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Cardiovascular

Surgery

QuestionAnswer
Lower leg pain brought about by walking and relieved by rest. Arteriosclerotic disease of lower extremities
What is the workup of arteriosclerotic disease? Doppler to look for pressure gradient - no pressure gradient, then dz is in the small vessels and not ammenable to surgery - significant pressure gradient, CT angio or MRI angio is done to id the stenosis
What are the three most common sites for peripheral artery aneurysms? 1. popliteal artery 2. common iliac artery 3. femoral artery
1. What preop assessment would you use to evaluate a patient with known CAD? 2. If this exam is abnormal, what would you consider? 1. echo/dipyridimole stress test 2. preoperative revascularization
What is the benefit to retroperitoneal approach to abdominal aortic aneurysms as compared to transperitoneal? 1. Avoids formation of intra-abdominal adhesions 2. Does not interfere with GI/GI stoma 3. better tolerated in COPD patients
Severe flank pain, cardiovascular collapse. rupture AAA
Pharmacologic closure of a patent ductus arteriosus indomethacin
At what level of coronary artery stenosis is revascularization indicated? 70% or greater
1. How is single vessel coronary artery disease fixed? 2. Triple vessel? 1. angioplasty and stent 2. coronary bypass using the internal mammary
How much is normal cardiac output? 5L/min
If postoperative cardiac output is low. What should be measured to further investigate? 1. pulmonary wedge pressure should be measured 2. low PWP (0-3) suggests need for more IV fluids 3. high PWP (20+) suggests ventricular failure
What is the first thing to do if a CXR shows a coin lesion and cancer is suspected? find a previous CXR to compare
If a patient with a lesion on CXR does not have a previous X-ray to compare to, what is the initial workup? sputum cytology and CT scan
1. A baby with occasional signs of respiratory distress and difficulty swallowing. 2. What is used to confirm diagnosis? 1. Vascular ring 2. barium swallow, bronchoscopy
1. Baby went home after birth, and later was found to be cyanotic 2. Baby was blue from the moment of birth 1. Tetralogy of Fallot 2. Transposition of the great vessels
What indicates that a patient with aortic stenosis qualifies for surgical repair? 1. gradient of > 50 mm Hg on echo 2. congestive heart failure, angina or syncope
What indicates aortic valve replacement in patients with chronic aortic insufficiency? left ventricular dilation
What is the most commonly used predictor of postoperative pulmonary reserve for potential lung resection candidates? FEV1 > 800 ml of 60% predicted
Dissecting aortic aneurysm: 1. diagnosis 2. initial management 1. spiral CT 2. β-blockade
Patient with pain and numbness in arm and hand that is exacerbated by raising her arm over her head. thoracic outlet syndrome, resulting from compression of the brachial plexus or subclavian vessels in the anatomic pace bound by the first rib, clavicle and scalene muscles
Treatment for small cell lung cancer? - chemotherapy and radiation - it is rarely amenable to surgery b/c of extensive disease at presentation
Indications for aortic valve replacement in aortis stenosis. 1. congestive heart failure 2. angina 3. syncope
63 year old smoker with facial swelling, large dilated subcutaneous veins in upper chest and prominent jugular veins. superior vena cava syndrome from a bronchogenic carcinoma
How do you work up a coin lesion on CXR that is suspicious of cancer? 1. sputum cytology 2. CT
What is the first test in the workup of Peripheral Artery Disease? Ankle Brachial Index with doppler
1. Patient with recent MI now complains of severe abdominal pain. 2. Test to confirm 1. embolic occlusion of the superior mesenteric vessel 2. need mesenteric angiography
1. Patient with recent MI now has a painful, cold, paralytic lower extremity. 2. Treatment 1. arterial embolization 2. embolectomy with Fogarty cather and prophylactic fasciotomy
Where on the foot do the following typically occur: 1. Ischemic ulcer 2. Diabetic ulcer 1. dorsum 2. plantar aspect
Patient has flaccid paralysis and loss of pain sensation after AAA repair. Which artery is ischemic? Artery of Adamkiewicz
Infant with stridor and respiratory distress with difficulty swallowing. Vascular ring producing pressure on the tracheobronchial tree and esophagus
Muscular vs membraneous septal defects: 1. Closes spontaneously 2. associated with "failure to thrive" 1. muscular 2. membraneous
Equalization of heart chamber pressures on heart catheterization with square root sign on EKG. constrictive pericarditis
1. Patient with intermittent coldness, tingling in arm 2. Patient with intermittent coldness, tingling in arm with syncope. 1. thoracic outlet syndrome 2. Subclavian steal
How are the following aortic dissections managed: 1. ascending aorta 2. descending aorta 1. surgery 2. medical management with control of hypertension
Treatment for pulmonary edema 1. oxygen 2. furosemide 3. nitrate 4. morphine
Acute CHF management: LMNOP 1. Lasix 2. Morphine 3. Nitrates 4. Oxygen 5. Position (upright)
How does potassium effect digoxin levels? K+ and digoxin compete for myocardium binding sites 1. hyperkalemia decreases digoxin activity 2. hypokalemia increases digoxin toxicity
Patient with CHF presents with N/V, blurred vision. digoxin toxicity
How does digoxin toxicity effect potassium levels? leads to hyperkalemia b/c it inhibits the Na/K ATPase
Management of diastolic heart failure 1. diuretics 2. β-blocker
Management of chronic systolic heart failure 1. limit sodium and fluid intake 2. β-blocker 3. ACE/ARB 4. diuretics 5. spironolactone
Which leads do you use to evaluate bundle branch blocks? V1 and V6
1. Slurred upstroke of the QRS in an otherwise healthy patient you just "passed out" during exercise. 2. Treatment 1. Wolff-Parkinson-White syndrome 2. β-blocker
1. Pulsus paradoxus 2. Pulsus alternans 1. ↓ systolic BP with inspiration (tamponade, pneumothorax) 2. alternating weak and strong pulses (tamponade)
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