Notes in Chapter_25:_Thoracic

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Published	07/07/2024	A complicated parapneumonic effusion is defined as:1. pH {{c1::<7.2}}2. Glucose {{c1::<60 mg/dL}}3. WBC {{c1::> 50,000/mm}}
Published	07/07/2024	Tension pneumothorax is treated with:1st-line: emergent chest decompression via {{c1::needle}} thoracostomy in the {{c2::2nd}} intercostal space along…
Published	07/07/2024	Hemothorax is managed with {{c1::tube::needle/tube}} thoracostomy placed into the {{c1::5th}} intercostal space at the {{c1::poste…
Published	07/07/2024	Exudative pleural effusions must meet one of {{c1::Light's}} criteria, which are: - Pleural protein/serum protein > {{c2::0.5}}…
Published	07/07/2024	{{c3::Azygous}} vein runs along the {{c2::right}} side of the esophagus and {{c1::medial::medial/lateral}} to the IVC
Published	07/07/2024	Thoracic duct runs along the {{c3::right}} side and crosses midline at {{c2::T4-T5::vertebral level}}; it dumps into the {{c1::left subclavian}}&…
Published	07/07/2024	The {{c2::vagus::vagus or phrenic}} nerve runs {{c1::pos}}terior to the lung hilum
Published	07/07/2024	The {{c2::phrenic::vagus or phrenic}} nerve runs {{c1::an}}terior to the lung hilum
Published	07/07/2024	The right lung constitutes {{c1::55}}% of total lung volume
Published	07/07/2024	Accessory respiratory muscles include the {{c2::sternocleidomastoid::neck}}, {{c2::scalenes::neck}}, levator scapulae, serratus posteri…
Published	07/07/2024	Gases pass between adjacent alveoli through the {{c1::pores of Kohn}}
Published	07/07/2024	In general the pulmonary lymph node stations are numbered:{{c2::Mediastinal}} numbers {{c1::1}}-{{c1::10}}{{c2::Peripheral}} numbers {{…
Published	07/07/2024	The {{c2::thoracic duct}} runs between the {{c1::azygous vein}} and {{c1::esophagus}}(hollow structures)
Published	07/07/2024	{{c3::Thoracic duct}} begins at the {{c2::cisterna chyli::lymphatic structure}} (vertebral level {{c1::L2}})
Published	07/07/2024	Sternal angle is roughly located at {{c1::T5::vertebral level}}
Published	07/07/2024	Pre-op {{c7::lobectomy}} workup:{{c2::FEV1}} needs to be > {{c1::0.8}} or {{c1::80}}% of predicted (if it's close, the next step is {{c3::V/Q scan}…
Published	07/07/2024	The best predictor of post-op lobectomy complications is {{c1::FEV1::test}}
Published	07/07/2024	Contraindications to lung resection? - FEV1 < {{c1::0.8}} - DLCO < {{c2::10}} mL/min/mm Hg CO - pCO2 >{{c3::50}} - pO2 &l…
Published	07/07/2024	The most common complication following lung resection is {{c1::atelectasis}}
Published	07/07/2024	{{c1::Air leak}} is a unique complication that is most common after lung {{c2::segmentectomy/wedge resection::pulmonary surgery}}
Published	07/07/2024	{{c2::Cardiac arrhythmia}} is a unique complication that is most common after a(n) {{c1::pneumonectomy::lung surgery}}
Published	07/07/2024	Treatment for a simple pleural effusion is {{c1::medical}} management and treating the {{c2::underlying cause}}
Published	07/07/2024	A chest tube or drain is indicated in simple pleural effusion if {{c1::not responding to medical management}}
Published	07/07/2024	Complicated pleural effusion is treated with {{c1::chest tube drainage}} and antibiotics
Published	07/07/2024	Empyema is initially treated with {{c2::chest tube}} and antibiotics, however it may recur unless you also perform surgical {{c1::VATS …
Published	07/07/2024	Treatment of {{c3::retained}} traumatic hemothorax  - To troubleshoot you could try repositioning the {{c1::chest tube}} or replac…
Published	07/07/2024	Chylothorax typically has a {{c1::lymphocytic}} cell type predominance
Published	07/07/2024	Half of chylothorax patients are due to {{c1::trauma/iatrogenic injury}} and the other half is due to {{c1::lymphoma}}
