SCFHS Cardiothoracic Surgery exam questions

The Cardiothoracic Surgery exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Cardiothoracic Surgery practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Anatomy of the Thorax

   A chylothorax appears after a mid-oesophageal resection. At which vertebral level does the thoracic duct cross from the right to the left side of the chest?

   1. AAbout T10, near the aortic hiatus
   2. BAbout T5, behind the oesophagus
   3. CAbout T2, at the thoracic inlet
   4. DAbout T12, at the cisterna chyli
   Show answer and explanation

   Correct answer: B. About T5, behind the oesophagus

   The thoracic duct ascends on the right of the vertebral column and crosses to the left at about T4 to T5 behind the oesophagus. Injury below this level produces a right chylothorax and injury above it a left one. T10 is where it lies close to the aortic hiatus, T12 is the cisterna chyli region, and T2 is above the crossing.

   Reference: Snell, Clinical Anatomy by Regions, 9th ed. (2012)

2. Question 2 · Arrhythmias and Conduction Defects

   Which intervention best reduces the incidence of postoperative atrial fibrillation after cardiac surgery?

   1. AStarting prophylactic digoxin on the evening before surgery
   2. BAdding a calcium channel blocker routinely for prophylaxis
   3. CContinuing a beta-blocker through the perioperative period
   4. DWithholding beta-blockers until the second postoperative day
   Show answer and explanation

   Correct answer: C. Continuing a beta-blocker through the perioperative period

   Perioperative beta-blockade is the best supported prophylaxis, and amiodarone is an alternative. Calcium and digoxin do not prevent the arrhythmia. Withholding drugs does not lower the risk.

   Reference: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation

3. Question 3 · Cardio-pulmonary Resuscitation

   A monitored patient 12 hours after CABG develops ventricular fibrillation. What is the first step according to cardiac surgery advanced life support?

   1. AStart 2 minutes of chest compressions then analyse the rhythm
   2. BGive amiodarone 300 mg before any defibrillation attempt
   3. CPrepare immediately for femoral cannulation and bypass
   4. DUp to three sequential shocks before compressions
   Show answer and explanation

   Correct answer: D. Up to three sequential shocks before compressions

   In a monitored post-surgical patient with VF, immediate defibrillation with up to three stacked shocks is recommended before compressions, and emergency resternotomy follows if they fail. Compressions first delay defibrillation. Amiodarone comes after failed shocks, and cannulation is not the first step.

   Reference: Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery (2017)

4. Question 4 · Cardio-pulmonary Resuscitation

   In cardiac surgery advanced life support, how is epinephrine handled during a post-operative arrest?

   1. A1 mg is given every 3 to 5 minutes as in standard ACLS
   2. BVasopressin 40 units is given in place of epinephrine
   3. CRoutine 1 mg boluses are avoided
   4. DEpinephrine is given before the first shock
   Show answer and explanation

   Correct answer: C. Routine 1 mg boluses are avoided

   The STS consensus advises against routine 1 mg epinephrine because it can cause severe hypertension and bleeding on return of circulation. If a vasopressor is used, small doses are preferred. Standard ACLS dosing and giving epinephrine before shocks do not apply, and vasopressin is not a universal replacement.

   Reference: Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery (2017)

5. Question 5 · Cardiovascular and Pulmonary Pharmacology

   A patient on ticagrelor for a recent acute coronary syndrome is scheduled for elective CABG. What is the minimum time to hold the drug before surgery?

   1. AAt least 3 days before surgery
   2. BAt least 24 hours before surgery
   3. CAt least 7 days before surgery
   4. DAt least 10 days before surgery
   Show answer and explanation

   Correct answer: A. At least 3 days before surgery

   The 2021 revascularisation guideline recommends stopping ticagrelor at least 3 days before elective CABG, clopidogrel at least 5 days and prasugrel at least 7 days. Twenty-four hours is too short for platelet function to recover. Seven days is the prasugrel interval, and 10 days is longer than any recommended washout.

   Reference: 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization

6. Question 6 · Diseases of Lung and Mediastinum

   Before lobectomy, a patient has predicted postoperative FEV1 of 35% and DLCO of 38%. What is the next step?

   1. AProceed directly to lobectomy
   2. BPulmonary function test repeat in 6 months
   3. CRefuse surgery without further testing
   4. DCardiopulmonary exercise testing with VO2 max
   Show answer and explanation

   Correct answer: D. Cardiopulmonary exercise testing with VO2 max

   Guidelines advise exercise testing when predicted postoperative FEV1 or DLCO is below 60%, and a VO2 max below 10 mL/kg/min marks high risk. Proceeding without testing underestimates risk. Waiting for repeat tests delays care. Refusing surgery without objective risk stratification is premature.

   Reference: Sellke et al., Sabiston and Spencer Surgery of the Chest, 9th ed. (2016)

7. Question 7 · Anatomy of the Thorax

   Angiography shows an occlusion at the origin of the posterior descending artery in a right-dominant heart. From which vessel does the posterior descending artery arise in this pattern?

