Previous exam 2002 Flashcards
Most common endocarditis organisms in native valve, renal valve IVDU, PVE
Native: Streptococci Prosthetic: Early Coagulase negative (Staph Epidermedis) Late Strep IVUD Staph Aeurus
Renal
What are advantages of IMA skeletonization
Increased conduit length decreased infection easier to identify an IMA injury Less paraestheisa of chest wall Less likely to twist Convenient for complex arterial grafting (T-grafting and sequentials)
What are contraindications to using Bilateral internal thoracic arteries
Subclavian stenosis Calcification of mammary Severe obesity AV fistula in same arm Possible IDDM Cardiogenic shock/Emergency surgery Previous radiation to chest wall
Name 3 studies that show BITA is superior to LITA and what is survival difference
.
What are operative indications for Prosthetic valve endocarditis
Unstable prosthesis (rocking) Severe valvular insufficiency and CHF Recurrent emboli Heart block Abscess or fistula formation Fungal infection Persistent positive blood culture despite appropriate antiobiotic therapy Valve destruction? Vegetation of any size
Why is it important to get ethics committee approval for studies
Ensure the 4 main ethical principles are followed Beneficence Non-malifiencen Automony justice
Other points include: patient safety, informed consent, liability, not replicating previous work, department approval, peer review, disruption of standard of patient care, adequancy of resources
What is most common congenital arch anomaly
Aberrant right subcavian artery off left descending aorta
What are is spinal cord anatomy and what are protection strategies
Where is artery of Adamkiewicz
3 proven methods hypothermia left heart bypass CSF drainage Others: Pharmacological agnets (sterorid, mannitol, NMDA receptor anatognists reimplntation of spinal (T9 to L2) distal perfusion Monitoring sensory e
What are is spinal cord anatomy and what are protection strategies
Where is artery of Adamkiewicz
3 proven methods hypothermia left heart bypass CSF drainage Others: Pharmacological agnets (sterorid, mannitol, NMDA receptor anatognists reimplntation of spinal (T9 to L2) distal perfusion Monitoring sensory e
What are common causes of aneursym post coarctation repair
Post patch repair true aneursym can develop opposite the actual patch
Psuedo-aneursym can develop with any repair but most common after interposition graft
Use of prosthetic patch—up to 40% develope medial degeneration opposite the patch
Females who get pregnant later may develop anesusym
Older age
Ratio of circumference of aoarta at site of repair to that of the aorta at the diaphram if greater the 1.5 then you have a risk
What is management of chylothorax
Chest tube insertion and drainage
NPO
TPN or medium chain trigylercides only
Problems with malnutrition, lymphocyte depletion (functionally immunosuppresed after 14 days)
Operative indications: continued drainage x 14 days; ? 1 liter/day
What is difference between constrictive and restrictive cardiomyopathy
Constrictive CO is slightly lower Volumes of both ventricles depressed or normal EF is depressed or normal pericardium is thickened RVEDP (usually 1/3) of RVESP PA systolic is < 50 mmHg LAP is = to RAP and usually < 15 Restrictive LAP > RAP by more then 5 Mean RAP below 25 RVEDP < 1/3 of RVESP Lower CO EF is usually very low
What is incidence of HIV, HBV, HCV from needle stick
HIV 0.5%
HCV 2%
HBV 20%
risk is higher with hollow needle and gross contamination
What are class I MHC cells
All nucleated cells
Class I MHC HLA, A, B, B On surface of all nucleated ells No on RBC Activates CD8 (cytotoxic)
What are class II MHC cells
Antigen presenting cells
dendritic cells, macrophages, B cells, endothelial cells
Class II MHC
activates CD4 cells (helper)
HLA DR, DQ, DP,
Expressed on antiigen presentin cells
