Dear Readers, Welcome to Cardiac Surgery Interview Questions and Answers have been designed specially to get you acquainted with the nature of questions you may encounter during your Job interview for the subject of Cardiac Surgery Interview Questions. These Cardiac Surgery Questions and Answers are very important for campus placement test and job interviews. As per my experience good interviewers hardly plan to ask any particular questions during your Job interview and these model questions are asked in the online technical test and interview of many IT & Non IT Industries.
A. Closed chest massage is as effective as open chest massage.
B. The success rate for out-of-hospital resuscitation may be as high as 30% to 60%.
C. The most common cause of sudden death is ischemic heart disease.
D. Standard chest massage generally provides less than 15% of normal coronary and cerebral blood flow.
A. Call for help.
B. Obtain airway.
C. Electrical cardioversion.
A. External pacemaker.
B. Intravenous epinephrine, 10 ml. of 1:10,000.
C. Intravenous calcium gluconate, 10 ml. of 10% solution.
D. Intravenous atropine, 0.5 mg.
A. Comminuted tear of a single chamber.
B. Multiple-chamber injuries.
C. Coronary artery injury.
D. Tangential injuries.
A. Left anterior thoracotomy.
B. Right anterior thoracotomy.
C. Bilateral anterior thoracotomy.
D. Median sternotomy.
B. Distended neck veins.
C. Decreased heart sound.
D. All of the above.
A. Resection with end-to-end anastomosis.
B. Prosthetic patch aortoplasty.
C. Subclavian flap aortoplasty.
D. Prosthetic tube graft repair.
A. Pulmonary artery sling.
B. Double aortic arch.
C. Anomalous origin of right subclavian artery from the descending aorta.
D. Cervical aortic arch.
A. Posterior systolic murmur between the scapulas.
B. Diminished femoral pulses.
C. Elevated blood pressure in left arm as compared with right arm.
D. Peripheral cyanosis.
A. Continuous murmur.
B. Hyperactive precordium with bounding peripheral pulses.
D. Diminished femoral pulses.
A. Chest film.
B. Cardiac catheterization.
C. Retrograde aortography via an umbilical artery catheter.
D. Two-dimensional echocardiography with continuous-wave and color-flow Doppler echocardiography.
B. Pulmonary vascular disease.
C. Cerebrovascular accident.
D. Congestive heart failure.
A. Secundum defect.
B. Sinus venosus defect.
C. Ostium primum defect.
D. Complete atrioventricular (AV) canal defect.
E. Coronary sinus defect.
A. The size of the defect
B. The compliance of the right and left ventricles.
C. The systemic oxygen saturation.
D. Right atrial pressure.
E. The presence or absence of an associated ventricular septal defect (VSD).
A. Secundum defect
B. Sinus venosus defect
C. Ostium primum defect.
D. Coronary sinus defect.
A. A secundum ASD.
B. A sinus venosus ASD with PAPVR.
C. An ostium primum ASD.
D. A complete AV canal defect.
A. Secundum ASD.
B. Sinus venosus ASD with PAPVR.
C. An ostium primum ASD.
D. A complete AV canal defect.
A. Partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava.
B. Infracardiac (Type III) total anomalous pulmonary venous connection (TAPVC).
C. Pulmonary vein stenosis.
D. Cor triatriatum.
E. Supracardiac (Type I) TAPVC.
A. Complete heart block.
B. Acute pulmonary hypertensive crisis.
C. Pleural effusions.
D. Pulmonary venous obstruction.
A. Perimembranous lesions are located in the region of the membranous portion of the interventricular septum near the anteroseptal commissure of the tricuspid valve.
B. Muscular VSDs are holes in the interventricular septum that are bordered by muscle on three sides and by the pulmonary and the aortic valve annulus superiorly.
C. VSD, in its isolated form, is the most commonly recognized congenital heart defect.
D. The conduction bundle runs along the posteroinferior rim of a perimembranous VSD.
A. When coarctation of the aorta is associated with VSD, it most commonly occurs in infants with large lesions who have to undergo repair before age 3 months.
B. In some patients with VSD, aortic valve incompetence develops over time and progresses.
C. In the United States doubly committed or juxta-arterial VSDs are most commonly associated with aortic insufficiency.
D. PDA is present in approximately one fourth of infants with a VSD and concomitant congestive heart failure.
A. A large VSD is approximately the size of the pulmonary valve orifice or larger.
B. Large VSDs associated with high pulmonary blood flow result in an enlarged left atrium on chest x-ray.
C. Patients with small (restrictive) VSDs tend to have normal right ventricular and pulmonary arterial pressures with normal pulmonary vascular resistance and no evidence of pulmonary vascular disease.
D. A pulmonary vascular resistance greater than 10 to 12 units per sq. m. is considered a contraindication to operation.
A. Spontaneous closure of VSDs occurs in 25% to 50% of patients during childhood.
B. Tachypnea and failure to thrive are symptoms frequently associated with large VSDs.
C. Patients with normal pulmonary vascular resistance and left-to-right shunting across the VSD have Eisenmenger’s complex.
