Fiser Chapter 25. THORACIC Flashcards Preview

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Flashcards in Fiser Chapter 25. THORACIC Deck (100)
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1

What runs along right side of SVC and dumps into it?

Azygous vein

2

What runs along the right side, crosses midline at T4-T5, and dumps into the left subclavian vein at its junction with the IJ?

Thoracic duct

3

What runs anterior to hilum and posterior to hilum?

Anterior to hilum: phrenic nerve

Posterior to hilum: vagus nerve

4

Right and left lung volumes

Right 55%

Left 45%

5

Muscle use in quiet inspiration

Diaphragm 80%, intercostals 20%

Greatest change in dimension is superior/inferior

6

What are the accessory muscles?

SCM, levators, serratus poterior, scalens

7

Type I and II pneumocytes

I: gas exchange

II: surfactant production

8

Pores of Kahn

Direct air exchange between alveoli

9

What is the minimum postop FEV1 needed before pneumonectomy?

FEV1 > 0.8 (or >40% of predicted postop value)

If too close, get a qualitative VQ scan to see contribution of that portionof lung to overall FEV1. If low, may still be able to resect.

10

What is tthe minimum postop DLVO needed?

10 mL/min/mmHg CO (or >40% of predicted postop value)

Measures CO diffusion and represents OXYGEN EXCHANGE CAPACITY. Depends on pulmonary capillary surface area, hemoglobin content, and alveolar architecture.

11

What are minimum preop values of pCO2, pO2, and VOx max (max O2 consumption) before lung resection?

pCO2 < 50

pO2 > 60 at rest

VOx max > 10-12 mL/min/kg

12

Most common cx after wedge resection / segmentectomy?

Persistent air leak

13

Most common cx after lobectomy?

Atelectasis

14

Most common cx after pneumonectomy?

Arrhythmias

15

Cough, hemoptysis, atelectasis, PNA, pain, weight loss

Get CXR to look for lung cancer

16

MCC cancer related death in US

Lung cancer

17

Strongest influence on survival in lung ca?

Nodal involvement

18

Mets in lung cancer?

- Brain most common
- Supraclavicular nodes, other lung, bone, liver, adrenals

19

Lung cancer recurrence

Usually appears as disseminated mets

80% is within first 3 years

20

Lung ca overall 5 year survival

10% -> 30% with resection for cure

21

Lung ca resectability

Stage I and II resectable

Stage IIIa (T3N1M0) possibly resectable

22

Lung ca types

Non-small cell carcinoma (80%): squamous cell (central), adeno (peripheral and most common)

Small cell carcinoma (20%): neuroendocrine in origin, usually unresectable at time of diagnosis (<5% candidates for surgery), overall <5% 5 year survival; T1N0M0 has a 50% 5yr survival, most get just chemoradiation

23

Suspect lung cancer and PET shows mediastinal lymphadenopathy (>1cm), what's next step?

LN biopsy

24

What is unresectable in lung cancer?

T4 (mediastinum, esophagus, trachea, vertebra, heart, great vessels, malignant effusion)

Nodes positive

Distant mets

-Can still resect if invading chest wall, pericardium, diaphgram, phrenic nerve, or <2cm away from carina)

25

Lung ca and hypercalcemia

PTHrP from squamous cell carcinoma

26

Lung ca and ACTH and ADH

Small cell Ca (ACTH most common paraneoplastic lung ca)

27

Most malignant lung tumor

Mesothelioma: aggressive local, nodal, and distance mets

28

Non-small cell Ca chemo (stage II or higher)

Carboplatin, taxol

29

Small cell lung Ca chemo

Cisplatin, Etoposide

30

XRT in Lung ca?

Yes