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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
Most common cause of post-nissen dysphagia >4wks; dx test
Recurrent hiatal hernia or herniated wrap; barium swallow
26
Gold standard test for pathologic acid reflux
pH monitoring
27
DeMeester score indicating pathological reflux
>14.72
28
Reflux surgery, unable to bring GE junction 3cm below diaphragm; next step
Collis gastroplasty and Toupet fundoplication
29
Iron deficiency anemia, esophageal webs, dysphagia; dx
Plummer-Vinson syndrome
30
Caustic ingestion, stable, diagnostic test
CT chest/abd with IV and oral Gastrografin
31
Traction or epiphrenic diverticulum; workup(why)
Endoscopy to rule out malignancy Manometry to rule out dysmotility
32
Traction or epiphrenic diverticulum; tx
Myomtomy v. Diverticulectomy +/- HH repair or fundoplication
33
Hiatal hernia types
Type 1 sliding Type 2 para-esophageal Type 3 mixed Type 4 other organs
34
Belsey Mark IV fundoplication
Transthoracic anterior 270-degree plication of the fundus buttressed by the diaphragmatic crura
35
Zenker diverticula > 2cm; tx
Stapling or diverticulectomy
36
Zenker diverticula <2cm; tx
Myotomy or myotomy and pexy
37
SCC of proximal esophagus; tx
Chemorads
38
Aperistalsis and failure of LES relaxation; dx and pathology
Achalasia, injury/inflammation ganglion cells
39
Siewert classification GE junction tumors
Type I - 5cm to 1cm above Z-line Type II - 1cm above to 2cm below Type III - 2cm to 5cm below
40
Mallory-Weiss tear s/p failed endoscopy; next step
Repeat endoscopy then angiography
41
Most common long-term complication related to repaired esophageal atresia
Dysphagia
42
Spirometric changes with right upper lobe cancer
Decreased FRC
43
Light's criteria for exudative effusions
Pleural:serum protein >0.5 Pleural:serum LDH >0.6 Pleural LDH >2/3 upper limit of normal
44
Effusion volume detectable on upright CXR
300mL
45
Most common anterior and middle mediastinal tumor in children
Lymphoma
46
Most common posterior mediastinal tumor in children
Neurogenic
47
Ohio hiker with calcified RUL lesion; dx and tx
Histoplasmosis, no tx, Ampho B
48
Standard treatment bronchial carcinoid
Surgical resection with mediastinal node sampling
49
Most common anterior mediastinal tumor in adults
Thymoma
50
Trapped lung as a result of empyema; tx
VATS decortication and pleurodesis
51
Diagnostic imaging for SVC syndrome
CT with IV contrast
52
SOB, facial plethora/cyanosis, RUE edema and mediastinal tumor; dx
SVC syndrome,
53
Mortality benefit in ARDs
TV 6ml/kg and proning
54
Persistent air leak and pneumomediastinum s/p lung txp; dx test
Bronchoscopy to eval for bronchial dehiscence
55
S/p pneumonectomy with dyspnea, stridor, and recurrent pneumonia. Bronchoscopy reveals a dynamic obstruction of the left bronchus. Dx and tx
Post-pneumonectomy syndrome, tissue expander in pneumonectomy site
56
Swelling arm and face, lymphadenopathy, bulky mediastinal granuloma on bx; dx
Chronic fibrosing mediastinitis causing SVC syndrome
57
Common sites of metastasis for pheo and mutation
Bone, lung, liver, kidneys, lymph nodes; SDHB gene
58
Apical lung tumor causing shoulder pain, ptosis, miosis, anhidrosis, facial/UE edema; dx and tx
Pancoast tumor, chemorads followed by resection
59
SCC of lung associated paraneoplastic
Overproduction of PTH leading to hypercalcemia
60
Small cell lung cancer associated with what paraneoplastic syndrome
Overproduction of ADH or ACTH
61
Subxiphoid pericardial window approach
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
Tx of complicated parapneumonic effusions
Thoracentesis, thoracotomy or surgical drainage

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