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CT surgery (pestana) Flashcards

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1
Q

Baby who has trouble swallowing, stridor, and episodes of respiratory distress w/ “crowing” respirations and hyperextended positioning. Barium swallow shows extrinsic compression of tracheobronchial tree and/or esophagus. Dx?

A

Vascular rings

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2
Q

What test do you order to differentiate btwn vascular rings and tracheomalacia? Also, which symptom of vascular rings would be missing in tracheomalacia?

A

Bronchoscopy: shows segmental tracheal compression in vascular rings
Tracheomalacia lack dysphagia

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3
Q

How do you treat vascular rings?

A

Surgery that divides the smaller of the 2 aortic arches

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4
Q

In general, what’s the best way to Dx morphologic cardiac anomalies?

A

Echo

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5
Q

What type of shunts cause murmur, pulmonary circulation overload, and long-term damage to pulm vasculature?

A

L-to-R shunts

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6
Q

Patient in late infancy w/ PMH of freq colds + faint systolic pulm flow murmur and fixed split S2. Dx?

A

ASD

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7
Q

How do you dx ASD?

A

Echo

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8
Q

Tx of ASD?

A

Closure (surgical or cath)

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9
Q

2-3 mo old baby w/ failure to thrive and loud pansystolic murmur @LSB. CXR: increased pulm vasculature markings. Dx?

A

VSD

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10
Q

Dx of VSD?

A

Echo

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11
Q

MC site of VSD?

A

High in membranous septum

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12
Q

How do you treat a typical VSD?

A

Surgical closure

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13
Q

What type of VSD produces a murmur but otherwise few symptoms?

A

Small, restrictive VSD low in the muscular septum

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14
Q

2-3 mo old baby w/ small, restrictive VSD low in the muscular septum. Tx?

A

Obs- most close spontaneously w/in first 2-3 yr of life.

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15
Q

3 day old baby w/ bounding peripheral pulses and a continuous “machinery-like” murmur. Dx?

A

PDA

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16
Q

Dx of PDA?

A

Echo

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17
Q

Treatment of PDA in a preemie who hasn’t gone into CHF?

A

Close w/ indomethacin

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18
Q

Tx of PDA in full-term babies, preemies w/ CHF, and preemies who don’t close w/ indomethacin? 2 options

A

Surgical closure or embolization w/ coils

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19
Q

What type of shunt p/w murmurs, diminished vascular markings in the lung, and cyanosis?

A

R-to-L

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20
Q

Which R-to-L shunt is cyanotic but kills by overloading the pulmonary circulation?

A

Truncus arteriosus

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21
Q

5 yo who is small for their age w/ bluish lips and fingertips, clubbing, and cyanotic spells relieved by squatting. Dx?

A

ToF

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22
Q

Young child w/ systolic ejection murmur in left 3rd ICS, CXR showing decreased vascular markings and a small heart, and EKG signs of RVH. Dx?

A

ToF

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23
Q

Dx of ToF?

A

Echo

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24
Q

Tx of ToF?

A

Surgery

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25
2 day old cyanotic baby who is SICK. Dx?
Transposition of great vessels
26
Transposition of great vessels- Dx?
Echo
27
Transposition of great vessels- how do babies stay alive until Dx?
Concurrent ASD/VSD/PDA (1 or more)
28
Transposition of great vessels- Tx?
Surgery
29
Older person w/ angina, exertional syncope, and a harsh midsystolic murmur @ R 2nd ICS and the left sternal border. Dx?
Aortic stenosis
30
Aortic stenosis. Dx?
Echo
31
Treatment of symptomatic aortic stenosis?
Valve replacement
32
Pt w/ wide pulse P, blowing high-pitched diastolic murmur best heard @ R 2nd ICS and left lower sternal border during full expiration. Dx?
Chronic aortic insufficiency
33
In general, when do you do valve replacement in chronic aortic insufficiency?
Any evidence of LV dilitation on echo
34
Young IVDU w/ sudden onset of CHF and new loud diastolic murmur at 2nd R ICS. Dx?
Acute aortic insufficiency
35
How do you treat acute aortic insufficiency?
Emergent valve replacement + long-term Abx
36
Patient w/ DOE, orthopnea, PND, cough, hemoptysis, and low-pitched rumbling diastolic apical murmur who is now becoming cachectic and developing Afib. Dx?
Mitral stenosis
37
Dx of mitral stenosis?
Echo
38
Tx of symptomatic mitral stenosis?
Valve repair (surgical comissurotomy or balloon valvuloplasty)
39
DOE, orthopnea, Afib, and apical high-pitched holosystolic murmur that radiates to axilla and back. Dx?
Mitral regurg
40
MCC of mitral regurg?
MVP
41
Tx of symptomatic mitral regurg?
Annuloplasty
42
Middle-aged sedentary male smoker w/ T2DM, HLD, and FHx CAD who p/w angina. Dx?
CAD
43
What % stenosis is criteria for intervention in CAD?
70%. And don't forget you also need good distal vessel!
44
Triple vessel CAD. Tx?
CABG
45
Normal CO and CI?
CO: 5 L/min CI: 3
46
If post-op heart surgery patient has considerably decreased CO or CI, what should you measure next?
PCWP
47
Post-op heart surgery patient has considerably decreased CO or CI. PCWP is low (0-3). What does this patient need?
IVF!
48
Post-op heart surgery patient has considerably decreased CO or CI. PCWP is high (20 or greater). What's likely wrong?
Ventricular failure
49
Patient p/w DOE, hepatomegaly, ascites. Square root sign + equalization of pressures on cath. Dx?
Chronic constrictive pericarditis
50
Tx of chronic constrictive pericarditis?
Surgery
51
Coin lesion on CXR. Next best step?
Compare to older xray
52
Coin lesion on CXR and either no older CXR for comparison or lesion wasn't present on old CXR. What 2 tests should you order?
Sputum cytology and CT chest and abdomen
53
Dx of central lung cancer? Peripheral?
Central: bronch w/ bx Periph: percutaneous bx
54
Strongly suspect lung cancer but can't get dx w/ bronch bx or percutaneous bx. What else could you do?
VATS and wedge resection
55
If pneumonectomy is required for tx of lung cancer, and you're worried about post-op lung fxn (COPDer, SOB, etc), what tests should you get?
PFTs, V/Q scan
56
What residual FEV1 is req to proceed w/ pneumonectomy?
800 mL
57
How do you determine the residual FEV1?
Measure FEV1, then get a V/Q scan to determine fraction of FEV1 coming from each lung. Calculate what would remain after pneumonectomy.
58
What type of non-small cell lung cancer requires pneumonectomy?
Central lesions
59
What type of non-small cell lung cancer requires lobectomy?
Peripheral lesions
60
Patient w/ central non-small cell lung cancer would have would have FEV1 of 600 mL after pneumonectomy. What's your general treatment plan now?
Chemo + radiation
61
Which mets can be removed via pneumonectomy: hilar, carinal, and/or mediastinal?
Hilar. The other two preculde curative resection

Surgery clerkship (4 decks)

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