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ABSITE > Cardiothoracic > Flashcards

Cardiothoracic Flashcards

1
Q

Best patency rate for CABG

A

Internal thoracic(mammary) arteries

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2
Q

How to dx Barrett’s

A

4 quadrant biopsies every 2cm within Barrett segment showing columnar epithelium lining at least 1cm of the distal esophagus

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3
Q

Ongoing surveillance for Barrett’s

A

Endoscopy 3-5yrs

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4
Q

Recurrent GERD >2months s/p fundoplication

A

Slipped, migrated or disrupted fundoplication

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5
Q

Short v long segment Barrett’s

A

Short <3cm, long at least 3cm

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6
Q

Nondysplastic long segment BE; tx

A

Surveillance 2-5yrs

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7
Q

Staging workup up suspected esophageal Ca

A

Upper endoscopy with bx, CT CAP, PET and EUS

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8
Q

Esophageal cancer indicating upfront esophagectomy

A

T1b (submucosa) and low risk cT2 (muscular propria)

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9
Q

Esophageal Ca invades lamina propria; Stage and tx

A

T1a, Endoscopic therapy

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10
Q

Benign esophageal lesion approaches

A

Midesophagus - right thorax
Distal esophagus - left thorax/abdomen

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11
Q

Leiomyoma of the esophagus; tx

A

Enucleation and subsequent myotomy closure (<8cm and not annular)

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12
Q

Intermittent dysphagia, circular membrane distal esophagus; dx and tx

A

Schatzki’s ring, PPI and dilation or 4 quadrant biopsies

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13
Q

Risk of Barrett’s with Schatzki’s ring

A

Decreased

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14
Q

Blood supply esophagus

A

Cervical - inferior thyroid
Thoracic - aortic branches and bronchial
Abdominal - Left gastric

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15
Q

Sensory nerve supply to the upper epiglottis

A

Glossopharyngeal nerve (gag reflex)

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16
Q

Sensory nerve supply laryngeal mucosa above vocal cords

A

Internal branch of the superior laryngeal nerve (cough reflex)

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17
Q

Sensory nerve supply larynx below the vocal cords

A

Recurrent laryngeal nerve

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18
Q

Motor innervation to the intrinsic muscles of the larynx, except cricothyroid muscles

A

Recurrent laryngeal

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19
Q

Motor innervation to the cricothyroid

A

External branch of the superior laryngeal nerve

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20
Q

Contained, stable esophageal perforation; tx

A

Observation, abxs

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21
Q

First line for esophageal motility disorders

A

CCBs and nitrates

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22
Q

Heller myotomy; steps

A

5cm inner and outer myotomy above GE junction and 3cm below, expose mucosa, Dor fundoplication

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23
Q

Shown to increase healing in the primary repair of thoracic esophageal perforations

A

Pedicled intercostal muscle flap

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24
Q

Gold standard test dx esophageal perforation

A

Gastrografin swallow study

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25
Q

Most common cause of post-nissen dysphagia >4wks; dx test

A

Recurrent hiatal hernia or herniated wrap; barium swallow

26
Q

Gold standard test for pathologic acid reflux

A

pH monitoring

27
Q

DeMeester score indicating pathological reflux

A

> 14.72

28
Q

Reflux surgery, unable to bring GE junction 3cm below diaphragm; next step

A

Collis gastroplasty and Toupet fundoplication

29
Q

Iron deficiency anemia, esophageal webs, dysphagia; dx

A

Plummer-Vinson syndrome

30
Q

Caustic ingestion, stable, diagnostic test

A

CT chest/abd with IV and oral Gastrografin

31
Q

Traction or epiphrenic diverticulum; workup(why)

A

Endoscopy to rule out malignancy
Manometry to rule out dysmotility

32
Q

Traction or epiphrenic diverticulum; tx

A

Myomtomy v. Diverticulectomy +/- HH repair or fundoplication

33
Q

Hiatal hernia types

A

Type 1 sliding
Type 2 para-esophageal
Type 3 mixed
Type 4 other organs

34
Q

Belsey Mark IV fundoplication

A

Transthoracic anterior 270-degree plication of the fundus buttressed by the diaphragmatic crura

35
Q

Zenker diverticula > 2cm; tx

A

Stapling or diverticulectomy

36
Q

Zenker diverticula <2cm; tx

A

Myotomy or myotomy and pexy

37
Q

SCC of proximal esophagus; tx

A

Chemorads

38
Q

Aperistalsis and failure of LES relaxation; dx and pathology

A

Achalasia, injury/inflammation ganglion cells

39
Q

Siewert classification GE junction tumors

A

Type I - 5cm to 1cm above Z-line
Type II - 1cm above to 2cm below
Type III - 2cm to 5cm below

40
Q

Mallory-Weiss tear s/p failed endoscopy; next step

A

Repeat endoscopy then angiography

41
Q

Most common long-term complication related to repaired esophageal atresia

A

Dysphagia

42
Q

Spirometric changes with right upper lobe cancer

A

Decreased FRC

43
Q

Light’s criteria for exudative effusions

A

Pleural:serum protein >0.5
Pleural:serum LDH >0.6
Pleural LDH >2/3 upper limit of normal

44
Q

Effusion volume detectable on upright CXR

A

300mL

45
Q

Most common anterior and middle mediastinal tumor in children

A

Lymphoma

46
Q

Most common posterior mediastinal tumor in children

A

Neurogenic

47
Q

Ohio hiker with calcified RUL lesion; dx and tx

A

Histoplasmosis, no tx, Ampho B

48
Q

Standard treatment bronchial carcinoid

A

Surgical resection with mediastinal node sampling

49
Q

Most common anterior mediastinal tumor in adults

A

Thymoma

50
Q

Trapped lung as a result of empyema; tx

A

VATS decortication and pleurodesis

51
Q

Diagnostic imaging for SVC syndrome

A

CT with IV contrast

52
Q

SOB, facial plethora/cyanosis, RUE edema and mediastinal tumor; dx

A

SVC syndrome,

53
Q

Mortality benefit in ARDs

A

TV 6ml/kg and proning

54
Q

Persistent air leak and pneumomediastinum s/p lung txp; dx test

A

Bronchoscopy to eval for bronchial dehiscence

55
Q

S/p pneumonectomy with dyspnea, stridor, and recurrent pneumonia. Bronchoscopy reveals a dynamic obstruction of the left bronchus. Dx and tx

A

Post-pneumonectomy syndrome, tissue expander in pneumonectomy site

56
Q

Swelling arm and face, lymphadenopathy, bulky mediastinal granuloma on bx; dx

A

Chronic fibrosing mediastinitis causing SVC syndrome

57
Q

Common sites of metastasis for pheo and mutation

A

Bone, lung, liver, kidneys, lymph nodes; SDHB gene

58
Q

Apical lung tumor causing shoulder pain, ptosis, miosis, anhidrosis, facial/UE edema; dx and tx

A

Pancoast tumor, chemorads followed by resection

59
Q

SCC of lung associated paraneoplastic

A

Overproduction of PTH leading to hypercalcemia

60
Q

Small cell lung cancer associated with what paraneoplastic syndrome

A

Overproduction of ADH or ACTH

61
Q

Subxiphoid pericardial window approach

A

Vertical incision over xiphoid, removed, finger dissection separating diaphragm form pericardium, grasp with Allis and sharply incise, aspirate and drain through separate incisions, close in two layers

62
Q

Tx of complicated parapneumonic effusions

A

Thoracentesis, thoracotomy or surgical drainage

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