Anterior Mediastinal Mass Flashcards

1
Q

What are causes of SOB with anterior mediastinal mass?

A
  • mass compression airways
  • mass compression heart or great vessels
  • mass induced V/Q mismatch
  • mass induced post-obstructive PNA
  • SVC syndrome —> venous obstruction causing engorgement of airways and mucosal edema
  • cardiac defecits a/w downs
  • myasthenia gravis a/w thymoma (a common anterior mediastinal mass)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are signs and symptoms of having myasthenia gravis

A
dyspnea 
diplopia (blurred vision) 
ptosis 
dysphagia 
difficulty chewing 
dysarthria 
muscle weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

diagnosis for Myathenia Gravis?

A

tensilon test = first line = giving edrophonium increases muscle strength (will worsen pt if having cholinergic crisis)
nerve stimulation
antibody immunoassays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What’s a common source of MG?

A

thymoma
one of the most common anterior mediastinal masses
30- 65% of patients with thymoma develop MG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is bulbar sympamotology?

A
weakness in CNs 5. 7, 9 - 11 
facial weakness 
difficulty chewing 
dysphagia 
dysarthria (difficulty speaking)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What’s the pathophys of MG?

A

autoimmune disorder
destruction of post-synaptic nicotinic ACh receptors

less receptors in NMJ –> muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are airway concerns with Down’s Syndrome?

A
macroglossia 
subglottic stenosis 
micrognathia 
atlanto-axial instability 
bradycardia occurs in 50% of downs patients who get inhalational induction 

could complicate mask ventilation, laryngoscopy, ETT placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

would you use anticholinergic drugs in MG?

A

anticholinergic drugs can increase muscle weakness and bulbar symptomatology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What’s the cutoff for atlanto-axial instability?

A
  • anterior atlantodental interval > 4-5mm in lateral view
  • H&P
  • identify S/S of cord compression (gait abn, clumsiness, fatigue with ambulation, numbness, weakness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are common paraneoplastic syndromes associated with cancer (mediastinal mass)

A
  • SIADH: produces vasopressin –> hyponatremia, euvolemic
  • Cushing’s : increased ACTH or CRH –> low K, alkalosis, HTN, psychosis
  • Lambert - Eaton Myasthenic Syndrome: a/w small cell lung cancer, antibodies to pre-junctional voltage gated Ca channels –> less ACh released to motor end-plate
  • humoral hypercalcemia –> parathyroid hormone related peptides –> muscle weakness, arrhythmias, N/V, renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a known complication when doing mediastinoscopy?

A

innominate artery compression
monitor by having R pulse ox to monitor pleth, have L art line (know it won’t be obstructed if innominate artery compression happens)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the blood pressure classification ranges?

A

normal SBP < 120 / < 80
preHTN SBP 120 - 139 / 80 - 89
stage 1 HTN SBP 140 - 159 / 90 - 99
stage 2 HTN SBP > 160 / DBP > 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly