Deck 22: Cardiothoracic Surgery

Question 1

Which membrane covers the surface of the lungs?

A) ciliated mucosa
B) pericardium
C) parietal pleura
D) visceral pleura

Answer 1

D

Question 2

Where is the insertion point for the mediastinoscope?

A) suprasternal notch
B) oropharynx
C) subxiphoid
D) umbilicus

Answer 2

A

Question 3

All of the following structures are found within the mediastinum EXCEPT:

A) heart
B) thymus
C) esophagus
D) diaphragm

Answer 3

D

Question 4

Which of the following are the final branchings of the respiratory tree?

A) alveoli
B) bronchi
C) bronchioles
D) lobes of the lung

Question 5

Lung tissue has what kind of consistency?

A) friable
B) slimy
C) calcified
D) elastic

Question 6

Which nerve could be damaged during lung decortication resulting in paralysis or partial paralysis of the diaphragm?

A) accessory
B) hypoglossal
C) phrenic
D) vagus

Question 7

Thymomas, neurogenic tumors, and pleuropericardial cysts can be biopsied during which procedure?

A) bronchoscopy
B) laryngoscopy
C) mediastinoscopy
D) thoracoscopy

Question 8

Which structure within the respiratory tract is the proximal and superior?

A) bronchus
B) diaphragm
C) larynx
D) trachea

Question 9

What is the name of an air-filled sac that has the appearance of a blister on the surface of lung tissue?

A) alveolar sac
B) bleb
C) bronchiole
D) germ cell

Question 10

In which procedure would an incision NOT be required for insertion of the endoscope?

A) bronchoscopy
B) mediastinoscopy
C) pectus excavatum via VATS
D) video-assisted thoracic surgery

Question 11

Which instrument has the appearance of a misshapen pancake spatula?

A) Allison lung retractor
B) Bailey rib contractor
C) Davidson scapula retractor
D) Lovelace lung grasping forceps

Question 12

For which of the following procedures would the rigid bronchoscope be preferred?

A) visualization of the upper lobe bronchi
B) removal of foreign body in children
C) transbronchial lung biopsy
D) bronchial washings

Question 13

How many ribs are considered "true" ribs with direct connection to the sternum with costal cartilage?

A) three
B) seven
C) nine
D) twelve

Question 14

In which part of the respiratory system does the exchange of oxygen and carbon dioxide take place?

A) alveoli
B) bronchi
C) bronchioles
D) pulmonary vein

Question 15

What is the medical term for visible changes in density on chest x-ray that indicates pulmonary pathology?

A) hemoptysis
B) hilum
C) infiltrate
D) inspiration

Question 16

What is the medical term for coughing up blood?

A) asthma
B) bronchitis
C) hemoptysis
D) pneumonitis

Question 17

How many lobes are there in the right lung?

A) two
B) three
C) four
D) five

Question 18

The manubrium, body, and xiphoid process are portions of the:

A) ribs
B) lungs
C) sternum
D) bronchial tree

Question 19

Which of the following regarding blood flow is correct?

A) right atrium, pulmonary vein, lungs, pulmonary artery, left ventricle
B) right ventricle, pulmonary vein, lungs, pulmonary artery, left atrium
C) right atrium, pulmonary artery, lungs, pulmonary vein, left ventricle
D) right ventricle, pulmonary artery, lungs, pulmonary vein, left atrium

Question 20

What is the name of the device that is attached to suction for collection of mucous or bronchial washing specimens?

A) aerobic culture tube
B) insufflation tubing
C) myringotomy tube
D) Lukens tube

Question 21

The main bronchi, pulmonary arteries, veins, and lymphatic vessels enter the lung on the medial surface through the:

A) hilum
B) trachea
C) diaphragm
D) mediastinum

Question 22

Which of the following will be required upon completion of any procedure in which the pleural cavity has been opened?

A) passive wound drain such as a Penrose
B) chest tube attached to a Pleur-evac system
C) active wound drain such as a Jackson-Pratt
D) compression dressing with Ace or tensor bandages

Question 23

Which chamber of the heart is responsible for pumping blood into the pulmonary artery?

A) left atrium
B) right atrium
C) left ventricle
D) right ventricle

Question 24

How many pulmonary veins are there?

A) one
B) two
C) three
D) four

Question 25

What is the name of the procedure performed to release constriction of the lungs by fibrin layers?

A) pectus excavatum
B) upper lobectomy
C) pneumonectomy
D) lung decortication

Question 26

Which statement regarding the anatomical placement of the heart is CORRECT?

