Podcast
Questions and Answers
A patient presents with an asymptomatic elevated hemidiaphragm on chest X-ray. Which of the following is the MOST likely next step in confirming the diagnosis of unilateral diaphragmatic paralysis?
A patient presents with an asymptomatic elevated hemidiaphragm on chest X-ray. Which of the following is the MOST likely next step in confirming the diagnosis of unilateral diaphragmatic paralysis?
- Pulmonary function testing (PFTs)
- Fluoroscopy (correct)
- Arterial blood gas (ABG) analysis
- Measuring forced vital capacity (FVC)
A patient who recently underwent a coronary artery bypass graft (CABG) presents with sternal wound drainage, increasing sternal pain, and fever. Which of the following is the MOST likely diagnosis?
A patient who recently underwent a coronary artery bypass graft (CABG) presents with sternal wound drainage, increasing sternal pain, and fever. Which of the following is the MOST likely diagnosis?
- Pericarditis
- Mediastinitis (correct)
- Costochondritis
- Pneumonia
Which of the following is the MOST common cause of mediastinitis in the United States?
Which of the following is the MOST common cause of mediastinitis in the United States?
- Eroding carcinoma
- Post-operative coronary artery bypass graft (CABG) (correct)
- Tracheal disruption during bronchoscopy
- Esophageal perforation
A patient experiencing marked dyspnea and difficulty sleeping lying down should be evaluated for which of the following conditions?
A patient experiencing marked dyspnea and difficulty sleeping lying down should be evaluated for which of the following conditions?
Which of the following diagnostic findings is MOST suggestive of esophageal perforation?
Which of the following diagnostic findings is MOST suggestive of esophageal perforation?
A chest X-ray of a patient with suspected esophageal rupture reveals mediastinal widening, air in the mediastinum, and hydropneumothorax. Which of the following is the MOST likely diagnosis?
A chest X-ray of a patient with suspected esophageal rupture reveals mediastinal widening, air in the mediastinum, and hydropneumothorax. Which of the following is the MOST likely diagnosis?
Which of the following is a common clinical finding in patients with mediastinitis following cardiac surgery?
Which of the following is a common clinical finding in patients with mediastinitis following cardiac surgery?
What is the MOST appropriate initial treatment for mediastinitis following a coronary artery bypass graft (CABG)?
What is the MOST appropriate initial treatment for mediastinitis following a coronary artery bypass graft (CABG)?
Which of the following conditions is MOST likely to cause bilateral diaphragmatic paralysis?
Which of the following conditions is MOST likely to cause bilateral diaphragmatic paralysis?
The '5 T's' are a helpful differential for anterior mediastinal masses. Which of the following is NOT one of the '5 T's'?
The '5 T's' are a helpful differential for anterior mediastinal masses. Which of the following is NOT one of the '5 T's'?
A patient presents with new-onset neck pain and subcutaneous emphysema. Which of the following is the MOST likely underlying cause?
A patient presents with new-onset neck pain and subcutaneous emphysema. Which of the following is the MOST likely underlying cause?
A patient with a history of postpolio syndrome presents with progressive dyspnea. Which of the following is the MOST likely underlying cause of their respiratory compromise?
A patient with a history of postpolio syndrome presents with progressive dyspnea. Which of the following is the MOST likely underlying cause of their respiratory compromise?
A patient has been diagnosed with mediastinitis following cardiac surgery. Cultures reveal the presence of Staphylococcus aureus and Staphylococcus epidermidis. Which of the following antibiotic regimens is MOST appropriate for initial empiric therapy?
A patient has been diagnosed with mediastinitis following cardiac surgery. Cultures reveal the presence of Staphylococcus aureus and Staphylococcus epidermidis. Which of the following antibiotic regimens is MOST appropriate for initial empiric therapy?
Which of the following is the MOST common type of mass found in the posterior mediastinum?
Which of the following is the MOST common type of mass found in the posterior mediastinum?
