Cardiothoracic 1

Question 0

70-year-old woman develops pneumonia. Receives antibiotics and condition improves. One week later notices increased pain in chest, increased cough, recurrent fever. CXR shows pleural effusion in right lung field. Likely diagnosis? Causal organisms? Management?

Answer 0

Empyema

S pneumoniae in community, S aeurus in hospital

#Antibiotics
#evacuate pus (Chest tube drainage)
#reexpand long (Chest tube drainage)

Question 1

Events that suggests lung empyema contains anaerobic organisms?

Answer 1

#History of alcoholism
#Unconsciousness
#Recent operation or aspiration

Question 2

Failure to expeditiously use chest drainage in lung empyema may lead to? Management?

Answer 2

Loculation

Thoracotomy and decortication (removal of inflammatory tissue trapping long) via minithoracotomy or VATS

Question 3

53-year-old man with NIDDM, Three-year history of angina, 30 pack year smoking history, hypercholesterolemia presents with increasingly frequent severe chest pain. Now has angina at rest. ECG demonstrates ischemic pattern – diagnosis? Management?

Answer 3

Pre-infarction angina (emergency)

#Bedrest, sedation, oxygen, 
#beta blockers, nitroglycerin, aspirin, heparin
#ROMI

Question 4

Normal ejection fractions?

Answer 4

Children – 90%
Young adults – 70-80%
Older – 50-60%

Question 5

Coronary blockage that significantly reduces survival and is an indication for bypass? Associated with?

Answer 5

Left main; sudden-death

Question 6

Viable alternatives to coronary artery bypass? Problem?

Answer 6

Percutaneous transcatheter coronary angioplasty – 30-60% reobstruct within one year

Question 7

Conduits used in coronary artery bypass?

Answer 7

Saphenous vein and internal mammary artery (best)

Question 8

Basic steps of coronary artery bypass?

Answer 8

#Median sternotomy
#Cardiopulmonary bypass
#grafts are sewn (In free grafts, inflow portion sewn to aorta)

Question 9

Cardioplegia solution – purpose? Mechanism?

Answer 9

Stops heart and diastole, protect it from ischemia, provides motionless field for surgeon

High potassium (60 mEq/L)

Question 10

Complications of cardiopulmonary bypass?

Answer 10

Inflammatory response that might lead to respiratory and myocardial complications postoperatively

Question 11

When to use off-bypass coronary surgery?

Answer 11

#High-risk patients 
#patients with one or two easily accessible arteries

Question 12

42-year-old with no one heart murmur experiences severe shortness of breath and fatigue. ECHO shows severe mitral regurgitation – mechanism?

Answer 12

Myxomatous degeneration of mitral valve (possibly from ischemia if myocardium)

Question 13

Barlow syndrome? Difference in men versus women

Answer 13

Prolapse of the mitral valve;

Marker of severe mitral valve disease versus common disorder that rarely progresses

Question 14

Most common causes of mitral stenosis?

Answer 14

Rheumatic fever and scarlet fever

Question 15

Surgical management of mitral valve disease?

Answer 15

Mitral stenosis – Commissurotomy (split the commissures and reconstitute the lumen by mechanical dilators)

Mitral regurgitation – excise redundant portions of mitral leaflets and reinforce annulus with annuloplasty ring

Question 16

Causes of aortic statuses?

Answer 16

#Congenital
#Arteriosclerotic
#deteriorative

Question 17

Findings associated with aortic stenosis that decrease life expectancy?

Answer 17

Shortness of breath, angina, syncope

Question 18

Workup for aortic stenosis? Results that indicated surgery as an option?

Answer 18

#Cardiac catheterization – lumen size, pressure gradient, ventricular function, CAD
#Carotid Doppler – rule out carotid artery obstruction

High grade aortic valve stenosis with preserved ventricular function

Question 19

Mechanical valves versus tissue valves?

Answer 19

Durable but require anticoagulation versus non-thrombogenic but requires replacement at seven years