Published	07/07/2024	Patients present with chylothorax when they {{c1::begin PO intake}}
Published	07/07/2024	Chylothorax diet has to exclude {{c1::fat}} except {{c1::medium chain fatty acids}};higher volume leaks are treated with {{c2::TPN}} and {{c3::octreot…
Published	07/07/2024	Surgical indications for chylothorax are failing {{c2::conservative management (low fat diet, TPN, octreotide)}} or if {{c1::high-…
Published	07/07/2024	{{c3::Iatrogenic}} chylothorax can usually be treated with {{c1::ligation}} or {{c1::repair}}
Published	07/07/2024	{{c3::Malignant}} chylothorax is usually treated with {{c2::pleurodesis}}, although the use of {{c1::radiation}} has been showing good effic…
Published	07/07/2024	Pleurodesis performed for malignant chylothorax is done using {{c1::talc}} mixed with {{c2::saline}}
Published	07/07/2024	A surgical indication for pneumothorax is persistent {{c1::air leak}} for > {{c1::7}} days
Published	07/07/2024	Social factors that indicate surgical treatment for spontaneous pneumothorax: - If the patient has a {{c1::high risk profession (SCUBA diver or p…
Published	07/07/2024	If NO blebs during a blebectomy are visualized on VATS, the next step is {{c1::wedge resection of the pulmonary apices}}
Published	07/07/2024	Two types of pleurodesis:1) Mechanical: scratch pad and cautery2) Chemical: {{c1::betadine > doxycycline > bleomycin > talc}}{…
Published	07/07/2024	Acute mediastinitis is managed with {{c1::debridement}} and {{c1::drainage}}
Published	07/07/2024	Chylothorax ligation is done on the {{c1::right}}-side in the {{c2::inf}}erior mediastinum
Published	07/07/2024	Massive hemoptysis is defined as greater than {{c1::600}} mL per day
Published	07/07/2024	Massive hemoptysis (>600 mL/day) usually comes from the {{c1::bronchial artery::vessel}}
Published	07/07/2024	Massive hemoptysis first steps: - {{c2::Xray}} to find the bleeding side (L or R) - Immedately after, lay patient down on the {{c1::sam…
Published	07/07/2024	The most common cause of mediastinal lymphadenopathy is {{c1::lymphoma}}
Published	07/07/2024	The most common mediastinal tumor is a(n) {{c1::neurogenic}} tumor, located in {{c2::pos}}terior mediastinum
Published	07/07/2024	{{c2::Enteric}} cysts and {{c3::lymph}}omas are most commonly located in the {{c1::middle/posterior}} mediastinum
Published	07/07/2024	Most types of {{c1::cysts::mass}} are located in the {{c2::middle}} mediastinum
Published	07/07/2024	{{c1::Thymoma}} patients have {{c1::myasthenia}} 50% of the time (myasthenia or thymoma)
Published	07/07/2024	Thymomas are indicated for operation if {{c1::they exist}}
Published	07/07/2024	Why do myasthenia gravis patients who do NOT have a thymoma get surgery?{{c1::Thymectomy shows 80% improvement even without thymoma}}
Published	07/07/2024	{{c4::Mediastinoscopy}} will not reach mediastinal germ cell tumors if anterior or posterior, so either {{c2::parasternal med…
Published	07/07/2024	Mediastinal germ cell tumors: - {{c1::Semi}}noma (rarely produce HCG and are always AFP {{c2::nega}}tive) - {{c1::Non-semi}}noma (high HCG a…
Published	07/07/2024	Seminoma vs non-seminoma treatment: - {{c1::Non-s}}eminoma: {{c2::requires chemo (cisplatin, bleomycin, etoposide)::treatment}} - {{c1:…
Published	07/07/2024	Radiation is indicated for {{c3::s}}eminoma only if {{c2::metastatic}} or if {{c1::bulky lymph nodes}} are present
Published	07/07/2024	Pericardial vs bronchogenic cysts: - {{c2::Bronchogenic}} cysts are treated with {{c1::resection}} - {{c2::Pericardial}} cysts are treated w…
Published	07/07/2024	The most common neurogenic mediastinal tumor type is a(n) {{c1::neurolemm}}oma (aka {{c1::schwann}}oma)
