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Surgery > Pestana- 6. Cardiothoracic Surgery > Flashcards

Pestana- 6. Cardiothoracic Surgery Flashcards

1
Q

What do you expect if a baby goes into respiratory distress with “crowing respirations” and assumes a hyperextended position?

A

vascular rings

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2
Q

What other symptoms (other than respiratory) should you think of with vascular rings?

A

pressure on esophagus causing difficulty swallowing

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3
Q

What should be on your differential with vascular rings?

A

tracheomalacia

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4
Q

How do you rule out tracheomalacia?

A

bronchoscopy

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5
Q

How do you diagnose vascular rings?

A

barium swallow (shows typical extrinsic compression from abnormal vessel)

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6
Q

How do you treat vascular rings?

A

surgery to divide the smaller of the two aortic arches

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7
Q

What is the best way to diagnose morphologic cardiac anomalies?

A

echocardiogram

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8
Q

What type of congenital heart defect has a faint pulmonary flow systolic murmur and fixed split S2?

A

ASD

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9
Q

What is the most common outcome for small, restrictive VSDs low in the muscular septum?

A

spontaneous closure within 2-3 years of life

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10
Q

Where are most VSDs anatomically?

A

high in the membranous septum

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11
Q

What is the typical physical exam finding in VSDs?

A

pansystolic murmur at left sternal border

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12
Q

What do you see on CXR in a patient with a VSD?

A

increased pulmonary vascular markings?

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13
Q

When will a PDA become symptomatic?

A

in the first few days of life

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14
Q

What is the typical physical exam findings in PDA?

A

bounding peripheral pulses

“machinery-like” heart murmur

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15
Q

How can you achieve closure of a PDA in a premature infant?

A

indomethacin

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16
Q

What are the two options for closure of PDA in a baby who cannot be treated with indomethacin?

A
  • Surgical division

- Radiological embolization with metal coils

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17
Q

What is the most common cyanotic congenital heart defect?

A

Tetralogy of Fallot

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18
Q

What will a child with Tetralogy of Fallot look like?

A

small
blue lips and fingers
clubbing
cyanosis spells relieved by squatting

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19
Q

What is the typical physical exam finding in Tetralogy of Fallot?

A

systolic ejection murmur in left 3rd intercostal space

20
Q

What will an EKG in Tetralogy of Fallot show?

A

right ventricular hypertrophy

21
Q

What allows a child with transposition of the great vessels to stay alive?

A

ASD
VSD
PDA

22
Q

What do you think of with harsh midsystolic heart murmur at the right second intercostal space and along the left sternal border?

A

aortic stenosis

23
Q

What are the surgical indications in aortic stenosis?

A
  • Gradient >50 mmHg

- First indication of CHF, angina or syncope

24
Q

What do you think of with a wide pulse pressure and blowing, high-pitched, diastolic heart murmur best heard at the second intercostal space and along the left lower sternal border?

A

chronic aortic insufficiency

25
Q

When should you do a valvular replacement for chronic aortic insufficiency?

A

at first evidence on echo of LV dilatation

26
Q

What do you suspect in a patient who suddenly develops a loud, diastolic murmur at hte right second intercostal space?

A

acute aortic insufficiency 2/2 endocarditis (drug user)

27
Q

How do you treat acute aortic insufficiency?

A

emergency valve replacement and long-term abx

28
Q

What should you suspect in a patient with DOE, orthopnea, cough and hemoptysis and a low-pitched, rumbling diastolic apical heart murmur?

A

mitral stenosis

29
Q

What usually causes mitral stenosis?

A

rheumatic fever

30
Q

What issue usually develops after mitral stenosis progresses over time?

A

a-fib

31
Q

What do you suspect in a patient with an apical, high-pitched, holosystolic heart murmur that radiates to the axilla and back?

A

mitral regurgitation

32
Q

How do you treat mitral regurg?

A

Annuloplasty (repair valve) preferred over prosthetic replacement

33
Q

At what percentage stenosis is intervention for coronary disease indicated?

A

> /=70%

34
Q

When (in coronary artery disease) is an angioplasty or stent preferred?

A

single vessel disease (that is not left main or LAD)

35
Q

When would you typically use multiple coronary bypass in coronary artery disease treatment?

A

triple vessel disease

36
Q

What vessel do you use for the most important vessel bypass?

A

internal mammary

37
Q

What should you do if a heart surgery patient has a CO of

A

measure the pulmonary wedge pressure (LEDP)

38
Q

What does a PCWP of 0-3 indicate?

A

patient needs more IV fluids

39
Q

What does a PCWP of >20 indicate?

A

ventricular failure

40
Q

What are the signs of chronic constrictive pericarditis?

A

dyspnea on exertion
hepatomegaly
ascites

41
Q

What are the typical cardiac catheterizaiton findings in chronic constrictive pericarditis?

A
  • “square root sign”

- equalization of pressures (RA, RV diastolic, PA diastolic, PCWP, LV diastolic)

42
Q

What is the likelihood that a coin lesion over the lungs will be malignant in a patient over 50?

A

80%

43
Q

After comparing a coin lesion to an old CXR, what are the next two tests to perform?

A
  • Sputum cytology

- CT scan (chest and liver included)

44
Q

What type of lung cancer is not treated with surgery?

A

small cell

45
Q

How do you predict the operability of lung cancer?

A

by predicting residual function after resection

46
Q

What is the minimum predicted FEV1 for operability of lung cancer?

A

800 mL

47
Q

How do you predict future FEV1 in a patient who is to receive surgery for lung cancer (pneumonectomy)?

A

FEV1 then ventilation-perfusion scan

Surgery (13 decks)

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