Cardiothoracic and Peripheral-Vascular SP1

Question 1

Bronchoscopy position

Answer 1

supine

Question 2

Aspirated foreign bodies in bronchoscopy

Answer 2

likely to enter right bronchus

right is more vertical, shorter, and wider than left

Question 3

Lukens tube

Answer 3

bronchoscopy

cytological container

Question 4

Mediastinoscopy incision

Answer 4

suprasternal notch

Question 5

Mediastinoscopy positioning

Answer 5

hyperextend head and neck

shoulder rolls

positioned same as tracheostomy

Question 6

Mediastinoscopy anesthesia

Answer 6

general

Question 7

Mediastinoscopy purpose

Answer 7

visualize and biopsy lymph nodes or tumors at tracheobronchial junction

under carina of trachea

upper lobe bronchi or subdivisions

Question 8

Thoracotomy incisions

Answer 8

median sternotomy

lateral

posteriorlateral

Question 9

Endotrachial tube

Answer 9

Thoracotomy

double lumen to collapse lung while allowing respiration in non operative lung

Question 10

Lungs

Answer 10

visceral pleura-serous membrane

reflection of parietal pleura of thoracic cavity

50ml of pleural fluid for lubrication during inspiration and expiration

Question 11

Intercostal nerve

Answer 11

forward and alongside the posterior intercostal artery

shares intercostal groove on inferior edge of corresponding rib

anesthesia injected into nerve

Question 12

TNM system

Answer 12

stage cancer

T-size, location, spread

N-spread to lymph node or nodes

M-metetastic activity in different organs

Question 13

Wedge resection

Answer 13

parenchyma (alveoli, bronchiole, alveolar duct, terminal bronchiole

remove small, peripherally located benign primary tumors, inflammation, biopsy chronic diffuse lung disease

Question 14

Thoracoscopy

Answer 14

VATS - video assisted thoracic surgery

more visualization in anterior mediastinum

diagnose pleural disease, treatment of cysts, blebs, effusions

Question 15

Bleb

Answer 15

small collection of air on the pleural surface

increase risk of pneumothorax

Question 16

Effusion

Answer 16

abnormal accumulation of fluid in pleural space

Question 17

Pluerodesis treatment

Answer 17

talc, tetraclycine, sclerosing treatment

Question 18

Thoracoscopy wound class

Answer 18

class 1 clean

Question 19

VATS indications

Answer 19

biopsy of mediastinal masses

wedge resection

pericardectomy

evacuate blood clots

Question 20

Thoracostomy

Answer 20

incision into chest wall while allowing drainage

Question 21

Restrictive and obstructive pulmonary disease

Answer 21

lung may not fully expand/contract

hypoxia

Question 22

Lung pressure system

Answer 22

negative intrapleural

collapse follows anything interrupting neg. pressure (air in pleural space)

Question 23

Chest-catheters

Answer 23

one or more postop

closed-chest drainage

re-establish neg pressure by draining stuff

Question 24

Chest drain mechanisms

Answer 24

positive expiratory pressure

gravity

suction

Question 25

Chest drain systems

Answer 25

attached to water-seal or gravity drain water-seal used when gravity isnt enough

Question 26

Three bottle system

Answer 26

first: drainage from intrapleural space two: water seal three: suction determined by amount of water

Question 27

Angioscopy

Answer 27

endoscopically view interior of vessels alternative to angiography reveal retained artherosclerotic plaque, thrombi, and evaluate suture lines

Question 28

Aortofemoral bypass incision

Answer 28

combination midline abdominal and inguinal

Question 29

Aortofemoral different from AAA

Answer 29

bypass iliac artery not fix weakening of aorta

Question 30

Heparin

Answer 30

ratio for irrigation 1000u/500ml IV bolus to provide systemic anticoagulation pretreat lumen of shunt or graft given before clamp to prevent thromboembolitic event

Question 31

Papaverin

Answer 31

suppression of vasospasm

Question 32

Vasospasm

Answer 32

blood vessels spasm leading to vasoconstriction

Question 33

Preclotting

Answer 33

knitted polyester-soak in blood graft becomes impervious due to fibrin

Question 34

AV fistula

Answer 34

direct connection between artery and vein long term dialysis preferable to external shunt

Question 35

AV fistula anastamosis

Answer 35

side of A to side of V end of A to side of V end of V to side of A end of V to end of A

Question 36

Brescia-Cimino

Answer 36

connection between radial artery and cephalic vein at wrist longest patency and lowest infection rate most common

Question 37

Thrombus vs. embolus

Answer 37

clot formed to side of blood vessel clot that has traveled from elsewhere

Question 38

Carotid endarterectomy incision

Answer 38

longitudinal over carotid bifurcation

Question 39

Carotid endarterectomy anesthesia

Answer 39

cervical plexus block general

Question 40

Carotid endarterectomy intraop assessment

Answer 40

with cervical plexus block pt. is awake EEG for general anesthesia

Question 41

Cervical plexus block

Answer 41

anesthesia and analgesia to head and neck superficial or deep deep for carotid endarterectomy

Question 42

Circle of Willis arteries

Answer 42

anterior, middle, posterior cerebral anterior, posterior communicating

Question 43

Shunt

Answer 43

continuous blood blow to brain additional dissection and dislodging debris difficult to view endpoint of endarterectomy

Question 44

Arteriotomy

Answer 44

#11 blade over stenosis #7 handle lengthened with Pott's angulated scissors

Question 45

Carotid endarterectomy indications

Answer 45

transient cerebral ischemia small pieces of plaque lodge in small cerebral vessels

Question 46

Patch

Answer 46

necessary if adequate lumen cannot be established synthetic (PTFE/polyester) autogenous (saphenous vein)

Question 47

PTFE

Answer 47

polytetrafluoroethylene

Question 48

Clamp removal sequence

Answer 48

external and common carotids internal carotids LAST minor debris does not get into internal carotids