which chamber of the heart is responsible for pumping blood into the pulmonary artery
right ventricle
the coronary arteries originate from the
ascending aorta
what is not one of the cardiac valves
septal
what suture is frequently used for anastomosis of the saphenous vein in a CABG
6-0, 7-0 ploypropolene
with what is a median sternotomy closed
heavy gauge stainless steel wire
what is frequently used to repair septal defect in pediatric patients
dacron patch
which congenital defect involves failure of closure of connection between the PA and Aorta
patient ductus arteriosis
term meaning incurable diseases of the heart for which the only treatment is transplant
cardiomyopathies
atraumatic instrument designed to gently occlude blood flow without causing permanent damage
vascular clamp
tiny vessels that nourish the cells of arterial walls
vasa vasorum
portion of the aorta that descends but is above the diaphragm
thoracic
portion of the aorta that runs between level of diaphragm and bifurcation of iliac arteries
abdominal
arteries that become the femoral arteries as they exit the pelvis
external iliac
artery that serves the head and neck and arises directly from the aortic arch
left common carotid
the largest vein in the body, runs alongside the aorta
vena cava
how many ribs are TRUE ribs with direct connection to sternum with costal carilage
7
what structures are found within the mediastinum except
diaphragm
for which procedure would the rigid bronchoscope be preferred
removal of foreign body in children
what part of the respiratory system does exchange of oxygen and carbon dioxide take place
alveoli
lung reduction surgery is performed for patients with emphysema
true
lung tissue is friable
true
the apex of the lung is located superiorly and just above the clavicle
false
the coronary arteries originate from the
ascending aorta
collection device attached to chest tubes relies on water seal to reestablished negative pressure
true
the manubrium, body and xiphoid process are portions of the
sternum
condition when pus is not cleared from pleural cavity and makes a fibrous constrictive layer
empyema
harvested saphenous vein for coronary artery graft is reversed for anastomosis due to the valves
true
the ventricles of the heart have thinnger myocardium than the atria
false
thymomas, neurogenic tumors and pleuropericardial cysts can be biopsied during which procedure
mediastinoscopy
video assisted thoracic surgery procedures use carbon dioxide for distention
false
what is frequently used to repair atrial and ventrical septal defects in pediatric patients
dacron patch
the average lifespan of biolgic and mechanical heart valve replacements is 10-15 years
true
cardiomyopathy is incurable disease of heart and only treatment is heart transplant
true
what is the medical term for coughing up blood
hemoptysis
the name of an air filled sac has the appearnece of a blister on the surface of lung tissue
bleb
an acute condition in which heart muscle dies from ischemia and may lead to sudden caridac death
lukens tube
lung decortication is perfromed to release constriction of the lungs by fibrun layers
true
atelectasis is
collapsed lung
a heart murmur is usully hear with ausculation over the mitral valve
true
device for newley diagnosed patient in need of meodialysis is
arterivenous fistula and shunt
aortic valve stenosis often result from
aging process and rheumatic fever
atherosclerotic thickening is treated with balloon angioplasty
true
procedure after lung ransplant to aspirate secretions and check for leaks is
bronchoscopy
glass syringes cause less accumulation of bubbles
true
angioplasty balloon should reach 1-2 cm beyond the atherosclerotic lesion
true
ejection fraction is percentage blood pumped out of the heart
true
heartblock would require a pacemaker
true
specialized receptors in arterial tissue that control BP, O2 and carbon dioxide concentrations
aortic bodies
tiny vessels that nourish arterial walls
vasa vasorum
superior mesenteric artery supplies inferior upper abdominal organs
true
angioplasty stents are made from
titanium, polypropylene and stainless steal mesh
water seal in drainage collection device for chest tubes reestablishes negative pressure
true
section of the CNS that controls force rate of contractions heart
medualla oblangata
TIAs are not treated are with carotid endarterectomy
false
what is done with aneurysm sac in AAA repair
