Flashcards in Pestana Cardiothoracic/Vascular Deck (33):
How are morphological cardiac anomalies (ie. Tertalogy of Fallot) best diagnosed?
Atrial Septal Defects. What is often elicited on history? Direction of shunt? Characteristic sounds? Tests? Treatment?
Frequent colds. L-> R. Faint pulmonary systolic murmur and FIXED SPLIT SECOND HEART SOUND. Echocardiogram. Surgery or cardiac catherization.
A newborn presents with stridor and episodes of respiratory distress (the baby hyperextends and displays crowing respiration), as well as dysphagia? Tests? Tretment?
Vascular ring (double aortic arch with a vascular ring encircling the trachea and esophagus). Barium swallows. Surgical correction.
A newborn presents with stridor and episodes of respiratory distress (the baby hyperextends and displays crowing respiration)? Tests? Treatment?
Tracheomalacia (weak trachea). Bronchoscopy. Stenting.
Treatment for small ventricular septal defects low in the muscular septum?
Nothing, they will spontaneously close within the first three years.
What is the typical location of a ventricular septal defect? When do problems arive? Characteristic sounds (and where to listen)? Tests and signs? Treatment?
High in the membranous septum. Failure to thrive within the first few months. Loud pansystolic murmur (listen near left sternal border). Increased pulmonary vascular markings on Xray, do Echo. Surgical closure.
When does a patent ductus arteriosus present? Characteristic sounds and clinical findings? Tests? How can premature babies (without congestive heart failure) be treated? How are all other babies treated?
First few days of life. Bounding peripheral pulses and "machinery like" heart murmur. Indomethacin (NSAID). Surgical division or embolization.
A 5 year old child looks small for their age.You note clubbing, a bluish hue on their lip and fingers, and spells of cyanosis relieved by squatting? Characteristic sounds (and location)? Signs on Xray and EKG? Diagnostic test and treatment?
Tetralogy of Fallot. Systolic ejection murmur in left third intercostal space. Diminished pulmonary vascular markings and small heart on Xray, right ventricular hypertrophy signs on EKG. Preform ECHO to diagnose, surgical repair.
A 2 day old child looks cyanotic? Why must this be corrected immediately? Diagnostic test?
Transposition of the great vessels. An Atrial septal defect, ventricular septal defect, and/or patent ductus arteriosus is keeping them alive, if they close, the baby will die. Echo.
A patient presents with angina and exertional syncopal episodes. You hear a harsh midsystolic murmur over the right second intercostal space, as well as the left sternal border? What congential anomaly would you most likely find on Echo? Treatment?
Aortic stenosis. Bicuspid aortic valve. Valve replacement if symptomatic.
A patient presents with years of angina and exertional syncopal episodes. You hear a decrescendo blowing diastolic heart murmur over the right second intercostal space and the left lower sternal border during full expiration? Is pulse pressure decreased, increased or normal? What congential anomaly would you most likely find on Echo? Treatment?
Chronic aortic insufficiency. Widened pulse pressure. Bicuspid aortic valve. Valve replacement if left ventricular dilation occurs.
A 30 year old IV drug user develops symptoms of congestive heart failure? Cause? Characteristic sounds and where to listen? Tests? Treatment?
Acute aortic insufficiency. Bacterial endocarditis. Loud diastolic murmur at the right second intercostal space. Echo. Emergency valve replacement and antibiotics.
A patient presents with exertional dyspnea, orthopnea, and cough. He complains that he wakes up at night with shortness of breath. You notice a low pitched, rumbling diastolic apical heart murmur? What in his PMH would be suspected? What arrythmia can develop? Tests? Treatment?
Mitral stenosis. Rheumatic fever. Atrial fibrillation. Echo. Valvular repair - comissurotomy.
A patient presents with exertional dyspnea, orthopnea, and EKG has shown bouts of atrial fibrillation. You hear an apical, high pitched, holosystolic heart murmur? Where does the murmur radiate? Cause of the murmur? Tests? Treatment?
Mitral regurgitation. Back and axilla. Mitral prolapse. Echo. Annuloplasty (not replacement).
A 60 year old man presents with progressive, unstable, disabling angina. He has PMH of smoking, type 2 diabetes, and hypercholesterolemia. You take him to the cath lab, when is intervention necessary? Treatment for single vessel disease? Treatment for multiple vessel disease?
