High Yield Cardiothoracic and Vascular Surgery Questions

1. A 55-year-old male presents to the emergency department with acute onset of chest pain and shortness of breath. He reports that he was lifting a heavy object at work when he suddenly felt a sharp pain in his chest. A physical examination reveals decreased breath sounds on the left side and reduced chest expansion on the left side. A chest x-ray shows a left-sided hemothorax. What is the most appropriate initial management for this patient?

1. Needle aspiration
2. Tube thoracostomy
3. Observation
4. Surgery

2. A 50-year-old woman presents with pain and mass in the anterior chest wall. Physical examination reveals a large solid group which is fixed to the sternum. CT demonstrated a hypodense 6×7 cm round mass located on the lower part of the corpus sterni, with no sign of subcutaneous invasion. A biopsy reveals the mass to be a malignant tumour and diagnosed as chondrosarcoma. What is the most appropriate method of reconstruction after resection?

1. Prosthetic replacement
2. Autologous rib graft
3. Latissimus dorsi muscle flap
4. Pectoralis major muscle flap

3. A 60-year-old man with a history of COPD is brought to the emergency department with a productive cough, dyspnea and fever for the last 3 days. The temperature is 38.8°C (101.8°F). The blood pressure is 122/60 mmHg, pulse rate is 108 per minute, and respirations are 30 per minute. Pulse oximetry shows 93% oxygen saturation on the 4 L oxygen via nasal cannula. Despite this treatment, the patient is intubated, and the central venous catheter is placed in the right subclavian vein. The patient continues to desaturate over the next 15 minutes. Breath sounds are absent on the right side. The neck veins are distended. Which of the following is the next best step in management?

1. Endotracheal tube repositioning
2. Intravenous fluids
3. Needle thoracostomy
4. Pericardiocentesis

4.A 55-year-old male patient comes to the emergency department. Due to the sudden onset of shortness of breath and right-sided chest pain. He has a chronic history of COPD. He has been smoking for the last 40 years. Vitals are normal except pulse is 102 per minute and respirations are 24 per minute. Oxygen saturation shows 87% at room temperature. Breath sounds are decreased on the right side. Which of the following is the pathology of the disease?

1. Lung collapse
2. Bronchial obstruction
3. Alveolar oedema
4. Rupture of alveolar bleb

5.A 57-year-old woman presents to the heart and vascular clinic with a complaint of cramp-like pain after walking half a block. She has been diagnosed with peripheral arterial disease. She has been doing a structured exercise program for three months. However, there has been no improvement in her symptoms. Which of the following is the best next step?

1. Cilostazol
2. Propranolol
3. Pentoxifylline
4. Aspirin

6.A 72-year-old female presents to the emergency department with a complaint of severe pain in the right leg. The pain was acute in its onset. Her medical history is significant for atrial fibrillation. There is no history of leg pain with walking. On examination, the right leg is pale and cold; sensations are altered, and the dorsalis pedis pulse is not palpable as compared to the left leg. The patient is unable to move her right leg. Which of the following is the most likely diagnosis?

1. Acute limb ischemia due to thrombus
2. Acute limb ischemia due to embolism
3. Critical limb ischemia
4. Intermittent claudication

7.A 55-year-old male presents with a painful, swollen right arm. Physical examination reveals erythema, warmth, and tenderness in the upper arm. Duplex ultrasound confirms the presence of a deep vein thrombosis (DVT). The patient has no prior history of DVT or other known risk factors such as recent surgery or immobilization. What underlying abnormality should the physician be looking for in this patient?

 1. Factor V Leiden mutation

 2. Protein C deficiency

 3. Antithrombin III deficiency

 4. Malignancy

8. A 55-year-old female presents to the emergency department with a sudden onset of severe pain, swelling, and bluish discolouration of her right leg. She reports feeling feverish and short of breath over the past few days. Physical examination reveals a tense and tender right leg with diminished pulses and cyanotic toes. Which of the following is the most likely diagnosis?

