cardiovascular and vascular surgery: chapter 6-7

Question 1

coin lesion on chest xray means what, what is first step in managment

Answer 1

80% chance it is malignant if over 50

get old xray to see if was there for a year or two bc then not cancer

if no xray available or no previous lesion: sputum cytology and CT scan of chest and upper abdomen

Question 2

operability of lung cancer is predicted by what

Answer 2

residual function after resection in pneumonectomy (for lobectomy, fnct is less of an issue)

Question 3

dianosing cancer of the lung

Answer 3

cytology, if doesnt work

then bronchoscopy and biopsy for central lesion
percutaneous biopsy for peripheral lesion

VATS and wedge resection if all else fails

Question 4

5-6 year old who is cyanotic

what about 1-2 day old

Answer 4

5-6 yrs = TOF

1-2 days = TOGV

Question 5

when is surgical valve replacement indicated in AS

Answer 5

if gradient of more than 50mm

Question 6

a minimum of FEV1 of what needed for operability of lung

Answer 6

800 mL

do vent per scan to figure out what would remain after pneumonectomy and if less than 800mL then cannot do surgery, must do chemo and rads

Question 7

endocarditis in young drug addict who develop CHF and new loud diastolic murmur at the right second intercostal space is what and tx

Answer 7

acute AI

emergency valve replacement and long term antibiotics

Question 8

dyspnea on exertion, hepatogmegaly, ascites and equalization of pressures of RA and RV diastolic, pulmonary artery diastolic and pulmonary capillary wedge and LV diastolic on cardiac cath

Answer 8

chronic constrictive pericarditis

Question 9

PVD in LE workup

Answer 9

doppler looking for pressure gradient (ABI)

if gradient then CT angio or MRI angio then treat

Question 10

lung cancer and metastases with surgery, can it cure at

hilar metastases
nodal or mediatstinum

Answer 10

hilar, yes with pneumonectomy

nodal or mediatsinum no

Question 11

post op care of heart surgery pt

if CO is under 5 or CI of 3 then what should be measured and tx

Answer 11

pulmonary wedge pressure
(0-3) then more IV fluids
(20 or above) suggests ventricular failure

Question 12

FTT and loud pansystolic murmur at left sterbal border and increased pulmonary vascular markings on chest x ray is what

dx
tx

Answer 12

VSD

echo

surgery

Question 13

arterial embolization of extremity from a distant source management

when needs to be done time wise

early incomplete block

complete block

F/U

Answer 13

needs to happen within 6 hours

doppler locates point of obstruction

early incomplete use clot buster

embolectomy with fogarty cath if complete obstruction

fasciotomy to F/U

Question 14

treatment of MR

Answer 14

repair of valve preferred over prostehtic replacement

Question 15

treatment of small cell cancer of the lung

Answer 15

chemo and radiation

Question 16

definitive diagnosis of thoracic aorta dissection

Answer 16

MRI angiogram or CT angiogram but MR better

Question 17

pulmonary vascular markings on TOF

Answer 17

decreased

Question 18

where is TOF murmur

Answer 18

systolic ejection murmur in left third intercostal space

Question 19

child with difficulty swallowing and respiratoy distress with crowing resp, stridor and hyperextension of the neck

what is it
dx
tx

Answer 19

vascular ring

barium swallow and bronchosopy

surgery

Question 20

how to fix ASD

Answer 20

cardiac cath closure

Question 21

central lung lesions need what surgery

peripheral?

Answer 21

pneumonectomy

lobe for periph

Question 22

coldness tingling and muscle pain, with posterior neurologic signs like visual sx and equilibrium problems when arm exercised

Answer 22

subclavian steal syndrome

Question 23

what wheezing is seen in tracheomalacia

Answer 23

inspiratory wheezing