Cardiothoracic Surgery SAQs

  1. What are the branches of the left coronary artery? (2)
  2. Which artery supplies the right atrium? (1)
  3. Which artery supplies the left atrium? (1)
  4. Which artery supplies the posterior aspect of the left ventricle? (1)
  5. Which artery supplies the anterior aspect of the left ventricle? (1)
  6. Who is responsible for operating and monitoring the
  7. cardiopulmonary bypass equipment? (1)
  8. What is the name for the process of stopping the heart beating in order to perform a CABG? (1)
  9. What medication is used to stop the heart during a CABG? (1)
  10. What are the three main options for graft blood vessels used for a CABG? (3)
  11. What is the name of the process where graft veins become stenosed (narrowed) over time? (1)
  12. What are the two most serious and notable short-term complications of a CABG? (2)
  13. What incision may be used for minimally invasive mitral valve surgery? (1)
  14. What valvular pathology causes a slow-rising pulse and narrow pulse pressure? (1)
  15. What valvular pathology causes a pan-systolic, high-pitched, “whistling” murmur? (1)
  16. What are the two types of prosthetic heart valve? (2) Which lasts longer? (1)
  17. What type of prosthetic heart valve requires anticoagulation? (1) Which anticoagulant is used? (1) What monitoring is required? (1) What target is used for monitoring? (1)
  18. What type of prosthetic heart valve involves a "ball in a cage”? (1)
  19. What type of prosthetic heart valve involves two tilting metal discs? (1)
  20. What are the three major complications of mechanical heart valves? (3)
  21. What procedure can be used to treat severe aortic stenosis in patients that are deemed too high-risk for an open surgical valve replacement? (1)
  22. What syndrome would cause a patient with a ventricular septal defect to become cyanotic? (1)
  23. What congenital heart defect causes a mid-systolic, crescendo-decrescendo murmur, heard loudest at the upper left sternal border? (1)
  24. What congenital heart defect causes a pan-systolic murmur most prominently heard at the left lower sternal border, in the third and fourth intercostal spaces? (1)
  25. What congenital heart defect causes a systolic murmur heard below the left clavicle (left infraclavicular area) and below the left scapula? (1)
  26. In what circumstance might a deep vein thrombosis lead to a stroke? (1)
  27. How much fluid is normally present within the pericardial sac? (1)
  28. Which two categories can be used for the causes of a pericardial effusion? (2)
  29. Hiccups associated with a pericardial effusion are caused by compression of what nerve? (1)
  30. A hoarse voice associated with a pericardial effusion is caused by compression of what nerve? (1)
  31. What clinical sign involves an abnormally large fall in blood pressure during inspiration, noticeable when palpating the pulse? (1)
  32. What is the investigation of choice for diagnosing a pericardial effusion? (1)
  33. What investigation is most relevant in establishing the underlying cause of a pericardial effusion? (1)
  34. What are the two options for draining a pericardial effusion? (2)
  35. Which area of the thoracic aorta is most commonly affected by an aneurysm? (1)
  36. What is the normal diameter of the ascending and descending thoracic aorta? (2)
  37. What are the three layers of the aortic wall? (3)
  38. What procedure, used to treat thoracic aortic aneurysms, involves a catheter inserted via the femoral artery and the insertion of a stent graft into the affected section of the aorta? (1)
  39. What procedure used to treat thoracic aortic aneurysms involves a catheter inserted via the femoral artery and insertion of a stent graft into the affected section of the aorta? (1)
  40. What incision may be used for open repair of a thoracic aortic aneurysm? (1)
  41. What are the two most common types of non-small cell lung cancer? (2)
  42. What type of cancer is associated with asbestos? (1)
    On examination, enlargement of which lymph nodes would make you most suspicious of lung cancer? (1)
  43. What is the classic triad of Horner’s syndrome? (3)
  44. When would lung cancer cause Horner’s syndrome? (2)
  45. What type of lung cancer can cause syndrome of inappropriate ADH (SIADH)? (1) Which electrolyte abnormality does this present with? (1)
  46. What does Pemberton’s sign indicate? (1)
