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Surgery > Cardiothoracic Surgery > Flashcards

Cardiothoracic Surgery Flashcards

1
Q

Which of the following is not a risk factor in atherosclerosis?

A. Older age

B. Smoking

C. Sleep

D. Alcohol

A

C. Sleep

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2
Q

Outline the pathophysiological process of atherosclerosis.

A

Endothelial damage of the tunica intima in combination with elevated lipid levels result in accumulation of LDL in the tunica intima. Macrophages uptake LDL to become lipid-laden foam cells. An inflammatory response is mediated by cytokines which result in Ox-LDL, unable to return to circulation.

Fibrosis and sclerosis may occur which strengthens the atheroma with a fibrous cap.

Increased TNF-a may result in plaque destabilisation and necrosis which leads to plaque rupture.

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3
Q

What is the management for CAD?

A

Supportive: RF modification; referral to cardiologist
+
Medical: Antiplatelets + Beta blockers + Statins

± Surgery

  • PCI with coronary angioplasty
  • Coronary artery bypass graft
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4
Q

What is the term for the process of stopping a heartbeat during a CABG?

A

Cardioplegia using a EC solution with high concentration of electrolytes

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5
Q

What two types of grafts may be used in a CABG?

How do they differ.

A

Free graft (section entirely separated from original connections before reattaching in new site)

Pedicled graft (graft origin remains in tact and re-routed)

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6
Q

Why may vein grafts have a tendency to become stenosed?

A

Intimal hyperplasia whereby tunica intima layer becomes thickened due to increased pressure.

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7
Q

What are the complications of a CABG?

A 
Death (2-3%)
Stroke (1-5%)
Infection
AKI
Cognitive impairment
MI
AF
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8
Q

What is the INR range required for those with a mechanical valve?

A

2.5-3.5

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9
Q

What types of mechanical heart valves exist?

A

Tilting disc

St Jude (bileaflet valves) - lowest thrombus formation risk

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10
Q

What are the major complications of mechanical heart valves?

A

Thrombus formation
Infective endocarditis
Haemolysis causing anaemia

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11
Q

What are the types of ASD?

A

Patent foramen ovale

Ostium secondum

Ostium primum

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12
Q

How is an ASD best heard?

A

Mid-systolic, crescendo-decrescendo murmur loudest at upper left sternal border with fixed split second heart sound

No change with inspiration and expiration

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13
Q

Why does a fixed split second heart sound occur in ASD?

A

No change with inspiration and expiration as increased blood flow from L atrium into R atrium across ASD. The increasing volume that the RV most empty before the pulmonary valve ca close thus does not vary with respiration

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14
Q

How may a VSD present?

A

Pan-systolic murmur more prominent at left lower sternal border in 3/4th ICS

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15
Q

How is a VSD managed?

A

Surgery: Transvenous catheter closure; Open surgery

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16
Q

How may CoA present?

A

Systolic murmur infraclavicular; discrepancy of blood pressure in upper cf lower limbs

LV heave

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17
Q

How may a CoA be managed?

A

Percutaneous balloon angioplasty

Open surgical repair

18
Q

What are the causes of pericardial effusion?

A 
Infection
Autoimmune conditions
Injury
Uremia 
Cancer
Medications
19
Q

How may you manage a pericardial effusion?

A

Tx underlying cause
+
Drainage of effusion: Needle pericardiocentesis; Surgical drainage

A pericardial window may be used to create a fistula allowing fluid to drain the pericardial cavity into pleural or peritoneal cavity

20
Q

what is the difference between a true and false aneurysm?

A

True = all 3 layers of aorta

False = 2/3 layers, adventitia contains the blood

21
Q

How may a thoracic aortic aneurysm present?

A

Chest or back pain
Trachea or left bronchus compression may cause cough, shortness of breath and stridor
Phrenic nerve compression may cause hiccups
Oesophageal compression may cause dysphagia (difficulty swallowing food)
Recurrent laryngeal nerve compression may cause a hoarse voice

22
Q

Which type of lung cancer is related to PTHrP secretion?

A

SCC

23
Q

Which lung cancer is related to increased ß-hCG secretion?

