CV-Surgery

Question 1

treatment for Venous Thromboembolism & PE in pt with normal kidney function

Answer 1

Low molecular weight heparin therapy

Question 2

What is the wells score for pt with severe chest pain and dyspnea

1. HR>100
2. Hx of surgery 4 weeks ago
3. malignancy
4. no diagnosis that better explains symptoms

Answer 2

1) 1.5
2) 1.5
3) 1
4) 3
Total is 7 (wells score)- making PE likely diagnosis

Question 3

opening snap and diastolic murmur along with atrial fibrillation

Answer 3

Mitral stenosis

Question 4

Peripheral artery disease (PAD), diagnostic? Tx?

Answer 4

• Ankle-brachial index (ABI)

- Graded exercise therapy

Question 5

Acute Limb ischemia Diagnostic & tx?

Answer 5

• Duplex sonography

- Vascular bypass surgery

Question 6

Abrupt standing or Valsalva maneuver causes the murmur to occur earlier during systole and with an increased intensity. What is the defect?

Answer 6

Mitral valve prolapse

Question 7

High-frequency, mid-to-late systolic murmur heard best at the apex

Answer 7

Mitral valve prolapse

Question 8

most common valvular abnormality in the US and is usually asymptomatic

Answer 8

Mitral valve prolapse

Question 9

hx of atherosclerotic disease, pulmonary edema, JVD, and cold, clammy skin

Answer 9

Cardiogenic shock

Question 10

Best choice to diagnose DVT

Answer 10

Compression ultrasonography

Question 11

A child with easy fatigability, HTN, low-grade systolic ejection murmur, low extremity claudication and diminished pulses in LE. Dx?

Answer 11

coarctation of the aorta;

>5yo will have rib notching

Question 12

leg pain, paleness, pulse deficit, paralysis, paresthesia, and poikilothermia. Dx? NSIM?

Answer 12

• Acute limb ischemia

- Digital subtraction angiography

Question 13

S2 is widely split and does not vary with respiration and mid-diastolic murmur along the lower left sternal border

Answer 13

• Atrial septal defect

- Murmur due to increased flow across the tricuspid valve

Question 14

IV user with fever, leukocyte, Roth spots, and Tricuspid valve regurgitation and vegetations

Answer 14

infective endocarditis

Question 15

Infective endocarditis common bacteria and abx used for not confirmed & confirmed (after blood culture)?

Answer 15

Staphylococcus aureus

• IV vancomycin (empiric for not confirmed)
• IV nafcillin (confirmed)

Question 16

MVA, hypotension, tachycardia refractive to fluid resuscitation & vasopressors, combined with A-fb, negative FAST

Answer 16

Cardiac contusion causing cardiogenic shock

Question 17

The most common finding following cardiac and noncardiac surgery

Answer 17

arrhythmia- evident in PVC’s (eg. hypokalemia)

Question 18

cyanotic neonate, imperforated AV septum on the right side, left-axis deviation

Answer 18

Tricuspid valve atresia

Question 19

older female a waitress and smoker with dilated tortuous veins over both calves with multiple excoriation marks. Dx? NSIM?

Answer 19

Varicose veins- Chronic venous disease

Duplex ultrasonography

Question 20

The predamaged heart valve is a risk of infection with

Answer 20

viridian streptococci (Gram + )

Question 21

Hospitalized pt with the peripheral venous catheter placed with infection, risk with

Answer 21

Staph epidermidis (form biofilm)

Question 22

Pain and swelling on R calf and positive Homan’s sign on 4 days post craniotomy pt. Dx? NSIM?

Answer 22

DVT, place Inferior vena cava filter

Question 23

Dorsiflexion of the right foot causing server pain in the calf

Answer 23

positive Homan’s sign

Question 24

Pain and swelling on R calf and positive Homan’s sign Dx? NSIM?

Answer 24

DVT. Unfractionated heparin therapy

Question 25

Widened mediastinum, deviation of the esophagus, and depression of the left main-stem bronchus, as well as hemothorax, is

Answer 25

ruptured blood vessel (thoracic aorta)

Question 26

Treatment of choice for many cases of symptomatic mitral stenosis

Answer 26

Percutaneous mitral balloon commissurotomy

Question 27

lack of chest pain, history of rheumatic heart disease, low -pitched diastolic murmur with an opening snap and left atrial enlargement of x-ray. Dx?NSIM?

