Pestana Cardiothoracic surgery

Question 1

Infant with stridor and episodes of respiratory distress also have difficulty taking in milk

Answer 1

think vascular ring, which places pressure around the trachea and esophagus

Question 2

diagnosis and management of an infant with a suspected vascular ring

Answer 2

barium swallow (shows extrinsic tracheal compression)
surgery to correct  the two aortic arches

Question 3

diagnosis and management of ASD

Answer 3

diagnosis: echo
mgmt: surgical closure or cardiac cath

Question 4

diagnosis and management of VSD

Answer 4

diagnosis: echo
mgmt: surgical closure or cardiac cath

Question 5

diagnosis and management of PDA

Answer 5

diagnosis: echo
mgmt: indomethacin or surgical closure/embolization with coils if it does not close with medical management

Question 6

diagnosis and management of tetralogy of fallot

Answer 6

diagnosis: echo
mgmt: surgical repair

Question 7

diagnosis and management of ToGA

Answer 7

diagnosis: echo
mgmt: surgical repair

Question 8

How do patients with tetralogy of fallot present?

Answer 8

5-6 year olds who are small for their age
bluish hue in the lips or finger tips +/- clubbing
cyanotic spells relieved by squatting
systolic murmur
CXR reveals small heart with diminished pulmonary vascular markings
EKG reveals RVH

Question 9

What keeps patients with ToGA alive?

Answer 9

ASD, VSD, PDA, or a combination of these

Question 10

diagnosis and management of aortic stenosis

Answer 10

diagnosis: echo
mgmt: valve replacement when echo demonstrates a transvalvular gradient >50mmHg or if there is CHF, angina, or syncope

Question 11

diagnosis and management of aortic insufficiency

Answer 11

diagnosis: echo
mgmt: medical therapy but valve replacement when echo shows LV dilation

Question 12

Acute aortic insufficiency occurs in which patient population? How should these patients be managed?

Answer 12

young drug addicts

mgmt: emergency valve replacement and long-term antibiotics

Question 13

patients with prosthetic valves will require this

Answer 13

antibiotic prophylaxis for subacute bacterial endocarditis (ie when undergoing dental procedures)

Question 14

diagnosis and management of aortic insufficiency

Answer 14

diagnosis: echo
mgmt: surgical commissurotomy or balloon valvuloplasty when symptoms become more disabling

Question 15

diagnosis and management of mitral regurgitation

Answer 15

diagnosis: echo
mgmt: surgical annuloplasty

Question 16

What is the primary indication to do cardiac catheterization in a patient with CAD

Answer 16

progressive, unstable, or disabling angina

Question 17

how is a patient with single vessel CAD managed?

Answer 17

angioplasty and stent

Question 18

how is a patient with triple vessel CAD managed?

Answer 18

coronary bypass (using the internal mammary as graft)

Question 19

presentation of a patient with chronic constrictive pericarditis

Answer 19

dyspnea on exertion (rigid pericardium = impaired diastolic filling)
hepatomeagly + ascites
cardiac cath shows classic square root sign (occurs when diastolic filling suddenly stops because the fibrous pericardium has reached its maximum distensibility)

Question 20

causes of chronic constrictive pericarditis

Answer 20

repeated episodes of pericarditis of various etiologies
previous cardiac surgery
radiation therapy
tuberculosis

Question 21

management of a patient with chronic constrictive pericarditis 2

Answer 21

diuretics (removes excess fluid from body)

pericardiectomy - surgical removal of part or most of the scarred pericardium

Question 22

first thing to do when a coin lesion is noted on a CXR

Answer 22

look for a previous, older CXR to see if the lesion has changed over time

if it hasn’t changed, it is unlikely to be cancer

Question 23

next best step in management of a patient with suspected lung cancer (ie coin lesion has grown over time as visible on x-ray, hemoptysis, persistent cough)

Answer 23

suptum cytology and CT scan (chest + liver)

Question 24

How do you make the diagnosis in a patient with suspected lung cancer (ie coin lesion has grown over time as visible on x-ray, hemoptysis, persistent cough, (+) sputum culture, (+) CT scan)

Answer 24

bronchoscopy with biopsy for central lesions

percutaneous biopsy for peripheral lesions

Question 25

how is small cell cancer of the lung managed?

Answer 25

chemoRx and radiation Rx

Question 26

how is non-small cell cancer of the lung managed?

Answer 26

surgery

Question 27

How are central vs peripheral cancerous lesions of the lung managed surgically?

Answer 27

central: pneumonectomy
peripheral: lobectomy

Question 28

before removing a cancerous lesion of the lung, what must you do?

Answer 28

determine residual function of the lung after resection via PFTs (esp FEV1) and VQ scan

Question 29

what is the magical FEV1 number that will determine if a candidate is suitable for lung resection?

Answer 29

FEV1 > 800mL