1- 50 Surgery

1. Which of the following is the BEST indication of adequacy of perfusion by a heart valve machine? A. Venous oxygen saturation B. Arterial oxygen saturation C. Arterial Pco2 D. Urine output 2. What is the normal pressure in the left atrium? A. 0-5 mmHg B. 6-10 mmHg C. 11-15 mmHg D. 16-20 mmHg 3. Which of the following will BEST evaluate left atrial dilatation with mitral stenosis? A. Left lateral oblique view on CXR B. Echocardiography C. Posteroanterior view on CXR D. Electrocardiogram 4. Which of the following will NOT produce a forceful & bounding pulse? A. Patent ductus arteriosus B. Hyperthyroidism C. Aortic stenosis D. Aortic insufficiency 5. The pulse is small in all of the following, EXCEPT: A. Mitral stenosis B. Myocardial dilatation C. Pericardial effusion D. Syphilis 6. Which of the following is the MOST common complication of patent ductus arteriosus? A. Heart failure B. Pulmonary hypertension C. Pulmonary incompetence D. Bacterial endocarditis 7. Which of the following is a characteristic feature of patent ductus arteriosus? A. Continuous murmur at the 2nd left intercostal space B. Pansystolic murmur along the left sternal border C. Prominent pulmonary conus on CXR D. Streptococcus viridans endocarditis 8. What is the MAIN indication for surgery in pulmonary stenosis? A. Valve gradient >50 mmHg B. Right ventricular pressure >75 mmHg C. Right ventricular hypertrophy on ECG D. Valve diameter <1 cm

9. Which of the following refers to a low atrial septal defect associated with a cleft in the anterior leaflet of the mitral valve? A. Ostium primum defect B. Sinus venosus defect C. Patent foramen ovale D. Secundum defect 10. What is the MOST common type of ventricular septal defect? A. Left ventricular-right atrial defect B. Membranous septal defect C. Posterior septal defect D. Low muscular defect 11. A 1-year old child is found to have posterior membranous VSD. The pulmonary resistance is 40% that of the systemic. The next BEST thing to do is to: A. Observe the child since VSDs close spontaneously B. Repair immediately as an emergency C. Repair electively at age 10 D. Repair electively before ages 4-6 years 12. What is the MAJOR determinant of operability in ventricular septal defect? A. Age of patient B. Pulmonary vascular resistance C. Size of VSD D. Pulmonary artery pressure 13. Which of the following will BEST distinguish the murmur associated with tricuspid valve disease from that of mitral valve disease? A. Time relationship to that of the carotid pulse B. Exercise C. Examination of the jugular pulse D. Response to deep inspiration 14. Which of the following will NOT characterize Tetralogy of Fallot? A. Dextroposition of the aorta B. Right ventricular hypertrophy C. Pulmonary stenosis D. Increased lung field vascularity 15. What is the MOST sensitive marker of heart failure in children? A. Pulmonary congestion B. Weak pulses C. S3 gallop rhythm D. Hepatic enlargement

16. What is the operative mortality for elective coronary artery bypass surgery? A. <2% B. 2-3% C. 4-7% D. 8-10% 17. Which of the following is NOT an indication for coronary bypass surgery? A. Unstable angina unresponsive to medical management B. Angina related to isolated left main coronary artery disease C. Recurrent angina after myocardial infarction D. CHF with pulmonary hypertension 18. Which of the following is the BEST predictor for increased operative risk for coronary artery surgery? A. Degree of coronary artery obstruction B. History of myocardial infarction C. Ejection fraction D. Age of patient 19. The postpericardiectomy syndrome is characterized by: A. Sustained fever B. Presence of pericardial rub C. Response to corticosteroids D. All of the above 20. Which of the following statements is TRUE regarding cardiac tumors? A. Myxoma is the most common primary tumor B. Metastasis to the heart is extremely rare C. Excision of a myxoma is performed without a bypass procedure D. Sarcomas constitute 1% of cardiac tumors 21. A pulmonary embolus is MOST likely to develop after a thrombus in the: A. Long saphenous vein B. Popliteal veins C. Femoral veins D. Iliac veins 22. Cardiac complications after a major vascular procedure will MOST likely occur if: A. There is a history of angina & prior MI B. The left ejection fraction is <25% C. Aortic stenosis is present D. Jugular venous distention & signs of left ventricular failure are presen 23. Elective repair of an aortic aneurysm will carry a mortality risk of: A. 1-4% B. 5-10% C. 11-40% D. 41-60%