Answer 27

-Mitral valve stenosis -Percutaneous mitral balloon commissurotomy or mitral valve replacement (if not candidate for less invasive)

Question 28

For preoperative risk stratification in a patient with cardiovascular risk

Answer 28

Radionuclide scan- myocardial perfusion imaging | -used when pt exercising or if unable to exercise, drug-like dipyridamole can be used)

Question 29

Criteria used to indicate endocarditis

Answer 29

Duke criteria

Question 30

Widened pulse pressure and early diastolic blowing murmur

Answer 30

Aortic regurgitation

Question 31

IV drug user, fever, chills, leukocytosis, Aortic regurgitation, S3 gallop and pulmonary edema. Dx?NSIM and tx?

Answer 31

- Left-sided heart failure due to infective endocarditis - TTE (echo) - Mechanical valve replacement of the aortic valve

Question 32

Postinverventional pulsatile groin mass with bruit and echolucent sac on us. Dx? NSIM?

Answer 32

- Femoral artery pseudoaneursym | - Ultrasound-guided thrombin injection

Question 33

Tx for pseudoaneurysm that shows infection, cuase compressive symptoms (limb ischemia or neuropathy), expand rapidly, or could not be repaired

Answer 33

Surgical repair

Question 34

will initaiate rapid formation of a fibrin clot to stop blood flow into aneursym

Answer 34

US-guided thrombin injection

Question 35

Diagnostic used for possible acute aortic dissection/rupture with normal kidney function pt

Answer 35

contrast-enhanced CT angiography

Question 36

Diagnostic used for possible acute aortic dissection with abnormal kidney function pt

Answer 36

Transesophageal echocardiography (TEE)

Question 37

Syncope, orthostatic hypotension, low pitched rumbling mid-diastolic murmur over the apex, plopping sound,

Answer 37

obstruction of blood flow to the Left ventricle (cardiac myxomas)

Question 38

Dizziness, syncope with harsh crescendo-decrescendo late systolic ejection murmur heard over the 2nd right intercostal space

Answer 38

Aortic valve stenosis

Question 39

Pt with mechanical valve on warfarin plan for colon surgery in 5 days. Plan for anticoagulation?

Answer 39

- Stop warfarin now - Start LMWH (Dalteparin) in 2 days - Discontinue Dalteparin 24hr before surgery

Question 40

Pt with threatened lower extremity acute arterial occlusion due to A-fib is given heparin therapy and NSIM?

Answer 40

Ballon catheter embolectomy

Question 41

Acute arterial occlusion what NSIM

Answer 41

Percutaneous transluminal angioplasty

Question 42

5 weeks old, SOB, noisy breathing, regurgitation of his feeds, x-ray show anterior tracheal bowing and narrowing. Dx? NSIM?

Answer 42

- Vascular ring | - Surgical division of a vascular ring

Question 43

Health child, with Split S2 during inspiration. DX?NSIM?

Answer 43

``` Patent foramen ovale no intervention (unless >2.5 cm that needs surgical closure) ```

Question 44

Number 1 risk factor for rupture of an active abdominal aortic aneurysm

Answer 44

smoking

Question 45

severe abd pain, leukocytosis, elevated lactate & lactate dehydrogenase, A-fib suggest dx?NSIM?

Answer 45

Acute mesenteric ischemia | Balloon angioplasty and stenting

Question 46

Post femoral artery catheterization with limb ischemia, venous dilation, limb edema. Dx?

Answer 46

Femoral AV fistula -due to accedental puncture of femoral vein

Question 47

Post femoral artery catheterization with pain in the groin, a pulsatile mass, a systolic bruit over the swelling. Dx?

Answer 47

Femoral artery pseudoaneurysm

Question 48

Multiple cv diseases, erectile dysfunction and symptoms of intermittent claudication. Dx?

Answer 48

Leriche's syndrome (aortoiliac disease) is PAD- occlusion of either the bilateral iliac arteries or the aortic bifurcation