Pestana Cardiothoracic surgery Flashcards
Infant with stridor and episodes of respiratory distress also have difficulty taking in milk
think vascular ring, which places pressure around the trachea and esophagus
diagnosis and management of an infant with a suspected vascular ring
barium swallow (shows extrinsic tracheal compression) surgery to correct the two aortic arches
diagnosis and management of ASD
diagnosis: echo mgmt: surgical closure or cardiac cath
diagnosis and management of VSD
diagnosis: echo mgmt: surgical closure or cardiac cath
diagnosis and management of PDA
diagnosis: echo mgmt: indomethacin or surgical closure/embolization with coils if it does not close with medical management
diagnosis and management of tetralogy of fallot
diagnosis: echo mgmt: surgical repair
diagnosis and management of ToGA
diagnosis: echo mgmt: surgical repair
How do patients with tetralogy of fallot present? (6)
- 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
What keeps patients with ToGA alive?
ASD, VSD, PDA, or a combination of these
diagnosis and management of aortic stenosis
diagnosis: echo mgmt: valve replacement when echo demonstrates a transvalvular gradient >50mmHg or if there is CHF, angina, or syncope
diagnosis and management(3) of aortic insufficiency
diagnosis: echo
mgmt: medical therapy but [surgical commissurotomy] vs. [balloon valvuloplasty] when echo shows LV dilation
Acute aortic insufficiency occurs in which patient population? How should these patients be managed?
young drug addicts mgmt: emergency valve replacement and long-term antibiotics
patients with prosthetic valves will require abx. Why?
antibiotic prophylaxis for subacute bacterial endocarditis (ie when undergoing dental procedures)
diagnosis and management of mitral regurgitation
diagnosis: echo mgmt: surgical annuloplasty
What is the primary indication to do cardiac catheterization in a patient with CAD (3)
progressive, unstable, or disabling angina
how is a patient with single vessel CAD managed?
angioplasty and stent
how is a patient with triple vessel CAD managed?
coronary bypass (using the internal mammary as graft)
presentation of a patient with chronic constrictive pericarditis (3)
- 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)
management of a patient with chronic constrictive pericarditis 2
diuretics (removes excess fluid from body) pericardiectomy - surgical removal of part or most of the scarred pericardium
first thing to do when a coin lesion is noted on a CXR
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
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)
sputum cytology and CT scan (chest + liver)
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)
bronchoscopy with biopsy for central lesions percutaneous biopsy for peripheral lesions
how is SOLC managed? (2)
chemoRx and radiation Rx
how is Non-SOLC managed?
surgery