24. Which of the following is associated with a dissecting aortic aneurysm? A. Paralysis of the lower extremity B. Cerebrovascular stroke C. Aortic insufficiency D. All of the above 25. Which of the following is NOT associated with a dissecting aortic aneurysm? A. Pregnancy B. Cystic medial necrosis C. Calcific medial necrosis D. Marfan’s syndrome 26. Optimal control of hypertension in type-III dissecting aortic aneurysm is achieved by: A. Trimethaphan + Furosemide B. Nitroprusside + Propranolol C. Nitroglycerin + Furosemide D. Propranolol + Furosemide + Methyldopa 28. Which of the following statements is TRUE regarding varicose veins? A. Are treated by ligation of large tributaries alone B. Should be excised if the deep system is occluded C. In the groin, they receive tributaries mainly from the inferior epigastric vein D. May be treated effectively by injection therapy (sclerotherapy) 29. In arterial embolus, 50% : A. Arise from atherosclerotic plaques B. Involve the extremities C. Result in gangrene of the extremity if not treated D. Involve the cerebral circulation 30. How do you BEST manage a patient with combined aortoiliac & femoropopliteal occlusive disease and ischemic rest pain? A. Aortofemoral bypass B. Femoropopliteal bypass C. Aortofemoral & femoropopliteal bypass D. Vasodilator therapy 32. What is the percentage chance of limb-threatening gangrene developing in untreated intermittent claudication? A. <20% B. 30% C. 45% D. 60%

33. Which of the following statements is TRUE regarding thromboangiitis obliterans (Burger’s disease)? A. Occurs mainly in elderly males B. Is often associated with aortic aneurysm C. Is often associated with diabetes D. Affects small vessels in the upper extremities 34. Which of the following statements is NOT true regarding popliteal aneurysms? A. Associated with abdominal aneurysm in 30-50% B. Likely to lead to spontaneous rupture C. Likely to lead to threatening ischemia if thrombosis occurs D. Caused by atherosclerosis 35. Which of the following statements is TRUE regarding below-knee post-amputation for vascular disease? A. There is less efficient function than that after a through-knee amputation B. Stump prognosis can be judged by transcutaneous oxygen monitoring C. The tibia & fibula are of equal length D. The line of transection is 2 inches above the medial malleolus 36. An 18-year old male has a painful swollen leg. There is tenderness in the calf and ecchymosis is present. The MOST likely cause is: A. Medial lemniscus tear B. Deep vein thrombosis C. Superficial thrombophlebitis D. Plantaris tear

37. Which of the following is the procedure of choice for renovascular hypertension secondary to fibromuscular dysplasia of the right renal artery? A. Aortorenal saphenous vein bypass B. Patch angioplasty of the renal artery C. Percutaneous transluminal angioplasty D. Transaortic renal endarterectomy 38. Which of the following statements is TRUE regarding renovascular hypertension? A. Systolic pressure alone is elevated B. Removal of a small kidney results in normal pressure in most cases C. The cause is usually atherosclerosis D. The renin-angiotensin mechanism is suppressed 39. Which of the following statements is TRUE regarding splenic artery aneurysms? A. Require splenectomy for optimal treatment B. Are more common in males than in females C. Are caused in most cases by atherosclerosis D. May rupture during pregnancy

40. Which of the following statements is TRUE regarding an asymptomatic carotid bruit? A. Is always associated with significant internal carotid occlusive disease B. Represents an increased risk for coronary artery disease C. Is associated with stroke in 20% of patients undergoing resection of an abdominal aortic aneurysm D. Requires urgent operative intervention 41. Giant cell arteritis in the elderly is associated with all of the following, EXCEPT: A. Stroke B. Seizures C. Blindness D. Elevated ESR 42. A 63-year old male has had a cyanotic painful left 4th toe for 2 days. The peripheral arteries on both sides are patent. There is no previous history of cardiac or vascular disease. The MOST likely diagnosis is: A. Digital embolus B. Digital atherosclerosis C. Raynaud’s syndrome D. Atheroembolism 43. Which of the following is a sign of satisfactory arterial flow? A. Bradycardia on compressing the femoral artery B. Incompetent saphenofemoral junction C. Absence of leg edema D. Rapid venous filling time 44. A 78-year old female suddenly develops severe diffuse abdominal pain 4 days after MI complicated by atrial fibrillation. But on examination, the abdomen is soft & nontender, with slightly hyperactive bowel sounds and no distention. The next MOST important procedure is: A. Serial clinical examination & WBC counts B. Diagnostic peritoneal lavage C. Colonoscopy D. Angiography 45. Which of the following is the MOST likely diagnosis in #44? A. Mesenteric embolus B. Nonocclusive ischemic disease C. Congestive cardiac failure D. Digoxin toxicity 46. A 22-year old male patient had a catheter inserted into the superior vena cava. He would manifest all of the following, EXCEPT: A. Dilated upper extremity veins B. Edema of the face C. Edema of the upper extremity D. Horner’s syndrome

47. All following conditions could require insertion of a catheter into the superior vena cava, EXCEPT: A. Intralipid administration B. Refractory ascites C. Chemotherapy D. Hydrocephalus 48. Which of the following veins cannot be used to obtain access for catheter insertion? A. Internal mammary B. Saphenous C. Cephalic D. Internal jugular 49. In a 6-year old child with atrial septal defect with no cyanosis, blood flows MAINLY: A. From the right atrium to the left atrium B. From the left atrium to the right atrium C. Equally in both directions D. Intermittent according to phase of cardiac cycle 50. The shunt in atrial septal defect becomes clinically significant when the pulmonary flow is greater than the systemic flow by a factor of: A. 0.5 B. 1.5 C. 5.0 D. 10.0