Free Cardiothoracic Surgery Practice Questions

Question 1

Separation from cardiopulmonary bypass after repair of P2 prolapse is followed by hypotension. Transesophageal echocardiography shows a small, hyperdynamic left ventricle, anterior mitral leaflet-septal contact, a late-peaking outflow jet, and posteriorly directed mitral regurgitation. The patient is receiving epinephrine. Which intervention should be tried first?

Accepted Answer

Reduce epinephrine, restore preload, and support afterload with phenylephrine.

Answer

Increase epinephrine and add milrinone to improve forward output.

Answer

Give furosemide and nitroglycerin to reduce regurgitant volume.

Answer

Return to bypass for mitral valve replacement because regurgitation persists after repair.

Question 2

A right upper lobectomy specimen contains an adenocarcinoma with a 2.6-cm invasive component confined to lung parenchyma. Three lymph nodes contain metastases, all from station 4R; systematic nodal dissection shows no involvement of other sampled regional stations. There is no distant disease, and no neoadjuvant treatment was given. Under the IASLC ninth-edition TNM classification, which nodal category and overall stage apply?

Accepted Answer

N2a; stage IIB

Answer

N2a; stage IIIA

Answer

N2b; stage IIIA

Answer

N1; stage IIA

Question 3

The Heart Team reviews a 59-year-old man with diabetes and limiting angina despite appropriate medical therapy. Angiography shows severe proximal LAD, obtuse marginal, and right coronary stenoses with suitable distal bypass targets. Left ventricular ejection fraction is 45%, operative risk is low, and there is no major frailty. He prioritizes long-term survival and avoiding repeat procedures. Which recommendation best serves those goals?

Accepted Answer

Perform CABG with an internal thoracic artery graft to the LAD and other grafts.

Answer

Continue medical therapy alone because the left main coronary artery is not involved.

Answer

Use multivessel drug-eluting stents to avoid the short-term risks of surgical revascularization.

Answer

Stent the proximal LAD first and reserve treatment of the other vessels for recurrent symptoms.

Question 4

A central left lung carcinoma cannot be removed with negative margins by sleeve lobectomy, so pneumonectomy is being considered. Preoperative FEV1 is 88% predicted and DLCO is 50% predicted. Quantitative perfusion assigns 30% of total perfusion to the left lung. Exercise capacity has not been assessed. Using the perfusion-based estimate and the 2025 ERS/ESTS fitness framework, which interpretation should guide the operability discussion?

Accepted Answer

Predicted postoperative DLCO is 35%; further assessment of exercise reserve is warranted.

Answer

Predicted postoperative DLCO is 15%; the patient should be directed to nonsurgical treatment.

Answer

Predicted postoperative DLCO is 35%; predicted postoperative FEV1 above 60% permits proceeding without further assessment.

Answer

Predicted postoperative DLCO remains 50%; the low perfusion of the removed lung makes functional loss negligible.

Question 5

A term newborn remains profoundly cyanotic despite ventilation and prostaglandin E1. Echocardiography shows the aorta arising from the right ventricle, the pulmonary artery arising from the left ventricle, an intact ventricular septum, a widely patent ductus arteriosus, and a restrictive atrial communication. Which intervention most directly addresses the limitation to systemic oxygenation?

Accepted Answer

Perform urgent balloon atrial septostomy.

Answer

Increase prostaglandin E1 to enlarge the already patent ductus.

Answer

Add inhaled nitric oxide to lower pulmonary vascular resistance.

Answer

Create a systemic-to-pulmonary arterial shunt to increase pulmonary flow.

Question 6

After CABG, a patient’s platelet count falls from 250 to 92 × 10^9/L by postoperative day 2, recovers to 238 by day 4, and falls again to 104 on day 7. Duplex ultrasonography now confirms a proximal leg deep venous thrombosis. The patient is receiving unfractionated heparin, has no active bleeding, and has normal hepatic function. There is no sepsis or other convincing cause for the second platelet fall. While antibody and functional assays are pending, what anticoagulation plan is appropriate?

Accepted Answer

Stop all heparin exposure and begin therapeutic argatroban.

Answer

Continue therapeutic unfractionated heparin until laboratory testing confirms the diagnosis.

Answer

Replace unfractionated heparin with therapeutic enoxaparin while awaiting the assay results.

Answer

Stop heparin and withhold anticoagulation until the platelet count has recovered.

Question 7

On osteopathic structural examination, the left fifth through eighth ribs move freely with exhalation but fail to rise normally during inspiration. Adjacent ribs have normal excursion. In planning muscle-energy treatment, which dysfunction and key rib should be identified?

Accepted Answer

Exhaled group dysfunction; treat rib 5 as the key rib.

Answer

Exhaled group dysfunction; treat rib 8 as the key rib.

Answer

Inhaled group dysfunction; treat rib 5 as the key rib.

Answer

Inhaled group dysfunction; treat rib 8 as the key rib.

Question 8

Resting echocardiography in a patient with exertional dyspnea shows an aortic valve area of 0.76 cm², mean gradient of 24 mmHg, stroke-volume index of 27 mL/m², and ejection fraction of 30%. During low-dose dobutamine, stroke volume increases by 32%, the mean gradient rises to 47 mmHg, and valve area remains 0.79 cm². How should these findings change the treatment discussion?

Accepted Answer

The stenosis is truly severe; proceed with evaluation for aortic valve replacement.

Answer

The stenosis is pseudo-severe; optimize heart-failure therapy and reassess before considering replacement.

Answer

The stenosis remains indeterminate; CT calcium scoring is required before its severity can be classified.

Answer

The stenosis is moderate; defer intervention until the resting mean gradient exceeds 40 mmHg.

Question 9

A patient with dysphagia to solids and liquids has no mechanical obstruction on endoscopy. High-resolution manometry shows median integrated relaxation pressures above the laboratory’s position-specific upper limits in both supine and upright testing. Of 10 test swallows, six have premature contractions with distal latency of 3.2 seconds and distal contractile integral of 1,200 mmHg·s·cm; four are failed. No swallow has normal peristalsis. Which Chicago Classification v4.0 diagnosis fits this tracing?

Accepted Answer

Type III achalasia

Answer

Distal esophageal spasm

Answer

Type II achalasia

Answer

Esophagogastric junction outflow obstruction

Question 10

After several days of overhead painting, a 28-year-old develops a heavy, swollen, bluish right arm with prominent superficial veins. The hand is warm, radial pulses are normal, and strength and sensation are preserved. Duplex imaging demonstrates acute axillosubclavian venous thrombosis; there is no catheter or known malignancy. Which anatomic mechanism best explains this presentation?

Accepted Answer

Subclavian vein compression between the clavicle and first rib.

Answer

Subclavian vein compression between the anterior and middle scalene muscles.

Answer

Subclavian artery compression between the clavicle and first rib.

Answer

Lower brachial plexus compression by a cervical rib at the thoracic outlet.

Free Cardiothoracic Surgery Practice Questions

Domain 2: Cardiac & Cardiac Surgery (49-53%)

Question 1

Question 2

Question 3

Question 4

Domain 3: Chest (1-5%)

Question 5

Domain 4: Esophagus (2-5%)

Question 6

Domain 6: Osteopathic Manipulative Medicine (1-3%)

Question 7

Domain 7: Other (6-8%)

Question 8

Domain 9: Thoracic (23-27%)

Question 9

Question 10

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