Cardiothoracic Flashcards
Azygous v anatomy
runs along right, dumps into SVC
Thoracic duct anatomy
runs along right, crosses at T4, dumps into left subclavian at junction w/ internal jugular vein
Phrenic n anatomy
runs anterior to hilum
Vagus n anatomy
runs posterior to hilum
Pneumocyte responsible for gas exchange
Type I
Pneumocyte responsible for surfactant production
Type II (phosphatidylcholine)
Direct air exchange between alveoli
Pores of Kahn
Most common cause of cancer-related death in US
Lung cancer
Most common site of brain metastasis
brain
Best predictor of pulmonary complications and being able to wean off ventilator
FEV1
Most common complication after pneumonectomy
arrhythmias
Most common lung cancer
adenocarcinoma
T staging of lung cancer
1 <3cm
2 >3cm but >2cm away from carina
3 local invasion or <2cm away from carina
4: distant invasion or malignant effusion (unresectable)
N staging of lung cancer
1 ipsilateral hilum nodes
2 ipsilateral mediastinal/subcarinal/aortopulmonary window (unresectable)
3: CL mediastinal, supraclavicular (unresectable)
Staging for lung cancer
I: T1-2, N0 IIa: T1, N1 IIb: T2, N1 or T3, N0 IIIa T1-3, N2 IIIb T4, N3 IV: M1
Paraneoplastic syndrome associated w/ squamous cell
PTH-related peptide
Paraneoplastic syndrome associated w/ small cell
ACTH, ADH
Non-small cell cancer chemo
Carboplatin, Taxol
Small cell cancer chemo
cisplatin, etoposide
Best test for T/N status lung cancer
CT chest/abdomen
Best test for M status lung cancer
PET
Chamberlain procedure
anterior thoracotomy or parasternal mediastinotomy assessed enlarged AP window nodes
Most common coin lesion
granuloma
Most common coin lesion tumor
hamartoma
Most common coin lesion cancer
lung adenocarcinoma
What makes lung tumor operable
FEV1 > 0.8
DLCO >10
No N2, N3, M disease
Treatment for adenoid cystic adenoma
Resect, XRT
Treatment for mucous gland adenoma
Resect
Most common benign adult lung tumor
hamartoma (made from fat, cartilage, connective tissue)
Appearance of hamartoma on CT
calcifications + popcorn lesion
Anterior Mediastinal Tumor
T's -Thymoma Thyroid cancer T-cell lymphoma Teratoma parathyroid Thymus
Middle mediastinal tumor
Heart, trachea, ascending aorta -Bronchiogenic cysts Pericardial cysts Enteric cysts lymphoma
Posterior mediastinal tumor
Esophagus, descending aorta
enteric cysts
neurogenic tumors
lymphoma
Treatment for thymoma
all thymomas require resection
50% rule w/ thymoma
50% malignant
50% symptomatic
50% associated w/ myasthenia gravis
ME/TX of myasthenia gravis
Antibody to ACh receptor
TX: neostigmine, steroids, plasmapharesis
Most common germ cell tumor in mediastinum
Teratoma (Tx resect +/- chemo)
Most common malignant germ cell tumor in mediastinum
Seminoma (Tx: XRT +/- chemo)
Seminoma lab tests
10% Beta-HCG +
AFP -
Non-seminoma lab test
90% Beta-HCG +
AFP +
Bronchiogenic cyst tx
posterior to carina –> resect
Pericardial cyst tx
at right costophrenic angle –> leave alone
Most common benign tumor of trachea
Papilloma (adults), Hemangioma (children)
Most common malignant tumor of trachea
SCC (adult), Carcinoid (children)
Rapid exsanguination after tracheostomy
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
Mangement of trachea-esophageal fistula
Place large volume cuff ET below fistula, decomprssive gastrostomy, repair after weaned from ventilator
Most common site/source of lung abscess
superior segment of RLL, s. aureus
Tx of empyema depending on week
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)
Dx of chylothorax
Sudan red, increased lymphocyts, TAG >110
Tx of chylothorax
chest tube, octreotide, low fat diet
if that fails –> ligation of thoracic duct on right
If 2/2 to malignancy will need talc pleurodesis
Result of r–> L shunt
cyanosis (tetralogy of Fallot)
Result of L –> R shunt
CHF (VSD, ASD, PDA)
Eisenmenger’s syndrome
L–>R shunt to R–>L shunt
Ductus arteriosus
connection between descending aorta & left pulmonary artery, shunts blood away from lungs
Ductus venosum
connection between portal vein and IVC, shunts blood away from liver
Fetal circulation
2 umbilical arteries
1 umbilical vein
Tx of VSD
Diuretics, Digoxin
Repair (if large @ 1yr, If medium @ 5yr) - earlier if failure to thrive
ASD defects
Ostium secundum (most common, central) Ostium primum (frequent in Down's syndrome)
Tx of ASD
diuretics, digoxin, repair at 1-2 years of age
Tetralogy of Fallot (4 parts)
VSD
Pulmonic stenosis
Overriding aorta
RV hypertrophy
Most common congenital heart defect that results in cyanosis
Tetralogy of Fallot
Tx of Tetralogy of Fallot
B-blocker
Repair (3-6 months): RV outflow tract obstruction removal & enlargement, VSD repair
PDA tx
Indomethacin causes PDA to close (surgical repair through left thoracotomy if it persists)
Left main coronary anatomy
branches into left anterior descending and circumflex
Best conduit for CABG
Internal mammary artery off subclavian artery, place next to LAD, collaterizes w/ superior epigastric artery
what protects heart during CABG
Potassium and cold solution cardioplegia - arrests heart in diastole
Indications for CABG
L main disease (>50% stenosis)
3 vessel disease
2 vessel disease involving LAD
lesions not amenable to stenting
Symptoms of aortic stenosis
dyspnea on exertion, angina, syncope
Effect of mitral regurgitation
LV dilated, afib, pulmonary congestion
Effect of mitral stenosis
Rare now (used to be from rheumatic fever) Pulmonary edema and dyspnea
Tx of mitral stenosis
Balloon commissurotomy to open valve
Most common site of endocarditis on prosthetic valves
aortic valve
Most common site of endocarditis on naïve valve
mitral valve
Most common bug of endocarditis in drug users
pseudomonas
Most common benign tumor of heart
myxoma (75% in LA)
Most common malignant tumor of heart
angiosarcoma
Most common metastatic tumor to heart
lung cancer
Where is lowest oxygen tension of any tissue in the body
coronary veins
TX of SVC syndrome
Emergent radiation