外科：胸外

59 flashcards · Other · by Wanying Koh

1. pneumothorax indications for surgery: recurrent bilateral atelectasis tension pneumothorax hemothorax

   all except atelectasis 可以

2. bleb vs. bullae

   bleb < 1cm bullae > 1cm

3. after pneumonectomy, alveolar compliance inc/dec? pulmonary vascular resistance inc/dec? airway conductance inc/dec?

   dec inc dec

4. criteria for off endotracheal tube: tidal volume minute ventilation PaO2 RSBI

   tidal volume 不能太少 >5 minute ventilation <10 PaO2 不能太少 >70 RSBI <105

5. lung ca + cervical lympadenopathy next step?

   biopsy of cervical LN to confirm diagnosis

6. smoking old man, body weight lloss, clubbing fingers, hemoptysis, bilateral wheezing , cxr: L lung hilar LN 病變 sputum cytology: eosinophilic staining , hyperchromatic nuclei diagnosis? diagnostic medium?

   NSCLC transbronchial biopsy

7. hypercalcemia most commonly occurs in SCLC SCC carcinoid tumor adenoCa

   SCC

8. malignant pleural effusion in lung Ca -- what staging？

   Stage IIIb, IV (T4, M1a)

9. nonresectable lung cancer includes

   recurrent laryngeal n. palsy SVC syndrome involvement of the main pulmonary a. (無 pancoast tumor with invasion of brachial plexus lower limb)

10. solitary pulmonary nodule requires resection in which patients? HIV patients benign nodule with calcifications 2 years CXR follow up with no increase in nodule size TB associated nodule

    HIV patients --> high risk for Ca

11. atypical carcinoid tumor pathology? carcinoid syndrome: uncommon or common? spread via? most commonly located at which part of RT?

    pathology: pleomorphic, mitosis inc. carcinoid syndrome: uncommon spread via LN lobar bronchi --> tx: lobectomy

12. lung abscess mostly resolve via what conservative tx or surgery?

    conservative : ABx, drainage, 拍痰

13. most common reason for lung abscess

    aspiration pneumonia

14. lung abscess indications for surgery

    haemoptysis >2cm cavitation persistent symptoms after conservative tx for 8wk suspected lung ca bronchopleural fistula

15. TB: surgical indications

    persistent TB despite adequate drug therapy bronchopleural fistula (+) TB infection with other lung pathology (bronchiectasis, bronchial obstruction, atelectasis) NTM infection malignancy recurrent/persistent haemoptysis cavitation (pleural effusion NOT FOR SURGERY)

16. lung sequestration dx

    MRA angiography! CT or MRI 也可

17. Diagnosis Occurs in which gender

    lymphangioleimyomatosis (LAM) ---- holes/cysts in lung females of child-bearing age

18. fat emboli syndrome triad

    altered mental status respiratory distress skin petechiae

19. pulmonary AVM associated with what complications

    brain abscess hemoptysis pneumothorax cerebral thrombosis 無 lung abscess

20. ARDS criteria

    acute onset pulmonary artery wedge pressure =< 18mmHg PaO2/FiO2 =< 200mmHg CXR: bilateral lung infiltrates

21. least common area of mediastinum tumors

    middle mediastinum

22. Most common post. mediastinum tumor Children Adults

    Children - neuroblastoma Adults - schwannoma

23. dumbbell shaped tumor, extending to spine Dx?

    spine = post. mediastinum. most popular tumor in mediastinum = neurogenic tumors (dumbbell shaped)

24. ant. neck soft mass, movable with tongue movement / swallowing action Dx?

    thyroglossal cyst

25. seminoma tx vs. nonseminoma tx.

    seminoma: tumor resection // CT + RT (對 CT 好, RT 不能monotherapy) nonseminoma: mostly meta, so NO op. mainly CT, can OP if dec. biomarkers

26. nonseminoma // seminoma biomarkers

    aFP, b-hCG NAB LDH, b-hCG SLB

27. nonseminoma s/s

    胸悶 胸痛 呼吸困難 性早熟

28. blood supply of esophagus

    thoracic aorta inferior thyroid artery L gastric a. bronchial a.

