Cardiothoracic

Question 1

Diaphragm Levels:
T8 ___
T10 ___
T12 ____

Answer 1

T8 Vena cava; T10 esophagus (and vagi), T12 Thoracic duct and aorta

Question 2

Type I alveoli: _____

Type II alveoli: _____ ; _% of alveoli?

Answer 2

I: functional gas exchange
II: produce surfactant (decrease surface tension);
1% of alveoli

Question 3

Pre-thoracotomy PFTs: need FEV
> _____ for pneumonectomy
> ____ for lobectomy
> ____ for wedge resection

Answer 3

> 2L for pneumonectomy
1L for lobectomy
0.6L for wedge resection
(Need predicted postop FEV1 > 0.8)

Question 4

____ now #1 lung cancer

Answer 4

adenocarcinoma

Question 5

____ lung cancer associated with PTH-like substance

Answer 5

squamous lung cancer

Question 6

___ lung cancer associated with ACTH, ADH

Answer 6

small cell lung cancer

Question 7

Lung cancer tumor size:
T1: \_\_\_
T2: \_\_\_\_
T3: \_\_\_
T4: \_\_\_\_

Answer 7

T1: < 3cm
T2: >3cm
T3: invasion of chest wall, pericardium, diaphragm or < 2 cm from carina
T4: unresectable= into mediastinum, heart, great vessel, esophagus, trachea, vertebrae, effusion

Question 8

Lung cancer nodes:
N1: ___
N2: ___
N3: ___

Answer 8

N1: ipsi hilar nodes
N2: ipsi mediastinal
N3: Unresectable= contralateral or scalene or subclavian nodes

Question 9

Lung cancer stages:
I: \_\_\_
II: \_\_\_
IIIa: \_\_\_
IIIb: \_\_\_
IV: \_\_\_

Answer 9

I: T1-2N0
II: T2N1
IIIa: up to T3 or N2
IIIb: unresectable T4 or N3
IV: M1

Question 10

Pancoast tumor involves

_______ and/or _____ nerve

Answer 10

sympathetic chain (Horner’s syndrome) and/or ulnar nerve

Question 11

____ (Left/right) lung can drain to ____ (left/right) mediastinum

Answer 11

Left lung can drain to right mediastinum (left to right, like reading)

Question 12

Thymoma: indication for resection? (yes/no)

Answer 12

yes

Question 13

Resecting thymus (even if no thymoma) in myasthenia gravis improves ____%

Answer 13

90%

Question 14

___% of myasthenia gravis patients have thymomas

Answer 14

10%

Question 15

Popcorn lesion on CXR is classically a ______.

Answer 15

hamartoma

Question 16

Thoracic outlet syndrome involves artery or vein __% of time

Answer 16

rarely; 1-3%, generally ulnar nerve paresthesias

Question 17

Spontaneous PTX:
____ (ratio) male predilection
___% recur then ___% of those again

Answer 17

10:1; 50%; 75%

Question 18

Spontaneous PTX indication for thoracoscopy

Answer 18

For 2nd time or continuous air leak

Question 19

Post MI VSD presents ____ (when).
___% of MI’s.
___ (type) murmur.

Answer 19

day 2-7;
2%;
pan-systolic

Question 20

SVC syndrome:
90% due to ______.
Rx with ___.

Answer 20

Lung cancer; XRT

Question 21

Takayasu arteritis:
Old/young? \_\_\_
Male/female? \_\_\_
Involves thoracic/abd aorta or both? \_\_\_
Dx by \_\_\_

Answer 21

Young female; involves thoracic and abd aorta and PA; Dx by angio

Question 22

Tissues valves:
Longer/shorter acting? ___
Anticoag or none? ___
Use in __, ___, and for all ___

Answer 22

short acting; no anticoag needed; use in patient who may become pregnant, has contraindication to coumadin; use in all tricuspid replacements

Question 23

Rheumatic fever leads to _____

Answer 23

mitral stenosis

Question 24

See mitral regurgitation with __ or ___

Answer 24

MI or valve degeneration

Question 25

Chylothorax (non-iatrogenic) usually due to ____. ( 75% it is _____).
Rx is _____.

Answer 25

posterior mediastinal tumor; 75% lymphoma; XRT may help

Question 26

Thoracic duct injury:

Rx with _____ + _____

Answer 26

drainage + NPO x 2 wks; if not resolved then R thoracotomy, ligate duct

Question 27

thoracic duct enters chest on ____ (right/left) with aorta at ____; crosses to (right/left) at ____, then joins _______

Answer 27

enters right with aorta at T12; crosses to left at T4; joins IJ/subclavian junction

Question 28

Thoracic aorta aneurysms: Operate if

____ or ____

Answer 28

> 6cm, symptomatic

Question 29

Aortic dissection:
Type ____ involves ____ and need to operate?
Type ____ involves ____ and need to operate?

Answer 29

A- involves ascending- must operate;

B- does not involve ascending- medical management

Question 30

___: Leading killer in US

Answer 30

CAD (2x cancer)

Question 31

CABG indications:
\_\_\_\_\_\_\_ symptoms
\_\_\_\_ % of \_\_\_\_ artery
\_\_\_\_\_\_ disease
\_\_\_\_% of \_\_\_ artery + other vessel

Answer 31

intractable symptoms; >50% left main; triple vessel disease; 70% LAD + other vessel

Question 32

Angioplasty:
___% restenosis by 1 year
vein graft 5 year patency ___%
IMA graft 20 year patency ___%

Answer 32

20%; 80%; 95%

Question 33

_____: #1 cardiac congenital defect
___% close on their own
OR if ___ or ___

Answer 33

VSD; 50% close; OR if symptoms or Failure to Thrive

Question 34

PDA: close all that ___ (med) does not at ___ (age)

Answer 34

indomethacin; 6 months of age

Question 35

IABP: augments ______ coronary blood flow and reduces ____ by inflating during _____.

Answer 35

diastolic; afterload; diastole

Question 36

IABP: inflates ____ (time) before T wave; deflates with ____.

Answer 36

40mec; p wave (Every year)