Published	07/07/2024	A mediastinal tumor that can make catecholamines is a(n) {{c1::paraganglioma}}
Published	07/07/2024	What additional exam should be done on men with mediastinal masses?{{c1::Testicular exam}}
Published	07/07/2024	The most common cause of iatrogenic SVC syndrome is {{c1::thrombosed central catheter}}
Published	07/07/2024	Thrombosed central line causing SVC syndrome is treated with {{c1::anti-coagulation}}
Published	07/07/2024	The strongest prognostic indicator in lung cancer patients is {{c1::nodal invovement}}
Published	07/07/2024	For centrally located lung tumors it is helpful to perform {{c2::mediastinoscopy}} which can assess mediastinal lymph nodes (except {{c1::ao…
Published	07/07/2024	{{c1::Aorto-pulmonary window}} nodes are assessed via the {{c3::Chamberlain}} procedure (aka {{c2::anterior thorac}}otomy or {{c2:…
Published	07/07/2024	Lung cancer airway invasion is examined via {{c1::bronchoscopy}}
Published	07/07/2024	A Stage I lung tumor is not resected if the patient has poor {{c1::pulmonary function tests (FEV1/DLCO)}}
Published	07/07/2024	Coin lesion in the lung causes: - Most common lesion: {{c1::granul}}oma - Most common tumor: {{c1::hamart}}oma - Most common …
Published	07/07/2024	Resection is possible in lung metastases from other organs if metastasis is {{c1::isolated}} and NOT associated with {{c2::systemic}} disease
Published	07/07/2024	Bronchial adenomas are usually located in the {{c1::upp}}er airways, most commonly caused by {{c2::carcinoid}} adenomas
Published	07/07/2024	Bronchial {{c2::adenoid cystic}} adenoma spreads along the {{c3::perineural lymphatics}}, but is very sensitive to treatment with {{c1::radiation…
Published	07/07/2024	Is resection indicated for pulmonary hamartomas?{{c1::No}}
Published	07/07/2024	The most common benign {{c3::tracheal::upper airway location}} tumors: - In {{c2::children::children or adults}} is {{c1::hemangi}}oma &nbsp…
Published	07/07/2024	The most common malignant tracheal tumor: - In {{c2::adults::children or adults}} is {{c1::squamous cell carcinoma}} tumor - In {{c2::childr…
Published	07/07/2024	Most common tracheal surgery complications: - Early: {{c1::laryngeal edema}} - Late: {{c1::granulation tissue}}
Published	07/07/2024	Tracheal surgery post-op {{c4::laryngeal edema::complication}} is treated with {{c1::reintubating}} the patient, {{c2::steroids::drug}}, and…
Published	07/07/2024	Post-intubation stenosis most commonly occurs at the {{c1::stoma}} site or the {{c1::cuff}} site
Published	07/07/2024	Post-intubation stenosis is initially treated with {{c1::serial dilation}}
Published	07/07/2024	Recurrent post-intubation stenosis is treated with {{c1::tracheal resection with end-to-end anastomosis}}
Published	07/07/2024	Two fistulas that can form after post-intubation stenosis are tracheo{{c1::esophageal}} and tracheo{{c1::innominate}} fistulas
Published	07/07/2024	The risk of tracheo{{c3::innominate}} fistula can be decreased by placing the tracheostomy between {{c1::2nd}} and {{c1::3rd}} ring, be…
Published	07/07/2024	In a tracheo{{c2::innominate}} fistula, the main temporizing measure to get patient to OR includes {{c1::digital compression of the&nbs…
Published	07/07/2024	Tracheoinnominate fistula surgical correction involves {{c1::ligation}} of the innominate artery
Published	07/07/2024	Tracheoinnominate fistulas usually occur in the first {{c1::3}} weeks after tracheostomy
Published	07/07/2024	Tracheo{{c3::esophageal}} fistula immediate intervention involves placing a(n) {{c1::large-volume cuff}} endotracheal tube {{…
Published	07/07/2024	Tracheoesophageal fistula repair should be ideally attempted {{c2::after::before or after}} patient is {{c1::weaned from ventilator}}