A) It is positioned exactly midline in the thoracic cavity.
B) It is positioned in the thoracic cavity with nearly its entirety on the left side.
C) It is positioned in the mediastinum with approximately 2/3 of the heart on the left side.
D) It is positioned in the mediastinum with approximately 2/3 of the heart on the right side.

Question 27

Which instrument is a lung-grasping forceps that resembles a very large Pennington?

A) Doyen
B) Duckbill
C) Lovelace
D) Langenbeck

Question 28

What is a commonly used rib self-retaining retractor available in adult and pediatric sizes?

A) Balfour
B) Bookwalter
C) Finochietto
D) Greenburg

Question 29

What is the term for a collapsed lung?

A) atelectasis
B) decortication
C) emphysema
D) pneumonitis

Question 30

Following lung transplantation, the surgeon will perform which procedure to aspirate secretions and check for leaks?

A) bronchoscopy
B) laryngoscopy
C) mediastinoscopy
D) video-assisted thoracoscopy

Question 31

Which structure is considered the "pacemaker" of the heart?

A) AV node
B) SA node
C) bundle of His
D) Purkinje fibers

Question 32

Which diagnostic study is MOST useful for verification of thoracic aortic dissection?

A) AP chest x-ray
B) CT scan
C) MRI scan
D) stress test

Question 33

Prior to the closure of a lobectomy procedure, the anesthesia provider performs a Valsalva maneuver to check for:

A) air leakage from bronchial closure
B) bleeding from the dissection bed
C) functionality of the diaphragm
D) perfusion of the unaffected lobes

Question 34

The name of the condition created when pus is not cleared from the pleural cavity and makes a fibrous constrictive layer is:

A) COPD
B) pleurisy
C) empyema
D) pneumonia

Question 35

Which of the following is a crushing clamp with sharp spikes in the jaw used on the bronchus?

A) Bailey
B) Doyen
C) Mixter
D) Sarot

Question 36

Which type of incision is made for a pneumonectomy?

A) Chevron
B) McBurney
C) epigastric
D) posterolateral

Question 37

In the event that a VATS procedure had to be converted to an open procedure, which open case would be performed?

A) coronary artery bypass
B) laparoscopy
C) thoracotomy
D) tracheotomy

Question 38

Which of the following thoracic procedures would require the patient to be put on cardiopulmonary bypass?

A) pneumonectomy
B) upper lobectomy
C) decortication of the lung
D) pulmonary thromboendarterectomy

Question 39

Which instrument is a rib shear?

A) Alexander
B) Bethune
C) Davidson
D) Satinsky

Question 40

Which additional pain control measure is taken for patients undergoing pectus excavatum repair by VATS?

A) Bier block
B) epidural
C) local with epinephrine
D) topical Lidocaine jelly

Question 41

Where are the cannulae MOST commonly placed for cardiopulmonary bypass procedures?

A) carotid artery and subclavian vein
B) right atrium and ascending aorta
C) right ventricle and descending aorta
D) femoral artery and brachiocephalic vein

Question 42

Which suturing technique maintains the aortic and venous cannulae?

A) figure of eight
B) purse-string
C) horizontal mattress
D) vertical mattress

Question 43

What is the name of the area between the visceral and parietal pleura that contains serous fluid to prevent friction?

A) hilum
B) mediastinum
C) pleural space
D) pericardial window

Question 44

The apex of the lung is located:

A) inferiorly and laterally
B) medially where the bronchus enters
C) medially just above the diaphragm
D) superiorly and just above the clavicle

Question 45

Which artery accounts for approximately 50% of occlusive coronary lesions?

A) circumflex branch
B) left anterior descending
C) mammary
D) right coronary

Question 46

Where is the apex of the heart located within the mediastinum?

A) superiorly on the right side
B) inferiorly on the right side
C) superiorly on the left side
D) inferiorly on the left side

Question 47

The force and rate of contraction of the heart is controlled by which part of the central nervous system (CNS)?

A) phrenic nerve
B) vagus nerve
C) Purkinje system
D) medulla oblongata

Question 48

All of the following are components of the "heart-lung" machine EXCEPT:

A) pump
B) oxygenator
C) defibrillator
D) heat exchanger

Question 49

Which suture is frequently used for anastomosis of the saphenous vein or internal mammary artery in CABG?

A) 6-0 or 7-0 polypropylene
B) 2-0 or 3-0 polyester
C) 6-0 or 7-0 polyglactin
D) 2-0 or 3-0 poliglecaprone

Question 50

What is the name of the acute condition in which heart muscle dies from ischemia and may lead to sudden cardiac death?

A) heart block
B) atherosclerosis
C) cardiac tamponade
D) myocardial infarction

Question 51

Which one of the following is NOT one of the cardiac valves?

