Cardiothoracic Surgery Practice Questions

Question 1

A 27-year-old male arrives in the emergency department with a stab wound over the precordial chest wall. The patient is in distress and is cold, sweaty, and pale. Initial physical examination is significant for muffled heart sounds, distended neck veins, and a 3 cm stab wound near the left sternal border. Breath sounds are present bilaterally without evidence of tracheal deviation. Which of the following additional findings would be expected on further evaluation?

Accepted Answer

15 mmHg decrease in systolic blood pressure with inspiration

Answer

Decrease in central venous pressure by 5 mmHg with inspiration

Answer

Decrease in the patient's heart rate by 15 beats per minute with inspiration

Answer

Steadily decreasing heart rate to 60 beats per minute

Answer

Elevated blood pressure to 170/110

Question 2

A 64-year-old woman is brought to the emergency department 1 hour after the onset of acute shortness of breath and chest pain. The chest pain is retrosternal in nature and does not radiate. She feels nauseated but has not vomited. She has type 2 diabetes mellitus, hypertension, and chronic kidney disease. Current medications include insulin, aspirin, metoprolol, and hydrochlorothiazide. She is pale and diaphoretic. Her temperature is 37°C (98°F), pulse is 136/min, and blood pressure is 80/60 mm Hg. Examination shows jugular venous distention and absence of a radial pulse during inspiration. Crackles are heard at the lung bases bilaterally. Cardiac examination shows distant heart sounds. Laboratory studies show:
Hemoglobin 8.3 g/dL
Serum
Glucose 313 mg/dL
Urea nitrogen 130 mg/dL
Creatinine 6.0 mg/dL
Which of the following is the most appropriate next step in management?

Accepted Answer

Pericardiocentesis

Answer

Furosemide therapy

Answer

Aspirin therapy

Answer

Hemodialysis

Answer

Norepinephrine infusion

Question 3

A 32-year-old man is brought to the emergency department 10 minutes after he sustained a stab wound to the left chest just below the clavicle. On arrival, he is hypotensive with rapid and shallow breathing and appears anxious and agitated. He is intubated and mechanically ventilated. Infusion of 0.9% saline is begun. Five minutes later, his pulse is 137/min and blood pressure is 84/47 mm Hg. Examination shows a 3-cm single stab wound to the left chest at the 4th intercostal space at the midclavicular line without active external bleeding. Cardiovascular examination shows muffled heart sounds and jugular venous distention. Breath sounds are normal bilaterally. Further evaluation of this patient is most likely to show which of the following findings?

Accepted Answer

A 15 mm Hg decrease in systolic blood pressure during inspiration

Answer

Inward collapse of part of the chest with inspiration

Answer

Subcutaneous crepitus on palpation of the chest wall

Answer

Cough productive of frank blood

Answer

Lateral shift of the trachea toward the right side

Question 4

A 45-year-old male is brought into the emergency room by emergency medical services due to a stab wound in the chest. The wound is located superior and medial to the left nipple. Upon entry, the patient appears alert and is conversational, but soon becomes confused and loses consciousness. The patient's blood pressure is 80/40 mmHg, pulse 110/min, respirations 26/min, and temperature 97.0 deg F (36.1 deg C). On exam, the patient has distended neck veins with distant heart sounds. What is the next best step to increase this patient's survival?

Accepted Answer

Pericardiocentesis

Answer

Heparin

Answer

Intravenous fluids

Answer

Aspirin

Answer

Intravenous colloids

Question 5

A 54-year-old man presents to the emergency department complaining of shortness of breath and fatigue for 1 day. He reports feeling increasingly tired. The medical records show a long history of intravenous drug abuse, and a past hospitalization for infective endocarditis 2 years ago. The echocardiography performed at that time showed vegetations on the tricuspid valve. The patient has not regularly attended his follow-up appointments. The visual inspection of the neck shows distension of the neck veins. What finding would you expect to see on this patient’s jugular venous pulse tracing?

Accepted Answer

Prominent y descent

Answer

Obliterated x descent

Answer

Absent a waves

Answer

Large a waves

Answer

Decreased c waves

Question 6

A 51-year-old man with a recent diagnosis of peptic ulcer disease currently treated with an oral proton pump inhibitor twice daily presents to the urgent care center complaining of acute abdominal pain which began suddenly less than 2 hours ago. On physical exam, you find his abdomen to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness. Given the following options, what is the next best step in patient management?

