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Rotation > surgery- cardio + radiology > Flashcards

surgery- cardio + radiology Flashcards

1
Q

aortic aneurysm: ___-___X measured at level of ______?

A

1-1.5X, at level of renal arteries

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2
Q

> ___cm is considered an aortic aneurysm, MC in what location?

A

> 3cm is an aneurysm. MC infraRenal.

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3
Q

connective tissue d/o (marfans, ehlers danlos) are at risk for what cardiac abnormality?

A

aortic aneursym and aortic dissection

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4
Q

what is Laplaces law?

A

Laplaces law: in short- larger aneurysms expand quicker and all expanding ones will eventually rupture

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5
Q

> ___cm increases rupture risk of aortic aneurysm?

>___cm NEEDS immediate Sx? (or expanding how quickly?)

A

> 5cm
5.5cm = Sx
(or >0.5cm expansion over 6 months)

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6
Q

MC symptom aortic aneurysm

A

asymptomatic till rupture

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7
Q

what is a chronic-contained aortic aneurysm/rupture?

A

uncommon, rupture may be tamponaded by surrounding retroperitoneum

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8
Q

what is an aortoenteric fistula?

A

presents as acute GI bleed in pts who underwent prior aortic grafting

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9
Q

Dx of aortic aneurysm? what about for monitoring expansion? what about thoracic?

A

Angiography is gold standard, US for monitoring expansion, CT for thoracic

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10
Q

Txt for aortic aneurysm/rupture

A

endovasc stent graft or open repair. + BBs to reduces shearing forces

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11
Q 
aortic aneurysm: 
\_\_\_-\_\_\_cm: monitor by US annually 
\_\_\_-\_\_\_\_cm: monitor by US Q6mo 
>\_\_\_cm: vascular surgeon referall 
>\_\_\_cm: immediated Sx
A

3-4cm: monitor by US annually
4-4.5cm: monitor by US q6mo
>4.5cm: vasc surgeon referral
>5.5cm immediate Sx

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12
Q

what is an aortic dissection and what is the MC type?

A

tear in innermost layer of aorta (intima)

65% ascending (high mortality)

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13
Q

what is the MOST important risk factor for aortic dissection?

A

HTN

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14
Q

turner syndrome pts are most at risk for what cardiac abnormality?

A

aortic dissection

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15
Q

aortic aneursym vs aortic dissection presentation:

A

BOTH pain, hypotension

dissection- SUDDEN tearing/ripping, decr. peripheral pusles, new onset aortic regurg

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16
Q

Sx txt for aortic dissection is used for what types?

A

Sx for acute proximal (stanford A, debakey I+II), or acute distal (type III) w/ complications.

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17
Q

conservative txt for aortic dissection is used for what types? what is the target BP and HR to acheive w/in ___min?

A

for descending and NO complications (stanford B/debakey III) = esmolol, labetolol.
Target SBP 100-120 mmHg and pulse <60bpm within 20min.

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18
Q

mesenteric ischemia is MC at what location?

A

splenic flexure b/c least collateral blood supply

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19
Q

MC cause of mesenteric ischemia

A

sudden decr blood supply to bowel:

MC from occlusion (embolus, thrombus). Nonocclusive (shock- decr blood, cocaine,)

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20
Q

severe abd pain out of proportion to PE. N/V/diarrhea, peritonitis - what is a likely cardiovascular cause?

A

mesenteric ischemia

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21
Q

Txt for mesenteric ischemia

A 
bowel rest (chronic), 
both - Sx revascularization (angioplasty w/ stenting or bypass), bowel resection if not salvageable
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22
Q

colonoscopy of chronic mesenteric ischemia shows what?

A

muscle atrophy w/ loss of villi

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23
Q

S+S chronic mesenteric ischemia

A

chronic, dull abd pain worse after meals. Intestinal angina, weight loss anorexia

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24
Q

what is carotid Dz?

A

when fat deposits (plague) clog the carotids → stroke

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25
Q

after lifestyle changes, BP and statins, what is the Txt for carotid Dz?

A

Sx- carotid endarterectomy (removal of plaques), or if unable to reach the plaque - Carotid angioplasty/stenting (balloon + mesh stent)

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26
Q

pericardial tamponade - pathophys?

A

pericardial effusion causing significant strain on heart → restriction of ventricular filling → decreased cardiac output.

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27
Q

pericardial tamponade acute vs chronic ?

A

Acute: small, rapidly developing effusions can cause tamponade
Chronic: (i.e. CA), pericardium can stretch to accommodate 1 L without hemodynamic compromise.

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28
Q

3 characteristic S+S of pericardial tamponade

A

Becks Triad- distant/muffled heart sounds, incr JVP, systemic hypotension. + pulsus parodoxus

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29
Q

what is pulsus parodoxus?