Following instrumentation of the esophagus for a therapeutic procedure, a patient develops signs and symptoms consistent with esophageal perforation. Where is the MOST likely location of this perforation?
Following instrumentation of the esophagus for a therapeutic procedure, a patient develops signs and symptoms consistent with esophageal perforation. Where is the MOST likely location of this perforation?
A patient diagnosed with unilateral diaphragmatic paralysis undergoes fluoroscopy. Which of the following findings would be MOST consistent with the diagnosis?
A patient diagnosed with unilateral diaphragmatic paralysis undergoes fluoroscopy. Which of the following findings would be MOST consistent with the diagnosis?
A patient being evaluated for a mediastinal mass is found to have myasthenia gravis. Which of the following anterior mediastinal masses is MOST strongly associated with this presentation?
A patient being evaluated for a mediastinal mass is found to have myasthenia gravis. Which of the following anterior mediastinal masses is MOST strongly associated with this presentation?
In the management of mediastinitis following cardiac surgery, after initial surgical debridement and broad-spectrum antibiotics, definitive wound closure is being considered. Which of the following factors is MOST critical to ensure before proceeding with definitive closure?
In the management of mediastinitis following cardiac surgery, after initial surgical debridement and broad-spectrum antibiotics, definitive wound closure is being considered. Which of the following factors is MOST critical to ensure before proceeding with definitive closure?
A patient presents with esophageal perforation secondary to Boerhaave syndrome. Which radiographic finding would STRONGLY suggest the presence of a pneumo-mediastinum?
A patient presents with esophageal perforation secondary to Boerhaave syndrome. Which radiographic finding would STRONGLY suggest the presence of a pneumo-mediastinum?
A patient has undergone a chest X-ray for dyspnea, which reveals an elevated hemidiaphragm. Further investigation reveals that the cause is phrenic nerve injury. Which of the following is the MOST likely etiology of phrenic nerve injury leading to diaphragmatic paralysis?
A patient has undergone a chest X-ray for dyspnea, which reveals an elevated hemidiaphragm. Further investigation reveals that the cause is phrenic nerve injury. Which of the following is the MOST likely etiology of phrenic nerve injury leading to diaphragmatic paralysis?
A patient is diagnosed with mediastinitis and undergoes surgical debridement. Post-operative cultures confirm the presence of MRSA. What is the MOST appropriate antibiotic treatment?
A patient is diagnosed with mediastinitis and undergoes surgical debridement. Post-operative cultures confirm the presence of MRSA. What is the MOST appropriate antibiotic treatment?
A CXR reveals an anterior mediastinal mass. The patient denies any symptoms of hyperthyroidism. Which of the following anterior mediastinal masses is LEAST likely?
A CXR reveals an anterior mediastinal mass. The patient denies any symptoms of hyperthyroidism. Which of the following anterior mediastinal masses is LEAST likely?
A patient with a history of cardiac surgery is admitted with suspected mediastinitis. Which of the following clinical findings, if present, would have the HIGHEST specificity for diagnosing mediastinitis?
A patient with a history of cardiac surgery is admitted with suspected mediastinitis. Which of the following clinical findings, if present, would have the HIGHEST specificity for diagnosing mediastinitis?
During the evaluation of a patient with a suspected mediastinal mass, a contrasted CT scan of the chest is performed. The scan reveals a well-encapsulated mass containing elements of all three germ cell layers (ectoderm, mesoderm, and endoderm). Which of the following is the MOST likely diagnosis?
During the evaluation of a patient with a suspected mediastinal mass, a contrasted CT scan of the chest is performed. The scan reveals a well-encapsulated mass containing elements of all three germ cell layers (ectoderm, mesoderm, and endoderm). Which of the following is the MOST likely diagnosis?
A 65-year old male, post CABG presents with a complaint of substernal pain radiating to the back, fever, and chills. On examination, crepitus is palpated near the sternal border. You suspect mediastinitis. Further questioning reveals the patient is allergic to vancomycin, what is your next line treatment?