Accepted Answer

Urgent CT abdomen and pelvis

Answer

Serum gastrin level

Answer

H. pylori testing

Answer

Abdominal radiographs

Answer

Upper endoscopy

Question 7

A 50-year-old male presents to the emergency with abdominal pain. He reports he has had abdominal pain associated with meals for several months and has been taking over the counter antacids as needed, but experienced significant worsening pain one hour ago in the epigastric region. The patient reports the pain radiating to his shoulders. Vital signs are T 38, HR 120, BP 100/60, RR 18, SpO2 98%. Physical exam reveals diffuse abdominal rigidity with rebound tenderness. Auscultation reveals hypoactive bowel sounds. Which of the following is the next best step in management?

Accepted Answer

Abdominal CT scan

Answer

Admission and observation

Answer

Chest radiograph

Answer

12 lead electrocardiogram

Answer

Abdominal ultrasound

Question 8

Three days after undergoing an open cholecystectomy, a 73-year-old man has fever and abdominal pain. He has hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. He had smoked one pack of cigarettes daily for 40 years but quit 1 year ago. He does not drink alcohol. Prior to admission to the hospital, his medications included lisinopril, metformin, ipratropium, and tamsulosin. He appears acutely ill and lethargic. His temperature is 39.5°C (103.1°F), pulse is 108/min, respirations are 18/min, and blood pressure is 110/84 mm Hg. He is oriented only to person. Examination shows a 10-cm subcostal incision that appears dry and non-erythematous. Scattered expiratory wheezing is heard throughout both lung fields. His abdomen is distended with tenderness to palpation over the lower quadrants. Laboratory studies show:
Hemoglobin 10.1 g/dl
Leukocyte count 19,000/mm3
Serum
Glucose 180 mg/dl
Urea Nitrogen 25 mg/dl
Creatinine 1.2 mg/dl
Lactic acid 2.5 mEq/L (N = 0.5 - 2.2 mEq/L)
Urine
Protein 1+
RBC 1–2/hpf
WBC 32–38/hpf
Which of the following is the most likely underlying mechanism of this patient's current condition?

Accepted Answer

Intraabdominal abscess formation

Answer

Wound contamination

Answer

Peritoneal inflammation

Answer

Impaired alveolar ventilation

Answer

Bladder outlet obstruction

Question 9

A 79-year-old man is admitted to the intensive care unit for hospital acquired pneumonia, a COPD flare, and acute heart failure requiring intubation and mechanical ventilation. On his first night in the intensive care unit, his temperature is 99.7°F (37.6°C), blood pressure is 107/58 mm Hg, and pulse is 150/min which is a sudden change from his previous vitals. Physical exam is notable for jugular venous distension and a rapid heart rate. The ventilator is checked and is functioning normally. Which of the following is the best next step in management for the most likely diagnosis?

Accepted Answer

Needle thoracostomy

Answer

Tube thoracostomy

Answer

FAST exam

Answer

Chest radiograph

Answer

Thoracotomy

Question 10

An 18-year-old man presents to a rural emergency department after being stabbed multiple times. The patient's past medical history is notable for obesity, diabetes, chronic upper respiratory infections, a 10 pack-year smoking history, and heart failure. He is protecting his airway and he is oxygenating and ventilating well. His temperature is 97.6°F (36.4°C), blood pressure is 74/34 mmHg, pulse is 180/min, respirations are 24/min, and oxygen saturation is 98% on room air. The patient is started on whole blood and the surgeon on call is contacted to take the patient to the operating room. During the secondary survey, the patient complains of shortness of breath. His blood pressure is 54/14 mmHg, pulse is 200/min, respirations are 24/min, and oxygen saturation is 90% on room air. Physical exam is notable for bilateral wheezing on lung exam. The patient goes into cardiac arrest and after 30 minutes, attempts at resuscitation are terminated. Which of the following is associated with this patient's decompensation during resuscitation?

Accepted Answer

Persistent intraabdominal bleeding

Answer

COPD

Answer

Congenital long QT syndrome

Answer

Heart failure

Answer

IgA deficiency

Cardiothoracic Surgery

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Aortic surgery basics

Cardiac tamponade recognition and treatment

Chest tube insertion and management

Congenital heart surgery principles

Coronary artery bypass grafting indications

Empyema and pleural space infections

Lung resection procedures

Lung transplantation candidacy

Mechanical circulatory support devices

Mediastinal masses evaluation and management

Pneumothorax management

Thoracotomy approaches and techniques

Valve replacement and repair procedures

Practice Questions

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About Cardiothoracic Surgery for USMLE

Lessons in Cardiothoracic Surgery

Master Cardiothoracic Surgery