Cardiothoracic

Question 1

Indications for CABG?

Answer 1

> 70% left main stem stenosis
symptomatic patients with >70% proximal LAD stenosis
symptomatic patients with >70% in all three vessels
concomitant valvular disease which requires replacement
vessel disease in a diabetic

Question 2

CABG procedure?

Answer 2

midline sternotomy
conduit (saphenous vein, left internal mammary artery, radial artery) is anastomosed

Question 3

Complications of CABG?

Answer 3

death
stroke
re-sternotomy for bleeding or tamponade
chest infection
atrial fibrillation
wound infection
renal failure

Question 4

Mechanical vs Bioprosthetic valves?

Answer 4

mechanical:
>20yrs
require warfarin
noisy

bioprosthetic:
10yrs
no need for warfarin
silent

Question 5

Causes of aortic stenosis?

Answer 5

‘wear and tear’ calcific degeneration
bicuspid valve
rheumatic disease

Question 6

Presentation of aortic stenosis?

Answer 6

SAD
syncope
angina
dyspnoea

ejection systolic crescendo-decrescendo murmur loudest in aortic area radiating to carotids
heaving apex beat

Question 7

Investigations in aortic stenosis?

Answer 7

ECG (left ventricular hypertrophy)
TTE (degree of stenosis)

Question 8

Indications for valve replacement in aortic stenosis?

Answer 8

mean gradient across valve >40 mmHg
symptomatic

Question 9

Surgical options in aortic stenosis?

Answer 9

open surgical aortic valve replacement via thoracotomy
transcatheter aortic valve implantation (TAVI)

Question 10

Causes of mitral regurgitation?

Answer 10

mitral valve prolapse due to ischaemia (papillary muscle rupture)
rheumatic disease
infective endocarditis
CT disorders

Question 11

Presentation of mitral regurgitation?

Answer 11

acute MR -> CCF
chronic MR -> exertional dyspnoea
orthopnoea
displaced apex beat
AFib

pansystolic murmur loudest at apex and radiating to axilla
+/- third heart sound

Question 12

Investigations for mitral regurgitation?

Answer 12

TTE
TOE

Question 13

Indications for surgery in mitral regurgitation?

Answer 13

acute MR
severe chronic MR

Question 14

Surgical approach to mitral regurgitation?

Answer 14

open valve replacement
endovascular Mitra clip if open surgery contraindicated

Question 15

Causes of mitral stenosis?

Answer 15

rheumatic heart disease most common

Question 16

Presentation of mitral stenosis?

Answer 16

rumbling mid-diastolic murmur at apex
signs of RHF
AFib
left parasternal heave
tapping apex beat

Question 17

Investigations for mitral stenosis?

Answer 17

CXR (enlarged left atrium)
TTE
TOE

Question 18

Surgical approach for mitral stenosis?

Answer 18

percutaneous valvotomy
open mitral valve replacement

Question 19

Causes of aortic regurgitation?

Answer 19

rheumatic disease
Marfan’s and CT disorders
large vessel vasculitis
infective endocarditis
aortic dissection

Question 20

Presentation of aortic regurgitation?

Answer 20

early diastolic murmur heard better on end expiration and leaning forwards

acute AR (dissection or endocarditis)
signs of LVF
chronic AR:
wide pulse pressure
water hammer pulse

Question 21

Investigations for aortic regurgitation?

Answer 21

CXR (cardiomegaly)
TTE

Question 22

Indications for surgery in aortic regurgitation?

Answer 22

acute AR is surgical emergency
chronic AR if left ventricular dilatation >5.5cm

Question 23

Classification of pneumothorax?

Answer 23

primary spontaneous
secondary spontaneous
traumatic

tension
non-tension

Question 24

Features of pneumothorax?

Answer 24

dyspnoea
chest pain
tachypnoea
hyper resonant hemithorax
absent breath sounds

Question 25

Investigations for pneumothorax?

Answer 25

CXR CT thorax more accurate for sizing

Question 26

Complications of pneumothorax?

Answer 26

tension pneumothorax pneumomediastinum haemo-pneumothorax recurrent pneumothorax

Question 27

Mx of pneumothorax?

Answer 27

conservative if small and asymptomatic (O2 and repeat CXR) if >2cm rim of air: needle aspiration in second intercostal space midclavicular line chest tube insertion in 4th-5th intercostal space in mid-axillary line VATS for bullectomy and pleurodesis

Question 28

Causes of secondary spontaneous pneumothorax?

Answer 28

chronic airway and alveolar disease systemic CT disease malignant lung and chest diseases

Question 29

Borders of the safe triangle for chest drain insertion?

Answer 29

lateral border of pectoralis major anterior border of latissimus dorsi fifth intercostal space

Question 30

Insertion of chest tube technique?

Answer 30

insert just above the rib to avoid the neurovascular bundle attach to underwater seal never lift underwater seal above the bed to avoid water entering the pleural space