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24 Cards in this Set

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What is an empyema
accumulation of pus in the pleural cavity.
At what point should thoracotomy with decortication (versus drainage) be used to remove purulent fluid and pleural rind in an empyema?
When the empyema is in the most advanced stage of chronic organizing phase. In this phase, the fluid collection is loculated and depositions of fibrin create a thick pleural rind, which prevents apposition of the lung to the parietal pleura.
What is the most common cause of Superior Vena Cava syndrome?
90% of the time is due to malignancy (75% of time due to bronchogenic carcinoma, second most common is lymphoma).
What are the signs/symptoms of superior vena cava syndrome?
edema of the upper body, cyanosis, dilated subcutaneous collateral vessels in the chest, headache.
What is the initial management of Superior Vena Cava syndrome?
for malignancies, radiation and chemotherapy, if applicable. in severe life-threatening complications surgical intervention or thrombolysis may be warranted.
What is the treatment for iatrogenic esophageal perforation?
its a surgical catastrophe requiring aggressive intervention in virtually all circumstances. If patient has no underlying esophageal disorder, fix the perf and drain the mediastinum. if motility disorder or cancer exists, perf and disorder must be addressed. in esoph cancer, usually esophagectomy.
What is the initial treatment of a lung abscess?
abx directed at the most likely organism. Usually abx are required over a longer term. If abscess doesn't resolve, percutaneous or surgical drainage or resection might be requried.
What is the initial treatment for a descending aortic dissection?
reduction in the change in blood pressure over time (dP/dT) with beta blockade.
What are the indications for operative intervention in a descending aortic dissection?
end organ failure(renal failure, lower extremity ischemia, intestinal ischemia), inadequate pain releif despite optimal medical therapy, and rupture or signs of impending rupture (increasing diameter or periaortic fluid).
What does the finding of prolonged high-amplitude contractions in the body of the esophagus in a highly symptomatic patient suggest?
DES (diffuse esophageal spasm).
What is the treatment of DES (diffuse esophageal spasm)?
long myotomy guided by manometric evidence. More than 90% of patients treated in this fashion will experience acceptable relief of symptoms if myotomy is performed correctly.
What are the symptoms of diffuse esophageal spasm?
spontaneous chest pain that radiates to the back, ears, neck, jaw, or arms.
What is the classic finding on esophageal contrast study?
"corkscrew espohagus"
What occurs usually in a spontaneous pneumothorax? In whom do they usually occur?
usually results from the rupture of subpleural blebs in young men (age 20 to 40), which is often signaled by a sudden onset of chest and shoulder pain.
What is the treatment of a spontaneous pneumothorax?
chest tube thoracostomy. in recurrent cases, thoracotomy with bleb excision and pleural abrasion. if pneumotherax is small, it may be monitored.
What is Boerhaave's syndrome? How can it be diagnosed?
spontaneous rupture of the esophagus. diagnosed by the presence of air in the mediastinum after an episode of vomiting and retching is virtually pathognomonic. Radiographic studies confirm diagnosis adn define location of perf. Esophagogram w/ water-soluble contrast is the initial test of choice.
How is Boerhaave's syndrome managed?
if leak is contained and patient does not have symptoms of sepsis, can be managed expectantly w/ abx. If pt. has systemic signs, surgical therapy is warranted.
In what percentage of patients with chest trauma does significant pump failure occur?
less than 5%.
How is myocardial contusion managed?
usually supportively, directed at inotropic support of the ventricle. other support may be warrented, but is different from patient to patient.
What should be suspected after CABG when the mediastinal chest tube clots, followed by hemodynamic decompensation w/ decreased mean arterial pressures and cardiac output w/ increasing filling pressures?
cardiac tamponade
How is intraoperative recognition of a thoracic duct injury treated?
ligation of the duct
If a thoracic duct injury occurs during intrathoracic surgery and is not recognized until several days postoperatively, how is it treated?
They frequently heal following the institution of a low-fat diet and either repeated thoracentesis or tube thoracostomy drainage. a low-fat, medium chain triglyceride diet often reduces the flow of chyle.
What is the most common benign cardiac tumor?
myxoma
What are the signs/symptoms of cardiac myxoma? treatment?
sx include valvular obstruction (mitral or tricuspid) or embolization systemically. often attached by a pedicle to the fossa ovalis of the left atrial septum. Treatment is resection.