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Surgery clerkship > CT surgery (pestana) > Flashcards

CT surgery (pestana) Flashcards

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1
Q

Baby who has trouble swallowing, stridor, and episodes of respiratory distress w/ “crowing” respirations and hyperextended positioning. Barium swallow shows extrinsic compression of tracheobronchial tree and/or esophagus. Dx?

A

Vascular rings

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2
Q

What test do you order to differentiate btwn vascular rings and tracheomalacia? Also, which symptom of vascular rings would be missing in tracheomalacia?

A

Bronchoscopy: shows segmental tracheal compression in vascular rings
Tracheomalacia lack dysphagia

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3
Q

How do you treat vascular rings?

A

Surgery that divides the smaller of the 2 aortic arches

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4
Q

In general, what’s the best way to Dx morphologic cardiac anomalies?

A

Echo

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5
Q

What type of shunts cause murmur, pulmonary circulation overload, and long-term damage to pulm vasculature?

A

L-to-R shunts

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6
Q

Patient in late infancy w/ PMH of freq colds + faint systolic pulm flow murmur and fixed split S2. Dx?

A

ASD

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7
Q

How do you dx ASD?

A

Echo

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8
Q

Tx of ASD?

A

Closure (surgical or cath)

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9
Q

2-3 mo old baby w/ failure to thrive and loud pansystolic murmur @LSB. CXR: increased pulm vasculature markings. Dx?

A

VSD

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10
Q

Dx of VSD?

A

Echo

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11
Q

MC site of VSD?

A

High in membranous septum

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12
Q

How do you treat a typical VSD?

A

Surgical closure

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13
Q

What type of VSD produces a murmur but otherwise few symptoms?

A

Small, restrictive VSD low in the muscular septum

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14
Q

2-3 mo old baby w/ small, restrictive VSD low in the muscular septum. Tx?

A

Obs- most close spontaneously w/in first 2-3 yr of life.

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15
Q

3 day old baby w/ bounding peripheral pulses and a continuous “machinery-like” murmur. Dx?

A

PDA

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16
Q

Dx of PDA?

A

Echo

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17
Q

Treatment of PDA in a preemie who hasn’t gone into CHF?

A

Close w/ indomethacin

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18
Q

Tx of PDA in full-term babies, preemies w/ CHF, and preemies who don’t close w/ indomethacin? 2 options

A

Surgical closure or embolization w/ coils

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19
Q

What type of shunt p/w murmurs, diminished vascular markings in the lung, and cyanosis?

A

R-to-L

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20
Q

Which R-to-L shunt is cyanotic but kills by overloading the pulmonary circulation?

A

Truncus arteriosus

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21
Q

5 yo who is small for their age w/ bluish lips and fingertips, clubbing, and cyanotic spells relieved by squatting. Dx?

A

ToF

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22
Q

Young child w/ systolic ejection murmur in left 3rd ICS, CXR showing decreased vascular markings and a small heart, and EKG signs of RVH. Dx?

A

ToF

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23
Q

Dx of ToF?

A

Echo

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24
Q

Tx of ToF?

A

Surgery

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25
Q

2 day old cyanotic baby who is SICK. Dx?

A

Transposition of great vessels

26
Q

Transposition of great vessels- Dx?

27
Q

Transposition of great vessels- how do babies stay alive until Dx?

A

Concurrent ASD/VSD/PDA (1 or more)

28
Q

Transposition of great vessels- Tx?

29
Q

Older person w/ angina, exertional syncope, and a harsh midsystolic murmur @ R 2nd ICS and the left sternal border. Dx?

A

Aortic stenosis

30
Q

Aortic stenosis. Dx?

31
Q

Treatment of symptomatic aortic stenosis?

A

Valve replacement

32
Q

Pt w/ wide pulse P, blowing high-pitched diastolic murmur best heard @ R 2nd ICS and left lower sternal border during full expiration. Dx?

A

Chronic aortic insufficiency

33
Q

In general, when do you do valve replacement in chronic aortic insufficiency?

A

Any evidence of LV dilitation on echo

34
Q

Young IVDU w/ sudden onset of CHF and new loud diastolic murmur at 2nd R ICS. Dx?

A

Acute aortic insufficiency

35
Q

How do you treat acute aortic insufficiency?

A

Emergent valve replacement + long-term Abx

36
Q

Patient w/ DOE, orthopnea, PND, cough, hemoptysis, and low-pitched rumbling diastolic apical murmur who is now becoming cachectic and developing Afib. Dx?

A

Mitral stenosis

37
Q

Dx of mitral stenosis?

38
Q

Tx of symptomatic mitral stenosis?

A

Valve repair (surgical comissurotomy or balloon valvuloplasty)

39
Q

DOE, orthopnea, Afib, and apical high-pitched holosystolic murmur that radiates to axilla and back. Dx?

A

Mitral regurg

40
Q

MCC of mitral regurg?

41
Q

Tx of symptomatic mitral regurg?

A

Annuloplasty

42
Q

Middle-aged sedentary male smoker w/ T2DM, HLD, and FHx CAD who p/w angina. Dx?

43
Q

What % stenosis is criteria for intervention in CAD?

A

70%. And don’t forget you also need good distal vessel!

44
Q

Triple vessel CAD. Tx?

45
Q

Normal CO and CI?

A

CO: 5 L/min
CI: 3

46
Q

If post-op heart surgery patient has considerably decreased CO or CI, what should you measure next?

47
Q

Post-op heart surgery patient has considerably decreased CO or CI. PCWP is low (0-3). What does this patient need?

48
Q

Post-op heart surgery patient has considerably decreased CO or CI. PCWP is high (20 or greater). What’s likely wrong?

A

Ventricular failure

49
Q

Patient p/w DOE, hepatomegaly, ascites. Square root sign + equalization of pressures on cath. Dx?

A

Chronic constrictive pericarditis

50
Q

Tx of chronic constrictive pericarditis?

51
Q

Coin lesion on CXR. Next best step?

A

Compare to older xray

52
Q

Coin lesion on CXR and either no older CXR for comparison or lesion wasn’t present on old CXR. What 2 tests should you order?

A

Sputum cytology and CT chest and abdomen

53
Q

Dx of central lung cancer? Peripheral?

A

Central: bronch w/ bx
Periph: percutaneous bx

54
Q

Strongly suspect lung cancer but can’t get dx w/ bronch bx or percutaneous bx. What else could you do?

A

VATS and wedge resection

55
Q

If pneumonectomy is required for tx of lung cancer, and you’re worried about post-op lung fxn (COPDer, SOB, etc), what tests should you get?

A

PFTs, V/Q scan

56
Q

What residual FEV1 is req to proceed w/ pneumonectomy?

57
Q

How do you determine the residual FEV1?

A

Measure FEV1, then get a V/Q scan to determine fraction of FEV1 coming from each lung. Calculate what would remain after pneumonectomy.

58
Q

What type of non-small cell lung cancer requires pneumonectomy?

A

Central lesions

59
Q

What type of non-small cell lung cancer requires lobectomy?

A

Peripheral lesions

60
Q

Patient w/ central non-small cell lung cancer would have would have FEV1 of 600 mL after pneumonectomy. What’s your general treatment plan now?

A

Chemo + radiation

61
Q

Which mets can be removed via pneumonectomy: hilar, carinal, and/or mediastinal?

A

Hilar. The other two preculde curative resection

Surgery clerkship (4 decks)

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