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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQ Cairo 03/05/2005 Time allowed: 30 minutes Choose the single best answer to the following : 1. Ventricular septal defects, either simple or combined with other anomalies, account for what percent of congenital heart disease? a) 5% b) 15% c) 25% d) 35% 2. The American Heart Association (AHA) recommends infective endocarditis propylaxis for patients with atrial septal defect (ASD): a) Before and following operation for closure of ASD. b) Only following operation for closure of ASD. c) Only before operation for closure of ASD. d) Neither before nor after closure of ASD. 3. For a patient eith Marfan’s syndrome and acute ascending dissection with associated aortic valvular incompetence and enlarged sinsuses of Valsalva, the appropriate operation would be: a) Resction of the origin of the dissection, and insertin of a Dacron tube graft. b) Resuspention of the aortic valve commissures and graft replacement of the ascending aorta. c) Replacement of the ascending aorta and aortic valve with a compsite graft. d) Wrapping the ascending aorta. e) None of the above. 4. The incidence of bicuspid aortic valve is: a) 1 : 100 b) 1 : 500 c) 1 : 1000 d) 1: 5000 5. Which of the following statements concerning aneurysms of the thoracic aorta is true? a) The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. b) Atherosclerotic aneurysms are multiple in approximately one-third of patients. c) Aneurysms of the ascending aorta are predominantly atherosclerotic. d) These aneurysms are usually associated with chest or back pain. e) Myocardial infarction is the most common cause of death in patients who do not undergo operation.

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Page 1: AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery …ezzeldinmostafa.com/Files/CTS Test bank.pdf · AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQ

AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQ Cairo 03/05/2005 Time allowed: 30 minutes Choose the single best answer to the following : 1. Ventricular septal defects, either simple or combined with other anomalies, account for what percent of congenital heart disease?

a) 5% b) 15% c) 25% d) 35%

2. The American Heart Association (AHA) recommends infective endocarditis propylaxis for patients with atrial septal defect (ASD):

a) Before and following operation for closure of ASD. b) Only following operation for closure of ASD. c) Only before operation for closure of ASD. d) Neither before nor after closure of ASD.

3. For a patient eith Marfan’s syndrome and acute ascending dissection with associated aortic valvular incompetence and enlarged sinsuses of Valsalva, the appropriate operation would be:

a) Resction of the origin of the dissection, and insertin of a Dacron tube graft. b) Resuspention of the aortic valve commissures and graft replacement of the

ascending aorta. c) Replacement of the ascending aorta and aortic valve with a compsite graft. d) Wrapping the ascending aorta. e) None of the above.

4. The incidence of bicuspid aortic valve is:

a) 1 : 100 b) 1 : 500 c) 1 : 1000 d) 1: 5000

5. Which of the following statements concerning aneurysms of the thoracic aorta is true?

a) The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms.

b) Atherosclerotic aneurysms are multiple in approximately one-third of patients. c) Aneurysms of the ascending aorta are predominantly atherosclerotic. d) These aneurysms are usually associated with chest or back pain. e) Myocardial infarction is the most common cause of death in patients who do not

undergo operation.

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 6. All of the following statements concerning tumors of the chest wall are correct EXCEPT:

a) Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs.

b) The most common primary malignant tumor of the chest wall is chondrosarcoma. c) Fibrous dysplasia is the most common primary benign tumor of the rib. d) Benign tumors of the bony thorax are more common than malignant tumors. e) Formost primary tumors of the chest wall, a wide excesional biopsy is indicated.

7. Anatomic features of tetralogy of Fallot which are reliably diagnosed echocardiographically include all of the following EXCEPT:

1) Right aortic arch. 2) Atrial septal defect. 3) Patent ductus arteriosus. 4) Anomalous origin of of left anterior descending coronary artery. 5) Atrioventricular septal (canal) defect.

8. The following criteria are correct for achalasia EXCEPT:

a) Dysphagia b) Retention of ingested food in the esophagus. c) Radiologic evidence of dilated body of the esophagus. d) Vigorous peristalsis by manometry and cineradiography. e) Carcinoma in association achalasia is uncommon

9. The Choussat-Fontan criteria for appropriateness of an atriopulmonary anastomosis include all of the following EXCEPT:

1) Pulmonary artery less than 15mmHg. 2) Pulmonary vascular resistance less than 4 units per square meter body surface

area. 3) Age less than 3 years. 4) Ventricular ejection fraction 0.6 or greater. 5) Normal sinus rhythm.

10. All are considered to be types of hiatal hernias EXCEPT:

a) Axial sliding. b) Paraesophagial. c) Combined. d) Short esophagus. e) Achalasia.

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Determine whether each choice is true or false. Any combination of answers may occur. A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct 11. Paraplegia following operation on descending thoracic aorta is

1) Increased by preoperative shock. 2) Increased by emergency surgery. 3) Affected by the duration of cross-clamp time. 4) Prevented by evoked somatosensory potential monitoring.

12. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

1) Coarctation of the aorta. 2) Bicuspid aortic valve. 3) Patent ducts arteriosus. 4) Ebstein’s anomaly.

13. Which of the following factors reduce(s) the five-ear cure rate of lung cancer following treatment to less than 20%?

1) Small cell anaplastic carcinoma. 2) Positive superior mediastinal lymph odes. 3) Stage III tumor. 4) Tumor diameter greater than 3 cm.

