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Flashcards in Pestana Cardiothoracic surgery Deck (28)
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1

Infant with stridor and episodes of respiratory distress also have difficulty taking in milk

think vascular ring, which places pressure around the trachea and esophagus

2

diagnosis and management of an infant with a suspected vascular ring

barium swallow (shows extrinsic tracheal compression) surgery to correct the two aortic arches

3

diagnosis and management of ASD

diagnosis: echo mgmt: surgical closure or cardiac cath

4

diagnosis and management of VSD

diagnosis: echo mgmt: surgical closure or cardiac cath

5

diagnosis and management of PDA

diagnosis: echo mgmt: indomethacin or surgical closure/embolization with coils if it does not close with medical management

6

diagnosis and management of tetralogy of fallot

diagnosis: echo mgmt: surgical repair

7

diagnosis and management of ToGA

diagnosis: echo mgmt: surgical repair

8

How do patients with tetralogy of fallot present? (6)

  1. 5-6 year olds who are small for their age
  2. bluish hue in the lips or finger tips +/- clubbing
  3. cyanotic spells relieved by squatting
  4. systolic murmur
  5. CXR reveals small heart with diminished pulmonary vascular markings
  6. EKG reveals RVH

9

What keeps patients with ToGA alive?

ASD, VSD, PDA, or a combination of these

10

diagnosis and management of aortic stenosis

diagnosis: echo mgmt: valve replacement when echo demonstrates a transvalvular gradient >50mmHg or if there is CHF, angina, or syncope

11

diagnosis and management(3)  of aortic insufficiency

diagnosis: echo

mgmt: medical therapy but [surgical commissurotomy] vs. [balloon valvuloplasty] when echo shows LV dilation

12

Acute aortic insufficiency occurs in which patient population? How should these patients be managed?

young drug addicts mgmt: emergency valve replacement and long-term antibiotics

13

patients with prosthetic valves will require abx. Why?

antibiotic prophylaxis for subacute bacterial endocarditis (ie when undergoing dental procedures)

14

diagnosis and management of mitral regurgitation

diagnosis: echo mgmt: surgical annuloplasty

15

What is the primary indication to do cardiac catheterization in a patient with CAD (3)

progressive, unstable, or disabling angina

16

how is a patient with single vessel CAD managed?

angioplasty and stent

17

how is a patient with triple vessel CAD managed?

coronary bypass (using the internal mammary as graft)

18

presentation of a patient with chronic constrictive pericarditis (3)

  1. dyspnea on exertion (rigid pericardium = impaired diastolic filling)
  2. hepatomeagly + ascites cardiac cath shows
  3. classic square root sign (occurs when diastolic filling suddenly stops because the fibrous pericardium has reached its maximum distensibility)

19

management of a patient with chronic constrictive pericarditis 2

diuretics (removes excess fluid from body) pericardiectomy - surgical removal of part or most of the scarred pericardium

20

first thing to do when a coin lesion is noted on a CXR

look for a previous, older CXR to see if the lesion has changed over time if it hasn't changed, it is unlikely to be cancer

21

next best step in management of a patient with suspected lung cancer (ie coin lesion has grown over time as visible on x-ray, hemoptysis, persistent cough) (2)

sputum cytology and CT scan (chest + liver)

22

How do you make the diagnosis in a patient with suspected lung cancer (ie coin lesion has grown over time as visible on x-ray, hemoptysis, persistent cough, (+) sputum culture, (+) CT scan)

bronchoscopy with biopsy for central lesions percutaneous biopsy for peripheral lesions

23

how is SOLC managed? (2)

chemoRx and radiation Rx

24

how is Non-SOLC managed?

surgery

25

How are central vs peripheral cancerous lesions of the lung managed surgically?

central: pneumonectomy peripheral: lobectomy

26

BEFORE removing a cancerous lesion of the lung, what must you do?

determine residual function of the lung b4 resection via PFTs (esp FEV1) and VQ scan

27

what is the magical FEV1 number that will determine if a candidate is suitable for lung resection?

FEV1 > 800mL

28

Common Causes of [Constrictive Pericarditis] (4)

'Ur an Idiot to constrict my Radio & T-V"

Idiopathic(includes previous cardiac surgery)

Radiation

TB

Viral