ST chapter 22 Cardiothoracic Surgery

Davidson Scapula Retractor

Which instrument has the appearance of a misshapen pancake spatula?

a. Allison lung retractor

b. Bailey rib contractor

c. Davidson scapula retractor

d. Lovelace lung grasping forceps

Seven

How many ribs are considered "true" ribs with direct connection to the sternum with costal cartilage?

a. three

b. seven

c. nine

d. twelve

Removal of foreign body in children

For which of the following procedures would the rigid bronchoscope be preferred?

a. visualization of the upper lobe bronchi

b. removal of foreign body in children

c. transbronchial lung biopsy

d. bronchial washings

Friable

Lung tissue has what kind of consistency?

a. friable

b. slimy

c. calcified

d. elastic

Phrenic

Which nerve could be damaged during lung decortication resulting in paralysis or partial paralysis of the diaphragm?

a. accessory

b. hypoglossal

c. phrenic

d. vagus

Bronchoscopy

In which procedure would an incision NOT be required for insertion of the endoscope

a. bronchoscopy

b. mediastinoscopy

c. pectus excavatum via VATS

d. video-assisted thoracic surgery

Larynx

Which structure within the respiratory tract is the proximal and superior?

a. bronchus

b. diaphragm

c. larynx

d. trachea

Alveoli

Which of the following are the final branchings of the respiratory tree?

a. alveoli

b. bronchi

c. bronchioles

d. loves of the lung

Sternum

The manubrium, body, and xiphoid process are portions of the:

a. ribs

b. lungs

c. sternum

d. bronchial tree

Diaphragm

All of the following structures are found within the mediastinum EXCEPT:

a. heart

b. thymus

c. esophagus

d. diaphragm

Visceral Pleura

Which membrane covers the surface of the lungs?

a. ciliated mucosa

b. pericardium

c. parietal pleura

d. visceral pleura

Hemoptysis

What is the medical term for coughing up blood?

a. asthma

b. bronchitis

c. hemoptysis

d. pneumonitis

Three

How many lobes are in the right lung?

a. two

b. three

c. four

d. five

Alveoli

In which part of the respiratory system does the exchange of oxygen and carbon dioxide take place?

a. alveoli

b. bronchi

c. bronchioles

d. pulmonary vein

Right ventricle, pulmonary artery, lungs, pulmonary vein, left atruim

Which of the following regarding blood flow is correct?

a. right atrium, pulmonary vein, lungs, pulmonary artery, left ventricle.

b. right ventricle, pulmonary vein, lungs, pulmonary artery, left atrium.

c. right atrium, pulmonary artery, lungs, pulmonary vein, left ventricle.

d. right ventricle, pulmonary artery, lungs, pulmonary vein, left atrium.

Lukens Tube

What is the name of the device that is attached to suction for collection of mucous or bronchial washing specimens?

a. aerobic culture tube

b. insufflation tubing

c. myringotomy tube

d. Lukens tube

Infiltrate

What is the medical term for visible changes in density on the chest x-ray that indicates pulmonary pathology?

a. hemoptysis

b. hilum

c. infiltrate

d. inspiration

Mediastinoscopy

Thymomas, neurogenic tumors, and pleuropericardial cysts can be biopsied during which procedure?

a. bronchoscopy

b. laryngoscopy

c. mediastinoscopy

d. thoracoscopy

Suprasternal Notch

Where is the insertion point for the mediastinoscope?

a. suprasternal notch

b. oropharynx

c. subxiphoid

d. umbilicus

Bleb

What is the name of an air filled sac that has the appearance of a blister on the surface of lung tissue?

a. alveolar sac

b. bleb

c. bronchiole

d. germ cell

Thoracotomy

In the event that a VATS procedure has been converted to an open procedure, which open case can be performed?

a. coronary artery bypass

b. laparoscopy

c. thoracotomoy

d. thracheotomy

Chest tube attached to a Pleur-evac system

Which of the following will be required upon completion of any procedure in which the pleural cavity has been opened?

a. passive wound drain such as a Penrose

b. chest tube attached to a Pleur-evac system

c. active wound drain such as a Jackson -Pratt

d. compression dressing with Ace or tensor bandages

Eqidural

Which additional pain control measure is taken for patients undergoing pectus excavatum repair by VATS?

a. Bier block

b. epidural

c. local with epinephrine

d. topical Lidocaine jelly

Lung Decortication

What is the name of the procedure performed to release constriction of the lungs by fibrin layers?