  47. What type of lung cancer is most associated with hypercalcaemia due to ectopic parathyroid hormone secretion? (1)
  48. What finding in the hands is most concerning for lung cancer? (1)
  49. What is the usual first-line investigation for suspected lung cancer? (1)
  50. What are the main options for obtaining a biopsy from a lung tumour? (2)
  51. What is the name for “keyhole” surgery to the thorax? (1)
  52. How do you measure the size of a pneumothorax on an erect chest x-ray? (2)
  53. What is the cut-off size of a pneumothorax for which aspiration is required? (1)
  54. Which anatomical landmarks form the “triangle of safety” for chest drain insertion? (3)
  55. What are two key complications of chest drains? (2)
  56. Which procedure involves creating an inflammatory reaction in the pleural lining so that the pleura stick together, sealing the pleural space? (1) What are the options for this? (2)
  57. What is the immediate initial management of a tension pneumothorax? (1)
  58. What incision may be used for bilateral lung transplants? (1)
  1. What are the branches of the left coronary artery? Circumflex (1) and left anterior descending (1)
  2. Which artery supplies the right atrium? Right coronary artery (1)
  3. Which artery supplies the left atrium? Circumflex artery (1)
  4. Which artery supplies the posterior aspect of the left ventricle? Circumflex artery (1)
  5. Which artery supplies the anterior aspect of the left ventricle? Left anterior descending (1)
  6. Who is responsible for operating and monitoring the cardiopulmonary bypass equipment? Clinical perfusionist (1)
  7. What is the name for the process of stopping the heart beating in order to perform a CABG? Cardioplegia (1)
  8. Which medication is used to stop the heart during a CABG? High-concentration potassium solution (1)
  9. What are the three main options for graft blood vessels used for a CABG? Saphenous vein (1), internal thoracic artery (1) and radial artery (1)
  10. What is the name of the process where graft veins become stenosed (narrowed) over time? Intimal hyperplasia (1)
  11. What are the two most serious and notable short-term complications of a CABG? Death (2-3% in straightforward cases) (1) and stroke (1-5% in straightforward cases) (1)
  12. What incision may be used for minimally invasive mitral valve surgery? Right-sided mini-thoracotomy (1)
  13. What valvular pathology causes a slow-rising pulse and narrow pulse pressure? Aortic stenosis (1)
  14. What valvular pathology causes a pan-systolic, high-pitched “whistling”, murmur? Mitral regurgitation (1)
  15. What are the two types of prosthetic heart valve? Bioprosthetic (1) and metallic mechanical valves (1) Which lasts longer? Metallic mechanical valves (1)
  16. What type of prosthetic heart valve requires anticoagulation? Metallic mechanical valves (1) Which anticoagulant is used? Warfarin (1) What monitoring is required? International normalised ratio (INR) (1) What target is used for monitoring? INR 2.5 - 3.5 (1)
  17. What type of prosthetic heart valve involves a "ball in a cage"? Starr-Edwards valve (1)
  18. What type of prosthetic heart valve involves two tilting metal discs? St Jude valve (bileaflet valve) (1)
  19. What are the three major complications of mechanical heart valves? Thrombus formation (1), infective endocarditis (1) and haemolytic anaemia (1)
  20. What procedure can be used to treat severe aortic stenosis in patients that are deemed too high-risk for an open surgical valve replacement? Transcatheter aortic valve implantation (TAVI) (1)
  21. What syndrome would cause a patient with a ventricular septal defect to become cyanotic? Eisenmenger syndrome (1)
  22. What congenital heart defect causes a mid-systolic, crescendo-decrescendo murmur, heard loudest at the upper left sternal border? Atrial septal defect (1)
  23. What congenital heart defect causes a pan-systolic murmur most prominently heard at the left lower sternal border, in the third and fourth intercostal spaces? Ventricular septal defect (1)
  24. What congenital heart defect causes a systolic murmur heard below the left clavicle (left infraclavicular area) and below the left scapula? Coarctation of the aorta (1)
  25. In what circumstance might a deep vein thrombosis lead to a stroke? Atrial septal defect (1)
  26. How much fluid is normally present within the pericardial sac? Less than 50mls (1)