Published	07/07/2024	Tracheoesophageal fistula repair involves tracheal {{c2::resection}} and {{c2::re-anastomosis}},then closing the esophagus hole using a(n) {…
Published	07/07/2024	Tracheoesophageal fistula chest x-ray would show dilated {{c1::esophagus}} and air in the {{c2::stomach}}
Published	07/07/2024	The most common site of intrapulmonary abscess is the {{c1::supe}}rior segment of {{c2::righ}}t {{c2::low}}er lobe
Published	07/07/2024	Pulmonary abscesses are treated with {{c1::antibiotics}}
Published	07/07/2024	Indications to drain pulmonary abscess are if {{c1::it doesn't resolve with antibiotics}}
Published	07/07/2024	In lung cancer, the best test to determine the extent of LOCAL invasion into adjacent structures is {{c1::MRI}}
Published	07/07/2024	Three stages of an empyema:1) {{c1::Exudative}} phase (1st week) - treated with chest tube and abx2) {{c1::Fibro-proliferative}} phase (2nd week)…
Published	07/07/2024	If patient has a chronically recurring empyema or is unable to tolerate decortication surgery, a(n) {{c1::Eloesser flap}} surgery&…
Published	07/07/2024	Two indications for Eloesser flap surgery are {{c2::chronically recurring}} empyema or the patient is {{c1::unable to tolerate decortication surg…
Published	07/07/2024	Spontaneous pneumothorax surgery indications: - No lung expansion despite {{c2::2 chest tubes}} - Patients who live in remote…
Published	07/07/2024	Malignant pericardial effusion is most commonly caused by {{c2::lung cancer}} and is treated with {{c1::pericardial window}}
Published	07/07/2024	{{c1::Catamenial}} pneumothorax is triggered by {{c2::menstruation::event}}, caused by the presence of {{c2::endometrial}} tissue in the ple…
Published	07/07/2024	Surgery is indicated for clotted hemothorax if > {{c1::25}}% of lung involved, visible {{c2::air fluid levels}} on imaging,or signs …
Published	07/07/2024	If a clotted hemothorax is NOT removed the most serious complication is {{c1::empyema}}
Published	07/07/2024	Whiteout chest x-ray with midline shift {{c1::toward}} the white out indicates {{c2::obstruction->collapse}}
Published	07/07/2024	Whiteout shift caused by mucous plugging/collapse is treated with {{c1::bronchoscopy}}
Published	07/07/2024	Whiteout chest x-ray with midline shift {{c2::away from}} the whiteout is most likely caused by {{c1::pleural effusion}}
Published	07/07/2024	The next step for a whiteout chest x-ray with no midline shift is {{c1::CT scan}}
Published	07/07/2024	The most specific indicator for {{c2::empyema}} on pleural fluid analysis is >{{c1::50,000 WBCs}}
Published	07/07/2024	Airway fires are most commonly caused by {{c1::lasers::surgical tool}}
Published	07/07/2024	Iatrogenic airway fire is treated with stopping {{c2::gas flow}}, removing {{c1::ET tube}}, re-intubate for 24 hours, and{{c3::bronchoscopy}…
Published	07/07/2024	{{c2::Arteriovenous malformations::Blebs or AV malformations}} usually occur in the {{c1::inf}}erior segments of the lungs
Published	07/07/2024	{{c2::Blebs::Blebs or AV malformations}} usually occur in the {{c1::sup}}erior segments of the lungs
Published	07/07/2024	Pulmonary arteriovenous malfomations are treated with {{c1::embolization}}
Published	07/07/2024	Most common chest wall tumors: - Benign: {{c1::osteochondr}}oma - Malignant: {{c1::chondrosarc}}oma
Published	07/07/2024	The most common complications of bronchoscopy biopsy are {{c1::pneumothorax}} and {{c1::bleeding}}
Published	07/07/2024	Lung tumor size cutoff for stage II (resectable) disease is less than {{c1::7}} cm
Published	07/07/2024	Lung cancers that are greater than {{c2::7}} cm (stage {{c3::IIIa}}) are resectable if there are {{c1::NO positive lymph nodes}}