A 65-year old male, post CABG presents with a complaint of substernal pain radiating to the back, fever, and chills. On examination, crepitus is palpated near the sternal border. You suspect mediastinitis. Further questioning reveals the patient is allergic to vancomycin, what is your next line treatment?
Which of the following procedures involves a small incision in the chest wall to remove air or fluid from the pleural space, and can be performed using either a needle or a tube?
Which of the following procedures involves a small incision in the chest wall to remove air or fluid from the pleural space, and can be performed using either a needle or a tube?
A patient with a recurrent pneumothorax is being considered for a procedure to obliterate the pleural space. Which of the following terms BEST describes this procedure?
A patient with a recurrent pneumothorax is being considered for a procedure to obliterate the pleural space. Which of the following terms BEST describes this procedure?
Inflammation of the pleura, often characterized by pleuritic chest pain, is best described by which term?
Inflammation of the pleura, often characterized by pleuritic chest pain, is best described by which term?
Which of the following conditions is characterized by a pleural effusion with milky fluid and elevated pleural triglyceride levels?
Which of the following conditions is characterized by a pleural effusion with milky fluid and elevated pleural triglyceride levels?
A patient presents with dyspnea and chest heaviness three days post-coronary artery bypass grafting. A milky white fluid is drained from the chest. This fluid is MOST likely indicative of:
A patient presents with dyspnea and chest heaviness three days post-coronary artery bypass grafting. A milky white fluid is drained from the chest. This fluid is MOST likely indicative of:
Which of the following pathophysiological mechanisms is MOST directly associated with the formation of a transudative pleural effusion?
Which of the following pathophysiological mechanisms is MOST directly associated with the formation of a transudative pleural effusion?
Cirrhosis of the liver typically leads to pleural effusions through which mechanism?
Cirrhosis of the liver typically leads to pleural effusions through which mechanism?
Infection and neoplasm are MOST likely to cause pleural effusions through which pathophysiological process?
Infection and neoplasm are MOST likely to cause pleural effusions through which pathophysiological process?
Which of the following physical exam findings is typically associated with a pleural effusion?
Which of the following physical exam findings is typically associated with a pleural effusion?
A chest X-ray finding suggestive of pleural effusion is:
A chest X-ray finding suggestive of pleural effusion is:
In a right lateral decubitus chest X-ray, free pleural fluid will:
In a right lateral decubitus chest X-ray, free pleural fluid will:
What is the recommended maximum volume of pleural fluid to remove during a single thoracentesis procedure to minimize the risk of pulmonary edema?
What is the recommended maximum volume of pleural fluid to remove during a single thoracentesis procedure to minimize the risk of pulmonary edema?
Which of the following pleural fluid analysis results is consistent with an exudative effusion based on Light's criteria?
Which of the following pleural fluid analysis results is consistent with an exudative effusion based on Light's criteria?
Which of the following conditions is MOST likely to cause a transudative pleural effusion?
Which of the following conditions is MOST likely to cause a transudative pleural effusion?
Empyema, a purulent pleural effusion, is MOST frequently a complication of:
Empyema, a purulent pleural effusion, is MOST frequently a complication of:
What is the MOST appropriate initial management for an empyema?
What is the MOST appropriate initial management for an empyema?
Hemothorax is defined as:
Hemothorax is defined as:
The MOST common cause of hemothorax is:
The MOST common cause of hemothorax is:
Which size chest tube is typically recommended for drainage of a hemothorax to prevent fibrothorax and trapped lung?
Which size chest tube is typically recommended for drainage of a hemothorax to prevent fibrothorax and trapped lung?
Pneumothorax is characterized by:
Pneumothorax is characterized by:
A tall, thin, 25-year-old male smoker presents with sudden onset sharp chest pain and dyspnea. This clinical presentation is MOST suggestive of:
A tall, thin, 25-year-old male smoker presents with sudden onset sharp chest pain and dyspnea. This clinical presentation is MOST suggestive of:
Which of the following is a typical symptom of pneumothorax?
Which of the following is a typical symptom of pneumothorax?
