Term
| cc of anatomic dead space? |
|
Definition
|
|
Term
|
Definition
upper 2/3 = inf thyroid art
lower = bronchial arteries
Lung parach = bronchial art |
|
|
Term
| where does azygous vein drain? |
|
Definition
|
|
Term
| phrenic vs vagus relative location in mediastinum? |
|
Definition
phrenic = anterior to hilum
vagus = posterior |
|
|
Term
| right vs left lung volume |
|
Definition
|
|
Term
|
Definition
right = upper, middle, lower
left = upper, lower, lingula |
|
|
Term
| % of quiet inspiration provided by which muscles? |
|
Definition
80% diaphragm
20% intercostals |
|
|
Term
|
Definition
type 1 = gas exchange
type 2 = surfactant |
|
|
Term
|
Definition
|
|
Term
|
Definition
| direct air exchange between alveoli |
|
|
Term
|
Definition
|
|
Term
| lung zones and relative pressures of art vs vein vs alv |
|
Definition
Zone 1 = apex (no PA flow at apex under nl conditions)
Zone 2 = middle (flow only w/insp)
Zone 3 = lower (continuous flow) |
|
|
Term
| PFT requirements for resections |
|
Definition
1. predicted post-op FEV1 > 0.8L (>40% predicted value)
2. pre-op: DLCO> 11-12 ml/min/mmHg (>50% predicted) OR predicted post-op > 40%
3. VO2 max > 10, O2>60, CO2< 45 |
|
|
Term
| best measure for prediction successful vent wean after pulm rsxn |
|
Definition
|
|
Term
| MC extremity nerve injury during thoracic rsxn |
|
Definition
brachial plexus
common peroneal nerve
-both at dependent extremity
*flex leg to avoid it* |
|
|
Term
post pneumnectomy syndrome
-def
-sx |
|
Definition
s/p right pneumonectomy-->mediastinal shift compression of bronchus
sx = stridor
tx = tissue expander |
|
|
Term
Long bronchial stump syndrome
-mcc? |
|
Definition
left pneumonectomy
(most other major cx are MC s/p right side)
sx recurrent infections from pooled secretions
tx = shorten it |
|
|
Term
mortality w..
wedge vs lobe vs pneumonectomy |
|
Definition
|
|
Term
| MCCx after lung resection |
|
Definition
atelectasis
MCC hypoxia
pphys is pulm shunting |
|
|
Term
|
Definition
1. CA eroding into trachea (stent it)
2. post-op (repair T and E then interpose tissue) |
|
|
Term
|
Definition
| -PNA w/infxn of parapneumonic effusion |
|
|
Term
|
Definition
WBC>500
bacteria
+Ve gram stain |
|
|
Term
|
Definition
1. exudative
2. fibrinopurulent
3. organizing (requires decort) |
|
|
Term
Early BPF
-MC timing/cause
-sx/dx/tx |
|
Definition
1. <7d (MC 24-48 hrs) 2/2 technical cx
2. MASSIVE air-leak. CXR w/collapse.
3. tx re-op: might need completion pneumonectomy. place IC muscle flap over bronchus |
|
|
Term
|
Definition
aka non-surgical BPF = > 10 d
-MCC pressure from empyema -->hole in bronchus |
|
|
Term
|
Definition
*Protect the contralat side from aspiration*
1. chest tubes, affected side down
2. bronch, abx
3. re-expand lung (VATS, CT drain etc), consider high freq ventilation (lowers airway pressure)
*Claggett procedure if after pneumonectomy* |
|
|
Term
MC benign adult lung tumor?
-what % of SPNs do they account for?
