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Surgery Clerkship > Dr. Pestana's Notes--Peds, Cardiothoracic, Vascular > Flashcards

Dr. Pestana's Notes--Peds, Cardiothoracic, Vascular Flashcards

1
Q

____ shows up with excessive salivation noted shortly after birth, or choking spells when first feeding. There may even be failure to pass an NG tube

A

Esophageal atresia

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2
Q

MC type of esophageal atresia. Dx

A

blind pouch in upper esophagus and fistula btwn lower esophagus and tracheobronchial tree (normal gas in bowel); failure of NG tube + CXR

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3
Q

How do you rule out VACERL anomalies?

A

vertebral/radial–check xray; imperforate anus–physical, xray; cardiac anomalies–EKG; esophageal atresia–NG tube; renal–US

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4
Q

Tx esophageal atresia

A

sx–but if delayed, a gastrostomy must be done to protect lungs from acid reflux

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5
Q

For an imperforate anus, look at the anus itself or a ______ nearby. Repair can sometimes be delayed, but must be done before _______.

A

fistula (vagina or perineum); toilet training time

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6
Q

If imperforate anal surgery needs to be done right away, a ____ is done for high rectal pouches, and later the primary repair; OR a primary repair can be done right away only if _______

A

colostomy; anal pouch is very close to rectum

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7
Q

Level of pouch of imperforate anus is assessed with a ___ taken ____

A

xray; upside down (gas goes up w/ metal marker taped to anus)

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8
Q

Congenital diaphragmatic hernia is always on the ___ side of the body. The major issue is _____ that still have fetal-type circulation; if this is the case, the surgery must be delayed _____ in order for maturation to occur

A

left; hypoplastic lungs; 3-4 days

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9
Q

Tx for babies in respiratory distress; dx

A

endotracheal intubation, low-pressure ventilation, sedation, NG suction [difficult cases may require extracorporeal membrane oxygenation (ECMO)]; sonogram before birth

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10
Q

In gastroschisis, the umbilical cord is ____ and the bowel is ______.

A

normal (defect to the right of the cord); angry/matted

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11
Q

In omphalocele, the umbilical cord goes ____ and the bowel is ______.

A

into the defect (has a thin membrane over bowel); normal

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12
Q

Small defects in the ventral wall can be closed primarily, but large ones require construction of a ______ in order to house and protect the bowel. Complete closure can usually be done in about ____.

A

Silastic (aka “silo”); one week

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13
Q

Babies with gastrochisis need ______ because the bowel will not work for about 1 month.

A

vascular access for parenteral nutrition

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14
Q

Exstrophy of the urinary bladder must be repaired within the first ______ of life.

A

one or two days

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15
Q

Three scenarios that green emesis + “double bubble” on CXR are seen in newborns

A

(1) duodenal atresia (2) annular pancreas (3) malrotation

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16
Q

What is a harbinger to malrotation besides bilious emesis and CXR finding of a “double bubble” in an infant? Dx?

A

little normal gas pattern beyond the double bubble on CXR; contrast enema or upper GI study

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17
Q

Clinical signs of malrotation can show up in infants in the first _____ of life.

A

few weeks

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18
Q

Intestinal atresia is identified in infants w/ green vomiting and multiple _____ throughout the abdomen.

A

air-fluid levels

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19
Q

No other congenital malformations are associated with intestinal atresia because this condition results from a _______ in utero.

A

vascular accident

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20
Q

_____ is seen in _____ infants when the first feeding causes intolerance, abd distention and a rapidly dropping platelet count (sign of sepsis).

A

Necrotizing enterocolitis; premature

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21
Q

Surgical intervention is needed for infants w/ necrotizing enterocolitis in the following scenarios (4)

A

abd wall erythema, air in portal vein, intestinal pneumatosis, pneumoperitoneum

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22
Q

Meconium ileus is seen in babies w/ _____. Xrays show dialated loops of small bowel and a _____ appearance in the lower abdomen.

A

CF; ground-glass

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23
Q

_____ enema is both diagnostic (microcolon) and therapeutic (dissolves pellets of meconium) in meconium ileus.

A

Gastrografin

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24
Q

Hypertrophic pyloric stenosis shows up at age _____, is more common in _____ w/ nonbilious projectile vomiting after each feeding.