Published	07/07/2024	Lung cancer with {{c2::contra}}-lateral lymph node involvement automatically makes the cancer N{{c1::3}}
Published	07/07/2024	If lung cancer involves pleura is it resectable?{{c1::No}}
Published	07/07/2024	Lung cancer within {{c1::2}} cm of the {{c2::carina}} usually makes it unresectable
Published	07/07/2024	Mediastinal lymph node resections generally begin at the {{c3::inferior pulmonary ligament::landmark}} where the level {{c1::9}} lymph nodes…
Published	07/07/2024	The gold standard for lymph node staging in lung cancer is {{c1::mediastinoscopy}}
Published	07/07/2024	During mediastinal dissection if you encounter bleeding around the right lower {{c4::paratracheal}} space (node station {{c3::4r::#}}) …
Published	07/07/2024	During mediastinal dissection if you encounter bleeding around the {{c3::subcarinal}} space (node station {{c4::7::…
Published	07/07/2024	Advantages of EndoBronchial UltraSound (EBUS) compared to mediastinoscopy: - It can acess level {{c2::10}} and {{c2::11}} nodes in the hilum&nbsp…
Published	07/07/2024	If a patient may need future lung cancer resection after {{c2::downstaging}} of the tumor, what a(n) {{c1::endobronchial ultrasoun…
Published	07/07/2024	Easiest lymph nodes to identify on mediastinoscopy: - Right side are {{c1::2R}}, {{c1::4R}}, 7, 9 - Left side are {{c1::5}}, {{c1::6}}, 7, 9
Published	07/07/2024	Which is better in lung cancer mediastinoscopy: whole node excision or sampling small part of lymph node?{{c1::Neither :)}}
Published	07/07/2024	At least {{c1::10::#}} lymph nodes should be sampled during a mediastinoscopy
Published	07/07/2024	Pre-surgical staging (based on imaging) for lung cancer is upstaged roughly {{c1::17}}% of the time after surgery/node biopsy
Published	07/07/2024	The lung cancer margins that are required if NOT taking a lobe is {{c1::2}} cm
Published	07/07/2024	{{c2::Superior mediastinal}} lymph nodes include node stations {{c1::2 and 4}}
Published	07/07/2024	{{c2::Aortic mediastinal}} lymph nodes include nodes {{c1::5 and 6}}
Published	07/07/2024	{{c2::Inferior mediastinal}} lymph nodes include nodes {{c1::7, 8, and 9}}
Published	07/07/2024	{{c2::N1 mediastinal}} lymph nodes include nodes {{c1::10-14}}
Published	07/07/2024	Lung cancer staging: - Stage {{c2::IA}} <{{c1::3}} cm - Stage {{c2::IB}} {{c1::3}}-{{c1::4}} cm
Published	07/07/2024	Lung cancer staging: - Stage {{c2::IIA}} {{c1::4}}-{{c1::5}} cm - Stage {{c2::IIB}} {{c1::5}}-{{c1::7}} cm or multiple tumors in the same lo…
Published	07/07/2024	Multiple primary lung tumors located in the same lobe is stage {{c1::IIB}}
Published	07/07/2024	In a spontaneous pneumothorax, is a large air leak an indication for surgery?{{c1::No (unless the patient is unstable)}}
Published	07/07/2024	The most significant modifiable risk factor for spontaneous pneumothorax is {{c1::smoking}}
Published	07/07/2024	{{c2::Malignant}} chylothorax can usually be treated with {{c1::pleurodesis}}
Published	07/07/2024	Surgical treatment for pneumothorax involves {{c2::pleurodesis}} with {{c1::bleb}}ectomy (if spontaneous pneumo)
Published	07/07/2024	When treating recurrent empyema, the {{c1::Eloesser flap::surgery}} is {{c2::permanent}} compared to a {{c1::Clagett window::surgery}}, which is {{c2:…
Published	07/07/2024	The {{c2::lef}}t side of the aorta gives rise to {{c1::two::#}} bronchial artery(ies)
Published	07/07/2024	The {{c2::righ}}t side of the aorta gives rise to {{c1::one::#}} bronchial artery(ies)
Published	07/07/2024	Someone accidentally sticks the carotid while putting in a central line (7F). They hold pressure for 10 minutes, no hematoma formation, no intra-arter…
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