D. Patients with a large VSD and low pulmonary vascular resistance can present with a middiastolic murmur at the apex.
A. A right ventricular approach is employed for the repair of most perimembranous VSDs.
B. Intracardiac repair is advisable for patients with intractable symptoms and for asymptomatic infants with evidence of increasing pulmonary vascular resistance.
C. Complete heart block is a common complication.
D. Hospital mortality after repair of VSD in infants approaches 20%.
C. Dextroposition of the aorta.
D. Pulmonary stenosis.
E. Right ventricular hypertrophy.
A. The size of the ASD.
B. The size of the VSD.
C. The degree of pulmonary stenosis.
D. The amount of aortic overriding.
A. Absence of the left pulmonary artery.
B. A right aortic arch.
C. A retroesophageal subclavian artery.
D. Anomalous origin of the left anterior descending coronary artery from the right coronary artery.
E. Primary pulmonary hypertension.
A. Maintenance of ductal patency with prostaglandins (PGE 1) to provide pulmonary blood flow while the baby is transferred to an institution equipped to provide more definitive therapy.
B. Banding of the pulmonary artery in an acyanotic patient with tetralogy of Fallot to control pulmonary blood flow and prevent the development of pulmonary hypertension.
C. Placement of a subclavian-to-pulmonary artery shunt on the side opposite the aortic arch in a 3-day-old infant with severe cyanosis.
D. Closure of the VSD and transannular patching of the right ventricle onto the main pulmonary artery in a 2-day-old infant.
A. The size of the ASD.
B. The baby’s age at presentation.
C. The size of the right ventricular cavity and tricuspid valve.
D. The presence of a tricuspid—as opposed to a bicuspid—pulmonary valve.
E. The level of hypoxemia at presentation.
A. A VSD is usually present.
B. In the Taussig-Bing type of double-outlet right ventricle, the VSD is usually noncommitted.
C. Patients with double-outlet right ventricle and a subaortic VSD usually have pulmonary stenosis.
D. Patients with double-outlet right ventricle with a subpulmonary VSD (Taussig-Bing malformation) tend to mimic patients with transposition of the great arteries and VSD in their presentation and natural history.
A. In double-outlet right ventricle with a subaortic or doubly committed VSD, a tunnel-type repair connecting a committed VSD with its respective great artery is usually employed.
B. Repair of the Taussig-Bing malformation can be accomplished using an intraventricular tunnel technique or by performing a straight patch closure of the VSD combined with an arterial switch procedure.
C. The hospital mortality rate is highest when a subaortic VSD is present.
D. Some hearts with double-outlet right ventricle and a noncommitted VSD must be repaired using a modification of the Fontan procedure.