-imaging appearance? |
|
Definition
hamartoma
-10% of all SPNs
-popcorn calc lesions
*don't need rsxn. just get f/u CT 3 mo* |
|
|
Term
upper airway tumors
-peds MC benign vs malig
-adult MC benign vs malig |
|
Definition
1. peds: hemangioma vs carcinoid
*90% benign*
2. adults: papilloma vs SCCA
*90% malig* |
|
|
Term
typical vs atypical bronchial carcinoid
-ddx |
|
Definition
atypical = necrotic, disorganized, >1 mitosis/2HPF, heterogeneous
-50% 5YSR & mets (vs 95% & 5% for typical) |
|
|
Term
Adenoid Cystic CA
-tx options |
|
Definition
very responsive to XRT
-slow growing (can survive decades w/mets)
-often have peri-neural invasion |
|
|
Term
Bronchial gland tumors
-MC type |
|
Definition
carcinoid (90% of adult bronchial gland tumors)
-resect w/1cm margins |
|
|
Term
|
Definition
racemic epi
steroids
+- intubation |
|
|
Term
| MC early vs late Cx after tracheal surgery |
|
Definition
early = laryngeal edema
late = granulation tissue formation |
|
|
Term
Post-intubation stenosis
-MC site |
|
Definition
@ stoma site of trach
@ cuff site of ET tube |
|
|
Term
TI fistula
-MCC
-tx options |
|
Definition
-MC after trach
1. blow up balloon
2. finger thru trach hole
3. rigid scope thru mouth to push trach against bleed
THEN..sternotomy |
|
|
Term
|
Definition
| keep tracheostomy @ 3rd ring or higher |
|
|
Term
|
Definition
between 2nd and 3rd rings
-too high = vocal cord problems
-too low = TI fistula |
|
|
Term
hemoptysis w/PA cath placement
-mgmt |
|
Definition
*CONTROL AIRWAY: death 2/2 asphyxiation*
-pull swan back slightly
-INCREASE PEEP (tamponade PA)
-Bronch, mainstem intubate the other side
-bleeding side down
-+/- lobectomy (MC RLL) |
|
|
Term
massive hemoptysis
-definition
-MCC |
|
Definition
> 600 cc in 24 hrs
-MCC = TB > bronchiectasis > lung abscess
*death from airway, not hemorrhage* |
|
|
Term
| MC site of hemoptysis bleeding |
|
Definition
| high pressure bronchial arteries |
|
|
Term
massive hemoptysis
-mgmgt options |
|
Definition
1. emergent rigid bronch,
2. bronchial arteriography + embolizaiton
3. PA angiography
-rarely need or want surg for this except
*Bleeding carcinoid tumor in o/w healthy pt* |
|
|
Term
MCC lung abscess
-MC location
-MC org |
|
Definition
-aspiration PNA
-superior segment, RLL
(2nd = posterior segment RUL)
-MC org = staph aureus |
|
|
Term
pleural effusion
exudative definition- |
|
Definition
Protein > 3
Spec grav > 1.016
LDH ratio > 0.6 (fluid:serum) |
|
|
Term
| mlaig pleurodesis technique |
|
Definition
|
|
Term
| recurrence rates of spont ptx? |
|
Definition
after 1st = 20%
after 2nd = 60%
after 3rd = 80%
*MC right side* |
|
|
Term
| Anatomy of scalene triangle |
|
Definition
Subclav VEIN, phrenic n = ANT to ANT scalene
Subclav ART + B. plexus is BETWEEN ant/middle scalene
Long thoraic runs POST to middle scalene
*throacic duct also ascends into the triangle before entering the SC-IJ junction* |
|
|
Term
|
Definition
pain and paresthesias (Neuro>>vascular TOS)
-MC from brachial plexus irritation- |
|
|
Term
|
Definition
Tinsel = tapping causes sxs
Adsons = dec radial pulse with head turned to ipsilateral side |
|
|
Term
|
Definition
imaging to look for cervical rib
nerve conduction < 60 m/S @ outlet |
|
|
Term
|
Definition
C8-T1 brachial plexus
-lower BPlexus
-weak 4th and 5th fingers/wrist flex/
-hypothenar muscle atrophy |
|
|
Term
|
Definition
conservatve tx first x 3 mo
-first rib rsxn |
|
|
Term
| TOS cause neurogoenic vs arterial |
|
Definition
neuro = cervical rib/brachial plexus irritation
Arterial = SC compression by anterior scalene hypertrophy |
|
|
Term
|
Definition
if non emergent --> catheter directed thrombolysis
-otherwise open brachial artery dissection/fogarty/bypass |
|
|
Term
|
Definition
| neuro > venous > arterial |
|
|
Term
Venous TOS (aka = ...)
