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ABSITE 2019 > Cardiothoracic > Flashcards

Cardiothoracic Flashcards

1
Q

Azygous v anatomy

A

runs along right, dumps into SVC

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2
Q

Thoracic duct anatomy

A

runs along right, crosses at T4, dumps into left subclavian at junction w/ internal jugular vein

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3
Q

Phrenic n anatomy

A

runs anterior to hilum

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4
Q

Vagus n anatomy

A

runs posterior to hilum

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5
Q

Pneumocyte responsible for gas exchange

A

Type I

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6
Q

Pneumocyte responsible for surfactant production

A

Type II (phosphatidylcholine)

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7
Q

Direct air exchange between alveoli

A

Pores of Kahn

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8
Q

Most common cause of cancer-related death in US

A

Lung cancer

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9
Q

Most common site of brain metastasis

A

brain

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10
Q

Best predictor of pulmonary complications and being able to wean off ventilator

A

FEV1

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11
Q

Most common complication after pneumonectomy

A

arrhythmias

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12
Q

Most common lung cancer

A

adenocarcinoma

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13
Q

T staging of lung cancer

A

1 <3cm
2 >3cm but >2cm away from carina
3 local invasion or <2cm away from carina
4: distant invasion or malignant effusion (unresectable)

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14
Q

N staging of lung cancer

A

1 ipsilateral hilum nodes
2 ipsilateral mediastinal/subcarinal/aortopulmonary window (unresectable)
3: CL mediastinal, supraclavicular (unresectable)

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15
Q

Staging for lung cancer

A 
I: T1-2, N0
IIa: T1, N1
IIb: T2, N1 or T3, N0
IIIa T1-3, N2
IIIb T4, N3
IV: M1
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16
Q

Paraneoplastic syndrome associated w/ squamous cell

A

PTH-related peptide

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17
Q

Paraneoplastic syndrome associated w/ small cell

A

ACTH, ADH

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18
Q

Non-small cell cancer chemo

A

Carboplatin, Taxol

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19
Q

Small cell cancer chemo

A

cisplatin, etoposide

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20
Q

Best test for T/N status lung cancer

A

CT chest/abdomen

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21
Q

Best test for M status lung cancer

A

PET

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22
Q

Chamberlain procedure

A

anterior thoracotomy or parasternal mediastinotomy assessed enlarged AP window nodes

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23
Q

Most common coin lesion

A

granuloma

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24
Q

Most common coin lesion tumor

A

hamartoma

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25
Q

Most common coin lesion cancer

A

lung adenocarcinoma

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26
Q

What makes lung tumor operable

A

FEV1 > 0.8
DLCO >10
No N2, N3, M disease

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27
Q

Treatment for adenoid cystic adenoma

A

Resect, XRT

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28
Q

Treatment for mucous gland adenoma

A

Resect

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29
Q

Most common benign adult lung tumor

A

hamartoma (made from fat, cartilage, connective tissue)

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30
Q

Appearance of hamartoma on CT

A

calcifications + popcorn lesion

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31
Q

Anterior Mediastinal Tumor

A 
T's 
-Thymoma
Thyroid cancer
T-cell lymphoma
Teratoma
parathyroid
Thymus
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32
Q

Middle mediastinal tumor

A 
Heart, trachea, ascending aorta
-Bronchiogenic cysts
Pericardial cysts
Enteric cysts
lymphoma
33
Q

Posterior mediastinal tumor

A

Esophagus, descending aorta
enteric cysts
neurogenic tumors
lymphoma

34
Q

Treatment for thymoma

A

all thymomas require resection

35
Q

50% rule w/ thymoma

A

50% malignant
50% symptomatic
50% associated w/ myasthenia gravis

36
Q

ME/TX of myasthenia gravis

A

Antibody to ACh receptor

TX: neostigmine, steroids, plasmapharesis

37
Q

Most common germ cell tumor in mediastinum

A

Teratoma (Tx resect +/- chemo)

38
Q

Most common malignant germ cell tumor in mediastinum

A

Seminoma (Tx: XRT +/- chemo)

39
Q

Seminoma lab tests

A

10% Beta-HCG +

AFP -

40
Q

Non-seminoma lab test

A

90% Beta-HCG +

AFP +

41
Q

Bronchiogenic cyst tx

A

posterior to carina –> resect

42
Q

Pericardial cyst tx

A

at right costophrenic angle –> leave alone

43
Q

Most common benign tumor of trachea

A

Papilloma (adults), Hemangioma (children)