a. pectus excavatum

b. upper lobectomy

c. pneumonectomy

d. lung decortication

Empyema

The name of the condition created when pus is not cleared from the pleural cavity and makes a fibrous constrictive layer is:

a. COPD

b. pleurisy

c. empyema

d. pneumonia

Air leakage from bronchial closure

Prior to closure of a lobectomy procedure, the anesthesia provider performs a Valsava maneuver to check for:

a. air leakage from bronchial closure

b. bleeding from the dissection bed

c. functionality of the diaphragm

d. perfusion of the unaffected lobes

Atelectasis

What is the term for a collapsed lung?

a. atelectasis

b. decortication

c. emphysema

d. pneumonitis

Posterolateral

Which type of incision is made for a pneumonectomy?

a. Chevron

b. McBurney

c. epigastric

d. posterolateral

Sarot

Which of the following is a crushing clamp with sharp spikes in the jaw used on the bronchus?

a. Bailey

b. Doyen

c. Mixter

d. sarot

Bethune

Which instrument is a rib shear?

a. Alexander

b. Bethune

c. Davidson

d. Satinsky

Finochietto

What is a commonly used rib self retain retractor available in adult and pediatric sizes?

a. Balfour

b. Bookwalter

c. Finochietto

d. Greenburg

Lovelace

Which instrument is a lung-grasping forceps that resembles a very large Pennington?

a. Doyen

b. Duckbill

c. Lovelace

d. Langenbeck

Pulmonary thromboendartectomy

Which of the following thoracic procedures would require the patient to be put on cardiopulmonary bypass?

a. pneumonectomy

b. upper lobectomy

c. decortication of the lung

d. pulmonary thromboendartectomy

Bronchoscopy

Following lung transplantation, the surgeon will perform which procedure to aspirate secretions and check for leaks?

a. bronchoscopy

b. laryngoscopy

c. mediastinoscopy

d. video-assisted throracoscopy

Hilum

The main bronchi, pulmonary arteries, veins, and lymphatic vessels enter the lung on the medial surface through the:

a. hilum

b. trachea

c. diaphragm

d. mediastinum

four

How many pulmonary veins are there?

a. one

b. two

c. three

d. four

CT scan

Which diagnostic study is MOST useful for verification of thoracic aortic dissection?

a. AP chest x-ray

b. CT scan

c. MRI scan

d. stress test

It is positioned in the mediastinum with approximately 2/3 of the heart of the left side

Which statement regarding the anatomical placement of the heart is correct?

a. It is positioned exactly midline in the thoracic cavity.

b. It is positioned in the thoracic cavity with nearly its entirety on the left side.

c. It is positioned in the mediastinum with approximately 2/3 of the heart on the left side.

d. It is positioned in the mediastinum with approximately 2/3 of the heart on the right side.

SA node

Which structure is considered the "pacemaker" of the heart?

a. AV node

b. SA node

c. bundle of His

d. Purkinje fibers

Right Ventricle

Which chamber of the heart is responsible for pumping blood into the pulmonary artery?

a. left atrium

b. right atrium

c. left ventricle

d. right ventricle

Left Ventricle

Which portion of the heart is responsible for pumping blood into the ascending aorta?

a. left atrium

b. right atrium

c. left ventricle

d. right ventricle

Ascending aorta

The coronary arteries originate from the:

a. ascending aorta

b. descending aorta

c. pulmonary artery

d. subclavian artery

Pleural space

What is the name of the area between the visceral and parietal pleura that contains serous fluid to prevent friction?

a. hilum

b. mediastinum

c. pleural space

d. pericardial window

Myocardium

What is the thickest part of the heart?

a. epicardium

b. endocardium

c. myocardium

d. pericardium

Inferiorly on the left side

Where is the apex of the heart located within the mediastinum?

a. superiorly on the right side

b. inferiorly on the right side

c. superiorly on the left side

d. inferiorly on the left side

Septal

Which one of the following is NOT one of the cardiac valves?

a. aortic

b. mitral

c. septal

d. tricuspid

Mitral

Which heart valve is also known as the bicuspid valve?

a. aortic

b. mitral

c. pulmonary

d. tricuspid

Superiorly and just below the clavicle

The apex of the lung is located:

a. inferiorly and laterally

b. medially where the bronchus enters

c. medially just above the diaphragm

d. superiorly and just below the clavicle

Defibrillator

All of the following are components of the "heart lung" machine except:

a. pump

b. oxygenator

c. defibrillator

d. heat exchanger

Right atrium and ascending aorta

Where are the cannula MOST commonly placed for cardiopulmonary bypass procedures?

a. carotid artery and subclavian vein

b. right atrium and ascending aorta

c. right ventricle and descending aorta

d. femoral artery and brachiocephalic vein

Hypothermia

Which of the following is commonly used method of preserving the heart by reducing its metabolic needs?

a. hypothermia

b. lung deflation

c. left ventricular venting

d. warning with heart exchange

Purse-String

Which suturing technique maintains the aortic and velour cannulae?