A

(>10mmHg decrease in systolic BP and decreased pulses with inspiration) [incr right heart filling = decr left heart filling].

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30
Q

echocardiogram = effusion + diastolic collapse of cardiac chambers

A

pericardial tamponade

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31
Q

MC symptom of peripheral arterial Dz?

A

intermittent claudication

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32
Q

intermittent claudication of aortic bifurcation / common iliac causes what symptoms?

A

buttock/hip/groin.

Leriche’s syndrome (triad claudication- butt/thigh pain, impotence, decr femoral pulses)

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33
Q

intermittent claudication of femoral and popliteal arteries causes pain where?

A

femoral: thigh/upper calf
popliteal: lower calf/ankle/foot

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34
Q

+ ABI for peripheral arterial Dz is what? what is normal?

A

+ if <0.9. Normal ABI is 1-1.2)

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35
Q

if plt inhibitors dont help intermittent claudication from PAD, what is a Sx txt?

A

Revascularization: percutaneous transluminal angioplasty. Bypass grafts (fem-pop bypass), endarterectomy

36
Q

prostate cancer symptoms

A

asymptomatic till bladder invasion, urethral obstruction or bone involvement.

37
Q

txt for prostate cancer

A

local dz = active surveillance/observation if low grade. → radical prostatectomy
Advanced dz: external beam radiation therapy, androgen deprivation (orchioectomy/GnRH agonists). Chemotherapy. If bone/other METS = localized radiation/cryotherapy.

38
Q

MC type of prostate CA, most important risk factor

A

adenocarcinoma. Most important risk factor - age >40yo,

39
Q

MC location for breast CA? MC places for METs?

A

upper outer quadrant, METS to lung, liver, bone, brain.

40
Q

what is paget’s dz and peau d’orange?

A

paget’s disease (scaly nipple), peau d’orange (lymphatic obstruction, poor prognosis)

41
Q

neoadjuvant endocrine therapy for breast CA: 3 med types

A

Neoadjucant endocrine therapy (hormone) if CA is estrogen receptor positive or progesterone receptor positive, HER2 positive
- anti-estrogen (tamoxifen), aromatase inhibitors, monoclonal Ab txt

42
Q

mammogram screening guidelines

A

ACS: >45yo annually, >55yo Q2yrs. ACOG: >40yo annually, USPTF: >50 Q 2yrs, of >40 if risk factors, 10yrs prior to age of 1st degree relative.

43
Q

MC type of breast CA

A

infiltrative ductal carcinoma or lobular carcinoma

44
Q

when should self breast exam be done?

A

after menstruation or on days 5-7 of cycle. (least hormone influence)

45
Q

preventative meds for breast CA

A

SERM - tamoxifen or raloxifene in post-menopausal women (or those >35yo with high risk). Or aromatase inhibitors

46
Q

symptoms of thyroid CA

A

MC -euthyroid (asymptomatic), thyroid nodule- rapid growth, fixed, no movement with swallowing, difficulty swallowing/hoarseness.

47
Q

besides subtotal or total thyroidectomy, what txts are there for thyroid CA?

A

+/- radioiodine therapy +/- thyroid suppression drugs

48
Q

how long do you monitor for residual cells after thyroidectomy? how do you do this?

A

. Monitor Thyroglobulin levels 6mo after for residual cells. (give recombinant TSH and check levels)

49
Q

MC type of thyroid CA

A

papillary (least aggressive)

50
Q

S+S colon CA right vs left sided

A

Right-sided: lesions bleed- anemia/fecal occult blood, diarrhea
Left-sided: bowel obstruction, changes in stool diameter, hematochezia

51
Q

txt for colon cancer, what stages require surgical resection vs chemo?

A

stage I-III = surgical resection. Stage III-metastatic = chemo (5FU)

52
Q

colon cancer screening: Avg risk vs 1st degree relative >60yo, vs first degree relative <60yo

A

Avg risk: fecal occult annually @50yo, colonoscopyQ 10yrs or flex sigmoid Q5yrs
1st degree relative >60yo: fecal occult annually @40yo, colonoscopy Q10yrs
1st degree relative <60yo: fecal occult annually @40yo (or 10yrs b4 dx), colonoscopy Q 5yrs

53
Q

colon CA: MC type and MC area of METS

A

adenocarcinoma . MC METS to liver

54
Q

MC cause of CA deaths is what type of CA ?

A

lung

55
Q

what is trousseau’s syndrome?

A

recurrent thrombophlebitis - sign of malignancy

56
Q

what are the two types of nonsmall cell lung cancer? is nonsmall or small/oat cell more aggressive?

A

nonsmall (adenocarcinoma, squamous cell, large anaplastic)

small/oat cell (aggressive)

57
Q

txt for lung CA nonsmall vs small cell?

