Cardiothoracic Surgery

Question 1

Vascular rings produce symptoms of pressure on the tracheobronchial tree and pressure on the esophagus, leading to which symptoms?

Answer 1

1) respiratory distress with “crowing” respiration; hyperextending neck
2) difficulty swallowing (compression shown by barium swallow)
(if only respiratory symptoms are present, think of tracheomalacia, which bronchoscopy can rule out)

Question 2

FIxed split second heart sound.

Treatment?

Answer 2

ASD (frequent colds!)

Tx with surgery or cardiac cath

Question 3

Ventricular septal defects (high/low) in the septum lead to failure to thrive.

Answer 3

High! (loud pansystolic murmur; surgical closure)

Low in the septum leads to spontaneous closure in years 2-3

Question 4

PDA (machinery like murmur, constant) in premature infants can be closed with indomethacin unless what? (x3)

Answer 4

1) already in heart failure
2) do not close with indomethacin
3) full-term baby

Question 5

What are features of the most common cyanotic heart murmur?

Answer 5

1) systolic ejection murmur in L 3rd intercostal space
2) small heart
3) diminished pulmonary markings on CXR
4) EKG showing RVH
5) bluish hue, cyanosis relieved by squatting

Question 6

What is the murmur of aortic stenosis?

Answer 6

midsystolic heart murmur heard at the right second intercostal space and along the left sternal border

Question 7

Surgical valvular replacement is indicated for aortic stenosis if there is a gradient of ___ mm Hg.

Answer 7

> 50 mm Hg

Question 8

Drug user with endocarditis who develop CHF and a new, loud diastolic murmur at the right second intercostal space:

Answer 8

acute aortic insufficiency –> emergency valve replacement and long term antibiotics

Question 9

How is mitral stenosis repaired?

Answer 9

Commisurotomy or balloon valvuloplasty

Question 10

Apical, high-pitched holosystolic heart murmur that radiates to the axilla and back:

Answer 10

mitral regurgitation (usually caused by mitral prolapse)

Question 11

T/F: In repair of the mitral valve for MR, annuloplasty is preferred over valve replacement.

Answer 11

True

Question 12

Classic square root sign on cardiac pressure tracing:

Answer 12

constrictive pericarditis

Question 13

First step in patient with coin lesion?

Answer 13

Find an old X ray!!

Question 14

If there isn’t an old X ray in working up potential lung cancer, what are the next steps?

Answer 14

1) sputum test

2) CT of chest and liver

Question 15

Low-pitched, rumbling diastolic apical heart murmur

Answer 15

mitral stenosis

Question 16

Diagnosis of lung cancer, if not established by cytology, requires what for central lesions and what for peripheral lesions?

Answer 16

central: bronchoscopy and biopsy
peripheral: percutaneous biopsy

Question 17

With regards to surgical treatment, peripheral lesions require what? central lesions?

Answer 17

central: pneumonectomy
peripheral: lobectomy

Question 18

If the predicted postoperative FEV1 is less than ___L, the patient is not a surgical candidate.

Answer 18

0.8 (800 mL)

Question 19

How does surgical removal of lung cancer depend on nodal metastases?

Answer 19

If hilar nodal metastases, can be removed with the pneumonectomy

If nodal metastases at the carina or mediastinum, curative resection is precluded