   1. AThe right coronary artery
   2. BThe left circumflex artery
   3. CThe left anterior descending artery
   4. DThe left main coronary artery
   Show answer and explanation

   Correct answer: A. The right coronary artery

   In a right-dominant system, about 85% of people, the right coronary artery gives off the posterior descending artery and supplies the inferior septum. In left dominance it comes from the circumflex. The left anterior descending artery and the left main do not give this branch.

   Reference: Snell, Clinical Anatomy by Regions, 9th ed. (2012)

8. Question 8 · Cardiac and Pulmonary Physiology

   Right heart catheterisation shows a mean pulmonary artery pressure of 32 mmHg, a wedge pressure of 14 mmHg and a cardiac output of 5 L per minute. What is the pulmonary vascular resistance?

   1. A6.4 Wood units
   2. B3.6 Wood units
   3. C9.2 Wood units
   4. D2.8 Wood units
   Show answer and explanation

   Correct answer: B. 3.6 Wood units

   Pulmonary vascular resistance equals the mean pulmonary artery pressure minus the wedge pressure, divided by cardiac output: (32 - 14) / 5 = 3.6 Wood units. Dividing the mean pressure alone gives 6.4. Adding the wedge pressure gives 9.2, and using the wedge pressure alone gives 2.8.

   Reference: Guyton and Hall Textbook of Medical Physiology, 14th ed. (2020)

9. Question 9 · Cardiovascular and Pulmonary Pharmacology

   A patient given high-dose tranexamic acid during cardiac surgery has a generalised seizure after surgery, with no structural cause on imaging. Which mechanism is implicated?

   1. AFibrinolysis causing cerebral haemorrhage
   2. BHeparin rebound after protamine
   3. CBlockade of GABA-A and glycine receptors in the brain
   4. DHypocalcaemia from the citrate in transfused blood
   Show answer and explanation

   Correct answer: C. Blockade of GABA-A and glycine receptors in the brain

   High doses of tranexamic acid block inhibitory GABA-A and glycine receptors, which lowers the seizure threshold. Risk rises with high dose, renal impairment and open-chamber surgery. The drug inhibits fibrinolysis rather than causing it. Heparin rebound causes bleeding, and citrate hypocalcaemia is not the usual explanation here.

   Reference: Miller's Anesthesia, 9th ed. (2019)

10. Question 10 · Valvular Heart Disease

    A patient with acute severe aortic regurgitation from endocarditis is in pulmonary oedema and awaiting urgent surgery. Which drug should be avoided?

    1. AA short-acting vasodilator such as nitroprusside
    2. BAn inotrope such as dobutamine
    3. CA loop diuretic
    4. DA beta-blocker to slow the heart rate
    Show answer and explanation

    Correct answer: D. A beta-blocker to slow the heart rate

    In acute regurgitation the left ventricle cannot dilate, and a fast heart rate shortens diastole and limits the regurgitant time. Beta-blockers slow the rate, lengthen diastole and can cause collapse. Vasodilators, inotropes and diuretics are used as a bridge to surgery.

    Reference: 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease

11. Question 11 · Diseases of Lung and Mediastinum

    A heavy smoker has shoulder pain radiating to the ulnar arm, wasting of the hand muscles and a drooping eyelid with a small pupil. Which structure is invaded to cause the eye signs?

    1. AThe sympathetic chain at the stellate ganglion
    2. BThe phrenic nerve over the anterior scalene muscle
    3. CThe recurrent laryngeal nerve at the thoracic inlet
    4. DThe superior vena cava at the right mediastinum
    Show answer and explanation

    Correct answer: A. The sympathetic chain at the stellate ganglion

    A superior sulcus tumour invades the sympathetic chain and stellate ganglion, causing Horner syndrome, and the lower brachial plexus, causing C8 to T1 pain and hand weakness. Phrenic invasion gives diaphragm paralysis, recurrent laryngeal invasion gives hoarseness, and caval obstruction gives facial swelling.

    Reference: Shields' General Thoracic Surgery, 8th ed. (2018)

12. Question 12 · Post-Operative Care of Cardiac Patient

    Two hours after bypass, a patient has a mean arterial pressure of 52 mmHg, a cardiac index of 3.8 L/min/m2, a low systemic vascular resistance and a normal central venous pressure. Which treatment is best?

    1. AIncrease the dobutamine infusion
    2. BGive a large bolus of 2 litres of crystalloid over ten minutes
    3. CInsert an intra-aortic balloon pump
    4. DAdd vasopressin to norepinephrine to restore vascular tone
    Show answer and explanation

    Correct answer: D. Add vasopressin to norepinephrine to restore vascular tone

    A low pressure with a high output and low resistance is vasoplegia, treated with vasoconstrictors such as norepinephrine and vasopressin, and methylene blue if it persists. More inotrope adds vasodilation and raises the heart rate. Large fluid loads are not needed when filling is normal, and a balloon pump supports a failing ventricle, not vascular tone.

    Reference: Bojar, Manual of Perioperative Care in Adult Cardiac Surgery, 6th ed. (2021)

Cardiothoracic Surgery reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Cardiothoracic Surgery questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.