A

nonsmall : surgical resection

small: chemo/radiation

58
Q

preventative screening for lung CA

A

CT annually for smoking w/in 15yrs and 55-80yo

59
Q

MC type lung CA?

A

nonsmall- adenocarcinoma

60
Q

5 METS “signs” of gastric cancer?

A

supraclavicular node (virchows), umbilical node (sister mary josephs), ovarian (krukenburg), rectal (Blumer’s shelf), left axillary lymph (irish sign)

61
Q

adenocarcinoma is the MC type of all cancers besides which two?

A

breast and thyroid

62
Q

when is surgical resection an option for liver CA txt?

A

if confined to a lobe and not assoc. w/ cirrhosis

63
Q

preventative screening for liver CA

A

US q 6months in someone with cirrhosis.

64
Q

MC type of live CA

A

usually METS from other cancer, primary liver neoplasm = hepatocellular carcinoma

65
Q

courvoiser’s sign

A

: palpable nontender distended gallbladder assoc with jaundice (common bile duct obstruction). - occurs in pancreatic CA

66
Q

Sx txt for pancreatic cancer, what if its the tail only?

A

whipple: radical pancreatic/duodenal resection (done if CA is confined to head or duodenal area)
Tail: distal resection

67
Q

txt for advanced/inoperative pancreatic CA

A

ERCP w/ stent placement as palliative txt for intractable itching

68
Q

MC type of pancreatic CA. what are the 3 most important risk factors?

A

adenocarcinoma - ductal. Most important risk factor (in order) - smoking, age, chronic pancreatitis

69
Q

radiology- what imaging studies are contraindicated for pregnancy?

A

absolute: IVP, MRI, nuclear bone scan
relative: Xray, CT, colonoscopy

70
Q

what are relative contraindications to contrast CT?

A

renal impairment, hyperthyroidism, pheochromocytoma, myasthenia gravis

71
Q

indication for HIDA scan

A

problems of liver, gallbladder and bial ducts. (radioactive tracer into vein)
Tests function of hepatocytes, patency, and integrity of the biliary ducts, gallbladder contractility, and sphincter of Oddi function.

72
Q

what are the limitations of a HIDA scan?

A

falsely positive when the gallbladder is not filling in the absence of cholecystitis. (severe liver disease,total parenteral nutrition, hyperbilirubinemia, inadequate fasting, and alcohol and opiate abuse.

73
Q

what are the indications for ERCP? ( endoscopic retrograde cholangiopancreatography)

A

treat stones, tumors or narrowed areas of the bile ducts

74
Q

amylase or lipase more specific?

A

lipase

75
Q

braided absorbable vs monofilament absorbable

A

braided: vicryl
monofilament: monocryl, chromic gut

76
Q

non-abs sutures: braided vs monofilament

A

braided: ethibond, silk
monofilament: ethilon

77
Q

what is the most important predictor of postop complication?

A

Surgical site is most important predictor. (aortic, thoracic and upper abdominal)

78
Q

post-op wound infection is w/in ___days of surgery. what are the bugs and drugs?

A

30 days
staph , strep, pseudomonas
Cefazolin, vancomycin, IV FQs

79
Q

causes of post-op fever: 5 Ws

A

wind (PNA, sinusitis)
wound (surgical incision, decubitus ulcers, lines)
walk (DVT, PE)
water (UTI, prostatitis, epididymitis)
wonder drugs (drug fever- abx, malignant hyperthermia, neuroleptic malignant syndrome)

80
Q

fever __-___days postop is MOST likely an infection

A

5-30

81
Q

general anesthesia: inhalation vs Total IV anesthetics

A

Inhalational Anesthetics – aka volatile anesthetics (Sevoflurane, Isoflurane, Desflurane, Nitrous Oxide*)

TIVA – Propofol, Dexmetatomadine, Remifentanyl

82
Q

three classes of thyromental distance for airway assessment

A

class A (maui), B (jaw lines up), C (kerin)

83
Q

what causes malignant hyperthermia and what are the effects from it?

A

Paralytics and Volatile Agents are the triggers → Hypermetabolic Crisis

  • Elevated temp is a late sign!
  • HUGE influx of Calcium!
84
Q

reversal agents for malignant hyperthermia: anticholinesterase (aka cholinergic) + anticholinergic

A

Neostigmine – anticholinesterase; reversal of NMB with glyco

Glycopyrolate – anticholinergic;

85
Q

what is the earliest, most specific and sensitive finding for malignant hyperthermia

A

incr end tidal CO2

86
Q

txt protocol for malignant hyperthermia

A

Txt: STOP volatile agent, flood with oxygen, cool down . Administer Dantrolene-Sodium (or Ryanodex)

Rotation (16 decks)

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