 1. Cellulitis

 2. Deep vein thrombosis(DVT)

 3. Lymphedema

4. Phlegmasia cerulea dolens

9. A 25-year-old male presenting to the emergency department with seizures is found to have the following facial findings. The patient is diagnosed with Sturge-Weber syndrome. Which of the following is the lesion shown below?

1. Haemangioma
2. Venous malformation
3. Lymphatic malformation
4. Capillary malformation

10. Identify the lesion shown in the image below:

1. Lymphatic malformation
2. Capillary malformation
3. Arteriovenous malformation
4. Venous malformation

11.  A 1-month-old male presents with the following lesion. Which of the following is the treatment of choice for this patient?

1. Observation and reassurance
2. Topical lidocaine
3. Systemic corticosteroids
4. Interferon

12. A 59-year-old male presents to the medical outpatient department with a complaint of a painless lump in the neck for the last six months. Furthermore, he mentions a low-grade fever, weight loss, and severe night sweats. In addition, he experiences rare symptoms of lump pain after drinking alcohol. His examination reveals a systematic progression to the lymph nodes' infectious regions. He is scheduled for a bone marrow biopsy. What would be the findings of the biopsy in this patient?

   1. Teardrop cells

   2. Reed -Sternberg cells

   3. Hairy cells

   4. Microcytic Hypochromic cells

13. A 30-year-old female presents to the surgical outpatient department complaining of fatigue, night sweats, and unexplained weight loss over the last two months. On examination, the painless, enlarged cervical lymph nodes are observed. There is a suspicion of lymphatic disorder, and further tests are ordered. Which of the following diseases is most commonly associated with the suspected disorder?

   1. Celiac disease

  2. Rheumatoid arthritis

 3. Hashimoto's thyroiditis

 4. Epstein-Barr virus (EBV) infection

14. A 49-year-old female presents to the emergency department with a complaint of lower extremity swelling for the past two months. She reports that her symptoms improved when she lay down. On examination, dilated veins are noted, along with pitting oedema. Ultrasound-guided sclerotherapy is recommended for the patient. Which of the following is most likely associated with this procedure?

  1. The volume of the sclerosant used is dependent on the site of the vein affected

 2. Closed needle technique is the most commonly used method

 3. Used for the management of deep axial system

 4. A duplex scan is not required before the procedure

15. A 65-year-old female presents to the clinic with a complaint of lower extremity swelling for the past three months. On examination, several dilated veins and telangiectasia are noted. A powered phlebectomy is recommended. Which of the following is most likely associated with this procedure?

  1. It is used to treat extensive branch varicosities

  2. Varicosities are marked horizontally during preoperative evaluation

 3. Phlebitis is not a complication of this procedure

 4. Complications are common, and paresthesia is the most common complication

16. A 53-year-old female was admitted to the surgical oncology ward to evaluate adenocarcinoma of the oesophagus. After a complete examination and test reports, it was noted that the muscular layer of the oesophagus, along with regional lymph nodes, is involved. There were no signs of distant metastasis. Which of the following is the correct stage according to the patient’s current pathology?

1. T1N0M1

2. T1N1M0

3. T4N0M1

4. T2N1M0

17. A 27-year-old male presents to the surgical outpatient department with complaints of generalized body weakness. He further gives a history that the weakness is aggravated after working and is relieved at rest. Upon questioning, he gave reports of the tests he had had before. The tests were for TSH, T3 and T4 levels, and all were normal. Which of the following is the gold standard investigation for the patient’s current pathology?

1. Single fiber electromyography

2. Acetylcholine levels

3. Repeat TSH levels

4. X Ray chest

18. A 65-year-old male patient, diagnosed with malignant pleural mesothelioma, had previously presented with complaints of shortness of breath, unintentional weight loss, and chest pain for 8 months. Chest x-ray showed right-sided pleural effusion, pleural thickening, and loss of lung volume. The immunohistochemistry report was consistent with the diagnosis of malignant pleural mesothelioma. What antibodies are used during the immunohistochemistry technique for malignant mesothelioma of epithelioid type?