A. Creation of a systemic artery–to–pulmonary artery shunt.
C. Creation of a bidirectional superior cavopulmonary anastomosis.
D. Pulmonary artery banding.
E. Fontan procedure.
A. Patient age of 25 years.
B. Severe mitral insufficiency.
C. Left ventricular end-diastolic pressure of 18 mm. Hg.
D. Right pulmonary artery stenosis.
E. Pulmonary vascular resistance of 6 Woods units.
A. Intravenous administration of PGE 1.
B. Supplemental oxygen.
C. Routine intubation and mechanical ventilation to achieve a PCO 2 between 30 and 35 mm. Hg.
D. Cardiac catheterization and balloon atrial septostomy.
A. Provides early relief of volume load on the single right ventricle.
B. Increases peripheral oxygen saturations to greater than 90%.
C. Permits concomitant repair of pulmonary artery or aortic arch stenoses.
D. Improves mortality and morbidity of subsequent Fontan procedure.
A. Most infants survive without operations until late childhood.
B. Most infants present with cyanosis.
C. Most infants present with congestive heart failure.
D. Repair requires a conduit from right ventricle to pulmonary arteries.
B. Abnormal origin of pulmonary arteries.
C. Subaortic stenosis.
D. Single ventricular outflow valve.
A. PGE 1 infusion to maintain duct patency.
B. Administration of intravenous fluid to increase intravascular volume.
C. Hyperventilation to decrease pulmonary resistance.
D. Oxygen administration to increase arterial oxygen tension.
E. Atrial balloon septostomy to improve atrial mixing.
A. Age older than 6 weeks with a left ventricular pressure of less than 50% of systemic pressure.
B. Dynamic left ventricular outflow tract obstruction.
C. Intramural coronary artery anatomy.
D. Valvar pulmonic stenosis.
E. Subpulmonary VSD.
A. Atrial arrhythmias.
B. Systemic or pulmonary venous obstruction.
C. Right ventricular outflow tract obstruction.
D. Systemic ventricular failure.
E. Progressive elevation of pulmonary vascular resistance.
A. It is most often due to commissural fusion of a trileaflet valve.
B. It may be associated with coarctation of the aorta, PDA, and mitral stenosis.
C. It can be managed medically until the child is large enough to undergo aortic valve replacement.
D. Success of valvotomy is determined by the adequacy of the left ventricle.
A. Enlargement of the aortic annulus.
B. Incision of fused commissures.
C. Insertion of a porcine valve prosthesis.
D. Transfer of the pulmonary valve to the aortic position.
A. Most patients present in early infancy with severe congestive heart failure.
B. An ejection click is a specific physical sign of subaortic stenosis.
C. The subaortic membrane is approached surgically via the aorta and aortic valve.
D. A concomitant septal myectomy decreases the incidence of recurrent subaortic stenosis.
A. Propranolol and verapamil.
B. Aortic valve replacement.
C. Dual-chamber sequential pacing.
D. Combined septal myectomy and mitral valve plication.
A. Surgical repair is indicated only when thef systolic gradient exceeds 75 mm. Hg.
B. Simple excision of the supravalvular membrane results in satisfactory relief of the stenosis in most patients.
C. The diffuse form of supravalvular aortic stenosis may cause obstruction to branches of the aortic arch.
D. Reoperation after repair of discrete supravalvular aortic stenosis is rare unless abnormalities of the valve itself also exist.
E. Over 2,000,000.
A. The right coronary artery.
B. The left coronary artery.
C. The anterior descending coronary artery.
D. The circumflex coronary artery.
A. There is a rich and quite effective collateral circulation in the coronary arterial bed.
B. The coronary arterial bed has minimal effective collaterals.
C. The coronary arterial bed is an absolute example of anatomic end-arteries.
E. Less than 20%.
A. Reduce the incidence of myocardial infarction.
B. Significantly relieves angina symptoms.
C. Statistically improve the life span.
D. Improve the ejection fraction of the left ventricle in many patients in whom it is significantly depressed preoperatively.
A. A 60-year-old man with class II angina, 75% proximal right coronary artery lesion, and normal ventricular function.
B. A 60-year-old man with unstable angina, three-vessel disease, and an ejection fraction of 35%.
C. A 60-year-old nondiabetic man with class III angina symptoms and focal discrete lesions in the mid-right coronary artery and mid-left circumflex artery.
D. A 60-year-old man with diabetes, class IV angina, 75% proximal left anterior descending and 75% proximal right coronary artery obstruction, and left ventricular ejection fraction of 60%.
D. Less than 15%.
D. Less than 5%.
D. 2% or less.
A. Multivessel disease.
B. Rescue atherectomy.
C. Cardiogenic shock prior to CABG.
D. Previous bypass surgery.
E. All of the above.
A. The operative mortality is higher for Y but the incidence of perioperative myocardial infarction is unchanged between X and Y.
B. The operative mortality is unchanged between X and Y but the perioperative incidence of myocardial infarction is higher in Y.
C. The operative mortality and perioperative incidence is higher in X than in Y.
D. The operative mortality and perioperative incidence of myocardial infarction are no different for X and for Y.
A. The risk for morbidity and mortality from reoperative coronary bypass grafting is increased.
B. Left ventricular function is better preserved at the time of reoperation.
C. The risk of sternal wound complications is greatly increased if the contralateral IMA is harvested at the time of reoperation.
D. A light clamp should be applied to the IMA pedicle to limit cardiac warming during cardioplegic arrest at the time of reoperation.
E. A functional study demonstrating a large portion of myocardium at risk should be obtained before reoperation.
A. Operative morbidity and mortality are increased over those for primary CABG.
B. Mortality most often stems from cardiac causes after reoperation.
C. Survival of patients after hospital discharge following coronary reoperation is nearly equivalent to survival after primary CABG.
D. Compared to primary CABG, return of anginal symptoms is delayed after reoperative CABG.
E. Myocardial protection and the risk of myocardial infarction in reoperation are complicated by increased noncoronary collaterals, patent atherosclerotic saphenous vein grafts, and more diffuse coronary atherosclerosis.
A. Gated equilibrium techniques provide more accurate measurements of ejection fraction than initial-transit methods.
B. Left ventricular imaging time for a gated equilibrium study is at least 10 times that of an initial-transit study.
C. Both techniques require the same radiopharmaceuticals.
D. Both techniques require a bolus injection.
A. Exercise ejection fraction.
B. Change in regional wall motion from rest to exercise.
C. Maximal cardiac output during exercise.
D. Change in heart rate during exercise.
A. Ventricular aneurysms are commonly associated with systemic arterial embolization.
B. Absent collateral circulation in an area of myocardium supplied by an acutely occluded artery favors aneurysm formation.
C. Posterobasal aneurysms are more common than those located in the anteroapical region.
D. Aneurysm repair can improve associated cardiac valve dysfunction.
E. Persistent ST segment elevation after acute myocardial infarction suggests aneurysm formation.
A. Class IV cardiac status.
B. Size of aneurysm.
C. Presence of left main coronary disease.
D. Emergent operation.
E. Location of aneurysm.
B. Antiviral agents.
D. Gamma globulin.
A. The presence of multiple coronary artery aneurysms.
B. Myocardial infarction and severe left ventricular dysfunction.
C. The presence of a 5 mm. aneurysm in the right coronary artery.
D. Progressive stenosis in the left anterior descending coronary artery.
E. None of the above.
A. The tricuspid valve is usually insufficient.
B. Typically there is a left-to-right shunt across the ASD.
C. The redundant anterior leaflet of the tricuspid valve may cause obstruction of the right ventricular outflow tract.
D. Pulmonary hypertension is a common late complication.
E. High pulmonary vascular resistance in neonates exacerbates tricuspid regurgitation and cyanosis.
A. In neonates, the tricuspid valve orifice may be oversewn and a systemic-pulmonary shunt created to provide pulmonary blood flow.