A

3 weeks; firstborn boys

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25
Q

Visible gastric peristaltic waves and a _____ mass in the RUQ is indicative of hypertrophic pyloric stenosis. A ____ can be diagnostic.

A

palpable “olive-size”; US

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26
Q

Tx of hypertrophic pyloric stenosis in babies

A

rehydration (correct hypochloremic, hypokalemic metabolic alkalosis), Ramstedt pyloromyotomy or balloon dilation

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27
Q

Biliary atresia should be suspected in infants ______ old who have progressively increasing jaundice. Dx.

A

6 to 8 weeks; HIDA scan after 1wk phenobarbital

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28
Q

Tx and prognosis of biliary atresia in infants

A

biliary surgery; 1/3 long-lasting, 1/3 needs liver transplant post-sx, 1/3 need transplant immediately

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29
Q

Hirschprung disease, aka _____, is recognized with chronic constipation. Physical exam.

A

aganglionic megacolon; rectal exam leading to explosive expulsion of stool/flatus w/ relief of adb distension

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30
Q

Dx Hirschprung dz

A

Xray can show distended prox colon and “normal” distal colon; confirmation w/ full-thickness bx of rectal mucosa

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31
Q

Intussusception is seen in _____ kids who have episodes of colicky abd pain that makes them double-up and squat.

A

6 to 12mo-old chubby, healthy-looking

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32
Q

Physical exam of intussuception shows a vague mass on the ___ side of the abd, and “empty” lower quadrant and _____ stools.

A

right; “currant-jelly”

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33
Q

Dx/therapeutic for Intussusception; last resort tx

A

barium or air enema; sx

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34
Q

Classic presentations of child abuse

A

subdural hematoma w/ retinal hemorrhages (shaken), multiple fractures in different bones at dif stages of healing, scalding burns, burns of buttocks

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35
Q

MCC lower GI bleeding in pediatrics. Dx

A

Meckel diverticulum; radioisotope scan looking for gastric mucosa [remember rule of 2’s]

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36
Q

Tx of undescended testicle.

A

orchiopexy

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37
Q

What is the term for a testicle that is in the canal at birth but can be easily pulled down where it belongs [NOT undescended testicle]? This is benign.

A

overactive cremasteric muscle

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38
Q

If an abd mass is found in a child that moves up and down with respiration, it is most likely a _______.

A

malignant liver tumor (hepatoblastoma or HCC)

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39
Q

If an abd mass is deep and nonmobile in a child, it can be a ______ from the kidney or a ____ from the adrenal glad.

A

Wilm’s tumor; neuroblastoma

40
Q

The prognosis in neuroblastoma in children depends on their ____. [neuroblastomas sometimes involute and spontaneously become benign]

A

age

41
Q

____ produce sxs of pressure on the tracheobranchial tree and pressure on the esophagus in newborns. Stridor and respiratory distress w/ “crowing” in a hyperextended position can occur because of this defect.

A

Vascular rings

42
Q

Dx vascular rings in newborns; what rules out tracheomalacia?

A

barium swallow; bronchoscopy

43
Q

Morphologic cardiac anomolies are best dx w/

A

echocardiogram

44
Q

In pts w/ an ASD, a faint pulmonary flow ____ murmur and _____ second heart sound is heard. Hx of frequent colds is helpful in diagnosis. Surgery can fix an ASD.

A

systolic; fixed split

45
Q

Small, restrictive VSDs low in the _____ produces a heart murmur, are usually asxs and close spontaneously within the first ____ of life.

A

muscular septum; 2 or 3 years

46
Q

VSDs high in the membranous septum cause failure to thrive in the first ____ of life; loud pansystolic murmur and increased _____ on CSR. Echo + sx.

A

few months; pulmonary vascular markings

47
Q

PDA is symptomatic in first few days of life; ____ peripheral pulses and continuous “machine-like” murmur. In premies who haven’t gone into CHF, closure is achieved w/ ___. Other babies need surgery or radiological embolization.

