thoracic.txt

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nsmallwood
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125530
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thoracic.txt
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2012-01-01 20:54:36
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thoracic
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  1. blood supply to the upper 2/3 of trachea
    inf thyroid
  2. accessory muscles
    levator, SCM, scalenes, serratus post
  3. normal pulm arterial pressure
    25/10 map 15
  4. best predictor of ability to be weaned from vent following lung resection
    FEV1
  5. what predicted post op FEV1 do you need for lung resection
    >0.8L or > 40% predicted
  6. preop parameters needed for lung rsxn
    • DLCO>11-12 or > 50%
    • PCO2 <45
    • P02 >60
    • VO2 max> 10
  7. MC nerve injury following lung rsxn
    brachial plexus
  8. how do you treat cardiac herniation after pneumonectomy
    pericardial gortex patch
  9. how does cardiac herniation present
    • hypotension
    • cyanosis
    • tachycardia
    • displace heart on cxr
  10. MC cx following lung rsxn
    atelectasis
  11. tx an adult tracheo esophageal fistula
    • esophageal cancer then just stent
    • post op after pneumonectomy then primary repair with interposition of tissue
  12. procedure for empyema with external drainage
    eloesser flap
  13. classic cxr of bronchopleural fistula post pneumonectomy
    lowering air fluid level with contralateral infiltrate
  14. mgmt of bronchopleural fistula
    • 1st place chest tube
    • bronch to confirm dx
    • place affected side down
    • abxs
    • High freq ventilation can help
    • +/- surgery
  15. sugerical management for bronchopleural fistula
    • early < 7 days then reoperate and place intercostal flap. If lobectomy or wedge may need completion pneumonectomy.
    • Late or empyema:
    • Decort as needed
    • if after pneumonectomy then Claggett procedure
  16. what is required for a diagnosis of hamartoma
    CT only can be diagnostic
  17. hamartomas consist of
    • fat
    • cartilage
    • connective tissue
  18. MC benign and malignant upper airway tumor in children
    hemangiom/carcinoid
  19. characteristics of adenoid cystic CA of upper airway
    • predilection for perineural invasion
    • slow growing with long survival even with mets
    • very responsive to XRT
  20. margin needed for bronchial gland tumors
    1cm
  21. MC late cx after trachea surgery
    granulation tissue
  22. tx tracheoesophageal fistula after tracheostomy
    • advance tube passed fistula site until pt is extubated.
    • once extubated then resect trachea with reanastomosis, primary repair of esophagus and buttress with strap muscles in between
  23. hemoptysis in pt with Swan
    • pull catheter back
    • increase PEEP
    • bronch and mainstem other side
    • keep bleeding side down
    • ultimately might require lobectomy
  24. massive hemoptysis is defined as
    >600cc/24hr
  25. massive hemoptysis is most common from
    TB
  26. MC non us cause of massive hemoptysis
    mycetoma
  27. mc site of bleeding with massive hemoptysis
    bronchial arteries
  28. fluid characteristics of an exudative effusion
    • protein > 3
    • spec gravity > 1.016
    • LDH fluid to serum ratio > 0.6
  29. what is the scalen triangle
    • ant and middle scalene
    • 1st rib
  30. MC anatomic abnormality of TOS
    cervical rib
  31. what is tinsels test
    tapping reproduces neurogenic sxs
  32. what is adsons test
    decrease radial pulse with head turned to ipsilateral side
  33. sxs of TOS
    • pain and paresthesias in medial forearm and fingers
    • motor weakness of hypothenar muscles
  34. dx TOS
    • Tinsels and Adsons
    • CXR
    • MRI
    • Nerve conduction <60 m/S
  35. subclavian artery involvement in TOS usually secondary to
    ant scalene hypertrophy
  36. emergent tx of arterial cx from TOS
    brachial artery dissection and fogarty with 1st rib resection. If intact motor or sensory then can just do thrombolytics
  37. where is the long thoracic nerve located
    posterior to middle scalene
  38. definition of solitary pulmonary nodule
    • single
    • <3cm
    • surrounded by normal lung
    • no adenopathy
    • no effusion
  39. what defines the low risk group in solitary pulmonary nodule
    • age <45
    • never smoked or quit >7 yrs ago
    • smooth lesion
    • size < 1.5cm
    • popcorn calcification or laminated
    • no change on CXR in 2 yrs
  40. criteria for indeterminate risk
    • age 45-60
    • size 1.5-2.2
    • scalloped
    • current or quit < 7 yrs
  41. criteria for high risk
    • age > 60
    • size >2.2
    • spiculated
    • current smoker
  42. what is the observation of a SPN consist of
    • ct q 3 mo x4
    • q 6 mo x 2
  43. Horner's syndrome
    • ptosis
    • miosis
    • anhidrosis
    • +/- ulnar nerve sxs
  44. MC site of mets
    brain
  45. left sided structures on mediastinoscopy
    • RLN
    • esophagus
    • aorta
    • main PA
  46. right sided structures on mediastinoscopy
    • azygous
    • SVC
  47. anterior structures on mediastinoscopy
    • innominate vein
    • innominate artery
    • right PA
  48. w/u for lung ca reveals paraaortic or AP LAD
    need chamberlain procedure
  49. for NSCC + LNs means your atleast what stage
    IIA
  50. T4 NSCC makes you what stage
    IIIB atleast
  51. examples of resectable T4 lesions
    • 2 primaries same lobe
    • minor heart invasion
    • carinal or tracheal
    • cortical bone not calcanous
    • subclavian vein/artery
  52. tx stage IIIA
    if t3 n1 then preop chemo xrt then surgery
  53. MCC of SVC syndrome
    NSCC
  54. tx of SVC syndrome
    emergent XRT unless its chronic then stent
  55. tx pancoast
    can resect after chemo xrt if no N2 dz
  56. causes PTHrP
    squamous
  57. causes ACTH or ADH release
    small cell
  58. MC paraneoplastic
    small cell ACTH
  59. paraneoplastic with clubbing
    squamous or adenocarcinoma
  60. hypertrophic pulmonary osteoarthropathy
    adenocarcinoma
  61. lung ca associated with eaton lambert
    small cell
  62. only small cell lung ca that gets resection
    T1 NO MO
  63. chemo for small cell
    • cisplatin
    • etoposide
  64. isolate lung mets that can be resected
    • colon
    • renal
    • sarcoma
    • melanoma
    • ovarian
    • endometrial
  65. MC mediastinal mass in adults and children
    neurogenic
  66. MC location for mediastinal tumor
    ant
  67. MC ant mediastinal tumor in adults and children
    • adults- thymoma
    • children- germ cell
  68. what type of thymoma is associated with a worse prognosis
    epithelial
  69. tx of teratomas
    rsxn then chemo if malignant
  70. MC primary malignant germ cell tumor
    seminoma
  71. tx seminoma of mediastinum
    • xrt
    • chemo for residual
  72. tx for non seminoma mediastinal tumor
    chemo xrt
  73. chemo for seminomas and non seminomas
    • cisplatin
    • bleomycin
    • etoposide
  74. thoracic duct crosses spine at
    T5 6

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