B. Techniques in repair of the tricuspid valve do not utilize plication of the atrialized right ventricle.
C. Closure of the ASD alone is adequate repair of the malformation.
D. If tricuspid valve replacement is performed, the valve should be sutured above the coronary sinus to avoid injury to the conduction system.
E. Currently, mechanical prostheses are recommended for tricuspid valve replacement because the durability of bioprosthetic valves in the tricuspid position is so poor.
A. Origin of the left coronary artery from the pulmonary artery.
B. Origin of the right coronary artery from the pulmonary artery.
C. Coronary artery fistula.
D. Membranous obstruction of the ostium of the left main coronary artery.
A. Coronary artery fistula.
B. Origin of the left coronary artery from the pulmonary artery.
C. Origin of the right coronary artery from the pulmonary artery.
D. Congenital coronary aneurysm.
A. Congenital origin of both coronary arteries from the pulmonary artery.
B. Congenital coronary artery fistula.
C. Membranous obstruction of the ostium of the left main coronary artery.
D. Congenital origin of the right coronary artery from the pulmonary artery.
B. Congestive heart failure.
D. Transvalvar gradient of 35 mm. Hg without symptoms.
A. Moderate aortic insufficiency seen on echocardiography with normal left ventricular end-systolic dimensions.
B. Moderate to severe aortic insufficiency seen on echocardiography with cardiomegaly on chest roentgenography.
C. Moderate aortic insufficiency seen on echocardiography with symptoms of congestive heart failure.
D. Moderate aortic insufficiency with an end-systolic left ventricular dimension of 70 mm. as seen on echocardiography.
A. Systemic embolization.
B. Infective endocarditis.
C. Onset of atrial fibrillation.
D. Worsening pulmonary hypertension.
A. Operation improves survival in patients with severe, symptomatic mitral valve disease.
B. Left ventricular dilatation with class I or class II heart failure is an indication for operation with mitral regurgitation.
C. Tricuspid regurgitation is most commonly caused by abnormalities of the leaflets themselves.
D. Mitral valve replacement requires resection of the mitral valve leaflets and chordae.
A. Pulmonary edema.
B. Hepatic failure.
A. Extensive leaflet calcification.
B. Mitral regurgitation.
C. Chordal rupture of the anterior mitral leaflet.
D. Significant annular dilatation.
A. Tricuspid regurgitation due to annular dilatation alone generally does not require valve replacement.
B. Mitral valve replacement with either a bioprosthesis or a mechanical valve requires warfarin anticoagulation.
C. Tricuspid valve replacement is generally an indication for using a tissue valve.
D. Chronic renal failure is a relative indication for tissue valves.
A. Patient younger than 30 years.
B. Young female patient who desires children.
C. An elderly patient.
D. Tricuspid valve replacement.
A. Bioprosthetic valves have a relatively high incidence of hemolysis.
B. Bioprosthetic valves have a lower incidence of postoperative prosthetic valve endocarditis.
C. Mechanical valves develop structural failure after an average of 7 to 10 years.
D. Mortality attributable to warfarin therapy approaches 5% per patient-year.
A. Pulmonary hypertension.
B. Pulmonary edema.
C. Left ventricular dilatation.
D. An opening snap after the second heart sound.
A. Left free wall.
B. Right free wall.
C. Posterior septum.
D. Anterior septum.
CARDIAC SURGERY Interview Questions and Answers ::