1. Myo D1, Myoglobin, Desmin

2. WT1, Calretinin, Mesothelin

3. Cytokeratin AE1/AE3, CA M5.2

4. CEA, TTF1, Napsin A, surfactant apoprotein

19. A 65-year-old male patient came into the respiratory ward, admitted with a pleural effusion and for pleural tap. The chest x-ray initially done had shown a unilateral pleural effusion. His medical history is not significant; he has never smoked in his life and worked as a plumber. On examination, he had a BP of 140/90 mmhg, a febrile, a respiratory rate of 21 per minute, and maintained oxygen saturation of 95% at room air while having shortness of breath. Chest auscultation revealed decreased breath sounds in the right lower zone.

30ml pleural tap from the right pleural space showed:

Appearance	Cloudy
Protein	54g/l
PH	7.36
Cytology	Few cells
MC & S	Negative

An HRCT chest showed pleural thickening and nodules on the right lower lung zone. What comes next in the investigation?

1. CECT chest
2. CT-guided pleural biopsy
3. Pleurodesis
4. Local anesthetic thoracoscopy

20. A 68-year-old male presents with a persistent cough and shortness of breath. Imaging shows a mass in the right lower lobe of the lung, with enlargement of the right hilar and right paratracheal lymph nodes. Biopsy confirms squamous cell carcinoma. According to the American Joint Committee on Cancer (AJCC) TNM staging system, what is the most likely stage of this patient's non-small cell lung cancer?

1. Stage I

2. Stage II

3. Stage III

4. Stage IV

21. A 65-year-old man presents to the clinic with a persistent cough and shortness of breath for the past few months. He has a significant smoking history of 45 pack-years and recently underwent a chest computed tomography (CT) scan, which revealed a Stage IIIB non-small cell lung cancer. The patient has no significant past medical history and is fit for surgery and radiation therapy. However, his oncologist recommends systemic chemotherapy to improve his prognosis. Which of the following options would be the most appropriate for systemic chemotherapy in this case?

1. Cisplatin and Etoposide
2. Carboplatin and Paclitaxel
3. Cisplatin and Vinorelbine
4. Carboplatin and Gemcitabine

22. A 45-year-old woman visits her doctor because she has been experiencing exhaustion and irregular menstruation cycles for the past year. For the past 25 years, the patient has smoked one half-pack of cigarettes per day and consumed four beers on weekends. She stands 160 cm (5 feet 3 inches) tall and weighs 79 kg (175 pounds); her BMI is 31 kg/m². An examination reveals extra fat around the base of the neck and an expanded abdomen. An analysis of her skin reveals several bruises on her arms and legs. The proximal muscles are weak and atrophied in general. Glucose levels are elevated in laboratory tests. ACTH levels in the blood are 169 pg/mL (N = 7-50). A 1 mg dexamethasone suppression test results in a blood cortisol level of 167 nmol/L (N = 50) and a 24-hour urine cortisol level of 425 g (N 300 g). A high-dose dexamethasone suppression test reveals a blood cortisol level of 164 nmol/L (N 50). Which of the following is the most likely underlying cause of these symptoms in this patient?

1. Exogenous corticosteroid administration
2. Pituitary adenoma
3. Small cell lung cancer
4. Adrenal adenoma

23. A 53-year-old woman has had chronic obstructive pulmonary disease (COPD), hypertension, and constipation. Her mother died of breast cancer at age 66; the patient's most recent mammography was regular six months ago. Her most recent primary HPV test, three years ago, came back negative. She does not consume alcohol. She smoked one pack of cigarettes daily for 25 years until quitting eight years ago after being diagnosed with COPD. The vital indicators are within normal ranges. Varicose veins in the lower extremities are discovered during a physical examination. The rest of the exam is unremarkable for her age. Which of the screening studies listed below is most appropriate at this time?

  1. Sigmoidoscopy

 2. Mammography

 3. Pap smear

 4. Low-dose CT scan of the chest

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Hope you found this blog helpful for your Cardiothoracic and Vascular Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.