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CT Surgery Flashcards

1
Q

Left to right shunts

A

Hole in heart, increased flow into right side, increased pulmonary pressures leads to pulmonary hypertension, RVH and eventually eisenmenger’s syndrome where the flow reverses and patient becomes cyanotic

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2
Q

ASD pathogenesis

A

Ostium primum (downs) or secundum

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3
Q

Murmur of ASD

A

Fixed split S2

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4
Q

How to diagnose ASD

A

Echo

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5
Q

How to treat ASD

A

Close the hole either with surgery or cath

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6
Q

Murmur of VSD

A

Harsh holosystolic murmur

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7
Q

Patient presentation of VSD

A

Is diverse: patient could be asymptomatic, have CHF, failure to thrive, dyspnea

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8
Q

How to treat VSD

A

If patient is asymptomatic, wait don’t treat.

If paitne tis symptomatic or has been waiting for greater than a year, treat it.

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9
Q

Murmur of patent ductus arteriosus

A

Continuous machine-like murmur that is NOT present on day 1.

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10
Q

How to close ductus arteriosis?

A

Indomethacin.

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11
Q

Right to left shunts

A

Cause early cyanosis. Due to catastrophic anatomy. Fatal. Decreased pulmonary flow.

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12
Q

TGA pathogenesis

A

Caused by maternal diabetes, not gestational. Failure of cardiopulmonary trunk to twist .

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13
Q

How to treat TGA

A

Need to create a shunt. use PGE to keep DA open to bridge to surgery.

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14
Q

Tetrology of fallot

A

Pulmonic stenosis, RVH, VSD, overriding aorta.

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15
Q

XRay for tet?

A

CXR shows boot shaped heart

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16
Q

Vascular rings pathogenesis

A

Pressure on tracheobronchial tree and esophagus

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17
Q

How do patients with vascular rings present?

A

Stridor, “crowing” respiration, difficulty swallowing

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18
Q

How to diagnose vascular rings?

A

Barium swallow shows extrinsic compression. Bronchoscopy rules out tracheomalacia.

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19
Q

How to treat vascular rings

A

Surgery to divide smaller of 2 aortic arches.

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20
Q

Which murmurs to work up in adults

A

All diastolic murmurs and all systolics 3+

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21
Q

Patient presentation of aortic stenosis

A

Patient has aortic calcifications or biscuspid aortic valve. Patient will be an old man with CP, SOB, syncope.

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22
Q

Murmur of aortic stenosis

A

Crescendo-descrendo systolic murmur at RSB

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23
Q

How to dx aortic stenosis?

A

Echo

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24
Q

How to treat aortic stenosis?

A

Replacement.

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25
How do patients get mitral stenosis?
Rheumatic heart disease
26
Murmur of mitral stenosis
Apex diastolic murmur with an opening snap
27
How does the murmur change if mitral stenosis is worse?
The opening snap is earlier if mitral stenosis is worse
28
Patient presentation with acute aortic regurg
Very seriously ill, from infection/infarction/dissection
29
Patient presentation with chronic aortic regurg
Insidious onset, head bobbing water hammer pulses
30
How to treat aortic regurgitation
Replace aortic valve and perhaps add cabg too
31
How to decide stent or cabg
After cath, if 1 vessel is diseased, stent. If 3 or more vessels are diseased or mainstem is blocked, do a cabg
32
Where to graft for cabg if main artery? If not?
Internal mammary. If not, take saphenous vein graft.
33
What to do if coin lesion found on CXR?
Compare to previous, see if changed.
34
What to do with coin lesion if no past CXR for comparison?
Sputum cytology and CT scan
35
How to work up central lung lesion?
Bronchoscopy and biopsy
36
How to work up peripheral lung lesion
Percutaneous biopsy
37
How to work up lung biopsy if bronch or perc were unsuccessful?
VATS
38
Paraneoplastic syndromes from small cell lung cancer?
SIADH, lambert eaton, ACTH
39
How to treat small cell lung cancer?
Chemo and radiation
40
Paraneoplastic syndromes from squamous cell lung cancer?
PTHrp causing hypercalcemia
41
How to determine if lungs can be operated on for lung cancer?
Really depends on residual lung volumes and FEV1 after pneumonectomy. If FEV1 is greater than 800ml after lung has been removed, then surgery is okay. If not, just do chemo and rad
42
Which surgical option for which lung cancer?
Central lung cancers need to be removed with pneumonectomy. Peripheral lesions can be removed with lobectomy.
43
When is surgery curative for lung cancer
If only hilar lymph nodes are involved. If mediastinal or carinal nodes are implicated, curative resection isn't possible.
44
When to start mammography?
Age 40
45
Best way to survey breast lesion found on exam or on mammography?
Do a mammographically or sonographically guided biopsy.
46
Fibroadenoma
Seen in young women, firm rubbery mass that is mobile
47
How to diagnose fibroadenoma?
FNA or sonogram
48
Giant juvenile fibroadenoma and treatment
Large rapidly-growing fibroadenoma in young girls. Must be removed because can cause permanent deformity.
49
Cystosarcoma phyllodes
Seen in women in late 20s. These grow to become very large and can replace the whole breast. Most are benign but can become sarcoma.
50
How to diagnose cystosarcoma phyllodes?
Do a core or incisional biopsy. Can't do FNA because need more breast.
51
Mammary Dysplasia (fibrocystic change)
Seen in 30s and 40s. Goes away with menopause. Cysts that come and go with menstrual cycle. If no dominant mass, do a mammogram. If there is a dominant mass, aspirate (not FNA). If mass goes away, great. If it persists, formal biopsy is required.
52
Intraductal papilloma
Seen in woman from 20-40 with bloody nipple discharge. Dx with mammogram
53
Breast abscess
Seen in breastfeeding women, treat with incision and drainage and biopsy of wall.
54
Indicators of breast cancer
Increased age, skin changes, nipple retraction, inflammation around breast, fixed mass.
55
How to treat breast cancer during pregnancy
No radiation at all. No chemotherapy during first trimester. can keep the baby.
56
Initial treatment for cancer?
Lumpectomy + sentinel LN biopsy + post-op radiation OR radical mastectomy with axillary sampling
57
Infiltrating ductal carcinoma
Standard form. Only inflammatory carcinoma is worse, so needs pre-op radiation as well.
58
DCIS Treatment
Can't met so no axillary sampling needed. If multicentric, do a mastectomy, but if confined to one quarter of the breast, can do a lumpectomy and radiation
59
Persistent headache or back pain in woman with recent breast cancer?
Very concerning for met. Do an MRI.
60
Where on the spine does breast met go?
Vertebral pedicles
61
What determines inoperability of breast cancer?
Local extent of cancer, not mets
62
Adjuvant systemic therapy for breast cancer?
Tamoxifen for young, anastrozole for older.

Surgery Clerkship (11 decks)

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