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Surgery Rotation EORE > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

what’s the MC cause of lung cancer?

A

smoking

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2
Q

where are METS MC in lung cancer?

A

brain, bone, liver, LNs, & adrenals

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3
Q

what are the 2 types of lung cancer?

A

Non-Small Cell Carcinoma (NSCC) & Small Cell Carcinoma (SCC)

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4
Q

who is adenocarcinoma lung cancer MC in?

A

smokers, women, & nonsmokers

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5
Q

where does adenocarcinoma lung cancer occur in the lungs?

A

peripherally

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6
Q

where does SCC lung cancer occur in the lungs?

A

centrally

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7
Q

what is squamous cell lung cancer a/w?

A

cavitary lesions (central necrosis), hypercalcemia, & pancoast syndrome

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8
Q

what are the types of NSCC lung cancer?

A
  1. Adenocarcinoma
  2. Squamous Cell
  3. Large Cell (Anaplastic) Carcinoma
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9
Q

what’s the s/s of lung cancer?

A

cough, hemoptysis, dyspnea

SVC syndrome

Hypercalcemia (esp. with Squamous Cell)

SIADH/Hyponatremia (MC w/ small cell)

Cushing’s syndrome (ectopic ACTH - MC w/ small cell)

Pancoast Syndrome (shoulder pain, Horner’s syndrome, atrophy of hand/arm muscles)

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10
Q

what’s the dx of lung cancer?

A
  1. CXR & CT scan (often seen on CXR but not used for screening; CT used for staging)
  2. Sputum cytology (good for central lesions)
  3. Bronchoscopy - for central lesions
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11
Q

what’s the tx of NSCC lung cancer?

A

surgical resection = TOC

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12
Q

what’s the tx of small cell lung cancer?

A

chemotherapy = TOC

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13
Q

what’s transudative pleural effusion?

A

d/t either incr. hydrostatic &/or decr. oncotic pressure

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14
Q

what’s the MC cause of transudative pleural effusion? other causes?

A

CHF = MC cause

nephrotic syndrome, cirrhosis = other causes

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15
Q

what is exudative pleural effusion? causes?

A

increase vascular permeability

causes: infection/inflammation

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16
Q

what are the s/s of pleural effusion?

A

MC asx

if symptomatic -> dyspnea, “pleuritic” chest pain, cough

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17
Q

what’s the PE like for pleural effusion?

A

decr. tactile fremitus, decr. breath sounds, dullness to percussion

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18
Q

what’s the dx test of choice for pleural effusion?

A

thoracentesis (dx and therapeutic)

19
Q

how do you dx pleural effusion?

A

CXR: PA/lateral -> blunting of costophrenic angles

Thoracentesis (test of choice, dx and therapeutic)

CT scan (to confirm empyema)

20
Q

what’s the light’s criteria?

A

criteria exclusive to exudates -> presence of ANY of the 3 = exudative pleural effusion:

  • pleural fluid protein: serum protein >0.5
  • pleural fluid LDG: serum LDH >0.6
  • pleural fluid LDH > 2/3 ULN LDH
21
Q

what’s the tx for pleural effusion?

A
  1. Treat the underlying condition
  2. Thoracentesis: GOLD STANDARD
  3. Chest tube pleural fluid drainage: if empyema (pleural fluid pH <7.2, glucose <40, pos. gram stain of pleura fluid)
  4. Pleurodesis (if malignant effusions or chronic - use talc (MC), doxycycline)
22
Q

what’s the criteria for empyema pleural effusion?

A

pleural fluid pH <7.2, glucose <40, pos. gram stain of pleura fluid

23
Q

what’s the GOLD STANDARD tx for pleural effusion?

A

Thoracentesis

24
Q

who is primary spontaneous pneumothorax MC in?

A

NO underlying lung disease

Mainly affects tall, thin men 20-40 y/o, smokers, + family h/o pneumothorax

25
Q

who is secondary spontaneous pneumothorax MC in?

A

d/t UNDERLYING lung disease w/out trauma (ex. COPD, asthma)

26
Q

what is spontaneous pneumothorax d/t?

A

bleb rupture

27
Q

what are the s/s of pneumothorax?

A

pleuritic unilateral chest pain that’s non-exertional and sudden in onset

dyspnea

28
Q

what’s the PE like for pneumothorax?

A

increased hyper-resonance to percussion, decreased remits, decreased breath sounds (over the affected side)

29
Q

what’s the PE like for a tension pneumothorax?

A

increased hyper-resonance to percussion, decreased remits, absent breath sounds (over the affected side)

incr. JVP, pulses paradoxus, hypotension

30
Q

what’s the dx for pneumothorax (except tension pneumothorax)?

A

CXR with expiratory view

-decr. peripheral lung markings

31
Q

what’s the tx for small (<15-20%) primary spontaneous pneumothorax?

A

observation for 6 hr with repeat CXR to confirm no press ion and 24-48 hr f/u

usu. resolve itself w/in 10 days

***give O2 to help with air resorption

32
Q

what’s the tx for pneumothorax if large or severe symptoms?

A

chest tube placement (thoracotomy)

33
Q

what’s the tx for a tension pneumothorax?

A

Needle aspiration in 2nd ICS mid-clavicular line

34
Q

what pneumonia’s commonly present post-op?

A

Hospital acquired pneumonia

OR

Ventilator acquired pneumonia

35
Q

when is HAP acquired post-op? onset timing (early/late)?

A

after >48 hrs after hospital admission
(can follow atelectasis)

early onset -> < 5 days

late onset -> >5 days

36
Q

when is VAP acquires post-op?

A

48-72 hrs after ET intubation

37
Q

what’s the s/s of post-op pneumonia?

A

cough, dyspnea, chest pain, AMS, malaise, fever

38
Q

what’s the PE like for post-op pneumonia?

A

Vitals: Dec O2 sat, inc HR/RR, fever

Bronchial breath sounds, dullness on percussion, incr. tactile fremitus, egophony

39
Q

what will the CXR of post-op pneumonia?

A

CXR will show consolidation (serial CXR to determine response to tx)

40
Q

what are the common bacteria in HAP pneumonia?

A

S. pneumonia

Mycoplasma pneumonia

41
Q

what’s the tx of HAP/VAP early onset < 5 days?

A

Ceftriaxone IV

OR

Levo IV/PO

OR

Ampicillin/Sulbactam *Unasyn) IV or Amox/Clav (Augmentin)

42
Q

what’s the tx of HAP/VAP late onset >5 days?

A

Cefepime IV OR Ceftazadime OR Meropenem IV OR Zosyn OR Levo

PLUS

Vanco IV

43
Q

how do you prevent post-op pneumonia?

A

Early mobilization after surgery

If patient is immobile chest physiotherapy can be performed to improve lung ventilation and dec accumulation of secretions

44
Q

what is seen on x-ray for for small cell lung cancer?

A

central hilar mass, mediastinal widening

Surgery Rotation EORE (10 decks)

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