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Flashcards in CT and Vascular Deck (38)
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1
Q

What are symptoms of vascular rings

A
  1. stridor

2. crowing respiration (baby assumes hyperextended position). If only respiratory Sx then think of tracheomalacia

2
Q

How do you dx vascular rings?

A

barium swallow and bronchoscopy (rules out tracheomalacia)

3
Q

What is the treatment for vascular rings?

A

divide smaller of the 2 aortic arches

4
Q

What is the best way to dx morphologic cardiac anomalies?

A

Echo

5
Q

How do L to R shunts present?

A

murmur, pulmonary circulation overload, long term damage to pulmonary vasculature

6
Q

Murmur of ASD

A

systolic flow murmur w/ fixed split 2nd heart sound

7
Q

When is an ASD ususally dxed?

A
  • late infancy. hx of frequent colds is common
8
Q

How do most VSD’s present?

A

if they high in the membranous septum - they have FTT, loud pansystolic murmur at LSB, increased pulmonary vasculature on CXR
- if the VSD is small and low in muscular septum they ususally close in first 2-3 years of life

9
Q

How do R to L shunts present?

A

presence of murmur, cyanosis.

10
Q

What is the MC cyanotic anomaly 2/2 to the heart?

A

TOF

11
Q

How does TOF present?

A
  • small kids, bluish hue in lips, spells of cyanosis relieved by squatting
  • systolic ejection murmur in left 3rd ICS
12
Q

CXR findings of TOF

A
  • small heart, diminished pulmonary vascular markings,
13
Q

EKG of TOF

A

RVH

14
Q

Tell me about TGA

A
  • kept alive by ASD, VSD, or PDA>
  • think of this in a 1 or 2 day old baby with cyanosis.
  • get ECHO!
15
Q

When to repair aortic stenosis

A

if gradient or more than 50 mmHg or at first indication of CHF, angina, or syncope

16
Q

When should chronic AR be repaired?

A
  • at first evidence on ECHO of beginning LV diltation
17
Q

When is acute AR seen?

A
  • endocarditis in young drug addcits who develop CHF and new murmur. Replace valve and start long term ABx
18
Q

Associations with Mitral Stenosis

A
  1. think rheumatic fever

2. as it progresses patient become thin and cachectic and get a fib.

19
Q

How is mitral stenosis repaired?

A
  • surgical commissurotomy or balloon valvuloplasty
20
Q

What is the post op care of heart surgery patients?

A
  1. optimize CO. if not normalget PCWP. if Low give IVFs if high it means ventricular failure
21
Q

How does chronic constrictive pericarditis present?

A
  1. DOE, hepatomegaly, ascites

2. equalization of pressures on cardiac cath

22
Q

Workup for suspected cancer of lung?

A
  1. get CXR
  2. sputum cytology
  3. CT scan for staging
23
Q

How do you dx lung cancer?

A
  1. Cytology of sputum
  2. bronchoscopy for central bx
  3. percutaneous for peripheral bx
  4. if above unsuccessful do VATS and wedge resection
24
Q

How to treat small cell cancer of lung?

A

chemo and radiation

25
Q

How is operability of lung cancer determines?

A

on residual function after resection.

  • central lesions require pneumonectomy
  • peripheral ones can be removed w/ lobectomy
  • Minimum FEV1 of 800mL is needed
26
Q

What to do about lung cancer mets?

A
  1. hilar mets can be removed w/ pneumoectomy

2. nodal mets at carina or mediastinum preclude curative resection

27
Q

How to dx lung cancer mets?

A
  1. CT
  2. PET
  3. endobronchial US - invasive option to sample mediastinal nodes
  4. cervical medistainal exploration is rarely needed
28
Q

What is subclavian steal syndrome?

A
  • arteriosclerotic stenotic plaque at origin of subclavian allows enough blood supply to reach the arm for normal activity but doesn’t allow enough to meet higher demands when arm is exercised
  • so then arm sucks blood away from the brain by reversing flow in the vertebral artery.
29
Q

What are the Sx of subclavian steal syndrome?

A
  • arm claudication, posterior neurologic signs

- if only vascular Sx were present think of thoracic outlet syndrome.

30
Q

How to dx subclavian steal syndrome?

A
  • duplex scanning. Bypass surgery cures it
31
Q

What to do with the different AAA sizes?

A
  1. < 4 cm, observe
  2. 5-6 cm have elective repair
  3. if grows 1 cm per year or faster do repair
32
Q

how are most AAA treated now?

A

endovascular stents. These cases are unruptured and the neck should be at least 2.5 cm

33
Q

What to do in pt w/ excruciating back pain in a patient w a large abdominal aortic anuerysm.

A

retroperitoneal hematoma is already forming so do emergent surgery.

34
Q

What is the workup of disabling intermittent LE claudication?

A
  1. Doppler students for pressure gradient

2. CT angio or MRI angio to look for stenosis or complete obstruction and to look for a good distal vessel for a graft

35
Q

What is the treatment of stenotic LE vascular segments?

A
  1. short ones - angioplasty and stenting
  2. extensive - bypass grafts
  3. multiple lesions - repair proximal ones
    - if grafts originate at aortobifemoral do prosthetic. for distal vessels use reversed saphenous grafts
36
Q

Arterial embolization from distant source Rx?

A
  1. early incomplete occlusions - do clot busters
  2. embolectomy w/ Fogarthy catheter for complete obstruction
  3. Fasciotomy if several hours have passes before revascularization
37
Q

Who gets dissecting aneuryms of thoracic aorta?

A

poorly controlled HTN

  • resembles an MI, pain radiates to back. unequal pules in UE. Xray shows wide mediastinum
  • do EKG and cardiac enzymes to r/o MI.
  • dx by noninvasive means first. Get spiral CT
38
Q

How to treat aortic dissections?

A
  1. ascending ones - surgery

2. descending ones - control HTN