NMS Thoracic Flashcards Preview

SURGERY CARDS > NMS Thoracic > Flashcards

Flashcards in NMS Thoracic Deck (90):
1

what are chances that coin lesion on CXR is malignant

50% at 50. under 50 chances decrease, over 50 chances increase

2

what do benign lesions look like vs. malignant

benign has smooth surfaces, malignant has irregular or spiculated surfaces

3

what are other benign lesions

Bulls' eyes, hamartomas which have popcorn appearance on CXR

4

which area of U.S. are coin lesions common

SW U.S. where coccidiomycosis is common and mid-Atlantic and OH valley where Histo occurs

5

most common mets to the lung are from

colorectal, breast, liver

6

if a lung lesion looks malignant what do you do

get a CT to characterize lesions and to look for enlarged lymph nodes in mediastinum, then do CT-guided needle bx

7

what do you do for a lesion with cough and hemoptysis and mediastinal enlarged lymph node

bronchoscopy for tissue diagnosis and to determine location of lesion and mediastinoscopy to determine state of mediastinal LNs

8

what do you do if needle bx shows malignant or indeterminate (lung)?

resection

9

what doubling time favors benign status vs. malignant status

if doubling time is 465 days then it favors benign. if doubling time is 5 wks to 280 days, favors malignant

10

what type of lung cancer usually presents late and not amenable to resection

small cell carcinoma

11

cure rate for Stage I lung tumors w resection

70%

12

Stage II lung cancer 5y survival

40-50%

13

surgical options for metastatic lesion involving mainstem bronchus

pneumonectomy (easier) or sleeve lobectomy (safer). sleeves not feasible if mainstem pulmonary artery involved

14

perioperative death rate from pneumonectomy

5-10% especially in those over 70 and those with cardiac or obstructive airway dz

15

at what stages can lung tumors be resected

stages I and II

16

at what stages are chemo and radiation the only treatments

stages III and IV

17

ipsilateral hilar lymph nodes are what stage

stage II

18

mediastinal lymph nodes are what stage

stage III

19

can a tumor undergo chemo and be downstaged and resected (lung)

yes

20

imaging modality good for detecting lung cancer mets

PET scan

21

symptoms of Pancoast tumor

Horner's syndrome, pain in ulnar area of elbow and wrist

22

how to verify superior sulcus tumor

CT, bronchoscopy, mediastinoscopy, needle bx

23

what are 5y survivals for stage II, IIIa, and IIIb lung cancer

stage II 44%
stage IIIA 22%
stage IIIB <10%

24

tx of pancoast tumor

1. irradiation over course of 6 wks then
2. surgical resection of chest wall and lung

25

in young healthy pt with hemoptysis and atelectasis, what would be suspect

bronchial adenoma thats obstructing bronchus

26

2 types of bronchial adenomas

1. carcinoids (malignant potential if originated in small bowel)
2. adenocystic carcinomas (invade locally)

27

how to dx bronchial adenoma

bronchoscopy with bx, careful bc they bleed!

28

how to treat bronchial adenomas

lobectomy. usually curative

29

carcinoid syndrome sxs?

flushing, diarrhea, wheezing from bronchospasm, facial telangiectasia, tricuspid regurg and pulmonary stenosis bc serotonin increases collagen production in valves

30

ddx for effusion (pleural)

cancer: bronchogenic carcinoma, mesothelioma

benign: CHF, viral/bacterial pneumonia, empyema, TB

31

how to dx pleural effusion

thoracentesis and pleural bx. you can cx the fluid and examine histology of bx for malignancy.

32

prognosis for mesothelioma

terrible. most die within a year. not responsive to chemo/radiation.
:(

33

only surgical tx for mesothelioma

extrapleural pneumonectomy. takes out lung, both visceral and parietal pleura, pericardium, and diaphragm at times.

34

etiology of spontaneous pneumothorax

rupture of apical blebs, pleural cavity pressure becomes same as atm, causing lung collapse and trachea deviated to side of collapse

35

etiology of tension pneumothorax

penetrating trauma to the lungs, pleural tear that allows air only to go into the pleural space, trachea deviates to contralateral side

36

tx of a pneumo

chest tube

37

what do you do if a patient is unresponsive to chest tube s/p pneumothorax

must investigate persistent air leaks from lung parenchyma with thoracoscope and surgical intervention

38

how to treat persistent or recurrent pneumo

1. thoracoscopic excision of blebs and pleurodesis (pleural abrasion to adhere visceral and parietal pleura)

39

what do you suspect with chest pain, cough, recurrent fever, and pleural effusion after a pneumonia treatment

Empyema!

40

most common causes of empyema

s.pneumo, staph and gram neg in hospitals; anaerobes if aspiration suspected or alcoholism or recent operation

41

how often empyema culture neg

35% bc of previous abx tx

42

how to treat empyema

1. empiric abx
2. chest tube for drainage

43

what happens if you dont treat an empyema

1. exudative phase
2. fibropurulent stage (loculation of fluid pockets)
3. organizing stage (scarring and inflammatory tissue)

44

how do you fix an untreated empyema

thoracotomy and decortication

45

how to manage unstable angina

1. admit and bed rest
2. oxygen
3. beta blockers, nitro, ASA, heparin, morphine is questionable
4. cardiac enzymes
5. cath or thrombolysis if MI+

46

3 major coronary arteries

1. RCA
2. LAD
3. Circumflex

(LAD and Circumflex from left main)

47

whats an abnormal EF

<55% (she said 40-50%)

48

how to treat left main dz

coronary artery bypass

49

alternative to bypass?

