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Cardiovascular
Surgery
| Question | Answer |
|---|---|
| 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) |
Created by:
amichael@siumed.edu
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