外科：心外

34 flashcards · Other · by Wanying Koh

1. ECMO // CPB open or closed circulation

   ECMO: closed (密閉) CPB: open (C <-> O)

2. type B aortic dissection + persistent pain for 3 weeks dx? tx?

   dx: chronic complicated type B aortic dissection tx: surgery needed

3. descending aortic dissection 時, CXR 會顯示 tracheal deviation to which side?

   tracheal deviation to the right

4. most common cause of abdominal aneurysm

   arterosclerosis

5. post-MI + cardiogenic shock + pulm. edema + apex systolic murmur 1) dx 2) surgical tx

   1) post-MI MVP prolapse / MV regurgitation 2) IABP ---> emergency repair of valve

6. post-MI VSD" what type of murmur + location

   systolic murmur with thrills at L lower sternal border

7. off pump CABG, transmyocardial laser revascularization, cardioplegic arrest CABG, minimally invasive CABG 哪個效果最差

   TMLR

8. risk factors of mortality after CABG

   female renal failure CHF poor LV function DM 3 vessel / 2 vessel disease LMCA stenosis prior heart surgery emergent OP (NOT a risk factor: obesity)

9. CHD: which cannot be treated by insertion of occluder / coil using endoscopy? PDA muscular type VSD ASD endocardial cushion defect complete type

   endocardial cushion defect complete type (need to fix atria, ventricles, valves 無法單純塞住)

10. which type of ASD can be treated using endoscopy 心導管 sinus venousus ostium secondum ostrium primum coronary sinus

    ostium secondum only

11. ebstein anomaly is most commonly associated with what defect

    ASD (會 R to L flow --> R atrium 血多)

12. type of VSD most assocated with aortic valve prolapse / atresia? subarterial perimembranous muscular inlet malalignment

    subarterial

13. biological or mechanical valve: old age patients pregnant pts 血友病 pts children hemodialysis pts

    biological biological biological mechanical biological

14. valve repair vs. valve replacement survival rate complications

    survival: repair > replacement complications: repair > replacement (contradictory -- 所以還未知)

15. Ross procedure: aortic valve replacement using what graft pulm. vavle replacement using what graft

    autograft (自己身體的 pulm. valve) homograft (別人的 pulm. vavle)

16. 服用 warfarin // heparin 各個要測量什麼

    warfarin -- prothrombin time heparin -- aPTT

17. diastolic murmur at apex

    mitral valve stenosis (SSS SID AVIS AVSD, // 2'2'A6' PAMT)

18. surgical indication for aortic vavle regurgitation

    symptomatic LV end diastolic dimension > 70mmHg LV end systolic dimension > 55mmHg LVEF <50%

19. treatment of DVT

    start warfarin with unfractionated heparin until INR 2-3 IV bolus 80 U/kg unfractionated heparin -----> 18 U/kg/h stop heparin 12-24hrs prior to surgery

20. ABI at R. femoral a. poorer than L. femoral a. highest occlusion at which area?

    iliac a. (PAOD 的 aortoiliac occlusive disease)

21. chronic occlusive disease tx 不能用 surgical bypass grafting embolectomy/thrombectomy endarterectomy

    embolectomy -- only for acute occlusive disease

22. pain, pulseless, pallor in R limb underlying dz: HTN, smoking Dx?

    acute thromboembolism 6Ps (pain, pulseless, pallor, paresthesia, paralysis, poikilothermia)

23. post-heart transplant

    SBP: higher than normal people HR: post-exercise lower than normal people, at rest higher than normal people (no vagus n. // SNS control) SV: not affected

24. post-heart surgery, low BP 80/60 HR 130 tx?

    heart 無法有效收縮 tx: inotropes 強心劑 dopamine, bosmin to increase heart contractility (correct contraction)

25. CPB 造成的 hemorrhage 可能原因有

    殘留 heparin --> anticoagulant CPB damaged platelets --> blood cant coagulate 出血點 沒查到 in op (CPB caused hemolysis wont cause continuous bleeding--> 會 eventually AKI)

26. symptoms of low cardiac output syndrome

    tachycardia, hypotension, increased capillary refill time, decreased peripheral pulses, cool extremities, decreased urine output

27. Extracorporeal perfusion 體外循環技術 is time limited? complications

    yes, time limited as heparin use is necessary --> may cause complications as body is 抗凝血狀態 ICH, infection, electrolyte imbalance, 血球地下

28. post-MI new systolic murmur after 1 week cardiogenic shock: s/s: low BP, high PAH (so not due to 心肌收縮不良) 4. inc. CVP: due to R heart 功能不好 / 血液跑到 R heart Dx: Tx:

    Dx: post-MI cardiac rupture 的 VSD Tx: IABP - for cardiogenic shock, 切除necrotic tissue, repair hole

29. valve anatomy - number of valves tricuspid mitral aortic pulmonary

    tricuspid - 3 (A, P, septal) mitral - 2 (A, P) aortic - 3 (R, L, post.) pulmonary - (R, L, ant.)

30. Koch triangle located at which heart function

    R heart AVRT, AVNRT 電燒治療時的定位點 tricuspid vavle repair/replacement 必須縫合之處

31. Debakey type II aortic dissection involvement of what

    only ascending aorta (types I, II, III: 701)

32. 停跳 (on pump) vs 不停跳 (off pump) indications

    停跳 (on pump): unstable hemodynamics, 狀況差 不停跳 (off pump): 其他比如 poor renal fnt, pulm. emphysema pts

33. total artificial heart & LV 輔助器 (HeartMate II, HeartWare) functions

    bridge to transplant destination therapy (severe HF 終極治療 -- 如果沒有 available transplant)

34. may thurner syndrome

    R common iliac a. 壓迫 L common iliac v. causes recurrent DVT