29. stricture areas of esophagus

    cricoid thyroid diaphragmatic hiatus bifurcation of trachea

30. best diagnostic tool for esophageal diverticula

    barium esophagram

31. pseudoachalasia what is it

    gastroesophageal junction 附近腫瘤壓迫, causing achalasia s/s. but no inc. in LES pressure (present in achalasia) imaging: bird beak sign

32. gold std dx for GERD

    24-hr pH monitoring (other: esophageal manometry -- for LES function; UGI endoscope -- check for malignancy)

33. GERD // achalasia 分別引起什麼 esophageal ca

    GERD -- adenocarcinoma achalasia -- SCC

34. upper/middle section esophagus: what type of cancer

    SCC (lower section -- adenoca)

35. most important diagnostic tool for esophageal cancer tumor staging

    endoscopic u/s

36. most common type of esophageal ca

    SCC

37. esophageal cancer resection & reconstruction most commonly used organ as replacement

    stomach --> gastric pull up (NOT jejunum)

38. caustic burn injury best time for reconstruction

    6-12mo after injury

39. most common organ to reconstruct esophagus after caustic burn injury

    stomach

40. 1-hr after ingestion of toxin, best cause of action is

    OBS and IV fluids. (esophagus 可能已穿孔，給予中和劑 may cause aspiration pneumonia, mediastinitis)

41. 中和劑 ingestion of acid: ingestion of basic:

    acid --> 喝 milk, antacid 來中和 base (e.g. clorox) --> 喝 vinegar / lemon juice 來中和

42. Boerhaave's syndrome 是什麼

    recurrent vomiting resulting in damage of esophageal sphincter --> inc. pressure of sphincter --> tear and rupture in esophagus

43. Mallory-Weiss syndrome dx tool

    UGI endoscope

44. adenoid cystic ca of lung characteristic 省長速率 大部分生長在

    慢性生長 氣管/支氣管處

45. tracheostomy at

    2nd/3rd tracheal ring 之間

46. trachea stenosis most commonly caused by

    endotracheal tube complications

47. hemothorax / pneumothorax immediate tx

    chest tube drainage

48. thoracotomy indications

    hemothorax >1500cc acutely or >200-300/hr esophageal perforation tracheobronchial injury

49. flail chest 定義 tx

    at least 3 neighbouring ribs fracture at at least 2 sites conservative + ORIF. surgery often not needed

50. 胸痛，血壓低，HR 快 dx: tx:

    tension pneumothorax (= pneumothorax w vital sign change, 其他：tracheal deviation) IV fluid (stabilize hemodynamics), chest tube

51. surgical indications for pneumothorax

    >72hrs 還在漏氣 recurrent bilateral lungs hemothorax tension pneumothorax

52. complications of pneumothorax

    recurrent tension pneumothorax reexpansion pulm. edema (治療的時候)

53. esophageal perforation dx rx

    dx: xray, 食道鏡 rx: emergency op 手術唯一治療方法

54. thoracic outlet syndrome most common gender 分類 affected areas // % nTOS vTOS aTOS

    F nTOS: 96% // affects brachial plexus (酸麻刺痛無力) vTOS: 3% // affects subclavian v. (發紺 靜脈曲張) aTOS: 1% // affects subclavian v. (缺血 疼痛) s/s due to local nerve/bv 壓迫

55. obstructive disease FEV1/FVC

    <70 下降

56. tension pneumothorax vs. cardiac tamponade 心音 BP 呼吸音 ext jugular v.

    心音都變小 (distant heart sounds) hypotension --> 導致 tachycardia 呼吸音變小 // no change bil. ext. jugular v. 鼓脹

57. mediastinum germ cell tumor most common in

    adult males (not elderly)

58. adenoid cystic carcinoma F or M slow or fast growing malignant or benign s/s tx

    F more slow growing malignant s/s invasion of trachea common, so often w stridor 1/3 have distant meta at diagnosis wide en bloc resection or RT

59. primary mediastinal cysts bronchogenic - commonly occurs at? 是否跟氣管相連 pericardial - commonly occurs at? enteric - commonly occurs at? which is most common

    most common: bronchogenic cysts pericardial - common at R. cardiophrenic angle bronchogenic - common at proximal to trachea/bronchi,少相連氣管 enteric - common at esophagus 旁邊