A) aortic
B) mitral
C) septal
D) tricuspid

Question 52

Which heart valve is also known as the bicuspid valve?

A) aortic
B) mitral
C) pulmonary
D) tricuspid

Question 53

The coronary arteries originate from the:

A) ascending aorta
B) descending aorta
C) pulmonary artery
D) subclavian artery

Question 54

Which of the following is the main underlying pathogenic cause of coronary atherosclerosis and clinical manifestations?

A) age
B) diet
C) ischemia
D) hypertension

Question 55

Which of the following is a commonly used method of preserving the heart by reducing its metabolic needs?

A) hypothermia
B) lung deflation
C) left ventricular venting
D) warming with heat exchanger

Question 56

Where is a Swan-Ganz catheter placed?

A) ascending aorta
B) coronary artery
C) pulmonary artery
D) vena cava

Question 57

Which instrument is used to make a small opening into the ascending aorta after the Satinsky partial occlusion clamp is placed?

A) aortic punch
B) Potts-Smith scissors
C) #11 blade
D) 5 mm trocar

Question 58

What is the thickest part of the heart?

A) epicardium
B) endocardium
C) myocardium
D) pericardium

Question 59

Which portion of the heart is responsible for pumping blood into the ascending aorta?

A) left atrium
B) right atrium
C) left ventricle
D) right ventricle

Question 60

What is the first step in the formation of an atheroma?

A) accumulation of cholesterol and lipids
B) collagen deposition and scar tissue formation
C) growth of new smooth muscle tissue
D) injury to endothelial lining

Question 61

Aortic valve stenosis and aortic regurgitation are often as a result of :

A) rheumatic fever
B) tuberculosis
C) heart block
D) angina

Question 62

What is frequently used to repair atrial and ventricular septal defects in pediatric patients?

A) Dacron patch
B) porcine valve
C) fascia lata
D) fibrin glue

Question 63

Which diagnostic method provides the MOST extensive details regarding valvular disorders?

A) cardiac catheterization
B) CT scanning
C) electromyography
D) MRI scanning

Question 64

Which device is used for patients awaiting heart transplant that allows them to be ambulatory and has both internal and external components to the system?

A) ventricular assist device
B) left ventricular vent
C) cardiac pacemaker
D) vena cava filter

Question 65

Which congenital defect has four components and is characterized by cyanosis causing appearance of "blue babies"?

A) coarctation of the aorta
B) patent ductus arteriosus
C) ventricular septal defect
D) tetralogy of Fallot

Question 67

What is the average lifespan of biologic and mechanical heart valve replacements?

A) 1 to 5 years
B) 5 to 10 years
C) 10 to 15 years
D) indefinite

Question 68

The drainage and collection device attached to chest tubes relies on a water seal to reestablish negative pressure in the pleural cavity.

Question 69

Which singular congenital defect involves failure of closure of the connection between the pulmonary artery and aorta?

A) atrial septal defect
B) ventriculo septal defect
C) patent ductus arteriosus
D) tetralogy of Fallot

Question 70

What is the term for a localized stricture of the aorta found in a pediatric patient?

A) coarctation
B) stenosis
C) prolapsed
D) arteriosis

Question 71

Video-assisted thoracic surgery procedures use carbon dioxide for distention.

Question 72

The saphenous vein used for coronary artery grafting must be reversed before anastomosis due to the presence of valves in the vein.

Question 73

With what is the median sternotomy closed?

A) fine gauge polypropylene
B) fine gauge surgical silk
C) heavy gauge stainless steel wire
D) heavy gauge chromic gut

Question 74

What is the name of the device used for patients who are unable to be weaned off of cardiopulmonary bypass?

A) intra-aortic balloon pump
B) left ventricular vent
C) cardiac pacemaker
D) vena cava filter

Question 75

Which surgical approach is used for repair of coarctation of the aorta and patent ductus arteriosus?

A) supine
B) prone
C) frog-legged
D) posterolateral

Question 76

A heart murmur is often heard with auscultation and indicative of involvement of which structure?

A) aortic valve
B) mitral valve
C) right ventricle
D) left ventricle

Question 77

What is the general term for incurable diseases of the heart for which the only treatment would be heart transplantation?

A) atherosclerosis
B) arrhythmias
C) cardioplegia
D) cardiomyopathies

Question 78

Commissurotomy is a surgical separation of the flaps of the:

A) mitral valve
B) left ventricle
C) pulmonary valve
D) right atrium

Question 79

The ventricles of the heart have thicker myocardium than the atria.

Question 80

Medtronic OCTOPUS® and Guidant Ultima OPCAB® are what type of devices for coronary artery bypass done off-pump?

A) retractors
B) stabilizers
C) cannulae
D) grafts