-pphys/pres
-dx gold standard
-tx |
|
Definition
Paget von schrotter
-effort induced SCV thrombosis = acutely swollen/blue arm
-Duplex US (technically venogram is gold but takes to long)
-Tx = cath directed thrombolysis + first rib rsxn same admission |
|
|
Term
| Surg approach to TOS based on type |
|
Definition
-neurogenic and venous = trans-axillary
-arterial = supra-clav |
|
|
Term
| Phrenic n path @ scalenes? |
|
Definition
| crosses anterior scalene from LATERAL to MEDIAL |
|
|
Term
| Long thocacic n path @ scalene? |
|
Definition
| posterior to middle scalene |
|
|
Term
|
Definition
from C2-C6 Tverse processes
-ant + mid insert @ 1st rib
-post inserts @ 2nd rib |
|
|
Term
|
Definition
-surgery: 75% success (best for arterial/venous)
-recurrence: 1% (2/2 partial first rib rsxn or you took 2nd rib)
*reoperation = posterior high thoracoplasty) |
|
|
Term
|
Definition
1. Single
2. < 3cm
3. Normal surrounding tissue
4. No adenopathy or pleural effusion |
|
|
Term
SPN
criteria for observation |
|
Definition
1. meet SPN criteria
2. low risk pt
*get tissue dx if not* |
|
|
Term
| Definition of low risk pt w/SPN |
|
Definition
1. Age < 45
2. Never smoker OR quit >7 years ago
3. smooth lesion, < 1.5 cm
4. POPCORN calcs (hamartoma) or laminated calc (granuloma)
5. no change in 2 years of CXR if available |
|
|
Term
| Regimen for following SPN |
|
Definition
serial CTs
*Q3 mo x 4, then Q6 mo x 2* |
|
|
Term
| int vs high risk pt w/SPN |
|
Definition
int = age 45-60, 1.5-2.2 cm, scalloped, smoker or quit recently
high = age>60, >2.2 cm, spiculated, smoker |
|
|
Term
| SPN w/u @ intermediate vs high risk pt |
|
Definition
1. int = trans-pleural or trans-bronchial bx (VATS if non-diagnostic)
*1% false neg rate, 10% PTX w/trans pleural, 1% chest tube rate)
2. high = VATS wedge |
|
|
Term
|
Definition
overall 5-10%
1. Age < 50 = 5% malig
2. Age > 50 = > 50 % malig |
|
|
Term
SPN
-MC lesion overall
-MC benign vs malig tumor |
|
Definition
1. MC overall = granuloma
2. MC tumor overall = hamartoma (10% of all cases)
3. MC malig = bronchogenic CA (MC adenoCA)
**#2 = mets (Breast CA MC)** |
|
|
Term
Lung cancer
-% asymptomatic |
|
Definition
|
|
Term
|
Definition
tumor invading chest wall/symp chain
-->horners (ptosis, miosis anhidrosis) +- ulnar nerve sxs
= T4 lesion |
|
|
Term
Lung cancer
-MC type
-MC met location
- |
|
Definition
|
|
Term
| 5YSR after rsxn of soltary brain met |
|
Definition
|
|
Term
| Side of tumor w/greater N3 rate |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Timing of lung CA recurrence? |
|
Definition
80% w/in 1-2 years
-(MC w/diffuse mets) |
|
|
Term
| PET CT false pos/neg rates for lung CA |
|
Definition
| 5-10% false pos and neg rate |
|
|
Term
Lung nodule w/u w/finding of mediastinal adenopathy
-mgmt |
|
Definition
Mediastinoscopy
*+ve ipsilateral (N2) or contralateral (N3) nodes = unresectable |
|
|
Term
| What are the left vs right vs anterior structures seen on mediastinoscopy? |
|
Definition
left = RLN, esoph, aorta, main PA
right = azygous, SVC
anterior = innominate vein & artery, right PA |
|
|
Term
Lung nodule w/u w/finding of para-arotic or Aorto-pulm window adenopathy
-mgmt |
|
Definition
Chamberlan procedure or VATS
**Mediastinoscopy does not assess aorto-pulmonary window nodes** |
|
|
Term
Lung nodule w/u w/finding of supra-clav or scalene adenoapathy
-mgmt |
|
Definition
|
|
Term
|
Definition
T0 = no evidence of primary
T1 = < 3cm, s/b lung, no isvsn of main bronchus
T2 = > 3cm OR invsn visceral pleura OR atelectasis/PNA NOT involving whole lung OR bronchus tumor > 2cm away from carina
T3 = invading chest wall/Diaph/mediastinal pleura/pericard OR..bronchus tumor w/in 2 cm carina..OR atelectasis/PNA of whole lung