Physical examination findings in a patient with pneumothorax typically include:
Physical examination findings in a patient with pneumothorax typically include:
A patient with a small primary spontaneous pneumothorax who is clinically stable may be initially managed with:
A patient with a small primary spontaneous pneumothorax who is clinically stable may be initially managed with:
For a large primary spontaneous pneumothorax (>2-3cm rim of air) in a stable patient, the FIRST line of management is typically:
For a large primary spontaneous pneumothorax (>2-3cm rim of air) in a stable patient, the FIRST line of management is typically:
Secondary pneumothorax is characterized by:
Secondary pneumothorax is characterized by:
Which of the following underlying conditions is a common cause of secondary pneumothorax?
Which of the following underlying conditions is a common cause of secondary pneumothorax?
Traumatic pneumothorax can be caused by:
Traumatic pneumothorax can be caused by:
In a tension pneumothorax, the clinical diagnosis is paramount and requires immediate intervention, which is:
In a tension pneumothorax, the clinical diagnosis is paramount and requires immediate intervention, which is:
Which of the following is a LATE sign of tension pneumothorax?
Which of the following is a LATE sign of tension pneumothorax?
The INITIAL step in the emergency treatment of a tension pneumothorax is:
The INITIAL step in the emergency treatment of a tension pneumothorax is:
Needle decompression for tension pneumothorax is typically performed at which intercostal space and location?
Needle decompression for tension pneumothorax is typically performed at which intercostal space and location?
Mesothelioma is a rare tumor MOST strongly associated with exposure to:
Mesothelioma is a rare tumor MOST strongly associated with exposure to:
Which of the following is TRUE regarding mesothelioma?
Which of the following is TRUE regarding mesothelioma?
A patient presents with pleuritic chest pain, dyspnea, and asymmetric chest expansion with decreased breath sounds on the left side. Percussion reveals hyper-resonance on the left. Which of the following is the MOST likely diagnosis?
A patient presents with pleuritic chest pain, dyspnea, and asymmetric chest expansion with decreased breath sounds on the left side. Percussion reveals hyper-resonance on the left. Which of the following is the MOST likely diagnosis?
A patient with known congestive heart failure presents with dyspnea. A chest X-ray reveals bilateral pleural effusions. Which type of pleural effusion is MOST likely in this clinical context?
A patient with known congestive heart failure presents with dyspnea. A chest X-ray reveals bilateral pleural effusions. Which type of pleural effusion is MOST likely in this clinical context?
A patient develops a pneumothorax following a subclavian central line insertion. This is best classified as what type of pneumothorax?
A patient develops a pneumothorax following a subclavian central line insertion. This is best classified as what type of pneumothorax?
Which of the following laboratory findings in pleural fluid would STRONGLY suggest an exudative effusion over a transudative effusion?
Which of the following laboratory findings in pleural fluid would STRONGLY suggest an exudative effusion over a transudative effusion?
Which of the following statements BEST differentiates needle thoracostomy from tube thoracostomy?
Which of the following statements BEST differentiates needle thoracostomy from tube thoracostomy?
A patient with a history of asbestos exposure presents with a pleural effusion and pleural thickening seen on chest imaging. Which of the following diagnoses is MOST concerning given the exposure history?
A patient with a history of asbestos exposure presents with a pleural effusion and pleural thickening seen on chest imaging. Which of the following diagnoses is MOST concerning given the exposure history?
A patient with a known pneumothorax shows visceral pleural lines on chest X-ray. What does the presence of these lines indicate?
A patient with a known pneumothorax shows visceral pleural lines on chest X-ray. What does the presence of these lines indicate?
Which condition is suggested by the physical exam finding of hyper-resonance to percussion over a lung field?
Which condition is suggested by the physical exam finding of hyper-resonance to percussion over a lung field?
In managing a secondary pneumothorax, what is the MOST critical difference in approach compared to a primary spontaneous pneumothorax?
In managing a secondary pneumothorax, what is the MOST critical difference in approach compared to a primary spontaneous pneumothorax?