suture over proximal graft
device attached to suction to collect mucous or bronchial washing
lukens tube
where is dilator inserted for angioplasty
femoral artery
epidural is given to control pain with VATS
yes
50% of occlusive coronary lesion occur in the
left anterior descending
used for patiens awaiting heart transplant
ventricular assist device
diagnostic method that provides the most extensive detail of valve is heart catheterization
true
gold standard for evaluation vascular disease
angioplasty
is hypothermia a method used to preserve the heart by reducting its metablic needs
yes
best choice for distal bypass graft for the lower extremity is
saphenous vein
congenital defect in which closure of pulmonary artery and aorta does not occur after birth
patent ductus arteriosus
vessels responsible for exchange of oxygen and metalic waste
capillaries
suture technique for attaching bifurcated graft to an artery is
running 5-0, 6-0 non absorbable
apex of heart is inferiorly on left side mediastinum
true
speciemn with AAA
thrombus
phrenic nerve needs to be protected during lung decortication to prevent paralysis diaphragm
true
aortogram provides detailed information with AAA
true
the thorax is separated from the abdomen by the
diaphragm
the respiratory begins with the nares and the
trachea
each primary bronchi divide into what
secondary bronchi
what do the lungs will
the thorax and pleural cavity
what is the function of the lungs
exchange carbon dioxide for oxygen
gas exchange order
bronchi-bronchioles-alveolar ducts-alveoli
what are the aveoli coated with
surfactant
what are the lungs lined with
pleural membrane and separated by the mediastinum
the pleural cavity has what kind of pressure
negative
when a whole is made in the chest the lung deflates this is called what
pneumothorax
the top of the lung is the
apex
blood supply to lungs is from
bronchial arteries which branch off the aorta
each bronchus has its own what
pulmonary artery and vein
what happens when you breathe in oxygen and release CO2
external respiration
what happens when the blood carries the oxygen to the capillaries
internal respiration
diagnostic tools for thoracic pathology
chest xray
CT scans
NOT ULTRASOUND
what is an infection of the pleural fluid causing pus
that may lead to fibrothorax
empyema
majority of most procedures are
lateral
what type of lumen is used with the affected lung will need to be collapsed during the procedure
double lumen ET tube
what things will be used for patient monitoring
foley catheter
arterial line
CVP (measure core blood pressure)
SWAN GANZ CATHETER
what incision is made into the chest wall to provide an opening for the purpose of drainage
thoracostomy
why would an underwater chest drainage system be used
to reestablish negative pressure in chest cavity
if a chamberlin procedure is done you would use
robinson 22fr catheter to create negative pressure and remove it
name 3 chest tube mechanisms
positive expiratory pressure
gravity
suction
why would bronchoscopy be performed
inspect the inside of the trachea and bronchi
what stapler can be used for a wedge resection
GIA
what is the removal of fibrinous deposits or restrictive membrane on the visceral pleura
decortication
what is compression of the subclavian vessels and the brachial plexus nerve complex at the superior aperture of the thorax
thoracic outlet syndrome
can thoracic outlet syndrome be genetic
yes
how do you relieve thoracic outlet syndrome
resection of the first rib
why would a single lung transplant be done
emphysema
why would a double lung transplant be done
cystic fibrosis or chronic infection in end stage pulmonary disease
for a lung transplant what can the donor be
cadaver
living relatives
brain death
what is the condition in which the breastbone is sunken into the chest
pectus excavatum
uncommon deformity chest wall that presents during childhood and worsens during adolescence
pectus carinatum
collapse of alveoli
Atelectasis
inhalation of foreign material or acidic vomitus
aspiration
blood clot inside the blood vessels to the lungs
pulmonary embolus
inherited disorder of exocrine glands that causes them to produce abnormally thick secretions of mucuous
cystic fibrosis
inflammation of mucous membrane of tracheobronchial tree
bronchitis
accumulation of pus in pleural space from bacterial infection such a pleurisy of TB
empyema
what is the name of the smallest structure of the lungs, where gas exchange occurs
bronchi
what is used to quiet the heart during cardiac surgery, how does it work
bypass machine
cannula inserted in aorta
what is cardioplegia
delivery of solution into coronary arteries
what are the 3 most common types of autografts for bypasses of the coronary artery
saphenous vein, mammory artery and radial artery
where do the majority of abdominal aortic aneurysms begin
below renal artery
what needs to be done in order to use an insitu graft
de valve, free up
what shapes do graft material come in
straight, bifurcated and patch
what is de-airing
sew in with clamp on
release clamp let blood flow threw clamp again sew and repeat
what is coarctation of aorta
narrowing of aorta descending
what is intermittent claudication
not enough oxygen to extremity
when an arterial embolectomy catheter is used what is attached to it
TB syringe filled with saline or heparin
how is carotid stenosis diagnosed
arteriogram
the muscle layer of the heart it
myocardium
which part of the heart is the largest and strongest
left ventricle
name the 4 valves of the heart
mitral, tricuspid, aortic and pulmonary
list the route of electrical activity of the heart
SA NODE
AV NODE
BUNDLE OF HIS
PARKINJE FIBERS
the heart has 2 layers what are they
parietal- outer layer
visceral- inner layer
what seperates the 2 layers
pericardial fluid
layers of the cardiac wall
epicardium-outter
myocardium-muscular
endocardium-inner
which are larger atrium or ventricles
ventricles
what supplies blood to the heart
right and left coronary arteries
the left atrium receives what type of blood from the lungs
oxygenated
the right atria receives what blood from the vena cava
deoxygenated
veins enter the what
heart
arteries leave the
heart
what is the main artery of the body
aorta
the aorta carries what blood out to the peripheral arteries
oxygenated
what type of arteries connect to the aortic arch
innominate
what is the largest vein of the body
vena cava
what are the layers of blood vessels
tunica adventitia- outer layer
tunica media- middle
tunica intima- outer
do veins have valves
yes
also known as plaque “coronary artery disease”
atherosclerosis
catheterization steps
vessel entered with finder needle guide wire inserted dilator is used to enlarge catheter is threaded wire removed catheter secured
what is the 2nd most common pathology of the heart
valve insufficiency or stenosis
the wall separating the chambers of the heart is called
septum
a weakened wall of an artery often thinned out and pouching
aneurysms
disorder of blood clotting system
hemophilia
what is attached to each end of a webster vessel cannula
syringe and vessel
when sewing in a graft what end is attached first
proximal
3 most common meds on the sterile field for vascular cases are
saline
thrombin
antibiotic irrgation
what medication is used to keep arterial grafts from spasaming
papaverine
what are some hemostatic agents
surgical
oxycel
bioglue
what are some drugs that affect the heart
isupre
levophed
dopamine
what are some diuretics
Lasix
bumex
what are some of the characteristics for grafts
non reactive to body
readily accessible
common suture
prolene 3-0 to 8-0 most common
ethibond braided non absorbable
coronary artery bypass grafts
saohenous vein
mammory artery
radial vein
must be inverted
only one anastomosis needed
must inverted
aortic or mitral valve replacements heartrate removed with
valve removed with pituitary rongeur
what is the pacemakers of the heart
SA node
what happens when the SA node or the AV node don’t work
need artificial pacemaker
what is the partial excision of adhered and thickened scarred pericardium
pericardiectomy
what is the most common filter for vena cava
greenfield
how long is pressure applied to the site for vena cava filter
3 minutes
where does abdominal aortic aneurysm begin
below the renal arteries
what kind of grafts are used in peripheral vascular surgeries
gortex
saphenous vein
during an embolectomy what is the most common post op complication
blood clot
how is arteriotomy closed
6-0 or 7-0 prolene suture
during an AV fistula if the patients own vessel cant be used for a graft what kind would they use
gortex
what are the common devices for venous access device implantation
groshong catheter
hickman catheter
why is a venous closure done
to treat venous reflux or venous insuffienceny
