Cardiothoracic 2

Question 0

45-year-old develops progressive SOB and weakness following respiratory illness. CXR shows a large heart shadow and congested lungs. ECHO reveals EF of 20% with moderate mitral regurgitation. Cardiac catheterization shows normal coronary arteries with poor ventricular contraction – likely diagnosis? Prognosis? Treatment?

Answer 0

Dilated cardiomyopathy (probably related to viral respiratory illness)

One third recovered, one third stay the same, one food dye

#Steroids, diuretics, immunosuppressives
#Beta blockers
#Heart Transplant

Question 1

55-year-old woman presents with regurgitation chewed, digested food. Long history of dysphasia. Suspected diagnosis? Confirm with? Specific location? Treatment?

Answer 1

Pharyngeal (Zenker) diverticulum; barium swallow or endoscopy

Between lower pharyngeal constrictor and cricopharyngeal muscle

Transection of cricopharyngeal muscle to prevent uncontrolled contraction

Question 2

Second location of pulsion diverticulum?

Answer 2

Distal esophageal gastric junction (epiphrenic diverticulum)

Question 3

Etiology of alcalasia? Treatment?

Answer 3

Loss of smooth muscle ganglionic cells of Auerbach plexus

Heller myotomy (100% effective) or transesophageal dilation (60% effective)

Question 4

Location of squamous cell carcinoma of the esophagus?

Answer 4

Upper and middle third of the esophagus

Question 5

Staging of esophageal tumors based on? Determine staging with what tests

Answer 5

Wall penetration and lymph nodes spread

Endoscopic ultrasound; CT scan

Question 6

Treatment for cervical/upper third esophageal cancer?

Answer 6

#Chemoradiation
#If persists, resection

Question 7

Treatment for cancer in the middle of the esophagus?

Answer 7

Neoadjuvant chemotherapy, then surgical resection

Question 8

Treatment for esophageal cancer in the lower third the esophagus?

Answer 8

Esophagectomy and proximal gastrectomy

Question 9

Patient presents with severe dysphasia and difficulty swallowing. Weight loss if 50 lbs. Coughs constantly - work up? Likely reason for cough? Treatment?

Answer 9

Barium swallow, esophagoscopy, biopsy

Chronic aspiration from TE from tumor erosion into trachea

Cancer progressed too far for curative procedure – palliative care (feeding gastrostomy, stent, radiation, palliative resection)

Question 10

Most likely tumor in the anterior mediastinum? Other tumors?

Answer 10

Thymoma (surgical resection)

Teratoma, lymphoma (Radiation and chemotherapy)