Which of the following best describes the primary goal of a thoracentesis?
Which of the following best describes the primary goal of a thoracentesis?
A patient presents with dyspnea, non-productive cough, and pleuritic chest pain. Auscultation reveals diminished breath sounds on the left side. Which of the following is the MOST likely underlying condition?
A patient presents with dyspnea, non-productive cough, and pleuritic chest pain. Auscultation reveals diminished breath sounds on the left side. Which of the following is the MOST likely underlying condition?
According to Light's criteria, which of the following pleural fluid analysis results suggests an exudative pleural effusion?
According to Light's criteria, which of the following pleural fluid analysis results suggests an exudative pleural effusion?
A patient with a known history of cirrhosis presents with increasing dyspnea. A chest X-ray reveals a moderate pleural effusion. What is the MOST likely mechanism causing this effusion?
A patient with a known history of cirrhosis presents with increasing dyspnea. A chest X-ray reveals a moderate pleural effusion. What is the MOST likely mechanism causing this effusion?
What is the MOST appropriate initial step in managing a patient suspected of having a tension pneumothorax?
What is the MOST appropriate initial step in managing a patient suspected of having a tension pneumothorax?
A 25-year-old male with Marfan's syndrome presents to the emergency department complaining of acute onset shortness of breath and right-sided chest pain. On physical exam, you note decreased breath sounds and hyperresonance to percussion on the right side. Which of the following is the MOST likely diagnosis?
A 25-year-old male with Marfan's syndrome presents to the emergency department complaining of acute onset shortness of breath and right-sided chest pain. On physical exam, you note decreased breath sounds and hyperresonance to percussion on the right side. Which of the following is the MOST likely diagnosis?
Following a motor vehicle accident, a patient is diagnosed with a hemothorax. Which of the following is the MOST important step in managing this condition to prevent long-term complications?
Following a motor vehicle accident, a patient is diagnosed with a hemothorax. Which of the following is the MOST important step in managing this condition to prevent long-term complications?
A patient with known asbestos exposure presents with a large pleural effusion and significant pleural thickening on imaging. Which of the following diagnoses should be of HIGHEST concern?
A patient with known asbestos exposure presents with a large pleural effusion and significant pleural thickening on imaging. Which of the following diagnoses should be of HIGHEST concern?
A patient with a history of COPD develops a secondary spontaneous pneumothorax. Why are secondary pneumothoraces generally considered more serious than primary spontaneous pneumothoraces?
A patient with a history of COPD develops a secondary spontaneous pneumothorax. Why are secondary pneumothoraces generally considered more serious than primary spontaneous pneumothoraces?
A researcher is investigating novel biomarkers in pleural fluid to differentiate between transudative and exudative effusions with greater accuracy than Light's criteria. Which of the following biomarkers, if elevated in exudative effusions compared to transudative effusions, would BEST support the hypothesis that increased vascular permeability is a key factor in exudate formation?
A researcher is investigating novel biomarkers in pleural fluid to differentiate between transudative and exudative effusions with greater accuracy than Light's criteria. Which of the following biomarkers, if elevated in exudative effusions compared to transudative effusions, would BEST support the hypothesis that increased vascular permeability is a key factor in exudate formation?
A 72-year-old male with congestive heart failure (CHF) presents with progressive dyspnea. Chest X-ray shows a bilateral pleural effusion. What is the most likely type of effusion?
A 72-year-old male with congestive heart failure (CHF) presents with progressive dyspnea. Chest X-ray shows a bilateral pleural effusion. What is the most likely type of effusion?
A patient with bacterial pneumonia develops a unilateral pleural effusion. Thoracentesis shows pleural fluid with LDH > 200 IU/L and protein ratio > 0.5. What is the most likely classification?
A patient with bacterial pneumonia develops a unilateral pleural effusion. Thoracentesis shows pleural fluid with LDH > 200 IU/L and protein ratio > 0.5. What is the most likely classification?
Which of the following findings on pleural fluid analysis is most suggestive of a malignant pleural effusion?