T4 = invasion surrounding structure OR..malig effusions..OR satellite tumor nodule of same lobe (different lobe = M1) |
|
|
Term
|
Definition
N1 = ispilat peri-bronchial or hilar
N2 = ipsilat mediastinal/carinal, esoph and inf pulm lig, AP window and peri-aortic
N3 = contralateral mediastinal or hilar supraclav or scalene nodes
(N2&3 = unresectable) |
|
|
Term
|
Definition
M1 = distant organ or LN (excludes supraclav and scalene )
-2nd lung CA in different lobe than primary - |
|
|
Term
|
Definition
Stage 1
A = T1
B = T2
Stage 2
A = T1, N1
B = T2, N1..OR..T3
Stage 3
A = T3, N1..OR..T1-3 + N2
B = any T4 or N3
Stage 4
M |
|
|
Term
|
Definition
Stg 1 and 2 = rsxn, MS LN dissection, Adjuvant chemo
Stg 3A (N1) = Neoadj CXRT->surg
(N2 unresectable)
Stg 3B = T4 = usually unresectable
Stg 4 = if just solitary brain lesion..NSGx, Lung rsxn, CXRT w/whole brain XRT |
|
|
Term
|
Definition
emergent XRT if acute
-chronic (non CA) -->PTA stent to SVC |
|
|
Term
|
Definition
sup sulcus tumor w/ horners
-neoadj CXRT -->Rsxn
Unlar nerve sxs w.out n2 dz
-neoadj CXRT-->Rsxn |
|
|
Term
Paraneoplastic syndromes
-SCCA
-Small cell CA |
|
Definition
SCCA = PTH related peptide
Small cell = ACTH, ADH
*MC paraneoplastic syndrome = small cell ACTH* |
|
|
Term
| MC paraneopalstic sydnrome? |
|
Definition
|
|
Term
| paraneoplastic syndromes from adenoCA? |
|
Definition
Clubbing
Hypertrophic pulmonary osteoarthropathy |
|
|
Term
|
Definition
peripheral neuopathy
Cerebellar degen
weakness, fatigue
**small cell** |
|
|
Term
| what is the most malig thoracic tumor? |
|
Definition
mesothelioma
-average 30 years to develop after exposure
-1 year survival after dx |
|
|
Term
Lung CA cell types
-two major categories and % of all CA |
|
Definition
Non-small cell (80%)
Small cell (20%) |
|
|
Term
Lunc CA cell types
Non-small cell subtypes |
|
Definition
NSCC
-adenoCA (MC overall): peripheral, gland formation
-Squamous: central, necrosis, obstructive PNA/hemopt, keratin
-bronchoalveolar |
|
|
Term
|
Definition
| adenoCA (non small cell, peripherally located) |
|
|
Term
Lung Ca types
-traits of small cell CA |
|
Definition
-central
-mediastinal mets common
*usually unresectable @ dx (<5% are surg candidates)*
**Chemo = cisplatin + etoposide +- XRT** |
|
|
Term
| method to inc median survival in limited stage small cell lung CA? |
|
Definition
|
|
Term
| small cell stage amenable to surgery? |
|
Definition
T1N0M0 only
-50% 5YSR w/stage 1 cure |
|
|
Term
|
Definition
| -take out primary first, then mets (mets dont metastasize) |
|
|
Term
SPN w/hx of previous CA 2 years ago
-the SPN is most likley... |
|
Definition
1. a met if hx sarcoma/melanoma
2. primary lung CA if hx of head/neck or breast CA
3. 50/50 if GI or GU CA |
|
|
Term
| what are the normal mediastinal structures |
|
Definition
ant = thymus
midd = heart, GVs, phrenic/vagus, trachea/main bronch, SVC/IVC
post = esoph, desc aorta, verts, throacic duct/azygous, hemi az |
|
|
Term
|
Definition
|
|
Term
| % mediastinal masses that are malig |
|
Definition
|
|
Term
| MC mediastinal tumor overall in any all ages combined |
|
Definition
| neurogenic (MC posterior) |
|
|
Term
| MC location for medistinal tumor in adults + children? |
|
Definition
|
|
Term
Kids medistinal mass:
1. MC overall
2. MC ant
3. MC mid
4. MC post |
|
Definition
1. neurogenic
2. germ cell
3. cyst
4. neurogenic |
|
|
Term
| DDx of anterior mediastinal mass? |
|
Definition
Ts
-Thyroid, parathy, Tcell lymphoma, Thymoma, teratoma, cystic hygroma |
|
|
Term
Adult medistinal mass:
1. MC overall
2. MC ant
3. MC mid
4. MC post |
|
Definition
1. neurogenic
2. germ cell
3. cyst
4. neurogenic |
|
|
Term
Thymomas
-% malig
-worst type
-sxs and % w/MG?