A. Proximal antegrade block in the slow conduction pathway.
B. Proximal retrograde block in the slow conduction pathway.
C. Proximal antegrade block in the fast conduction pathway.
D. Proximal retrograde block in the fast conduction pathway.
A. His bundle ablation.
B. Left atrial isolation procedure.
C. Corridor procedure.
D. Maze procedure.
1. Patient’s sensation of irregular heart rhythm.
2. Hemodynamic compromise because of loss of AV synchrony.
3. Increased vulnerability to thromboembolism.
Answer: A-1. B-1,2. C-1. D1,2,3
A. They usually occur in the right ventricle.
B. They are usually associated with a left bundle branch block pattern during the tachycardia.
C. They are usually more refractory to medical therapy than ischemic ventricular tachyarrhythmias.
D. They usually occur as a result of automaticity rather than re-entry.
A. This lesion, by site and histology, is the most common primary cardiac tumor.
B. It is best diagnosed by cardiac catheterization and angiography.
C. The symptom complex can mimic collagen vascular disease.
D. It has an intracavitary growth pattern.
E. It has a multicentric origin in the chamber wall.
A. Sarcomas are the most frequent primary malignancy.
B. Metastatic tumors are usually asymptomatic.
C. Adjuvant chemotherapy and irradiation are efficacious in prolonging survival.
D. Intra-atrial extension of renal neoplasms is a contraindication for surgical resection.
E. Constrictive physiology is an indication for operation.
A. Skin burns.
B. Painful chest wall muscle contractions.
C. Ventricular fibrillation.
D. Inability to pace.
A. Ischemic heart disease.
B. Sclerodegenerative disease.
C. Traumatic injury.
A. Complete heart block.
B. Second-degree AV block.
C. Chronic bifascicular block.
D. Sick sinus syndrome.
A. Lower pacing thresholds.
B. Improved electrogram sensing.
C. Decreased battery life.
D. Less patient discomfort.
A. 10 to 100 ohms.
B. 125 to 250 ohms.
C. 300 to 800 ohms.
D. 1000 to 1500 ohms.
A. QT interval.
B. Venous blood temperature.
C. Mixed venous oxygen saturation.
D. Body motion.
A. Anteromedial chest wall.
B. Anterolateral chest wall.
C. Inferomedial chest wall.
D. Inferolateral chest wall.
A. Pacemaker induction of atrial fibrillation.
B. Sensing of retrograde atrial activation.
C. Inappropriate ventricular sensing.
D. Lead fracture.
A. Digitalis compounds.
A. Discontinuation of Coumadin therapy on the day of the operation.
B. Discontinuation of Coumadin therapy on the day of the operation with replacement of clotting factors with fresh frozen plasma (FFP) before the start of the surgical procedure.
C. Discontinuation of Coumadin therapy 5 days before operation with no further anticoagulation therapy before surgery.
D. Discontinuation of Coumadin therapy 5 days before operation with the institution of intravenous heparin as the prothrombin time normalizes.
E. Discontinuation of Coumadin therapy 2 days before operation followed by large doses of aspirin.
A. Aggressive use of inotropic support with epinephrine.
B. Aggressive diuresis with furosemide and inotropic support with dopamine.
C. Afterload reduction with nitroprusside and inotropic support with dopamine.
D. Close perioperative monitoring and inotropic support with melrinone.
E. Intravenous digitalis with diuresis using furosemide as needed.
A. Correction of electrolytes and blood chemistries.
B. Evaluation for possible myocardial infarction.
C. Treatment with intravenous lidocaine.
D. Attempt to limit the ventricular response with digitalis.
E. Immediate cardioversion.
A. The coagulation cascade.
B. The fibrinolytic cascade.
C. Complement activation.
D. A and C.
E. A, B, and C.
A. Systemic blood pressure of 90/50 mm. Hg.
B. Arterial PO 2 of 230 mm. Hg.
C. Mixed venous hemoglobin saturation of 78%.
D. Central venous pressure of 1 mm. Hg.
E. Plasma lactate value of 6 mg. per dl.
A. Interstitial fluid increases.
B. Blood flow becomes nonpulsatile.
C. Platelet count decreases.
D. Complement is activated.
E. Systemic vascular resistance falls.
A. Preload reduction.
B. Afterload reduction.
C. Coronary blood flow enhancement.
D. Decreased ventricular end-diastolic pressure.
A. Medically refractory angina.
B. Acute papillary muscle rupture.
C. Left main coronary artery lesion.
D. Ventricular failure after cardiac surgery.
E. PTCA failure.
B. Limb ischemia.
D. Aortic thrombosis.
A. Infrared sensor.
B. Inductive coupling.
C. Thermionic coupling.
D. High-pressure liquid chromatography (HPLC).
E. Infrared spectroscopy.
A. It can support the circulation for over 1 year.
B. It may be complicated by infection or thromboembolism.
C. When further developed, it will be an ideal permanent heart substitute.
D. It is an ideal “bridge” for transplantation.
E. It can be implanted using techniques similar to those used for heart transplantation.
a. The most common form of the disorder is a double-inlet right ventricle
b. To be classified as a ventricle, the chamber must receive at least half of an inlet valve
c. This infant is a good candidate for a Blalock-Taussig shunt
d. Optimal correction of UVH diverts all vena caval blood flow into the pulmonary arteries (Fontan procedure)
e. In the absence of pulmonic stenosis, UVH usually presents as congestive heart failure
Answer: b, c, d, e
a. The most common associated abnormality is a bicuspid aortic valve
b. Chest radiograph is likely to show rib notching
c. The etiology is felt to be secondary to an inflammatory aortitis
d. In infancy, coarctation may present with a pink upper body and cyanotic lower body
e. “Paradoxical hypertension” seen after operative repair indicates residual stenosis from incomplete correction
Answer: a, b, d
a. Transseptal puncture should be used for definitive diagnosis
b. If this is a primary cardiac tumor it is most likely to be malignant
c. If this is a myxoma attached to the atrial septum, the adjacent septum should be removed with it
d. In infancy, the most common cardiac tumor is a rhabdomyosarcoma
e. The most common primary malignant tumor of the heart is angiosarcoma
Answer: c, e
a. Echocardiography alone is sufficient to confirm the diagnosis of Tetralogy of Fallot
b. Cyanotic spells may be appropriately treated by propranolol
c. The Blalock-Taussig shunt connects the right ventricle to the pulmonary artery
d. Increasing cyanotic spells is the most common indication for operation
e. Operative repair of right ventricular outflow obstruction is never extended across the pulmonic valve since intolerable pulmonary insufficiency would result