Which of the following findings on pleural fluid analysis is most suggestive of a malignant pleural effusion?
Which of the following is most characteristic of a chylothorax?
Which of the following is most characteristic of a chylothorax?
A patient with empyema presents with fever, pleuritic chest pain, and dyspnea. What is the best initial treatment?
A patient with empyema presents with fever, pleuritic chest pain, and dyspnea. What is the best initial treatment?
Which of the following is the most common cause of unilateral diaphragmatic paralysis?
Which of the following is the most common cause of unilateral diaphragmatic paralysis?
Which test is most useful for confirming diaphragmatic paralysis?
Which test is most useful for confirming diaphragmatic paralysis?
A patient with Guillain-Barré syndrome (GBS) develops bilateral diaphragmatic paralysis. Which of the following is the most appropriate management?
A patient with Guillain-Barré syndrome (GBS) develops bilateral diaphragmatic paralysis. Which of the following is the most appropriate management?
A patient presents with chest pain and subcutaneous emphysema after forceful vomiting. Which of the following is the most likely diagnosis?
A patient presents with chest pain and subcutaneous emphysema after forceful vomiting. Which of the following is the most likely diagnosis?
Which of the following is most strongly associated with anterior mediastinal masses?
Which of the following is most strongly associated with anterior mediastinal masses?
A 55-year-old man presents with chronic cough, weight loss, and facial swelling. Exam shows distended neck veins and upper extremity swelling. What is the most likely diagnosis?
A 55-year-old man presents with chronic cough, weight loss, and facial swelling. Exam shows distended neck veins and upper extremity swelling. What is the most likely diagnosis?
A patient with a recent coronary artery bypass graft (CABG) surgery presents with sternal pain, fever, and wound drainage. What is the most likely diagnosis?
A patient with a recent coronary artery bypass graft (CABG) surgery presents with sternal pain, fever, and wound drainage. What is the most likely diagnosis?
A 45-year-old man with cirrhosis presents with dyspnea and right-sided pleural effusion. Thoracentesis reveals a transudative effusion with no signs of infection. What is the most likely diagnosis?
A 45-year-old man with cirrhosis presents with dyspnea and right-sided pleural effusion. Thoracentesis reveals a transudative effusion with no signs of infection. What is the most likely diagnosis?
A patient with a known history of tuberculosis (TB) presents with fever, night sweats, and a unilateral pleural effusion. What is the most likely finding on pleural fluid analysis?
A patient with a known history of tuberculosis (TB) presents with fever, night sweats, and a unilateral pleural effusion. What is the most likely finding on pleural fluid analysis?
A 75-year-old male with lung cancer presents with dyspnea and a large malignant pleural effusion. He has recurrent symptomatic effusions despite repeated thoracentesis. What is the best next step?
A 75-year-old male with lung cancer presents with dyspnea and a large malignant pleural effusion. He has recurrent symptomatic effusions despite repeated thoracentesis. What is the best next step?
A patient with suspected pneumothorax presents with sudden dyspnea and pleuritic chest pain. Which of the following CXR findings is most consistent with tension pneumothorax?
A patient with suspected pneumothorax presents with sudden dyspnea and pleuritic chest pain. Which of the following CXR findings is most consistent with tension pneumothorax?
A patient with amyotrophic lateral sclerosis (ALS) develops progressive dyspnea, especially when lying flat. Which of the following is the most likely cause?
A patient with amyotrophic lateral sclerosis (ALS) develops progressive dyspnea, especially when lying flat. Which of the following is the most likely cause?
A 50-year-old male with severe cervical spine trauma is found to have elevated hemidiaphragm on CXR and paradoxical breathing on inspiration. What is the most likely diagnosis?
A 50-year-old male with severe cervical spine trauma is found to have elevated hemidiaphragm on CXR and paradoxical breathing on inspiration. What is the most likely diagnosis?
A patient with Guillain-Barré syndrome (GBS) develops progressive hypoventilation and hypercapnia. Which test is best to monitor for impending respiratory failure?