  27. Which two categories can be used for the causes of a pericardial effusion? Transudative (1) and exudative (1)
  28. Hiccups associated with a pericardial effusion are caused by compression of what nerve? Phrenic nerve (1)
  29. A hoarse voice associated with a pericardial effusion is caused by compression of what nerve? Recurrent laryngeal nerve (1)
  30. What clinical sign involves an abnormally large fall in blood pressure during inspiration, noticeable when palpating the pulse? Pulsus paradoxus (1)
  31. What is the investigation of choice for diagnosing a pericardial effusion? Echocardiogram (1)
  32. What investigation is most relevant in establishing the underlying cause of a pericardial effusion? Fluid analysis of the pericardial fluid (1)
  33. What are the two options for draining a pericardial effusion? Needle pericardiocentesis (1) and surgical drainage (1)
  34. Which area of the thoracic aorta is most commonly affected by an aneurysm? Ascending aorta (1)
  35. What is the normal diameter of the ascending and descending thoracic aorta? Less than 4.5cm for the ascending (1) and 3.5cm for the descending (1)
  36. What are the three layers of the aortic wall? Intima (1), media (1) and adventitia (1)
  37. What is the name for when the inner two layers of the aorta rupture, resulting in dilation of the vessel, with blood being contained only by the outer layer of the aortic wall? False aneurysm / pseudoaneurysm (1)
  38. What procedure, used to treat thoracic aortic aneurysms, involves a catheter inserted via the femoral artery and the insertion of a stent graft into the affected section of the aorta? Thoracic endovascular aortic repair (TEVAR) (1)
  39. What incision may be used for open repair of a thoracic aortic aneurysm? Midline sternotomy (1)
  40. What are the two most common types of non-small cell lung cancer? Adenocarcinoma (1) and squamous cell carcinoma (1)
  41. What type of cancer is associated with asbestos? Mesothelioma (1)
  42. On examination, enlargement of which lymph nodes would make you most suspicious of lung cancer? Supraclavicular (1)
  43. What is the classic triad of Horner’s syndrome? Partial ptosis (1), anhidrosis (1) and miosis (1)
  44. When would lung cancer cause Horner’s syndrome? A Pancoast tumour (tumour in the pulmonary apex) (1) pressing on the sympathetic ganglion (1)
  45. What type of lung cancer can cause syndrome of inappropriate ADH (SIADH)? Small cell lung cancer (1) Which electrolyte abnormality does this present with? Hyponatraemia (low sodium) (1)
  46. What does Pemberton’s sign indicate? Superior vena cava obstruction (1)
  47. What type of lung cancer is most associated with hypercalcaemia due to ectopic parathyroid hormone secretion? Squamous cell carcinoma (1)
  48. What finding in the hands is most concerning for lung cancer? Finger clubbing (1)
  49. What is the usual first-line investigation for suspected lung cancer? Chest x-ray (1)
  50. What are the main options for obtaining a biopsy from a lung tumour? Via bronchoscopy (transbronchial) (1) or percutaneous biopsy (1)
  51. What is the name for “keyhole” surgery to the thorax? Video-assisted thoracoscopic surgery (VATS) (1)
  52. How do you measure the size of a pneumothorax on an erect chest x-ray? Horizontally (1) from the lung edge to the inside of the chest wall, at the level of the hilum (1)
  53. What is the cut-off size of a pneumothorax for which aspiration is required? 2cm (1)
  54. Which anatomical landmarks form the “triangle of safety” for chest drain insertion? 5th intercostal space (1), midaxillary line (or the lateral edge of the latissimus dorsi) (1) and the anterior axillary line (or the lateral edge of the pectoralis major) (1)
  55. What are two key complications of chest drains? Air leaks (1) and surgical emphysema (1)
  56. Which procedure involves creating an inflammatory reaction in the pleural lining so that the pleura stick together, sealing the pleural space? Pleurodesis (1) What are the options for this? Abrasive pleurodesis (1) and chemical pleurodesis (e.g., with talc) (1)
  57. What is the immediate initial management of a tension pneumothorax? Insert a large bore cannula into the second intercostal space in the midclavicular line (1)
  58. What incision may be used for bilateral lung transplants? Clamshell incision (1)

 

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