Unit 3 Day 9 (Fri 5/1) Flashcards
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

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
Posterior Compartment of the Mediastinum
- vagus nerves
- sympathetic chains
80% of asymptomatic masses are _______.
Benign
50% of symptomatic masses are _______.
malignant
Mediastinal Mass Symptoms
Local
• Compression of adjacent structures
• Invasion of adjacent structures
Systemic
• Fever, anorexia, weight loss
• Endocrine syndromes
• Auto immune (thymus related)
Anterior Mediastinal Masses (Terrible T’s)
- Thymoma
- Teratoma
- Terrible Lymphoma
- Thyroid tissue
Middle Mediastinal Masses
- Lymphadenopathy
- Developmental cysts
Posterior Mediastinal Masses
-peripheral nerve (neuromas)
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
Visceral Pleura vs. Parietal Pleura
- visceral = attached to lung
- parietal = attached to chest wall
Pneumothorax
- air in the pleural space
- spontaneous (primary, secondary)
- traumatic (iatrogenic/hospital, non-iatrogenic)
Diagnostic Evaluation of Pneumothorax
- acute onset chest pain, dyspnea, cyanosis, anxiety
- hyper resonant chest percussion, dec. breath sounds
- confirmed by radiograph, CT, US
Pneumothorax Treatment
- observation
- supplemental oxygen
- simple aspiration
- tube thoracostomy (chest tube)
- pleurodesis
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
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

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

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