A patient with Guillain-Barré syndrome (GBS) develops progressive hypoventilation and hypercapnia. Which test is best to monitor for impending respiratory failure?
A 50-year-old male with myasthenia gravis undergoes a CT scan of the chest, which shows an anterior mediastinal mass. What is the most likely diagnosis?
A 50-year-old male with myasthenia gravis undergoes a CT scan of the chest, which shows an anterior mediastinal mass. What is the most likely diagnosis?
A patient with Boerhaave syndrome (esophageal rupture) is at risk for developing which life-threatening complication?
A patient with Boerhaave syndrome (esophageal rupture) is at risk for developing which life-threatening complication?
A patient with a history of lymphoma presents with progressive facial swelling, dyspnea, and distended neck veins. What is the most likely diagnosis?
A patient with a history of lymphoma presents with progressive facial swelling, dyspnea, and distended neck veins. What is the most likely diagnosis?
Which of the following mediastinal mass locations is most commonly associated with neurogenic tumors (e.g., schwannomas, neurofibromas)?
Which of the following mediastinal mass locations is most commonly associated with neurogenic tumors (e.g., schwannomas, neurofibromas)?
Flashcards
Unilateral Diaphragmatic Paralysis
Unilateral Diaphragmatic Paralysis
Phrenic nerve injury that may be caused by trauma or mediastinal tumor; nearly half are unexplained.
Bilateral Diaphragmatic Paralysis
Bilateral Diaphragmatic Paralysis
Generalized neuromuscular disease that may require mechanical ventilation.
Mediastinitis
Mediastinitis
Inflammation of the mediastinum, often infectious.
Operative Risk Factors for Mediastinitis
Operative Risk Factors for Mediastinitis
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Clinical Findings of Mediastinitis
Clinical Findings of Mediastinitis
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Clinical Findings of Mediastinitis
Clinical Findings of Mediastinitis
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Treatment for Mediastinitis
Treatment for Mediastinitis
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Etiologies of Esophageal Perforation
Etiologies of Esophageal Perforation
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Presentation of Esophageal Perforation
Presentation of Esophageal Perforation
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Pneumomediastinum due to Ruptured Esophagus
Pneumomediastinum due to Ruptured Esophagus
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Anterior Mediastinal Mass DDX
Anterior Mediastinal Mass DDX
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Middle Mediastinal Mass
Middle Mediastinal Mass
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Posterior Mediastinal Mass
Posterior Mediastinal Mass
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Thoracotomy
Thoracotomy
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VATS
VATS
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Thoracostomy
Thoracostomy
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Needle Thoracostomy
Needle Thoracostomy
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Tube Thoracostomy
Tube Thoracostomy
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Thoracentesis
Thoracentesis
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Pleurodesis
Pleurodesis
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Pleuritis
Pleuritis
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Pleurodynia
Pleurodynia
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Pleural Effusion
Pleural Effusion
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Chylothorax
Chylothorax
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Hemothorax
Hemothorax
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Pneumothorax
Pneumothorax
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Empyema
Empyema
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Transudative Effusion
Transudative Effusion
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Exudative Effusion
Exudative Effusion
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Pleural Effusion CXR Finding
Pleural Effusion CXR Finding
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Lateral Decubitus Views
Lateral Decubitus Views
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Thoracentesis Use
Thoracentesis Use
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Exudative Effusion Analysis
Exudative Effusion Analysis
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Transudative Effusion Causes
Transudative Effusion Causes
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Exudative Effusion Causes
Exudative Effusion Causes
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Empyema
Empyema
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Hemothorax Etiology
Hemothorax Etiology
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Pneumothorax Exam Findings
Pneumothorax Exam Findings
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Primary Pneumothorax
Primary Pneumothorax
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Secondary Pneumothorax
Secondary Pneumothorax
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Traumatic Pneumothorax
Traumatic Pneumothorax
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Iatrogenic Pneumothorax
Iatrogenic Pneumothorax
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Pneumothorax Treatment
Pneumothorax Treatment
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Tension Pneumothorax
Tension Pneumothorax
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Tension Pneumothorax Treatment
Tension Pneumothorax Treatment
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Mesothelioma
Mesothelioma
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Malignant Pleural Effusion
Malignant Pleural Effusion
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Characteristics of Chylothorax
Characteristics of Chylothorax
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Treatment for an empyema
Treatment for an empyema
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Diagnosis of Diaphragmatic Paralysis
Diagnosis of Diaphragmatic Paralysis
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Bilateral Diaphragmatic Paralysis Management
Bilateral Diaphragmatic Paralysis Management
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Boerhaave Syndrome
Boerhaave Syndrome
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Superior Vena Cava (SVC) Syndrome
Superior Vena Cava (SVC) Syndrome
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Study Notes
Pleural Effusion Types
- Congestive heart failure (CHF) often leads to transudative pleural effusion due to increased hydrostatic pressure and decreased oncotic pressure.