44
Q

Most common malignant tumor of trachea

A

SCC (adult), Carcinoid (children)

45
Q

Rapid exsanguination after tracheostomy

A

trachea-innominate artery fistula
-place finger in hole, hold pressure
Median sternotomy
ligation and resection of innominate artery (no graft)
avoided by keeping tracheostomy between 2nd-3rd ring

46
Q

Mangement of trachea-esophageal fistula

A

Place large volume cuff ET below fistula, decomprssive gastrostomy, repair after weaned from ventilator

47
Q

Most common site/source of lung abscess

A

superior segment of RLL, s. aureus

48
Q

Tx of empyema depending on week

A

1: chest tube antibiotics
2 (fibro-proliferative phase): chest tube, antibiotics, VATS/deloculation if no re-expansion
3-4: decortication, fibrous peel occurs around lung (can require intra-pleural tPA, Eloesser flap)

49
Q

Dx of chylothorax

A

Sudan red, increased lymphocyts, TAG >110

50
Q

Tx of chylothorax

A

chest tube, octreotide, low fat diet
if that fails –> ligation of thoracic duct on right
If 2/2 to malignancy will need talc pleurodesis

51
Q

Result of r–> L shunt

A

cyanosis (tetralogy of Fallot)

52
Q

Result of L –> R shunt

A

CHF (VSD, ASD, PDA)

53
Q

Eisenmenger’s syndrome

A

L–>R shunt to R–>L shunt

54
Q

Ductus arteriosus

A

connection between descending aorta & left pulmonary artery, shunts blood away from lungs

55
Q

Ductus venosum

A

connection between portal vein and IVC, shunts blood away from liver

56
Q

Fetal circulation

A

2 umbilical arteries

1 umbilical vein

57
Q

Tx of VSD

A

Diuretics, Digoxin

Repair (if large @ 1yr, If medium @ 5yr) - earlier if failure to thrive

58
Q

ASD defects

A 
Ostium secundum (most common, central)
Ostium primum (frequent in Down's syndrome)
59
Q

Tx of ASD

A

diuretics, digoxin, repair at 1-2 years of age

60
Q

Tetralogy of Fallot (4 parts)

A

VSD
Pulmonic stenosis
Overriding aorta
RV hypertrophy

61
Q

Most common congenital heart defect that results in cyanosis

A

Tetralogy of Fallot

62
Q

Tx of Tetralogy of Fallot

A

B-blocker

Repair (3-6 months): RV outflow tract obstruction removal & enlargement, VSD repair

63
Q

PDA tx

A

Indomethacin causes PDA to close (surgical repair through left thoracotomy if it persists)

64
Q

Left main coronary anatomy

A

branches into left anterior descending and circumflex

65
Q

Best conduit for CABG

A

Internal mammary artery off subclavian artery, place next to LAD, collaterizes w/ superior epigastric artery

66
Q

what protects heart during CABG

A

Potassium and cold solution cardioplegia - arrests heart in diastole

67
Q

Indications for CABG

A

L main disease (>50% stenosis)
3 vessel disease
2 vessel disease involving LAD
lesions not amenable to stenting

68
Q

Symptoms of aortic stenosis

A

dyspnea on exertion, angina, syncope

69
Q

Effect of mitral regurgitation

A

LV dilated, afib, pulmonary congestion

70
Q

Effect of mitral stenosis

A 
Rare now (used to be from rheumatic fever)
Pulmonary edema and dyspnea
71
Q

Tx of mitral stenosis

A

Balloon commissurotomy to open valve

72
Q

Most common site of endocarditis on prosthetic valves

A

aortic valve

73
Q

Most common site of endocarditis on naïve valve

A

mitral valve

74
Q

Most common bug of endocarditis in drug users

A

pseudomonas

75
Q

Most common benign tumor of heart

A

myxoma (75% in LA)

76
Q

Most common malignant tumor of heart

A

angiosarcoma

77
Q

Most common metastatic tumor to heart

A

lung cancer

78
Q

Where is lowest oxygen tension of any tissue in the body

A

coronary veins

79
Q

TX of SVC syndrome

A

Emergent radiation

ABSITE 2019 (8 decks)

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