Thoracics Flashcards
Discuss the presentation and management of massive hemoptysis
- is the expectoration of a large amount of blood or at a rapid rate of bleeding
- usually arise from bronchial artery
- death is due to asphyxiation
Diagnosis - bronchoscopy
Management - position in lateral position with bleeding lung on the dependent side
- protect airway and ventilate one lung
- control source of bleeding with balloon tamponade, ice saline lavage or topical medication
- thoracic surgery for definitive management
List the most common causes of massive hemoptysis
BATTLE CAMP
- Bronchiolitis (25%)
- Aspergilloma (10%)
- Tumour (bronchiogenic - 10%)
- TB (15%)
- Lung abscess (5%)
- Embolism
- Coagulopathy
- Autoimmune disease
- Mitral stenosis
- Pneumonia
Discuss the presentation and management of esophageal cancer
Epidemiology
- age >50yr
Pathophysiology
- squamous cell carcinoma most common (then adenocarcinoma)
- Barrett esophagus lead to adenocarcinoma from mucosal glandular cells at GE junction
Presentation
- progressive solid food dysphagia and unintentional weight loss
- GERD
- hoarseness
Investigations
- EGD
- CT chest and abdomen for staging
Management
- esophagectomy and lymphadenectomy (stage 1&2)
- endoscopic mucosal resection
- chemotherapy with cisplatin and 5FU (stage 3&4)
Discuss the presentation and management of esophageal leiomyoma
Epidemiology - 20-50yr - benign esophageal cancer - arise from smooth muscle tissue Presentation - need to >5cm to cause symptoms - dysphagia, retrosternal discomfort Investigtion - barium swallow demonstrate smooth concave mass - EDG show non-specific tumor without mucosal involvement Management - resection if symptomatic
Discuss the presentation and management of hiatal hernia
Pathophysiology:
- type 1 is herniation of stomach and gastroesophageal junction into thorax
- type 2 is herniation of part of stomach into thorax with no displacement of the GE junction
Presentation:
- Type 1: GERD
- Type 2: dysphagia and post-prandial fullness. Have risk for GI bleed, incarceration, obstruction
Investigation
- Barium swall
- EGD
Management
- type 1: lifestyle modification, possible Nissen fundoplication
- type 2: excision of hernia sac and repair of defect
Discuss the presentation and management of a spontaneous pneumothorax
Epidemiology
- young 20-40yr
- Risks: smoking, family history, Marfan, tall height, homocystinuria, thoracic endometriosis
Presentation
- sudden onset of dyspnea and pleuritic chest pain
- ipsilateral decreased chest expansion, hyperresonance on percussion, and decreased air entry
Investigations:
- CXR
Management
- if asymptomatic and <3cm of air rise can observe for 6hrs and then discharge
- if large than needle decompression and chest tube insertion
Discuss the presentation and management of spontaneous hemothorax
Presentation: - hematemesis - neck pain - dyspnea - odynophagea - subcutaneous emphysema Investigations: - CXR showing pneumomediastinum - CT chest - water soluble constrast drink Management - NPO, NG, ceftriaxone and flagyl - surgery if thoracic perforation with free air (<24hrs than primary closure)
Discuss the presentation and management of descending necrotizing mediastinitis
Pathophysiology - infection from oropharynx that extends into the mediastinum Presentation: - history of dental infection - neck pain with swelling - odynophagia - trismus - pleuritic retrosternal chest pain - stridor Investigations - CT chest Management - ABC - IV antibiotics - source control
Discuss the presentation and management of pleurisy
Pathophysiology - viral infection (influenza, EBV, CMV) - inflammation of pleura Presentation - pleuritic chest pain that raidates to shoulder and back Investigation - CXR show pleural effusion - CT chest Management - analgesia
Differentiate between a benign and malignant lung nodule
Benign - <1cm - no growth - discrete - smooth or lobulated - increased density - central or diffuse calcifications Malignant - >=1cm - Rapid growth - spiculated - irregular - decreased density - ground glass appearance