PTCA with stents, danger of reobstruction

50

sources of bypass grafts

internal mammary artery has best patency, reversed greater saphenous vein also used

51

what solutions used to help performance of bypass

cardioplegia solution, blood cardioplegia solution, hypothermia

52

operative mortality for bypass surgeries

3%, but less for low riskers

53

etiology of MVR

myxomatous degeneration of mitral valve; thought to be due to ischemia of mitral valve apparatus

54

how is MVP different from MVR

prolapse is eccentric closure and doesnt have to regurg!

common in young women, but in men it can be sign of severe mitral valve dz.

55

etiologies of mitral stenosis

rheumatic fever, scarlet fever. you get inflammation of connective tissues, leaflets progressively fuse, LA pressure goes up, R heart enlargement, pulmonary htn

56

treatment of mitral valve dz

can try to repair regurg by excision of redundant portion of leaflets and reinforcing mitral annulus with annuloplasty ring, but can replace if not successful

57

3 etiologies of aortic stenosis

1. congenital (bicuspid valve)
2. arteriosclerotic
3. deteriorative

58

aortic valve area less than what is severe stenosis

0.8 cm sq

59

workup for aortic stenosis

1. cardiac cath to detect aortic valve size, pressure gradient, ventricular function, check for CAD
2. carotid doppler to rule out internal carotid obstruction

60

when do pts with aortic stenosis usually present

late in life. extreme risk for sudden death

61

pros and cons of mechanical vs. tissue valves

mechanical valves need anticoagulation bc theyre thrombogenic; tissue valves nonthrombogenic but deteriorate. require replacement at 7 yrs

62

what can give you dilated cardiomyopathy if you've got normal coronary arteries

post-respiratory illness, etiology unclear

wtf??

63

prognosis for dilated cardiomyopathy

1/3 get better, 1/3 stay the same, 1/3 get worse

64

tx for dilated cardiomyopathy

steroids, diuretics, immunosuppressives, beta blockers, transplant

65

prognosis with transplant

immediate survival >90%
survival at 1 yr 85-90%
survival at 2 yrs 75%

66

immunosuppressives for transplants

cyclosporine, tacrolimus

67

most deaths from transplants happen from what

infection from immunosuppressive drugs and accelerated coronary atherosclerosis as a form of chronic rejection

68

what do we suspect with regurgitated undigested food and dysphagia

Zenker's diverticulum or pharyngeal diverticulum

69

etiology of pharyngeal diverticulum

abnormal uncoordinated constriction of cricopharyngeal muscle during swallow results in outpouching bw lower pharyngeal constrictor and cricopharyngeal muscle

70

where else can a pulsion diverticulum occur

distal esophagogastric junction: epiphrenic diverticulum. food can regurgitate and can be aspirated.

71

tx for pharyngeal diverticulum

1. excision if diverticulum is large
2. transect cricopharyngeal muscle to relax esophageal entrance and prevent uncontrolled contraction

72

tx for epiphrenic diverticulum

esophageal myotomy at esophageal gastric junction

73

sxs and etiology of achalasia

dysphagia, WL due to poor peristalsis of body of esophagus and failure of LES to relax. loss of smooth muscle ganglionic cells of Auerbach plexus

74

how to dx achalasia

barium swallow

75

associated conditions w achalasia

emotional stress, physical trauma, WL, Chagas

76

tx for achalasia

Heller myotomy or pneumatic dilation. maybe Ca channel blockers

77

types of cancers in different areas of esophagus

top 2/3 is squamous cell carcinoma, bottom 1/3 adenocarcinoma

78

esophageal cancer a/w what

alcohol, tobacco, Barrett's (40x w severe dysplasia)

79

how do you stage esophageal cancer

endoscopic ultrasound for wall penetration and LN spread. CT abdomen and chest for celiac node involvement. mediastinal or celiac node mets automatically stage III and incurable.

80

complication with middle third esophageal cancers

invasion of tracheobronchial tree

81

tx for esophageal ca

stage I (just to submucosa) can be resected but not in upper third of esophagus. Stage II and beyond is chemoradiation. but you can downstage then try to resect

82

two types of esophagectomies and types of incisions

transhiatal (cervical and upper abdominal incision). we want the anastomosis at the cervical area for easy access in case of complications

83

what do we do after an esophagectomy anastomosis

pyloroplasty to prevent gastric outlet obstruction

84

why would a person with esophageal cancer have constant cough

tracheoesophageal fistula from tumor invasion

85

palliative methods for esophageal cancer

esophageal stent, gastrostomy tube, radiation, palliative resection, supportive care

86

what type of tumor a/w weakness and double vision (in thorax/mediastinum)

thymoma a/w Myasthenia gravis

87

lymphoma tx

rad + chemo

88

common tumors of anterosuperior mediastinum

thymomas, lymphomas, germ cell tumors

89

common tumors of middle mediastinum

cysts (bronchiogenic/pericardial), lymphomas, mesenchymal

90

common tumors of posterior mediastinum

neurogenic neurilemomas from nerves and nerve sheaths