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Cardiovascular > Unit 3 Day 9 (Fri 5/1) > Flashcards

Unit 3 Day 9 (Fri 5/1) Flashcards

1
Q

Anterior-Superior Compartment of the Mediastinum

A

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


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2
Q

Middle Compartment of the Mediastinum

A
  • pericardial sac
  • heart
  • innominate veins and SVC
  • trachea and major bronchi
  • hila
  • lymph nodes
  • phrenic, upper vagus and recurrent laryngeal nerves
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3
Q

Posterior Compartment of the Mediastinum

A
  • vagus nerves

- sympathetic chains

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4
Q

80% of asymptomatic masses are _______.

A

Benign

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5
Q

50% of symptomatic masses are _______.

A

malignant

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6
Q

Mediastinal Mass Symptoms

A

Local
• Compression of adjacent structures
• Invasion of adjacent structures

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

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7
Q

Anterior Mediastinal Masses (Terrible T’s)

A
  • Thymoma
  • Teratoma
  • Terrible Lymphoma
  • Thyroid tissue
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8
Q

Middle Mediastinal Masses

A
  • Lymphadenopathy

- Developmental cysts

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9
Q

Posterior Mediastinal Masses

A

-peripheral nerve (neuromas)

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10
Q

Mediastinal Mass Diagnostic Evaluation

A

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

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11
Q

Visceral Pleura vs. Parietal Pleura

A
  • visceral = attached to lung

- parietal = attached to chest wall

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12
Q

Pneumothorax

A
  • air in the pleural space
  • spontaneous (primary, secondary)
  • traumatic (iatrogenic/hospital, non-iatrogenic)
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13
Q

Diagnostic Evaluation of Pneumothorax

A
  • acute onset chest pain, dyspnea, cyanosis, anxiety
  • hyper resonant chest percussion, dec. breath sounds
  • confirmed by radiograph, CT, US
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14
Q

Pneumothorax Treatment

A
  • observation
  • supplemental oxygen
  • simple aspiration
  • tube thoracostomy (chest tube)
  • pleurodesis
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15
Q

Tension Pneumothorax

A

• 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

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16
Q

Pleural Effusion

A

• 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
Q

Transudative Vs. Exudative Effusion Classification in Pleural Effusion

A
  • 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
Q

Pleural Tumors

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



19
Q

Cigarette Smoking Prevalence in US

A

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
Q

AHQR Guidelines: 5 A’s for Smoking Cessation

A
  • 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
Q

Smoking Cessation Pharmacotherapy

A

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

Cardiovascular (29 decks)

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