A

bounding; indomethacin

48
Q

Right-to-Left shunts have the following 3 characteristics

A

murmur, diminished vascular markings in the lung, cyanosis

49
Q

MC congenital heart cyanotic anomaly. Describe the heart sounds

A

Tetrology of Fellot; systolic ejection murmur in 3rd intercostal space [also RVH]

50
Q

Clinical signs Tetrology of Fellot. Tx

A

children small for age, blue fingers/toes, clubbing, spells cyanosis relieved by squatting; surgery

51
Q

How are kids kept alive when born w/ transposition of great vessels? When do you need to surgically correct this?

A

ASD, VSD or PDA; within first couple days of life

52
Q

____ produces angina and exertional syncopal sxs. There is a harsh midsystolic murmur heard best at right second intercostal space.

A

Aortic stenosis

53
Q

Surgery for aortic stenosis is indicated if there is a gradient of more than _____ or at the first indication of CHF, angina or syncope

A

50mmHg

54
Q

Chronic aortic insufficiency produces a wide pulse pressure and a _______ diastolic heart murmur, best heard when pt expires fully. Tx = medical until evidence of ______

A

blowing, high-pitched; left ventricular dilation

55
Q

Acute aortic insufficiency due to endocarditis is seen in ____ who suddenly develop CHF and new, loud diastolic murmur. Tx.

A

young drug addicts; emergency valve replacement + long-term abx

56
Q

Patients w/ prosthetic valves need ____ prophylaxis for subacute bacterial endocarditis.

A

abx

57
Q

MCC mitral stenosis. Describe the murmur

A

Rheumatic fever; low-pitched rumbling diastolic apical heart murmur

58
Q

As mitral stenosis progresses, it can cause _____. Symptoms include ____.

A

afib; dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, hemoptysis

59
Q

Mitral valve replacement can be done with a surgical _____ or ______

A

commissurotomy; balloon valvuloplasty

60
Q

Describe heart sound of mitral regurgitation.

A

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

61
Q

In mitral regurgitation, ____ is preferred in tx rather than ____

A

annuloplasty (valve repair); prosthetic replacement

62
Q

Typical pt w/ CAD

A

middle-aged sedentary man w/ FHx, hx smoking, DM2, HLD

63
Q

Main reason to do cardiac catheterization and evaluate for potential revascularization

A

sxs of unstable, progressive, disabling angina (one or more vessels >70% stenosis)

64
Q

Before cardiac catheterization/potential revascularization, must make sure pt has ______

A

good ventricular function (cannot resuscitate dead myocardium)

65
Q

Perfect candidate for angioplasty or stent is pt that has ____.

A

one occluded main vessel (LAD or left main artery)

66
Q

Triple coronary vessel disease makes multiple coronary bypass the best choice of tx. This uses the _____ for the most important vessel. Sometimes a mix of surgery and radiology is used.

A

internal mammary artery

67
Q

Post-op care of cardiac surgical pts requires that CO be about ___ liters/min [cardiac index of 3]. If less than that, need to give ____. If CO is more than 4x greater than the goal output, that suggests ventricular failure.

A

five; IV fluids

68
Q

(A) Clinical sxs chronic constrictive pericarditis. (B) What is the classic “sign” [that indicates early diastolic dip followed by plateau of diastasis before contraction]?

A

(A) dyspnea, hepatomegaly, ascites, equalization of pressures on cardiac cath (B) “square-root” sign

69
Q

A coin lesion on the lung has a ____ chance of being malignant in people over age 50; this is higher if there is a history of ____.

A

80%; smoking

70
Q

When first suspecting lung mets, must do a ______ and compare it to an older one, OR do [these two different tests]

A

CXR; CT (must include chest/liver) and sputum cytology

71
Q

To diagnose lung cancer, must do a ____ for central lesions or _____ for peripheral lesions. If these are unsuccessful and VATS and ____ may be needed.

A

bronchoscopy bx; percutaneous bx; wedge resection

72
Q

Pt population that has highest risk of lung cancer.

A

elderly w/ smoking hx w/ non-calcified lesion

73
Q

Surgery for lung cancer will be done ONLY if _____ remains (determined by a ______ scan) and the chances that it is curative [no mets] is good.

