Cardiothoracic

Question 1

Give examples of cyanotic hear disease

Answer 1

Right to left shunts - deoxygenated blood enters systemic circulation
Transposition of great arteries

Normally not cyanotic but if pulmonary pressure increases a right to left shunt is created:
Ventricular septal defect
Atrial septal defects
Patent ductus arteriosus
Transposition of great arteries

Question 2

Define pericardial effusion

Answer 2

Where excess fluid collects within the pericardial sac.

Question 3

Causes of pericardial effusion

Answer 3

Increased venous pressure - transudative effusion (HF, pulmonary hypertension)

Inflammatory process - exudative effusion (infection, autoimmune, injury, uraemia, cancer, medication)

Question 4

History of pericardial effusion

Answer 4

Quick haemodynamic compromise = cardiac tamponade
Chest pain
Shortness of breath
Feeling of fullness within the chest
Orthopnoea
Compression of surrounding nerves - phrenic (hiccups), oesophageal (dysphagia), recurrent laryngeal (hoarse voice)

Question 5

Clinical signs of pericardial effusions

Answer 5

Muffled heart sounds
Pulsus paradoxus - large fall in pressure on inspiration
Hypotension
Raised JVP
Fever
Pericardial rub

Question 6

Investigations in pericardial effusion

Answer 6

Echo
Fluid analysis - protein, culture, PCR, cytology, tumour markers

Question 7

Management of pericardial effusion

Answer 7

Treat cause and drain effusion
Needle decompression or surgical drainage
Aspirin
NSAID
Colchicine
Steroids

Question 8

What are the main types of lung cancer

Answer 8

Small cell lung cancer
Non-small cell lung cancer - (adenocarcinomas, squamous cell carcinoma, large-cell carcinoma)

Question 9

Red flags of lung cancer

Answer 9

Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent infections
Weight loss
Lymphadenopathy - supraclavicular

Question 10

What paraneoplastic conditions can lung cancer cause

Answer 10

Horner’s syndrome - ptosis, anhidrosis and miosis (Pancoast tumour, presses on sympathetic ganglion)
SIADH - SCLC secretes excess ADH
Cushing’s syndrome - SCLC secretes excess ACTH
Hypercalcaemia - SCLC secretes excess parathyroid hormone
Lambert-Eaton myasthenic syndrome - SCLS produces antibodies against voltage gated calcium channels, causing proximal weakness.

Question 11

Investigations in lung cancer

Answer 11

CXR
Staging CT
PET-
Bronchoscopy
Histology - biopsy from bronch

Question 12

Define pneumothorax

Answer 12

Occurs when air gets into the pleural space seperating the lung from the chest wall.

Question 13

Causes of pneumothorax

Answer 13

Spontaneous (tall thin man sudden breathlessness and pleuritic chest pain possibly playing sports)
Trauma
Iatrogenic
Pathologies - infection, asthma, COPD

Question 14

Management of pneumothorax

Answer 14

<2cm - no treatment unless very sob
>2cm or unstable = chest drain

Question 15

What are the boundaries of the triangle of safety

Answer 15

5th intercostal space
Midaxillary line
Anterior axillary line

Question 16

Define tension pneumothorax

Answer 16

Cause by trauma to the chest that creates a one way valve. This creates high pressure within the thorax and pushes the mediastinum across, this can kink large vessels and cause cardiac arrest.

Question 17

Clinical signs of tension pneumothorax

Answer 17

Tracheal deviation away from the side of the pneumothorac
Reduced air entry/chest expansion of affected side
Increased resonance to percussion on affected side
Tachycardia
Hypotension

Question 18

Management of a tension pneumothorax

Answer 18

Insertion of large bore cannula into the second intercostal space in the midclavicular line.