a. figure of eight

b. purse-string

c. horizontal mattress

d. vertical mattress

Medulla Oblongata

The force and rate of contraction of the heart is controlled by which part of the central nervous system?

a. phrenic nerve

b. vagus nerve

c. Purkinje system

d. medulla oblongata

Injury to endothelial lining

What is the first step in the formation of an atheroma?

a. accumulation of cholesterol and lipids

b. collagen deposition and scar tissue formation

c. growth of new smooth muscle tissue

d. injury to endothelial lining

Ischema

Which of the following is the main underlying pathological cause of coronary atherosclerosis?

a. age

b. diet

c. ischemia

d. hypertension

Left anterior descending

Which artery accounts for approximately 50% of occlusive coronary lesions?

a. circumflex branch

b. left anterior descending

c. mammary

d. right coronary

Myocardial Infarction

What is the name of the acute condition in which heart muscle dies from ischemia and may lead to sudden cardiac death?

a. heart block

b. atherosclerosis

c. cardiac tamponade

d. myocardial infarction

Pulmonary Artery

Where is the Swanz-Ganz catheter placed?

a. ascending aorta

b. coronary artery

c. pulmonary artery

d. vena cava

6-0 or 7-0 polypropylene

Which suture is frequently used for anastomosis of the saphenous vein or internal mammary artery in CABG?

a. 6-0 or 7-0 polypropylene

b. 2-0 or 3-0 polyester

c. 6-0 or 7-0 polyglactin

d. 2-0 or 3-0 poliglecaprone

Aortic Punch

Which instrument is used to make a small opening into the ascending aorta after the stinky partial occlusion clamp is placed?

a. aortic punch

b. Potts-Smith scissors

c. #11 blade

d. 5 mm trocar

Heavy gauge stainless steel wire

With what is the median sternotomy closed?

a. fine gauge polypropylene

b. fine gauge surgical silk

c. heavy gauge stainless steel wire

d. heavy gauge chromic gut

Stabilizers

Medatronic OCTOPUS and Guidant Ultima OPCAB are what type of devices for coronary artery bypass done off pump?

a. retractors

b. stabilizers

c. cannulae

d. grafts

Intra-aortic balloon pump

What is the name of the device used for patients who are unable to be weaned off of cardiopulmonary bypass?

a. intra-aortic balloon pump

b. left ventricular vent

c. cardiac pacemaker

d. vena cava filter

Ventricular assist device

Which device is used for patients awaiting heart transplant that allows them to be ambulatory and has both internal and external components to the system?

a. ventricular assist device

b. left ventricular vent

c. cardiac pacemaker

d. vena cava filter

Cardiomyopathies

What is the general term for incurable diseases of the heart for which the only treatment would be heart transplantation?

a. atherosclerosis

b. arrhythmias

c. cardioplegia

d. cardiomyopathies

Rheumatic fever

Aortic valve stenosis and aortic regurgitation are often a result of:

a. rheumatic fever

b. tuberculosis

c. heart block

d. angina

Cardiac Catheterization

Which diagnostic method provides the MOST extensive details regarding valvular disorders?

a. cardiac catheterization

b. CT scanning

c. electromyography

d. MRI scanning

Mitral Valves

A heart murmur is often heart with auscultation and indicative of involvement of which structure?

a. aortic valve

b. mitral valve

c. right ventricle

d. left ventricle

10 to 15 years

What is the average lifespan of biologic and mechanical heart valve replacements?

a. 1 to 5 years

b. 5 to 10 years

c. 10 to 15 years

d. indefinite

Coarctation

What is the term for a localized stricture of the aorta found in a pediatric patient?

a. coarctation

b. stenosis

c. prolapsed

d. arteriosis

Patent ductus arteriosus

Which singular congenital defect involves failure of closure of the connection between the pulmonary artery and aorta?

a. atrial septal defect

b. ventriculo septal defect

c. patent ductus arteriosus

d. tetralogy of Fallot

Dacron Patch

What is frequently used to repair atrial and ventricular septal defects in pediatric patients?

a. Dacron patch

b. porcine valve

c. fascia lata

d. fibrin glue

Tetralogy of Fallot

Which congenital defect has four components and is characterized by cyanosis causing appearance of "blue babies

a. coarctation of the aorta

b. patent ductus arteriosus

c. ventricular septal defect

d. tetralogy of Fallot

Posterolateral

Which surgical approach is used for repair of coarctation of the aorta and patent ductus arteriosus?

a. supine

b. prone

c. frog-legged

d. posterolateral

Mitral Valve

Commissurotomy is a surgical separation of the flaps of the:

a. mitral valve

b. left ventricle

c. pulmonary valve

d. right atrium