Answer: a, b, d
a. A systolic ejection click would signify that the stenosis is supravalvar
b. In the absence of cardiomegaly, cardiac catheterization to measure the pressure gradient is necessary
c. Development of syncope would suggest an intracranial lesion
d. In valvar aortic stenosis a pressure gradient of 80 mmHg is an indication for operative repair regardless of symptoms
e. In membranous subvalvar aortic stenosis a pressure gradient of 40 mmHg is an indication for operative repair
Answer: d, e
a. The most common cause of cyanosis this early is transposition of the great vessels (TGV)
b. If TGV is present, echocardiography will show that the posterior vessel leaving the left ventricle is a pulmonary artery
c. If TGV is confirmed by echocardiography, cardiac catheterization has little to add
d. The EKG is helpful in making the diagnosis of TGV since it shows reversed dominance of the ventricles
e. To improve mixing of pulmonary and systemic circulations, prostaglandin should be used to increase pulmonary vascular resistance
Answer: a, b
a. Spontaneous closure of the VSD is rare
b. Location of the VSD has little effect on the degree of cyanosis
c. Double outlet left ventricles do not occur
d. Coincidental aortic stenosis with DORV is not compatible with life
e. Doubly committed VSD refers to its relationship to the great vessels
Answer: a, e
a. Cardiac catheterization is indicated if the chest film shows cardiomegaly
b. Radiology report of “scimitar syndrome” findings on the chest film would indicate need for an arteriogram
c. If the catheterization report is “ostium secondum defect,” at least one pulmonary vein drains anomalously
d. Measured pulmonary vascular resistance of 14 Woods units/m2 with an ASD mandates early repair
e. An ASD with Qp/Qs of 1.8 can be observed until symptoms occur
a. Ischemia is due to perfusion of the myocardium with inadequately oxygenated blood
b. Selective coronary angiography should not be attempted because of the risk of myocardial infarction
c. Conservative treatment is preferred to allow the coronary artery to grow to a size that will allow bypass construction
d. If the infant deteriorates, ligation of the coronary at its origin is a viable option
e. The severity of the abnormality insures that it will always be detected in the first year of life
a. Pulmonary artery banding
b. Urgent closure if a VSD is found on echocardiography
c. Medical treatment only with digitalis and diuretics
d. If a VSD is found, repair is unlikely to be possible because of elevated pulmonary vascular resistance
e. If a restrictive VSD is found, spontaneous closure is a possibility and operative repair should be delayed
Answer: c, e
a. The second heart sound will show fixed splitting
b. Despite diagnostic echocardiography, cardiac catheterization is indicated to assess pulmonary artery resistance
c. Pulmonary artery banding is indicated to limit pulmonary flow and allow the child to grow
d. AVSD is classified according to the morphology of the anterior leaflet of the common A-V valve
e. Operative repair is best performed after 2 years of age
Answer: a, b, d
a. If aortic insufficiency is detected, the defect is likely to be subpulmonic in location
b. Finding aortic stenosis in addition to the VSD would be highly unlikely
c. The cath data indicate a restrictive type of VSD
d. If pulmonary vascular resistance falls with tolazoline administration, it is safe to close the VSD
e. Operative closure of VSDs is possible without ventriculotomy
Answer: a, c, d, e
a. The most likely diagnosis is coarctation of the aorta
b. If large pulmonary arteries are noted, a patent ductus is likely
c. To discriminate between a and b, prostaglandin administration can be used which will constrict the patent ductus arteriosus
d. If a ductus if found, operative repair should be delayed until the respiratory symptoms improve to reduce mortality rates
e. Normal ductus closure depends on increased oxygen saturation in the pulmonary artery
Answer: b, e
a. Natural history of this anomaly allows only 20% one-year survival
b. The most likely configuration of the truncal valve is bicuspid
c. Location of the pulmonary arteries minimizes the risk of pulmonary vascular obstructive disease (Eisenmengers)
d. Repair of the lesion requires an extracardiac conduit
e. Optimal timing of operative repair is at 6–12 months
Answer: a, d
a. Initial management should include prostaglandin infusion
b. Ventilatory adjustment should maintain PaCO2 at approximately 40 mmHg
c. Survival depends on sustained patency of the ductus arteriosus
d. Cardiac transplantation for HLHS requires inclusion of the donor aortic arch
e. Reconstruction for HLHS converts the pulmonary artery into the main outlet for a functional single ventricle (Norwood)
Answer: a, b, c, d, e
a. Onset of angina indicates concomitant coronary artery disease independent of valvular lesion
b. Percutaneous aortic balloon valvuloplasty should be considered since it has generally favorable results
c. Patient is not an operative candidate since heart failure has not occurred
d. A measured transvalvular pressure gradiant > 50 mmHg would be an operative indication
a. Perperal vasdilators are contraindicated
b. The inta-aortic balloon pump can be used to improve cardiac output
c. Furosemide and nitroglycerin would be appropriate
d. Valve replacement is necessary
Answer: c, d
a. Critical mitral stenosis is defined as an orifice area reduced to 2 cm2
b. With a fixed mitral orifice, the change from sinus rhythm to atrial fibrillation has little effect on cardiac output
c. Mural thrombi and thromboembolism are directly related to the presence of atrial fibrillation
d. Depressed cardiac output is usually due to depressed myocardial contractility
a. Mitral stenosis is the most common lesion
b. Of all cardiac valves, the aortic is the most anterior
c. Stenosis is the most common lesion of the aortic valve
d. Rheumatic heart disease is the most common cause of valve dysfunction
Answer: c, d
a. Chest radiograph will show cor bovinum
b. The apical murmur is due to the Gallavardin phenomenon
c. A carotid shudder would be expected
d. Abdominal exam will show a pulsatile liver
a. Severe heart failure is more likely from acute than chronic valvular dysfunction
b. Valvular dysfunction produces both volume and pressure afterload stress on the heart
c. Early cardiac dilation from valve dysfunction shifts the Frank-Starling curve to depress cardiac output
d. The LaPlace law predicts that wall stress decreases with increasing ventricular radius
