Surgery Pre- Test
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
27. Which of the following is NOT a treatment modality for subclavian steal syndrome? A. Ligation of vertebral artery
B. Carotid-vertebral bypass C. Carotid-subclavian bypass D. Axilloaxillary bypass
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
31. Which of the following is NOT an appropriate treatment of phlegmasia cerulea dolens in a patient 4 days after hysterectomy?
A. Bed rest & elevation B. Systemic heparinization C. Venous thrombectomy D. Local urokinase infusion
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
51. If a significant atrial septal defect shunt is present, the patient will MOST likely have: A. Cyanosis
B. Syncope C. Multiple emboli D. Recurrent pneumonia
52. Which of the following statements is NOT true regarding atrial septal defect? A. The shunt is from left to right
B. The most common secundum defect occurs at the midpoint of the septum C. Cyanosis is present
D. It accounts for 10-15% of congenital abnormalities 53. Cerebral venous thrombosis is MOST likely found in: A. Double aortic arch
B. Tetralogy of Fallot C. Ductus arteriosus D. Coarctation of the aorta
54. Dysphagia is MOST likely present in: A. Double aortic arch
B. Tetralogy of Fallot C. Ductus arteriosus D. Coarctation of the aorta
55. Differential pressure in the right arm and the right leg is MOST likely seen in: A. Double aortic arch
B. Tricuspid atresia C. Ductus arteriosus D. Coarctation of the aorta
56. Notching of the rib is MOST likely seen in: A. Double aortic arch
B. Tricuspid atresia C. Ductus arteriosus D. Coarctation of the aorta
57. Which of the following conditions is MOST likely associated with rubella? A. Double aortic arch
B. Tricuspid atresia C. Ductus arteriosus D. Coarctation of the aorta
58. Hypoplasia of the right ventricle is MOST likely seen in: A. Double aortic arch
B. Tricuspid atresia C. Ductus arteriosus D. Coarctation of the aorta
59. The recurrent laryngeal curves around which of the following? A. Double aortic arch
B. Tricuspid atresia C. Ductus arteriosus D. Coarctation of the aorta
60. Inflammatory process involving adjacent artery and vein is seen in: A. Diabetic foot
B. Mitral stenosis C. Burger’s disease D. Arteriovenus aneurysm
61. Femoral embolism is MOST likely seen in: A. Diabetic foot
B. Mitral stenosis C. Burger’s disease D. Arteriovenus aneurysm
62. Trivial injury leading to severe necrotic changes will MOST likely be seen in: A. Diabetic foot
B. Mitral stenosis C. Burger’s disease D. Arteriovenus aneurysm
63. Increased cardiac output is MOST likely seen in: A. Diabetic foot
B. Mitral stenosis C. Burger’s disease D. Arteriovenus aneurysm
64. Which of the following will have a normal right ventricle? A. Atrial septal defect
B. Pulmonary stenosis C. Both
D. Neither
65. Which of the following will have a continuous machinery murmur? A. Atrial septal defect
B. Pulmonary stenosis C. Both
D. Neither
66. Which of the following will have increased pulmonary flow? A. Atrial septal defect
B. Pulmonary stenosis C. Both
D. Neither
67. Cyanosis is common in which of the following? A. Atrial septal defect
B. Pulmonary stenosis C. Both
D. Neither
68. Which of the following accounts for less than 5% of congenital heart disease? A. Atrial septal defect
B. Pulmonary stenosis C. Both
D. Neither
69. Which of the following is characterized by loss of hair from toes and brittle nails? A. Arterial leg ulcer
B. Venous leg ulcer C. Both
D. Neither
70. Which of the following is usually located proximal to the malleoli? A. Arterial leg ulcer
B. Venous leg ulcer C. Both
D. Neither
71. Which of the following is characterized by severe pain at rest? A. Arterial leg ulcer
B. Venous leg ulcer C. Both
D. Neither
72. Which of the following is characterized by compression on lower part of the brachial plexus? A. Cervical rib
B. Carotid body tumors C. Both
73. Which of the following is characterized by cranial nerve involvement? A. Cervical rib
B. Carotid body tumors C. Both
D. Neither
74. Unilateral Raynaud’s features should make one suspect the possibility of an obstructive lesion such as:
A. Cervical rib
B. Carotid body tumors C. Both
D. Neither
75. Which of the following is usually located at the carotid bifurcation? A. Carotid artery aneurysm
B. Carotid artery atherosclerosis C. Both
D. Neither
76. Which of the following is characterized by cerebral infarction? A. Cervical rib
B. Carotid body tumors C. Both
D. Neither
77. Which of the following statements is TRUE regarding Tetralogy of Fallot? A. Clubbing is commonly encountered
B. The ECG is usually normal
C. Coarctation of the aorta is seen in >50%
D. In children 12-24 months of age, primary correction of the defect is indicated 78. Transposition of great vessels includes which of the following?
