Pestana- 6. Cardiothoracic Surgery Flashcards Preview

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Flashcards in Pestana- 6. Cardiothoracic Surgery Deck (47)
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1

What do you expect if a baby goes into respiratory distress with "crowing respirations" and assumes a hyperextended position?

vascular rings

2

What other symptoms (other than respiratory) should you think of with vascular rings?

pressure on esophagus causing difficulty swallowing

3

What should be on your differential with vascular rings?

tracheomalacia

4

How do you rule out tracheomalacia?

bronchoscopy

5

How do you diagnose vascular rings?

barium swallow (shows typical extrinsic compression from abnormal vessel)

6

How do you treat vascular rings?

surgery to divide the smaller of the two aortic arches

7

What is the best way to diagnose morphologic cardiac anomalies?

echocardiogram

8

What type of congenital heart defect has a faint pulmonary flow systolic murmur and fixed split S2?

ASD

9

What is the most common outcome for small, restrictive VSDs low in the muscular septum?

spontaneous closure within 2-3 years of life

10

Where are most VSDs anatomically?

high in the membranous septum

11

What is the typical physical exam finding in VSDs?

pansystolic murmur at left sternal border

12

What do you see on CXR in a patient with a VSD?

increased pulmonary vascular markings?

13

When will a PDA become symptomatic?

in the first few days of life

14

What is the typical physical exam findings in PDA?

bounding peripheral pulses
"machinery-like" heart murmur

15

How can you achieve closure of a PDA in a premature infant?

indomethacin

16

What are the two options for closure of PDA in a baby who cannot be treated with indomethacin?

-Surgical division
-Radiological embolization with metal coils

17

What is the most common cyanotic congenital heart defect?

Tetralogy of Fallot

18

What will a child with Tetralogy of Fallot look like?

small
blue lips and fingers
clubbing
cyanosis spells relieved by squatting

19

What is the typical physical exam finding in Tetralogy of Fallot?

systolic ejection murmur in left 3rd intercostal space

20

What will an EKG in Tetralogy of Fallot show?

right ventricular hypertrophy

21

What allows a child with transposition of the great vessels to stay alive?

ASD
VSD
PDA

22

What do you think of with harsh midsystolic heart murmur at the right second intercostal space and along the left sternal border?

aortic stenosis

23

What are the surgical indications in aortic stenosis?

-Gradient >50 mmHg
-First indication of CHF, angina or syncope

24

What do you think of with a wide pulse pressure and blowing, high-pitched, diastolic heart murmur best heard at the second intercostal space and along the left lower sternal border?

chronic aortic insufficiency

25

When should you do a valvular replacement for chronic aortic insufficiency?

at first evidence on echo of LV dilatation

26

What do you suspect in a patient who suddenly develops a loud, diastolic murmur at hte right second intercostal space?

acute aortic insufficiency 2/2 endocarditis (drug user)

27

How do you treat acute aortic insufficiency?

emergency valve replacement and long-term abx

28

What should you suspect in a patient with DOE, orthopnea, cough and hemoptysis and a low-pitched, rumbling diastolic apical heart murmur?

mitral stenosis

29

What usually causes mitral stenosis?

rheumatic fever

30

What issue usually develops after mitral stenosis progresses over time?

a-fib