-% MG w/thymoma? |
|
Definition
-50% malig (epithelial type worst prog)
-50% sxs, and 50% w/thymoma have MG
-10% w/MG have thymoma
**CHILDREN almost NEVER GET THYMOMA** |
|
|
Term
| MCC mediastinal adenopathy? |
|
Definition
|
|
Term
Germ cell tumors of mediastinum
types |
|
Definition
Teratoma (MC type)
Seminoma (MC primary malig)
Non-seminoma (bHCG, AFP +ve) |
|
|
Term
| Tx mediastinal germ cell tumors |
|
Definition
Teratoma = resection + chemo if malig
Seminoma = XRT, + Chemo @ +nodes
Non-sem = Chemo (cisplatin) + XRT |
|
|
Term
| Seminoma/non seminoma chemo reg |
|
Definition
cisplatin
bleomycin
etoposide |
|
|
Term
| prognostic marker for malig germ cell tumors |
|
Definition
|
|
Term
| % germ cell tumors with bHCG and AFP? |
|
Definition
seminoma = 10% b-HCG
Non sem = 90% bHCG and AFT |
|
|
Term
| tx mediastinal cyst based on type? |
|
Definition
bronchogenic and enteric cysts
-tx w/rsxn (MC posterior to carina)..can get infected, have small malig risk
Pericardial cyst--NTD |
|
|
Term
Neurogenic mediastinal tumors
sx
types |
|
Definition
10% intra-spinal involvement. sx pain, deficits
-neurolemma MC-->schwannoma, nerve sheath
-neurofibroma (nerve sheath)-->a/w von recklinghausen dz
(others = ganglioneuroma/neuroblastoma, neuroblastoma ) |
|
|
Term
|
Definition
| fluid is resistant to infection |
|
|
Term
|
Definition
-50% trauma, iatrogenic injury
-50% tumor (MC lymphoma) |
|
|
Term
| side of chylothorax based on site of injury? |
|
Definition
above t5-6 = left side
below t5-6 = right side
**duct crosses @ t5-t6 from right to left** |
|
|
Term
|
Definition
3 weeks of conservative tx
-chest tube, NPO/TPN, octreotide
Surg = ligation, low on right side in mediastinum (80% success) |
|
|
Term
|
Definition
Ant = SCM
post = Trap
Inf = SCV
Sup = omohyoid
Medial = IJ |
|
|
Term
| MCC arrest after blunt trauma |
|
Definition
|
|
Term
|
Definition
occurs in temporal relation to menstrual cycle
2/2 lung endometrial implants
-Tx VATS
-too many? leuprolide |
|
|
Term
|
Definition
granuloma from histoplasmosis
-infects LN-->become calcified-->erode into bronchus |
|
|
Term
CXR white out w/shift toward white out
dx/tx |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
parenchymal lesion + enlarged hilar LN
-TB |
|
|
Term
|
Definition
| INH, rifampin, pyrazinamide, streptomycin, ethambutol |
|
|
Term
|
Definition
lower lobes
-pulm art and vein connection
-p/w hemoptysis, sob
-tx embo
-a/w osler-weber-rendu syndrome |
|
|
Term
Osler weber rendu syndrome
-features |
|
Definition
Pulm AVMs
Teleangiectasias
-sxs bleeding (MC epistaxis) |
|
|
Term
|
Definition
Benign = osteochondroma
Malig = chondrosarcoma |
|
|
