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Surgery Clerkship > CT Surgery > Flashcards

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
Q

How do patients get mitral stenosis?

A

Rheumatic heart disease

26
Q

Murmur of mitral stenosis

A

Apex diastolic murmur with an opening snap

27
Q

How does the murmur change if mitral stenosis is worse?

A

The opening snap is earlier if mitral stenosis is worse

28
Q

Patient presentation with acute aortic regurg

A

Very seriously ill, from infection/infarction/dissection

29
Q

Patient presentation with chronic aortic regurg

A

Insidious onset, head bobbing water hammer pulses

30
Q

How to treat aortic regurgitation

A

Replace aortic valve and perhaps add cabg too

31
Q

How to decide stent or cabg

A

After cath, if 1 vessel is diseased, stent. If 3 or more vessels are diseased or mainstem is blocked, do a cabg

32
Q

Where to graft for cabg if main artery? If not?

A

Internal mammary. If not, take saphenous vein graft.

33
Q

What to do if coin lesion found on CXR?

A

Compare to previous, see if changed.

34
Q

What to do with coin lesion if no past CXR for comparison?

A

Sputum cytology and CT scan

35
Q

How to work up central lung lesion?

A

Bronchoscopy and biopsy

36
Q

How to work up peripheral lung lesion

A

Percutaneous biopsy

37
Q

How to work up lung biopsy if bronch or perc were unsuccessful?

A

VATS

38
Q

Paraneoplastic syndromes from small cell lung cancer?

A

SIADH, lambert eaton, ACTH

39
Q

How to treat small cell lung cancer?

A

Chemo and radiation

40
Q

Paraneoplastic syndromes from squamous cell lung cancer?

A

PTHrp causing hypercalcemia

41
Q

How to determine if lungs can be operated on for lung cancer?

A

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
Q

Which surgical option for which lung cancer?

A

Central lung cancers need to be removed with pneumonectomy. Peripheral lesions can be removed with lobectomy.

43
Q

When is surgery curative for lung cancer

A

If only hilar lymph nodes are involved. If mediastinal or carinal nodes are implicated, curative resection isn’t possible.

44
Q

When to start mammography?

A

Age 40

45
Q

Best way to survey breast lesion found on exam or on mammography?

A

Do a mammographically or sonographically guided biopsy.

46
Q

Fibroadenoma

A

Seen in young women, firm rubbery mass that is mobile

47
Q

How to diagnose fibroadenoma?

A

FNA or sonogram

48
Q

Giant juvenile fibroadenoma and treatment

A

Large rapidly-growing fibroadenoma in young girls. Must be removed because can cause permanent deformity.

49
Q

Cystosarcoma phyllodes

A

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
Q

How to diagnose cystosarcoma phyllodes?

A

Do a core or incisional biopsy. Can’t do FNA because need more breast.

51
Q

Mammary Dysplasia (fibrocystic change)

A

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
Q

Intraductal papilloma

A

Seen in woman from 20-40 with bloody nipple discharge. Dx with mammogram

53
Q

Breast abscess

A

Seen in breastfeeding women, treat with incision and drainage and biopsy of wall.

54
Q

Indicators of breast cancer

A

Increased age, skin changes, nipple retraction, inflammation around breast, fixed mass.

55
Q

How to treat breast cancer during pregnancy

A

No radiation at all. No chemotherapy during first trimester. can keep the baby.

56
Q

Initial treatment for cancer?

A

Lumpectomy + sentinel LN biopsy + post-op radiation OR radical mastectomy with axillary sampling

57
Q

Infiltrating ductal carcinoma

A

Standard form. Only inflammatory carcinoma is worse, so needs pre-op radiation as well.

58
Q

DCIS Treatment

A

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
Q

Persistent headache or back pain in woman with recent breast cancer?

A

Very concerning for met. Do an MRI.

60
Q

Where on the spine does breast met go?

A

Vertebral pedicles

61
Q

What determines inoperability of breast cancer?

A

Local extent of cancer, not mets

62
Q

Adjuvant systemic therapy for breast cancer?

A

Tamoxifen for young, anastrozole for older.

Surgery Clerkship (11 decks)

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