Unit 3 Day 9 (Fri 5/1) Flashcards Preview

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Flashcards in Unit 3 Day 9 (Fri 5/1) Deck (21):
1

Anterior-Superior Compartment of the Mediastinum

-thymus gland
-aortic root and great vessels
-substernal thyroid and parathyroid tissue
-lymphatic vessels and nodes
-inferior aspect of trachea and esophagus


2

Middle Compartment of the Mediastinum

-pericardial sac
-heart
-innominate veins and SVC
-trachea and major bronchi
-hila
-lymph nodes
-phrenic, upper vagus and recurrent laryngeal nerves

3

Posterior Compartment of the Mediastinum

-vagus nerves
-sympathetic chains

4

80% of asymptomatic masses are _______.

Benign

5

50% of symptomatic masses are _______.

malignant

6

Mediastinal Mass Symptoms

Local
• Compression of adjacent structures
• Invasion of adjacent structures

Systemic
• Fever, anorexia, weight loss
• Endocrine syndromes
• Auto immune (thymus related)

7

Anterior Mediastinal Masses (Terrible T's)

• Thymoma
• Teratoma
• Terrible Lymphoma
• Thyroid tissue

8

Middle Mediastinal Masses

-Lymphadenopathy
-Developmental cysts

9

Posterior Mediastinal Masses

-peripheral nerve (neuromas)

10

Mediastinal Mass Diagnostic Evaluation

Clinical Hx
-symptoms associated with obstruction of contiguous organs
-B symptoms- fevers, weight loss, drenching night sweats

Physical Exam
-lymphadenopathy
-weight loss

Radiologic Studies
-chest X ray (PA and lateral)
-CT

Labs

11

Visceral Pleura vs. Parietal Pleura

-visceral = attached to lung
-parietal = attached to chest wall

12

Pneumothorax

-air in the pleural space
-spontaneous (primary, secondary)
-traumatic (iatrogenic/hospital, non-iatrogenic)

13

Diagnostic Evaluation of Pneumothorax

-acute onset chest pain, dyspnea, cyanosis, anxiety
-hyper resonant chest percussion, dec. breath sounds
-confirmed by radiograph, CT, US

14

Pneumothorax Treatment

-observation
-supplemental oxygen
-simple aspiration
-tube thoracostomy (chest tube)
-pleurodesis

15

Tension Pneumothorax

• Intrapleural pressure exceeds atmospheric pressure throughout expiration and often during inspiration
• Causes hemodynamic compromise by decreasing venous return and limiting cardiac output
• Medical emergency
• Tachycardia, hypotension
• Respiratory distress, cyanosis, marked tachycardia, profuse diaphoresis

Treatment
• Do NOT wait for confirmatory chest radiograph
• Emergently insert an 18 gauge angiocath in the second intercostal space along the midclavicular line
• Place tube thoracostomy if pneumothorax confirmed

16

Pleural Effusion

• Result when the rate of pleural fluid formation
exceeds drainage

Clinical Presentation
• Dyspnea
• Pleuritic chest pain
• Dry cough
• Symptoms associated with underlying cause
• Decreased breath sounds, dullness to percussion, decreased tactile and vocal fremitus on examination


17

Transudative Vs. Exudative Effusion Classification in Pleural Effusion

• Transudative effusions result from alteration in hydrostatic forces that affect fluid formation (non-protein rich).

• Exudative effusions are due to alterations in permeability of the pleura or rate of fluid removal (protein rich).

18

Pleural Tumors

• Majority are malignant
• Majority are metastatic
– Lung: 37%
– Breast: 16%
– Lymphoma: 11%
– Gastrointestinal: 7%
– Genitourinary: 9%



19

Cigarette Smoking Prevalence in US

Has dec. over time, but has remained constant for last decade or so at ~20% of adults.
-still more than 40 million smokers
-tobacco is number one preventable cause of death is US

20

AHQR Guidelines: 5 A's for Smoking Cessation

-ask- screen all pts at every visit
-advise- strongly advise against smoking
-assess- assess willingness to quit
-assist- assist in quitting plan, pharmacotherapy, counsel
-arrange- schedule follow up

21

Smoking Cessation Pharmacotherapy

– Nico>ne replacement therapy (NRT)
– Bupropion (Zyban, Wellbutrin)
– Varenicline (Chan>x)
-combination therapy is most effective