Lecture 13 highlights

Question 1

What are the 2 main types of arterial disease? What is the most common cause of these?

Answer 1

Occlusive & aneurysmal
Atherosclerosis is responsible for majority of arterial occlusive disease

Question 2

What 2 things should be used to Dx carotid artery disease?

Answer 2

duplex ultrasonography & axial imaging

Question 3

What is Indicated for patients with symptomatic lesions (TIA or stroke) producing > 50% stenosis?

Answer 3

Carotid endarterectomy (CEA)

Question 4

What needs to be done after Carotid angioplasty and stenting (CAS)?

Answer 4

Clopidogrel for at least 30 days

Question 5

What are the 2 methods of revascularization w arterial occlusive disease?

Answer 5

Bypass grafting (traditional )
Endovascular angioplasty + stenting (alternative)

Question 6

Define pseudoaneurysm

Answer 6

disruption of artery wall; not all layers

Question 7

What is most concerning complication (persistent perfusion of the aneurysm) of EVAR for AAA?

Answer 7

Endoleak (esp types 1 and 3)

Question 8

What is standard to Dx thoracic aortic dissections?

Answer 8

CT angio (MRI angio if repeat)

Question 9

What are the 2 main classification systems for thoracic aortic dissections?

Answer 9

DeBakey (location & extent) & Stanford (location only)

Question 10

When should emergency surgery be done for thoracic aortic dissections?

Answer 10

Type A dissections

Question 11

Thoracic outlet syndrome: Descr Tx

Answer 11

1) Surgical thoracic outlet decompression (first rib resection and anterior scalene muscle excised)
reserved for neurogenic TOS not responsive to conservative treatment (posture + PT)
2) Surgical thoracic outlet decompression + arterial reconstruction for symptomatic arterial stenoses
3) Catheter-directed thrombolysis of venous occlusion  thoracic outlet decompression + venous reconstruction or angioplasty for effort thrombosis of subclavian vein

Question 12

1) What is the MC benign lung lesion?
2) MC finding?
3) What do you do if central lesion?

Answer 12

1) Hamartoma
2) Incidental
3) Bronchoscopy

Question 13

Differentiate exudative vs transudative Pleural effusion causes

Answer 13

Exudative: pleural or lymphatic disease (~50% due to neoplastic process)
Transudative: increased production or decreased absorption of pleural fluid (usually due to CHF)

Question 14

Name a cause of hydrothorax

Answer 14

Malignancy

Question 15

Empyema (pyothorax):
1) What are 2 causes?
2) What is a good Tx for all causes?

Answer 15

1) Parapneumonic empyema, staph aureus
2) Antibiotics

Question 16

Hemothorax: How are most cases treated?

Answer 16

Most treated effectively with large bore (28-36 F) closed chest tube drainage

Question 17

Chylothorax:
1) Initial Tx?
2) Surgical option?

Answer 17

1) closed chest tube drainage, lung re-expansion, & low-fat diet (milky-white drainage)
2) VATS

Question 18

Pneumothorax: When is it a surgical emergency?

Answer 18

Tension and open pneumothoraces

Question 19

Spontaneous pneumothorax (SP):
1) Differentiate primary and secondary
2) Standard test for Dx?

Answer 19

1) Primary SP: young pts with blebs & otherwise normal lungs
Secondary SP: pts with significant structural lung disease (mostly due to COPD with bleb rupture)
>Ex. Scuba diver, jet pilots, Marfan syndrome
2) PA and lateral CX

Question 20

What is gold standard for tx of Spontaneous pneumothorax (SP)?

Answer 20

Chest tube

Question 21

What is used to check placement of chest tubes?

Answer 21

CXR

Question 22

Most common primary malignant tumor of pleura is malignant ___________ and _________ is a common cause

Answer 22

mesothelioma; asbestos exposure

Question 23

Chamberlain procedure uses what?

Answer 23

Mediastinoscopy

Question 24

What is the more current, minimally-invasive option for pectus excavatum?

Answer 24

Nuss procedure