how common is malignancy of coin lesion in lungs
depends on age: 50% at 50 yo
characteristics of lung lesion on xray that suggests malignancy
poorly defined border, no calcifications
workup of solitary pulmonary nodule found on CXR
CT --> BRONCHOSCOPY (bx lesion) --> MEDIASTINOSCOPY (bx nodes) ? needle bx
what to do with solitary pulm nodule workup showing benign lesion? malignant lesion?
BENIGN: follow with CT in 6-12 months; MALIGNANT: stage, then resect if Stage I/II, chemo/rads if Stage III
how to stage lung cancer? mgmt of each stage
STAGE I: solitary lung cancer (resection) STAGE II: lung cancer + LN in lung (resection) STAGE III: lung cancer + LN in mediastinum or elsewhere (can't resect, need to do chemo/rads)
two big categories of lung cancer; what are differences in mgmt
1) small cell lung cancer: usually presents with mets; so cant resect --> chemo 2) non-small cell lung cancer: often resectable +/- chemorads; usually adeno vs. squamous cell (SCC a/w PTHrp)
how does surgical mgmt of non-small cell lung cancer differ if it involves an airway
if NOT involved airway, can do thoracotomy --> lobectomy; if BRONCHUS involved, need thoracotomy --> pneumonectomy (remove whole lung), can also consider "sleeve lobectomy" = lobectomy + removal of section of bronchus (safer but harder)
what are the sx of pancoast tumor? what is mgmt?
multiple sx: brachial plexus sx, horner's pain from chest wall invasion; usually invasive at time of dx --> tx occurs in 2 phases 1) preop radiation for debulking, followed by 2) surgical resection
what is concern with hemoptysis + atelectasis? what is mgmt?
bronchial obstruction causing infection , decreased lung function; worrisome causes include BRONCHIAL ADENOMA: has malignant potential --> requires lobectomy
tx of mesothelioma
extrapleural pneumonectomy: bad prognosis despite aggressive tx (<1 yr)
most common cause of nonresolving pneumothorax with chest tube
technical error: improper placement or leak at site of entry --> replace tube
what causes empyema in lung? what bugs? how to treat
pus in pleural cavity: occurs as a complication of pneumonia, usually from S.pneumo/gram neg rods; tx in 3 steps: 1) abx 2) drainage 3) reinflate lung (CT usually sufficient, but may need minithoracotomy/VATS if loculated)
how does IMA (internal mammary artery) compare to other vessels for CABG
best patency rate (90% at 10 yrs)
what are risks of cardiopulmonary bypass
causes a generalized inflammatory response which can lead to hemorrhagic, respiratory, and myocardial complications in postop period
in what cases does aortic valve stenosis require surgery? how do you determine patient's operative candidacy?
if SEVERE and symptomatic (angina, syncope, dyspnea/CHF, etc.) , base operative candidacy on cath results, NOT AGE
what is prognosis for dilated cardiomyopathy? how do you treat
1/3 do better, 1/3 do worse, 1/3 stay the same; tx with beta blockers (decreased demand) and, if necessary, heart transplant
causes of death following heart transplant (2)
1) infection 2) atherosclerosis (a type of chronic rejection)
Most common mediastinal tumors
thymoma, teratoma, lymphoma, germ cell tumor (in young patients)
3 areas of mediastinum and common masses in each
SUPEROANTERIOR: thymoma, lymphoma MIDDLE: cysts, lymphoma POSTERIOR: neurogenic tumors, cysts
treatment of cysts in mediastinum. why?
cysts are benign but may have inflammatory complications including fistula --> NEED TO BE REMOVED
for which thyroid cancers do you use I131 or thyroid hormone suppression postop?
follicular and papillary; doesnt help for medullary since thats parafollicular (C-cell) hyperplasia