A

residual pulmonary function to survive (minimum of FEV1 of 800mL); ventilation-perfusion scan

74
Q

Can small cell cancer of lung be treated surgically?

A

No–only w/ chemo and radiation

75
Q

Surgical excision of lung cancer centrally requires a _____ and peripherally requires a ______. Which one compromises lung function most?

A

pneumonectomy; lobectomy; pneumonectomy

76
Q

Hilar mets can be removed via _____, but nodal mets at the carina or mediastinum preclude curative resection. CT or ___ can help identify nodal/other mets. ____ can also invasively sample mediastinal nodes.

A

pneumonectomy; PET scan; endobronchial

77
Q

Describe the pathophysiology of Subclavian steal syndrome

A

arteriosclerotic stenotic plaque at origin of subclavian (before vertebral artery) allows enough blood supply to reach arm for nml activity, but not when arm exercised–reverses vertebral flow away from brain

78
Q

Clinical signs Subclavian steal syndrome. Dx

A

when exercise, pt has claudication of arm and posterior neurologic signs (visual/balance); Duplex scanning

79
Q

Exercise-inducing claudication of the arm ONLY suggests ____, rather than Subclavian steal syndrome

A

thoracic outlet syndrome

80
Q

Tx Subclavian steal syndrome

A

Bypass surgery

81
Q

AAA is typically asxs and is found incidentally on imaging or as a _____ on physical exam in an older man

A

pulsatile abdominal mass

82
Q

If AAA is ____ or smaller, it can be observed safely. If it is ____ or larger, patient should have elective repair. Aneurysms that grow ____ or faster also need elective repair.

A

4cm; 5-6cm; 1cm/yr

83
Q

AAA + _____ means that the aneurysm will rupture within a day or two; AAA + ____ means its already leaking and aa retroperitoneal hematoma is forming. Emergency surgery is required for both!

A

abd tenderness; excruciating back pain

84
Q

Only factor contributing to LE arteriosclerotic occlusive dz is ___. The first clinical sign is ____. If not bother the pt much, can just watch it and give ____ for patients who run.

A

smoking; claudication; cilostazol [PDE inhibitor on cAMP]

85
Q

Workup of intermittent claudication includes _____ looking for pressure gradient, aka _____. An ideal value is 1. Anything less than ____ needs a f/u CT angio or MRI angio to plan revascularization.

A

Doppler studies; ankle-brachial index (ABI); 0.8

86
Q

Bypasses or prosthetic materials are used to treat claudication. Angioplasty and stents are only used for ____. Presurgery, ______ stents are stored in the freezer and as they are warmed in the body, they deploy themselves.

A

short segments; nickel alloy

87
Q

______ is indicative when a patient comes to you saying he cannot sleep due to pain in his calf; he typically dangles his leg over the bed. This is a dangerous harbinger to ______ and must be operated on.

A

Resting claudication; ulceration and/or gangrene

88
Q

Urgent evaluation and tx of arterial embolization, usually due to _____, should be done within ____. Doppler studies will locate the obstruction.

A

a recent MI; 6 hours

89
Q

Tx arterial embolization of LE

A

embolectomy w/ Fogarty catheter, and fasciotomy if several hours have passed before revascularization

90
Q

Dissecting aneurysm of thoracic aorta occurs in the pt with _____. There may be ____ pulses in the UEs and xray shows ______.

A

HTN; unequal; wide mediastinum

91
Q

Aortic dissection can mimic sxs of MI–how do you rule out MI?

A

cardiac enzymes and EKG

92
Q

Definitive dx aortic dissection (best method)

A

CT angio

93
Q

Aortic dissections of the ____ aorta are tx surgically because the aortic valve may have been damaged, while dissections of ____ are tx medically b/c consequences of interrupting blood supply to SC is too great.

A

ascending; descending

94
Q

A FNA can be done in the office and is a great diagnostic tool, however it cannot show _____. FNA is ALWAYS contraindicated in ____ and ______.

A

cell architecture; testicular mass (spread cancer); hemangioma in the liver (fatal bleeding)

95
Q

Small skin cancers can be removed via ____ and bigger ones are usually biopsied first via _____.

A

excision; incision (take at edge of lesion)

Surgery Clerkship (7 decks)

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