70% stenosis or greater of a coronary vessel. Angioplasty and stent. Coronary artery bypass graft (CABG).
A patient on post op day 2 from CABG is not producing adequate urine and has a PCWP of 3? Treatment?
A patient presents with exertional dyspnea, hepatomegaly, and ascites. When looking on his pressure contour, you note a "square root sign?" What will be charactersitic about his diastolic pressures? Treatment?
Chronic constrictive pericarditis. Right atrial, ventricular, pulmonary arterial, PCWP, and left ventricular diastolic pressures will be equal. Surgical therapy.
A 60 year old smoker presents with coughing and hemoptysis. On CXR you note a coin lesion in his right lung? What do you do first? If that doesn't work, what do you do next?
Seek an old CXR - see if the lesion has always been there! Sputum cytology and chest/abdominal CT Scans.
A patient presents with coughing and hemoptysis. CXR reveals a new coin lesion. Cytology and CT are inconclusive. Test for central lesion? Test for peripheral lesion? If those tests are inconclusive, then what do you do?
Bronchoscopy and and biopsies. Percutaneous biopsy. Video assisted thoracic surgeyr with wedge resection.
Treatment of small cell lung cancer?
Chemoradiation. They are not surgical candidates.
How to determine if a patient with non small cell lung cancer can be operated on? If not a surgical candidate, treatment?
Determine FEV1, the fraction that comes out of each lung ( by V/Q scan), and see what the FEV1 would be after resection. A minimum of 800ml is required. Chemoradiation.
Difference in surgical treatment between central and peripheral lung cancers?
Pneumonectomy (and removal of hilar nodes if necessary) vs. lumpectomy.
Which thoracic nodes can not be curatively resected surgically in metastatic lung cancer? Test for lung metastasis?
Carinal or mediastinal nodes. CT scan.
A man complains of coldness, tingling, and muscle pain in his arms, along with dizziness and vertigo when he goes to the gym? Cause? Tests? Treatment?
Subclavian steal syndrome. Ateriosclerotic plaque at the origin of the vertebral, during high metabolic demands, the arm steals blood from the vertebral away from the brain. Duplex scanning shows reversal of flow. Bypass surgery.
AAA are typically asymptomatic...until they rupture and kill you of course. What signs exist before that though? When should surgery be preformed?
Pulsatile abdominal mass on PE, and widened mediastinum on CT. If aneurysm is >5cm or grows >1cm per year, elective surgery is required. Percutaneous endovascular stenting.
A patient presents with excruciating back pain and is beginning to look SHOCKY but denies trauma. What would CT reveal? Treatment?
A widened mediastinum with an AAA >5cm. Emergency surgery.
A smoker complains of leg pain while walking, that quickly resolves once he rests? Tests? Medical therapy?
Intermittent claudication from arteriosclerotic occlusive disease. Doppler studies - look for pressure gradient. Cilostazol (phosphodiesterase inhibitor).
A smoker complains of leg pain that is painful while walking and resting, it even wakes him from sleep. PE reveals a shiny atrophic, hairless legs with absent dorsalis pedis pulses. Tests? Treatment (depending on location)?
Rest pain from arteriosclerotic occlusive disease. Doppler studies - look for pressure gradient. CT angio or MRI angio. Bypass graft: Proximal (Dacron graft) Distal (reversed saphenous vein graft).
What is the typical PMH for a patient that develops an arterial embolization?
Recent MI (mural thrombus) or atrial fibrillation (clot from atrial appendage)
What are the 6 P's for the presentation of arterial embolization?
Painful, pale, poikilothermic (cold), pulseless, paresthetic, and paralytic - lower extremity.
Tests for a patient with arterial embolization? Treatment (early and late)? Complications?
Doppler studies. Clot Busters, Embolectomy with Fogarty catheter. Compartment syndrome if it has been hours between symptoms and revascularization.
A patient presents with sudden onset of extremely severe tearing chest pain that radiates to the back and migrates down. Unequal pulses exist between the upper extremities? What tests rule out MI? Diagnostic test? Treatment?
Dissecting aneurysm of the thoracic aorta. EKG normal and normal Troponins. Spiral CT scan. Surgical intervention.