Answer: a, b
a. The organisms most likely responsible are gram-negative and fungal
b. The pulmonic valve is most likely to be affected
c. A negative echocardiogram is useful to exclude the diagnosis
d. Valve replacement is necessary if the native valve is excised to treat infection
a. Oxygen and lidocaine should be administered prophylactically
b. If chest pain persists, IV nitroglycerin should be used to limit infarct size
c. Ca-channel blockers are also of value to limit infarct size
d. Morphine IV can be used but has no therapeutic effect
a. Under circumstances of increased oxygen demand by the myocardium, O2 extraction from arterial blood can increase
b. Coronary flow is maximal during systole
c. Adenosine is the most important metabolic regulator of coronary blood flow
d. Sympathetic nerve stimulation constricts coronary arteries despite the need for increased cardiac output
Answer: c, d
a. In 80%–85% of cases the posterior descending coronary artery (PDA) arises from the circumflex coronary artery
b. The PDA gives off the AV nodal artery
c. The great cardiac vein ascends along the right coronary artery to empty into the coronary sinus
d. Thebesian veins drain from only left and right ventricles
a. Nitroglycerin primarily dilates coronary arterioles
b. b-blocking agents act to reduce myocardial O2 demand
c. Ca-channel blocking agents reduce ventricular contractility
d. Ca-channel agents should not be used if there is an element of coronary vasospastic disease
Answer: b, c
a. The mortality rate for cardiogenic shock after acute MI is increased more than 10 fold in comparison to no shock
b. Age, ejection fraction, MI size and previous MI serve as predictors of cardiogenic shock
c. Acute loss of more than 20% of myocardium frequently results in cardiogenic shock and death
d. Emergency revascularization is contraindicated for the MI patient in cardiogenic shock
Answer: a, b
a. Thrombolytic therapy should be considered immediately since the benefit is greater the earlier it is given
b. Of the drugs available, recombinant tPA produces better results than SK or APSAC although it is more expensive
c. Thrombolytic therapy requires catheterization for intracoronary administration
d. Addition of heparin and antiplatelet drugs produces no incremental benefit
a. The electrocardiogram is most likely to show a prominent Q in lead 3 if this is an MI
b. If Q wave is present, the infarct is subendocardial rather than transmural
c. Creatine kinase measurement alone is diagnostic of MI
d. Since bradycardia rarely occurs with MI, another diagnosis should be considered
a. A long symmetric lesion in the left main coronary artery would be appropriate for PTCA
b. Multiple obstructive lesions in the same artery would be a contraindication to PTCA
c. A focal lesion in the left anterior descending coronary artery where the vessel is 1 mm in diameter would allow PTCA
d. Successful PTCA for a simple lesion carries a recurrent stenosis risk of less than 10%
a. Operative mortality in patients > 70 years is more than double that of younger patients
b. If the patient is a woman, the risk is higher than it would be for a man
c. A previous CABG procedure increases the complexity and complication rate, but does not alter mortality rate
d. Results are better if there is ischemic cardiomyopathy than if there is hibernating myocardium
Answer: a, b
a. An intra-aortic balloon pump should be used and cardiac catheterization performed
b. If the infarct was posterior, this is most likely due to a ventricular septal defect
c. Pulmonary wedge pressure tracing of prominent V waves without an O2 step-up suggests papillary muscle rupture
d. Operative repair of a post MI VSD should be delayed to allow strengthening of the myocardium to hold sutures
Answer: a, c
a. All patients with typical anginal symptoms should have coronary arteriography
b. Atypical patients with borderline positive stress tests should have arteriography
c. Patients who require valve procedures do not require arteriography
d. Patients in refractory heart failure awaiting cardiac transplantation should have coronary arteriography
a. CABG is more effective than medical treatment for relieving angina and improving physical work capacity
b. In CABG for unstable angina, there is no difference in late outcome between stable and unstable cohorts
c. For CABG, the most common arterial graft is the left internal mammary artery
d. Long term patency is improved when arterial grafts are used but there is no difference in the early mortality rate
Answer: a, b, c
a. Thyroid tests are included to rule out hyperthyroidism
b. Typically positive stress ECG would show elevated ST segments
c. Dipyridamole is a useful adjunct to thallium scanning as it increases coronary perfusion pressure
d. Persisting defects on thallium scan indicate reversible myocardial ischemia
a. Rethrombosis is most likely and thrombolytic therapy alone should be repeated
b. The problem could have been prevented by early elective catheterization and PTCA
c. Patient has an indication for catheterization and PTCA if single vessel disease is found
d. Findings of multivessel disease at catheterization would indicate need for operative bypasses
e. If operative bypass is deemed necessary, there should be a 30-day delay to allow myocardial healing
Answer: c, d
a. An inotropic drug should be used initially to increase cardiac output
b. If low cardiac output persists despite optimal physiological and pharmacological support, a balloon pump (IABP) should be inserted
c. Decreased cardiac filling pressures suggest the possibility of cardiac tamponade
d. When IABP is used, the balloon is inflated during diastole
Answer: b, d
a. This is a rare event since less than 5% of patients with coronary artery disease (CAD) are asymptomatic with exercise
b. Such a patient could progress to heart failure from ischemic cardiomyopathy
c. Typical angina pectoris is promptly relieved by rest or relaxation
d. Dyspnea on exertion can represent an angina equivalent
Answer: b, c, d
a. Since a heart rate of 180/min should be tolerated at his age, the hypotension must have another cause
b. A vagal maneuver that breaks the tachycardia suggests atrial flutter as the etiology
c. Atrial overdrive pacing should be tried for paroxysmal atrial tachycardia (PAT)
d. Verapamil IV should be used for rate control
e. Cardioversion is preferred for patients on digoxin
Answer: c, d
a. Direct current catheter endocardial ablation has a high likelihood of success.
