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Thoracic Surgery Flashcards

1
Q

most common entry for esophageal surgery

A

right thoracotomy

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2
Q

regions of the esophagus

A

cervical; proximal; middle; distal

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3
Q

when to use left thoracotomy

A

distal esophageal surgery

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4
Q

most common time to experience GERD symptoms

A

post heavy, greasy meal

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5
Q

most common GERD surgery

A

laparoscopic nissen fundoplication

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6
Q

most common type of esophageal cancer

A

adenocarcinoma

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7
Q

most common segment of GI tract used to reconstruct alimentary canal

A

stomach

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8
Q

dysphagia

A

difficulty ingesting food from mouth to stomach

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9
Q

most common surgical procedure for esophageal cancer

A

Ivor-Lewis (right thorax + abdominal incision)

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10
Q

most common lung neoplasm

A

metastatic lesion from another primary malignancy

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11
Q

causes of odynophagia

A

esophagitis (candida, CMV, HSV)

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12
Q

heartburn (pyrosis/water brash) can indicate:

A

strictures or achalasia

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13
Q

singultus (hiccups)

A

result of diaphragmatic irritation; could indicate hernia, acute gastric dilation, or subendocardial MI

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14
Q

causes of recurrent bronchitis/pna:

A

recurrent aspiration d/t: esophageal obstruction, congenital malformation, diverticula, or other dysmotility d/o

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15
Q

differences between esophageal d/o and angina pectoris:

A
  • chest pain relieved when bending over
  • relieved by belching
  • pain may be relieved by nitroglycerin (if esophageal spasm)
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16
Q

first study obtained in w/u of dysphagia, regurg or heart burn:

A

barium esophagography (barium swallow)

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17
Q

purpose of esophageal manometry:

A
  • assess fxn of UES and LES

- ID contraction abnormalities

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18
Q

demeester score

A
  • score indicating which patients may benefit from anti-reflux surgery
  • higher score indicates more acidic environment
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19
Q

diagnostic eval MANDATORY for w/u of esophageal dz:

A

upper endoscopy (direct visualization)

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20
Q

endoscopic exam findings in GERD

A
  • extent of mucosal injury

- presence of atypical histologic changes (in Barrett’s)

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21
Q

endoscopic ultrasound evaluates:

A
  • esophageal wall

- adjacent lymph nodes

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22
Q

diagnostic tool used to guide FNA for esophageal cancer:

A

endoscopic ultrasound

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23
Q

most common cause of GERD:

A

incompetent LES

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24
Q

causes of incompetent LES:

A
  • hiatal hernia (most common)
  • gastric outlet obstruction
  • food/drug induced LES relaxation
  • abdominal esophageal peristaltic activity
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25
symptoms of GERD:
- heavy pressure-like discomfort in epigastrium
26
complications of GERD:
- narrowing distal esophagus (Schatzkis ring) | - hyperplasia of distal esophageal mucosa (Barrett's esophagus* malignant!)
27
follow up with Barrett's esophagus:
- routine f/u endoscopy every 6-12 mo w/biopsies
28
work-up for esophageal sxs:
- barium swallow - esophageal manometry - pH study - upper endoscopy
29
medical treatment of GERD:
- behavior modifications - PPIs - H2 blockers - antacids
30
common indication for GERD surgery in pediatric population:
aspiration pneumonitis
31
indications for GERD surgery:
- fail medical management - cannot continue PPIs - complication from GERD
32
nerve of concern in laparoscopic nissen fundoplication:
vagus nerve
33
esophageal adenocarcinoma presentation:
- healthier | - less advanced disease
34
esophageal SCC presentation:
- advanced disease - greater weight loss - hx smoking and EtOH abuse
35
diagnostic tool for identifying esophageal mets:
-PET scan
36
common location for distant esophageal mets:
- liver | - lungs
37
TNM
tumor depth nodes mets
38
early esophageal cancer disease is stage:
= stage IIa (limited local tumor invasion, no lymph node involvement, no mets)
39
McKeown approach for esophageal cancer:
- cervical + right thorax + abdominal incision
40
palliative measures for esophageal cancer:
- esophageal dilation - stents - laser & photodynamic therapy - radiation & chemoradiation
41
indications for laryngoscopy:
carcinoma of lung is suspected
42
when is a lung carcinoma inoperable?
tumor involvement of recurrent laryngeal nerve
43
types of bronchoscopy
1- rigid bronchoscopy | 2- flexible bronchoscopy (during intubation)
44
mediastinoscopy use:
- sampling mediastinal lymph nodes for staging cancer
45
positive cytologic findings in thoracentesis indicate:
inoperable tumor
46
leading cause of cancer death in the US:
bronchogenic carcinoma
47
most common lung carcinoma:
adenocarcinoma
48
second most common lung carcinoma:
SCC
49
treatment for non- small cell lung carcinoma:
surgery
50
treatment for small cell lung carcinoma:
radiation and chemo (surgery if early on)
51
most common symptom of bronchogenic carcinoma
unrelenting coughing
52
metastatic bronchogenic carcinoma SXS:
weight loss, malaise, HA, n/v, bone pain
53
non-metastatic bronchogenic carcinoma SXS:
Cushing syndrome, hypercalcemia, myasthenic neuropahties, hypertrophic osteoarthropathies, gynecomastia
54
Pancoast tumors can cause:
Horner syndrome (ptosis, miosis, anhidrosis)
55
most common dx tool to find bronchogenic carcnioma:
CXR (nodule, infiltrate, atelectasis)
56
contraindications for thoracotomy: SSSTOP IT
- SVC syndrome - supraclavicular node mets - scalene node mets - tracheal carina involvement - oat cell ca - PFTs show FEV < 0.8L - infarction (Myocardial) - tumor elsewhere (mets)
57
pulmonary nodules are more (benign/malignant)
benign (60/40)
58
carcinoid tumor (carcinoid adenoma, bronchial gland tumor) characteristics:
- well differentiated neuroendocrine tumor - younger than 60 - more commonly in GI tract
59
carcinoid tumor clinical features:
- mostly asymptomatic - can be hemoptysis, cough, focal wheezing, recurrent pna - carcinoid syndrome (flushing, diarrhea, wheezing, hypotension)
60
carcinoid tumor diagnostic studies:
- pink or purple central lesion on bronchoscopy | - CT to determine extent and growth
61
carcinoid tumor treatment:
- surgical excision | - NOT radiation or chemo
62
double lumen ETTs used for:
isolated lung (cardiothoracic surgery)
63
most common open approach for lung procedures
posterolateral thoracotomy

Surgery (2 decks)

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