Cardiothoracic Surgery

Front 1

What is an empyema

Back 1

accumulation of pus in the pleural cavity.

Front 2

At what point should thoracotomy with decortication (versus drainage) be used to remove purulent fluid and pleural rind in an empyema?

Back 2

When the empyema is in the most advanced stage of chronic organizing phase. In this phase, the fluid collection is loculated and depositions of fibrin create a thick pleural rind, which prevents apposition of the lung to the parietal pleura.

Front 3

What is the most common cause of Superior Vena Cava syndrome?

Back 3

90% of the time is due to malignancy (75% of time due to bronchogenic carcinoma, second most common is lymphoma).

Front 4

What are the signs/symptoms of superior vena cava syndrome?

Back 4

edema of the upper body, cyanosis, dilated subcutaneous collateral vessels in the chest, headache.

Front 5

What is the initial management of Superior Vena Cava syndrome?

Back 5

for malignancies, radiation and chemotherapy, if applicable. in severe life-threatening complications surgical intervention or thrombolysis may be warranted.

Front 6

What is the treatment for iatrogenic esophageal perforation?

Back 6

its a surgical catastrophe requiring aggressive intervention in virtually all circumstances. If patient has no underlying esophageal disorder, fix the perf and drain the mediastinum. if motility disorder or cancer exists, perf and disorder must be addressed. in esoph cancer, usually esophagectomy.

Front 7

What is the initial treatment of a lung abscess?

Back 7

abx directed at the most likely organism. Usually abx are required over a longer term. If abscess doesn't resolve, percutaneous or surgical drainage or resection might be requried.

Front 8

What is the initial treatment for a descending aortic dissection?

Back 8

reduction in the change in blood pressure over time (dP/dT) with beta blockade.

Front 9

What are the indications for operative intervention in a descending aortic dissection?

Back 9

end organ failure(renal failure, lower extremity ischemia, intestinal ischemia), inadequate pain releif despite optimal medical therapy, and rupture or signs of impending rupture (increasing diameter or periaortic fluid).

Front 10

What does the finding of prolonged high-amplitude contractions in the body of the esophagus in a highly symptomatic patient suggest?

Back 10

DES (diffuse esophageal spasm).

Front 11

What is the treatment of DES (diffuse esophageal spasm)?

Back 11

long myotomy guided by manometric evidence. More than 90% of patients treated in this fashion will experience acceptable relief of symptoms if myotomy is performed correctly.

Front 12

What are the symptoms of diffuse esophageal spasm?

Back 12

spontaneous chest pain that radiates to the back, ears, neck, jaw, or arms.

Front 13

What is the classic finding on esophageal contrast study?

Back 13

"corkscrew espohagus"

Front 14

What occurs usually in a spontaneous pneumothorax? In whom do they usually occur?

Back 14

usually results from the rupture of subpleural blebs in young men (age 20 to 40), which is often signaled by a sudden onset of chest and shoulder pain.

Front 15

What is the treatment of a spontaneous pneumothorax?

Back 15

chest tube thoracostomy. in recurrent cases, thoracotomy with bleb excision and pleural abrasion. if pneumotherax is small, it may be monitored.

Front 16

What is Boerhaave's syndrome? How can it be diagnosed?

Back 16

spontaneous rupture of the esophagus. diagnosed by the presence of air in the mediastinum after an episode of vomiting and retching is virtually pathognomonic. Radiographic studies confirm diagnosis adn define location of perf. Esophagogram w/ water-soluble contrast is the initial test of choice.

Front 17

How is Boerhaave's syndrome managed?

Back 17

if leak is contained and patient does not have symptoms of sepsis, can be managed expectantly w/ abx. If pt. has systemic signs, surgical therapy is warranted.

Front 18

In what percentage of patients with chest trauma does significant pump failure occur?

Back 18

less than 5%.

Front 19

How is myocardial contusion managed?

Back 19

usually supportively, directed at inotropic support of the ventricle. other support may be warrented, but is different from patient to patient.

Front 20

What should be suspected after CABG when the mediastinal chest tube clots, followed by hemodynamic decompensation w/ decreased mean arterial pressures and cardiac output w/ increasing filling pressures?

Back 20

cardiac tamponade

Front 21

How is intraoperative recognition of a thoracic duct injury treated?

Back 21

ligation of the duct

Front 22

If a thoracic duct injury occurs during intrathoracic surgery and is not recognized until several days postoperatively, how is it treated?

Back 22

They frequently heal following the institution of a low-fat diet and either repeated thoracentesis or tube thoracostomy drainage. a low-fat, medium chain triglyceride diet often reduces the flow of chyle.

Front 23

What is the most common benign cardiac tumor?

Back 23

myxoma

Front 24

What are the signs/symptoms of cardiac myxoma? treatment?

Back 24

sx include valvular obstruction (mitral or tricuspid) or embolization systemically. often attached by a pedicle to the fossa ovalis of the left atrial septum. Treatment is resection.