b. If the arrhythmia is inducible at EP study, there is an indication for operative intervention.
c. A recent MI would be a contraindication to operation
d. Ventricular failure would be a contraindication to operation
e. Monomorphic ventricular tachycardia is least amenable to surgical resection.
Answer: b, c, d
a. The most likely cause of SCD is ventricular arrhythmia
b. There is 30–40% chance of recurrent SCD in one year
c. Empiric antiarrhythmic drug therapy improves survival
d. An inducible ventricular tachyarrhythmia at EP study carries a favorable prognosis
e. If a ventricular aneurysm is found with arrhythmia, aneurysm resection is adequate treatment
Answer: a, b
a. There is no special conduction path from the sinoatrial (SA) to the atrioventricular (AV) node
b. The blood supply to the AV node is from the anterior descending coronary artery
c. The only normal muscular connection between atria and ventricles is the bundle of His
d. The aortomitral continuity is the only area where supraventricular accessory pathways cannot occur
e. The sinus node artery arises from the right or circumflex coronary artery
Answer: a, c, d, e
a. A physical or electrical stimulus causes sodium fast channels and calcium slow channels to open
b. During the effective refractory period, only the slow calcium channels are closed
c. Rapid repolarization follows potassium egress from the cell
d. Extracellular hypokalemia increases sodium channel size increasing automaticity
e. Catecholamines increase outward potassium flow from myocytes
Answer: a, c, d
a. The goal of the EP study is either sustained or non-sustained ventricular tachycardia
b. Patients with less than 5 repetitive complexes in response to stimulation are considered noninducible
c. An induced reentry from ventricular stimulation is not necessarily pathological
d. Microreentry arrhythmias are typical after myocardial infarction
e. Macroreentry arrhythmias are typical of myocardial ischemia
Answer: a, b
a. Electrophysiologic studies (EPS) will require catheters in or at the right atrium, His bundle, right ventricle and coronary sinus
b. Pacing for EPS uses stimuli twice the diastolic threshold
c. The anomalous conducting bundle (Kent) is found in the right free wall if the coronary sinus catheter records the earliest atrial activity during reciprocating tachycardia
d. If the atrial catheter records the earliest activity during tachycardia, the bundle of Kent is located in the left free wall
e. If neither left or right bundle-branch block prolong the VA interval, the anomalous bundle is in the septum
Answer: b, e
a. If her arrhythmia is ventricular tachycardia, she is not a candidate for an Automatic Implantable Cardiac Defibrillator (AICD) since it only recognizes fibrillation
b. If an AICD is appropriate, it offers a 50% improvement in mortality compared to drug therapy
c. Poor ventricular function is a contraindication to AICD implantation
d. AICD should not be used for patients awaiting cardiac transplantation
e. AICD can provide antitachycardia pacing as well as defibrillation
Answer: b, e
a. The pathophysiology of WPW is a single bundle of Kent
b. Dangerous ventricular responses in WPW are due to the shorter refractory period of the accessory pathway
c. Identification of the accessory pathway of WPW is an indication for its interruption
d. Approximately half of the patients who have successful division of accessory pathways demonstrate VA block postop
e. Both radiofrequency catheter and surgical ablation offer excellent results with low morbidity
Answer: b, d, e
a. Membrane-stabilizing local anesthetics (Class 1) act via sodium channel blockage
b. Class 1 drugs also shorten the refractory period
c. b-blocking drugs (Class 2) block the sympathetic nervous system but not circulating catecholamines
d. Bretylium and other Class 3 drugs inhibit potassium influx into cells
e. Calcium channel blockers (Class 4) directly affect the SA and AV nodes
Answer: a, d, e