A

Large cell carcinoma

24
Q

Which lung cancer is the most common in non-smokers?

A

AC

25
Q

Which lung cancer is typically peripheral and caveatting?

A

Large cell carcinoma

26
Q

Which of the following is not an extra pulmonary manifestation of lung cancer?

A. Pemberton’s sign

B. Horner’s Syndrome

C. SIADH

D. Hypocalcaemia

A

D

27
Q

Which of the following is not an extra pulmonary manifestation of lung cancer?

A. Pemberton’s sign

B. Horner’s Syndrome

C. Limbic encephalitis

D. Hypernatraemia

A

D

28
Q

Which anti-bodies may be present in Limbic encephalitis?

A

Anti-Hu

29
Q

What is the management of lung cancer?

A 
MDT meeting
\+
Chemo
\+
Radio
\+ 
Surgery: Segmentectomy; Lobectomy; Pneumonectomy
30
Q

What are the three main approaches when doing a lung resection?

A

Anterolateral thoracotomy with an incision around the front and side

Axillary thoracotomy with an incision in the axilla (armpit)

Posterolateral thoracotomy with an incision around the back and side (the most common approach to the thorax)

31
Q

A patient presents with SOB suddenly occurring following a fall from height. O/E there is a focal area of hyper resonance and reduced air entry. They are haemodynamically stable.

CXR shows a clear lung edge.

What is your management?

A

<2cm = watch and wait + 2 week follow up

> 2cm = aspiration by needle

32
Q

Where do you insert a chest drain?

A

Emergency is 2nd ICS in MCL

Triangle of safety: AAL + MAL + 5th ICS (lat dorsi edge)

Go above the rib to avoid the NV bundle at the rib edge

Check air is bubbling through fluid into the drain bottle

33
Q

Should a chest drain fail to correct or there is recurrent pneumothoraces, what management options are available?

A

Pleurodesis (abrasive or chemical)

Pleurectomy

34
Q

Talk through the process of a lung/heart transplant.

Indications, approach, incisions, processes and post-op care.

A

Indications for heart: IHD; CM; CHD

Indications for lung: CF; COPD; PH; PF

Approach: lateral thoracotomy; Midline sternomotomy; Clamshell incision

Time between donor and transplant must be short (<6hrs); cold ischaemic time follows then operation begins whilst organ being transported; cardiopulmonary bypass + LMWH; cardioplegia; transplant; warmed; cardioplegia reversed ± temporary pacing or cardioversion used; transfer to intensive care

Immunosuppression

35
Q

Following a heart transplant a patient is regularly monitored with CT-Angiography. What complication of heart transplants are being screened?

A

Cardiac allograft vasculopathy (CAV)

The donor heart is not innervated, meaning the patient will experience symptoms of ischaemia in the heart tissue. This means they will not have any symptoms of angina or myocardial infarction following stenosis of coronary arteries

36
Q

Destruction of the bronchioles 1 year following lung transplant is termed?

A

Bronchiolitis Obliterans Syndrome (BOS)

37
Q

Acute pulmonary oedema and alveolar damage with reduced SpO2 within 2 days of lung transplant surgery is termed?

A

Primary graft dysfunction

38
Q

What are the risk factors for a rib fracture?

A
  • Blunt trauma
  • Physical abuse
  • OP
  • Advanced age: > 45 years
  • Athletics
  • Bone tumours/metastases
39
Q

How do you manage a rib fracture?

A

• Supportive: Analgesia/ Physiotherapy/ Tx underlying cause
+
Tx complications

If >2 adjacent ribs…
Surgery: Rib fixation

40
Q

What clinical feature is key to pleurisy?

A

Pleuritic chest pain - inspiratory exacerbated chest pain

41
Q

Give 3 examples of transudative pleural effusion.

A

Portal hypertension
Cardiac failure
Renal failure
Hypoalbuminaemia

42
Q

How may a unilateral diaphragm paralysis present?

What may be seen in CXR?

A

Paradoxical chest wall movements

Elevated hemidiaphragm (due to Phrenic nerve palsy)

Surgery (10 decks)

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