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? (6)

Answer 8

1. 5-6 year olds who are small for their age
2. bluish hue in the lips or finger tips +/- clubbing
3. cyanotic spells relieved by squatting
4. systolic murmur
5. CXR reveals small heart with diminished pulmonary vascular markings
6. 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(3) of aortic insufficiency

Answer 11

diagnosis: echo
mgmt: medical therapy but [surgical commissurotomy] vs. [balloon valvuloplasty] 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 abx. Why?

Answer 13

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

Question 14

diagnosis and management of mitral regurgitation

Answer 14

diagnosis: echo mgmt: surgical annuloplasty

Question 15

What is the primary indication to do cardiac catheterization in a patient with CAD (3)

Answer 15

progressive, unstable, or disabling angina

Question 16

how is a patient with single vessel CAD managed?

Answer 16

angioplasty and stent

Question 17

how is a patient with triple vessel CAD managed?

Answer 17

coronary bypass (using the internal mammary as graft)

Question 18

presentation of a patient with chronic constrictive pericarditis (3)

Answer 18

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

Question 19

management of a patient with chronic constrictive pericarditis 2

Answer 19

diuretics (removes excess fluid from body) pericardiectomy - surgical removal of part or most of the scarred pericardium

Question 20

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

Answer 20

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 21

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) (2)

Answer 21

sputum cytology and CT scan (chest + liver)

Question 22

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 22

bronchoscopy with biopsy for central lesions percutaneous biopsy for peripheral lesions

Question 23

how is SOLC managed? (2)

Answer 23

chemoRx and radiation Rx

Question 24

how is Non-SOLC managed?

Answer 24

surgery

Question 25

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

Answer 25

central: pneumonectomy peripheral: lobectomy

Question 26

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

Answer 26

determine residual function of the lung b4 resection via PFTs (esp FEV1) and VQ scan

Question 27

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

Answer 27

FEV1 > 800mL

Question 28

Common Causes of [Constrictive Pericarditis] (4)

Answer 28

‘Ur an Idiot to constrict my Radio & T-V”

Idiopathic(includes previous cardiac surgery)

Radiation

TB

Viral