A. Aorta arising from the right ventricle
B. Pulmonary artery arising from the left ventricle
C. Patent ductus arteriosus & patent atrial septal defect in some cases D. All of the above
79. Which of the following statements is TRUE in intra-aortic balloon pumping? A. The balloon is inflated during systole
B. The balloon is deflated during diastole C. The pump must be removed after 6 hours
D. The balloon usually is inserted via the femoral artery
80. Which of the following statements is TRUE after a cardiac trauma? A. The critical zone of intracardiac pressure is 17 cm of water
B. The pericardium can contain only 150-250 mL of blood before tamponade and cardiac failure can occur C. Aspiration of the pericardial cavity is used only for diagnostic purposes and temporary relief before doing a thoracotomy.
D. All of the above
81. Which of the following statements is TRUE after a cardiac arrest? A. Brain damage is likely to occur within 1-2 minutes
B. Metabolic alkalosis occurs
C. Resuscitation is attempted by massage applied directly over the right chest wall D. 1 mL of epinephrine 1:10,000 may be injected directly into the heart
82. Failure to defibrillate the heart may be caused by which of the following? A. Myocardial anoxia
B. Acidosis
C. Inadequate electrical current D. All of the above
83. The uncertainty of brain damage after cardiac arrest is treated by: A. Maintaining the body temperature below 38 ˚C
B. High dose corticosteroids
C. IV Lidocaine for cardiac irregularities D. All of the above
84. Which of the following statements is TRUE regarding coronary artery bypass grafts? A. Results in 8-10% mortality
B. Results in 15% of grafts becoming occluded within 12 months C. Are particularly indicated if CHF is present
D. Results in <50% survival after 5 years
85. The MOST common location of a cardiac myxoma is in the: A. Left ventricle
B. Right ventricle C. Right atrium D. Left atrium
86. Tetralogy of Fallot:
A. Accounts for the majority of children with cyanosis who reach 2 years old B. Results in a right to left shunt
C. Does not always have symptoms D. Includes aortic stenosis
87. Which of the following statements is TRUE regarding prosthetic heart valve endocarditis? A. Occurs in 1-8% of cases
B. Usually occurs 5-10 years after operation C. Is associated with a high mortality D. All of the above
88. Peripheral resistance is reduced by which of the following? A. Nitroprusside
B. Morphine
C. Increased pressure in the carotid sinus & aortic arch D. All of the above
89. Which of the following statements is TRUE regarding thromboangiitis obliterans? A. The popliteal pulse is usually palpable
B. Improvement can be anticipated if the patient stops smoking C. Angiography reveals an abrupt cutoff of the peripheral pulse D. All of the above
90. Which of the following statements is TRUE regarding a below-knee amputation? A. Increased energy expenditure of the walking leg by 20%
B. Is likely to heal even if the popliteal pulse is absent C. Is usually not performed with a fishmouth incision D. All of the above
91. Which of the following features correctly describes the lower extremity vessels? A. Long saphenous vein passes anterior to medial malleolus
B. Long saphenous vein receives tributaries from the lateral part of the foot C. Short saphenous vein terminates in the popliteal vein
D. Long saphenous vein ends in the femoral vein
92. Which of the following statements is TRUE regarding a femoral embolus? A. Is the most common site in the extremity
B. Does not frequently result in necrosis since striated muscle is resistant to anoxia C. Should be treated conservatively by anticoagulation alone
D. Causes pain in >95% of patients
93. Which of the following statements is TRUE regarding the diabetic foot? A. Dorsalis pedis & posterior tibial arteries are always absent
B. Gangrene of the toe always requires urgent below-knee or above knee amputation C. Arterial reconstruction is frequently required
94. Which of the following statements is TRUE regarding traumatic thoracic aneurysms?
A. Arise mainly in the descending aorta at the level below the site of the ligamentum arteriosum, lower border of the 4th thoracic vertebra.
B. Mainly results from knife injuries
C. Carry the possibility that recurrent laryngeal nerve injury may occur during repair D. All of the above
95. Which of the following statements is TRUE regarding primary lymphedema of the lower extremity? A. May be present at birth and in older individuals may be due to varicose veins
B. Is called precox when it arises in teenagers C. Shows hypolplasia in just over half the patients D. All of the above
96. Which of the following statements is TRUE regarding lymphatics of the lower extremity? A. Pass to the popliteal fossa receiving lymph mainly from the distribution of the long saphenous tributaries
B. Pass mainly in front of the inguinal ligament
C. The upper vertical glands are the main tributaries of the perineum D. Drain to the para-aortic glands
97. Which of the following statements is TRUE regarding a pulmonary embolus?
A. Arises from the lower extremity in 85% of patients and shows a wedged-shaped infarct on CXR B. May lead to tachycardia and tachypnea
C. Dyspnea, pain, & hemoptysis occur in <10% D. All of the above
98. Eleven years after undergoing right modified radical mastectomy, a 61-year old woman develops raised red and purple nodules over the right arm. The MOST likely diagnosis is:
A. Lymphangitis B. Lymphedema
C. Lymphangiosarcoma (Stewart-Treves syndrome) D. Metastatic breast cancer
99. A young patient sustains blunt trauma to his right knee that results in acute thrombosis of his popliteal artery. The tissue MOST sensitive to ischemia is:
A. Muscle B. Nerve C. Skin D. Fat
100. A newborn girl with a family history of lymphedema is noted to have bilateral lower extremity swelling. The MOST likely diagnosis is:
A. Lymphedema praecox B. Milroy’s disease C. Lymphedema tarda D. Meige’s disease
