Question 1

Which of the following criteria must be met for a patient to be considered for abdominal aortic aneurysmectomy?

Accepted Answer

Patients who are diagnosed with aneurysms greater than or equal to 5 cm or who have rapid aneurysm enlargement are considered for surgical repair.

Question 2

Which of the following revascularization procedures is the BEST option when all three vessels of the coronary arterial supply are severely occluded?

Accepted Answer

The Coronary Artery Surgery Study (CASS)concluded that surgical revascularization is the optimal choice for management of coronary artery disease when all three vessels are severely obstructed.

Question 3

The findings of the Stenting and Angioplasty with Protection in Patients at High risk for Endarterectomy (SAPPHIRE)trial concluded which of the following about carotid artery stenting compared to endarterectomy on the risk for death,stroke,or MI 30 days and 1 year post procedure?

Accepted Answer

The SAPPIRE trial randomly compared carotid artery stenting to endarterectomy.Analysis of 30-day and 1-year outcomes,including deaths,stroke,or MI,found that carotid stenting was not inferior to CEA.However,the overall results in both arms of this trial were noted to be disturbingly high,with a risk of 12.2% among stenting patients and 20.1% among endarterectomy patients.

Question 4

You are evaluating a patient who is post a posterolateral thoracotomy procedure and is complaining of ipsilateral shoulder pain.Which of the following is LEAST likely a probable cause of the shoulder pain?

Accepted Answer

Shoulder pain occurs after both thoracotomy and VATS and is thought to be primarily referred pain of diaphragmatic irritation transmitted by the phrenic nerve.Other probable causes include a chest drain placed too far into the apex of the hemithorax,the posterior end of a large posterolateral thoracotomy incision may not be blocked by a functioning thoracic epidural block,and chronic arthralgia of the shoulder prior to surgery that is exacerbated by positioning.

Question 5

Which of the following therapeutic interventions would be MOST appropriate for a patient who had a thoracoabdominal incision?

Accepted Answer

Individuals with a thoracoabdominal incision often have problems with coughing,deep breathing,and thoracic extension.Segmental breathing and side bending stretch are appropriate for lateral thoracotomy.

Question 6

A patient who is positioned one-quarter turn from supine (operative side elevated)with the upper most arm flexed at the elbow and placed beneath the back is in preparation for which of the following surgical approaches?

Accepted Answer

Patients are positioned one-quarter turn from supine (operative side elevated)with the uppermost arm flexed at the elbow and placed beneath the back in preparation for an anterolateral thoracotomy.

Question 7

A patient who is status post-abdominal aortic aneurysm repair will be at high risk for pulmonary complications.Which of the following interventions would BEST address pulmonary risk?

Accepted Answer

Due to the invasiveness of this procedure throughout the abdomen,patients undergoing this procedure are at high risk for pulmonary complications.Incisional pain and the use of the abdominal musculature in coughing discourage the patient from full inspirations as well as effective forceful huffing or coughing.Clinical techniques to assist with cough for AAA repair include splinting with pillows or towel rolls at the incisional site and forceful huffing.

Question 8

To drain air from the chest cavity,chest tubes are commonly placed in which of the following anatomical sites?

Accepted Answer

To drain air,intrapleural tubes are inserted into the second or third intercostal space at the midclavicular line.

Question 9

Which of the following musculoskeletal impairments is avoided by the surgeon sparing the long thoracic nerve during a lateral thoracotomy?

Accepted Answer

Postoperative scapular winging is avoided by careful preservation of the long thoracic nerve.

Question 10

Which of the following surgical approaches is MOST commonly used for cardiac procedures?

Accepted Answer

Cardiac procedures are performed almost exclusively through a median sternotomy.

Question 11

Which of the following reasons BEST supports the administration of vascular endothelial growth factor (VEGF)with a collagen-binding domain (CBD),an agent that is used for stimulating the growth of new blood vessels?

Accepted Answer

The adult heart has been shown to have a reduced ability to produce growth factors and stimulate angiogenesis in response to ischemia.VEGF has several isoforms and is considered to be a potent angiogenic agent because it is endothelial cell specific.The delivery system should target the injured myocardium to improve the local therapeutic efficacy of VEGF and decrease its possible adverse effects.Use of a collagen-binding domain with VEGF aids the VEGF to be retained in the cardiac extracellular matrix,which is rich in collagen I.

Question 12

Which of the following advantages of video-assisted thoracoscopic surgery over a thoracotomy is MOST related to recovery in the activities domain within the International Classification of Functioning (ICF)model?

Accepted Answer

The activities domain of the ICF model is reflected by task level activities,thus early patient mobilization and recovery would reflect functional mobility for getting out of bed,walking,transfers,etc.Other answer options reflect structure changes and facility outcomes.

Question 13

The implantable cardioverter defibrillator is BEST indicated in which of the following heart conditions?

Accepted Answer

An implantable cardioverter defibrillator is similar to a pacemaker,but is designed to correct life-threatening arrhythmias.An ICD detects and corrects all tachycardias,ventricular fibrillation,and bradycardia.

Question 14

The provision of interventions including deep breathing,incentive spirometer,and coughing to a patient who is early post-coronary artery bypass graft BEST prevents which of the following clinical complications?

Accepted Answer

The use of interventions such as deep breathing,incentive spirometer,and coughing assists in the prevention of pulmonary infection and atelectasis.Chest soreness would not be prevented by these interventions but may be reduced.

Question 15

A patient presents with a left chest wall intrapleural drainage tube that is connected to a sealed collection system.Which of the following actions is MOST appropriate for the physical therapist treating the patient?

Accepted Answer

The presence of chest drainage tubes would not preclude the patient's participation in physical therapy activities.Mobility is encouraged unless another complication is a limiting factor.

Question 16

If atherosclerosis is diagnosed in the carotid arteries,which of the following arteries may also be atherosclerotic secondary to the nature of the disease process?

Accepted Answer

The clinician should suspect that other vessels,besides the carotid vessels,have atherosclerosis because atherosclerosis is a systemic disease.The other vessels to suspect include the coronary arteries,peripheral vasculature,and possibly the renal vasculature.

Question 17

An example of an atrioventricular nodal arrhythmia of which a pacemaker is indicated is which of the following?

Accepted Answer

Pacemakers are indicated for sinoatrial nodal disorders (bradyarrhythmias),atrioventricular nodal disorders (complete heart block,Mobitz type II arrhythmia),or tachyarrhythmias (supraventricular tachycardia,frequent ventricular ectopy).

Question 18

A patient who is positioned one-quarter turn from prone (operative side elevated)with the uppermost arm elevated forward,flexed at the elbow,and placed by the head is in preparation for which of the following surgical approaches?

Accepted Answer

In preparation for a posterolateral thoracotomy,patients are positioned one-quarter turn from prone (operative side elevated)with the uppermost arm elevated forward,flexed at the elbow,and placed by the head.

Question 19

When a patient is being considered for peripheral vascular disease intervention (surgical versus percutaneous transluminal angioplasty),which of the following factors considered is a lesion characteristic?

Accepted Answer

The type of intervention for peripheral vascular disease is determined based on specific factors.Characteristics of the lesion include location,stenosis versus occlusion,and lesion length.

Question 20

The primary cause of perioperative morbidity and mortality in the thoracic surgical population is which of the following?

Accepted Answer

The major causes of perioperative morbidity and mortality in the entire thoracic surgical population is respiratory complications such as atelectasis,pneumonia,or respiratory failure.

Quiz 11: Cardiovascular and Thoracic Interventions