Cardiothoracic surgery

Question 1

what graft vessel is usually used in a coronary artery bypass graft ?

Answer 1

saphenous vein

Question 2

what are the 2 most serious complications of a coronary artery bypass graft?

Answer 2

Death
Stroke

Question 3

what is the lifespan if bioprosthetic valves?

Answer 3

10 years

Question 4

what is the downside of mechanical valves compared with bioprosthetic?

Answer 4

require lifelong anticoagulation with warfarin

Question 5

what is the INR target range for mechanical valves

Answer 5

2.5 – 3.5

Question 6

what are 3 major complications of mechanical heart valves?

Answer 6

Thrombus formation
Infective endocarditis
Haemolysis causing anaemia

Question 7

what is a pericardial effusion?

Answer 7

where excess fluid collects within the pericardial sac

Question 8

what is pericardial tamponade?

Answer 8

pericardial effusion is large enough to raise the intra-pericardial pressure. This increased pressure squeezes the heart and affects its ability to function

Question 9

name 2 causes of a transudative effusion?

Answer 9

Congestive heart failure
Pulmonary hypertension

Question 10

Name 3 exudative causes of pericardial effusion

Answer 10

Infection e.g. HIV, TB
Autoimmune e.g. Lupus, RA
Injury to pericardium e.g. post MI, trauma
Uraemia secondary to renal impairment
Cancer
Medications e.g. methotrexate

Question 11

what are some symptoms of chronic pericarditis?

Answer 11

Chest pain
Shortness of breath
A feeling of fullness in the chest
Orthopnoea (shortness of breath on lying flat)

Question 12

what are signs on examination of pericardial effusion?

Answer 12

Quiet heart sounds
Pulsus paradoxus (an abnormally large fall in blood pressure during inspiration, notably when palpating the pulse)
Hypotension
Raised JVP
Fever (with pericarditis)
Pericardial rub (with pericarditis)

Question 13

what is the investigation of choice for pericardial effusion?

Answer 13

echocardiogram

Question 14

what is the management of a pericardial effusion ?

Answer 14

Drainage -? needle pericardiocentesis, surgical drainage
Tx underlying cause

Question 15

what are the 3 layers of the aorta?

Answer 15

intima, media and adventitia

Question 16

what is a false aneurysm?

Answer 16

(or pseudoaneurysm) occur when the inner two layers (intima and media) rupture and there is dilation of the vessel, with the blood only being contained within the outer (adventitia) layer of the aorta.

Question 17

what are some symptoms of thoracic aortic aneurysms?

Answer 17

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

Question 18

Name 3 subtypes of non-small cell lung cancer

Answer 18

Adenocarcinoma
Squamous cell carcinoma
Large-cell carcinoma

Question 19

what type of lung cancer is responsible for paraneoplastic syndromes?

Answer 19

small cell lung cancer

Question 20

what are the presenting features of lung cancer?

Answer 20

Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy – often supraclavicular

Question 21

what are some findings on chest xray that are suggestive of lung cancer?

Answer 21

Hilar enlargement
Peripheral opacity – a visible lesion in the lung field
Pleural effusion – usually unilateral in cancer
Collapse

Question 22

State 3 causes of pneumothorax

Answer 22

Spontaneous
Trauma
Iatrogenic, for example, due to lung biopsy, mechanical ventilation or central line insertion
Lung pathologies such as infection, asthma or COPD

Question 23

what is the 1st line investigation for a pneumothorax?

Answer 23

erect chest xray

Question 24

what is used to detect a pneumothorax that is too small to see on CXR?

Answer 24

CT thorax

Question 25

what is the management of a pneumothorax with no shortness of breath and less than a 2cm rim of air on the chest x-ray?

Answer 25

No treatment is required as it will spontaneously resolve
Follow up in 2 – 4 weeks is recommended

Question 26

what is the management of a pneumothorax with shortness of breath and/or more than a 2cm rim of air on the chest x-ray?

Answer 26

Aspiration followed by reassessment
When aspiration fails twice, a chest drain is required

Question 27

what are the landmarks of the triangle of safety?

Answer 27

The 5th intercostal space (or the inferior nipple line)
The midaxillary line (or the lateral edge of the latissimus dorsi)
The anterior axillary line (or the lateral edge of the pectoralis major)

Question 28

state 2 key complications of chest drains

Answer 28

Air leaks around the drain site (indicated by persistent bubbling of fluid, particularly on coughing)
Surgical emphysema (also known as subcutaneous emphysema) is when air collects in the subcutaneous tissue

Question 29

what are the signs of a tension pneumothorax?

Answer 29

Tracheal deviation away from side of the pneumothorax
Reduced air entry on the affected side
Increased resonance to percussion on the affected side
Tachycardia
Hypotension

Question 30

what is the immediate management of a tension pneumothorax?

Answer 30

Insert a large bore cannula into the second intercostal space in the midclavicular line

Question 31

what are the most common indications for a lung transplant?

Answer 31

Chronic obstructive pulmonary disease (COPD)
Pulmonary fibrosis
Cystic fibrosis
Pulmonary hypertension