- Bacterial pneumonia can lead to exudative pleural effusion. The fluid will have LDH >200 IU/L and a protein ratio > 0.5 due to increased capillary permeability from the infection.
- Malignant pleural effusions are exudative and typically present with a pH < 7.2 and may have positive cytology.
- Chylothorax is characterized by a milky pleural fluid with triglycerides > 110 mg/dL.
Empyema Treatment
- Empyema is best treated with drainage and IV antibiotics; persistent infection may occur without drainage.
Diaphragmatic Paralysis
- Phrenic nerve injury is the most common cause of unilateral diaphragmatic paralysis.
- Fluoroscopy ("Sniff Test") is most useful for confirming diaphragmatic paralysis.
- Bilateral diaphragmatic paralysis, as seen in Guillain-Barré syndrome (GBS), can lead to respiratory failure and often requires intubation with mechanical ventilation.
- Cervical trauma with elevated hemidiaphragm suggests phrenic nerve injury as the cause of unilateral diaphragmatic paralysis.
- Elevated hemidiaphragm on CXR and paradoxical breathing suggests unilateral diaphragmatic paralysis due to phrenic nerve injury.
- Amyotrophic lateral sclerosis (ALS) can cause bilateral diaphragmatic paralysis, leading to orthopnea.
Disorders of the Mediastinum
- Boerhaave syndrome (esophageal perforation) presents with vomiting, subcutaneous emphysema, and pneumomediastinum. Esophageal perforation can lead to mediastinitis.
- Anterior mediastinal masses are associated with the "4 T's": Thymoma, Teratoma, Thyroid tumor, and "Terrible" Lymphoma.
- Mediastinal masses + facial swelling + JVD is indicative of Superior Vena Cava (SVC) syndrome.
- SVC Syndrome presents with facial swelling and distended neck veins. The symptoms are typically caused by a mediastinal mass.
- Posterior mediastinal masses are commonly associated with neurogenic tumors like schwannomas and neurofibromas.
Mediastinitis
- Recent CABG surgery with fever, sternal pain, and wound drainage is suggestive of mediastinitis.
- Post-CABG is the most common cause of mediastinitis due to sternal wound infections.
Pleural Effusion Characteristics
- Cirrhosis with right-sided pleural effusion indicates hepatic hydrothorax (a transudative effusion).
- Tuberculosis (TB) effusions are exudative, with lymphocytic predominance, low glucose, and low pH.
- For recurrent malignant pleural effusions, pleurodesis is indicated to prevent fluid reaccumulation.
Tension Pneumothorax Diagnosis
- Tension pneumothorax is consistent with tracheal deviation away from the affected side and absent breath sounds.
Monitoring Respiratory Failure
- In Guillain-Barré syndrome (GBS) with progressive hypoventilation and hypercapnia, use negative inspiratory force (NIF) to monitor for respiratory decline; intubation may be necessary.
Anterior Mediastinal Masses
- Myasthenia gravis with an anterior mediastinal mass points to thymoma as the likely diagnosis.
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