14. According to the TMN principles for staging lug cancers, which of the bronchogenic carcinomas described below is orare considered to be Stage I ?

1) Large cell carcinoma 4 cm in diameter without lymph node metastases. 2) Poorly differentiated adenocarcinoma without metastases to lymph nodes. 3) Squamous cell carcinoma with atelectasis and extension to visceral pleura without

lymph node metastases or pleural effusion. 4) Alveolar cell carcinoma without metastases to the lymph nodes.

15. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve replacement include(s):

1) Much greater resistance to infection. 2) Satisfactory long-term durabilityi adolescents. 3) Good hemodyamic performance in the 17 mm and 19 mm sizes relative to

tilting disc valves. 4) Low thromboembolic risk without systemic anticoagulation.

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16. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for CABG include(s):

1) Chest wall dysesthesias. 2) Respiratory insufficiency. 3) Increased incidence of mediastinits in diabetic patients. 4) Paresis or paresthesias of the arm.

Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 (1) Pulmonary Atresia/Intact Ventricular Septum (2) Pulmonary Atresia/Ventricular Septal Defect

17) Initial treatment is BTS. 18) Suprasystemic RV pressure is common. 19) Hypoplasia of RV & tricuspid valve is common. 20) PA hypoplasia & MAPCAs from descending aorta are common.

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AIN SHAMS UNIVERSITY MD Cardiothoracic Surgery Faculty of medicine Paper I Cairo 30/4/2005 Time allowed : 2 and half hours I . Give short account on each of the following :

1. Complications of cardiac catheterization

2. Current role of hypothermia in open heart surgery

II. Give short account on management of the following :

1. Bochdaleck hernia 2. Post-thoracotomy air-leak

3. Post-thoracotomy Chylothorax

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo 30/4/2005 Time allowed : 30 minutes

1. Which one of the following vasopressors has the least direct effect on the heart ?

A. Dopamine B. Vasopressin C. Dobutamine D. Norepinephrine E. Epinephrine

2. With hypovolemic shock, all the following are reduced except which one ?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Myocardial oxygen demand is dependant upon ( more than one answer ) :

A. Cardiac output B. Left ventricular systolic pressure C. Heart rate D. Left ventricular end – diastolic pressure E. Left ventricular wall thickness

4. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is

Least reliable for a tumor located in the : A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

5. The condition that is least likely to be associated with respiratory distress in

the newborn is : A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

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6. A right upper lobectomy with mediastinal L.N. dissection is done for lung Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with One of the three brochial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

7. Which of the following statements regarding myomectomy for hypertrophic

Cardiomyopathy is correct ? A. It reduces the incidence of sudden death B. It has a success rate of 90% for relieving symptoms & reducing

outflow tract obstruction C. It is widely applicable in patients with hypertrophic cardiomyopathy D. It may exacerbate the mitral regurgitation associated with

hypertrophic cardiomyopathy

8. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is Evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

9. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

10. Which of the following statements regarding anticoagulation for atrial

Fibrillation is not correct ? A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF

because the risk thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective

as coumadin D. For patients younger than 65 years with lone AF, aspirin alone is

sufficient to prevent stroke because the risk of thromboembolism is low

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11. Which of the following ECG findings is specific for diagnosing pericarditis ? A. Diffuse ST segment elevation B. ST segment elevation that is concave upwards C. ST segment elevation combined with T wave inversions D. PR segment depression 12. Which of the following statements regarding cardioversion of atrial

Fibrillation is not correct ? A. The absence of thrombus on transthoracic echocardiogram allows

Immediate, safe cardioversion B. Patients who have had AF for less than 24 hours do not need anti –

Coagulation before cardioversion C. Patients who have had AF for more than 48 hours should receive

Coumadin for 3 weeks before cardioversion D. Maintenance of sinus rhythm with antiarrhythmic drugs does not

Obviate the need for coumadin therapy

13. Which of the following statements regarding Marfan syndrome is not Correct ?

A. Mitral valve prolapse and rupture may occur as a result of elongation of the chordae tendinae

B. Aortic regurgitation may occur as a result of aortic dilatation C. Complications of ascending aortic aneurysm account for more than

90% of deaths from Marfan syndrome D. Operation is advisable in symptomatic patients with an ascending

aneurysm greater than 6 cm ; asymptomatic patients should be followed with serial imaging studies

14. Coarctation of the aorta may be associated with all of the following except:

A. Aneurysm of the circle of Willis B. Central cyanosis C. Hypertension D. Rib notching E. Bicuspid aortic valve

15. All the following statements about the coronary circulation are true except:

A. Heart rate is the most important determinant of myocardial oxygen Consumption

B. Coronary perfusion of the left ventricle occurs mainly during diastole C. The subendocardial region of the myocardium is more sensitive to

ischemia D. A 50% coronary stenosis on angiography corresponds approximately

to a 75% reduction in cross-sectional area E. The abnormal coronary vasodilator response to shear stress and

mediators such as acetylcholine is due to deficient prostacyclin production in diseased coronary arteries

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TRUE OR FALSE : For the next 3 questions , determine whether each choice is true ( T ) or false ( F ):

16. Which of the following statements correctly characterize major determinants of cardiac performance ?

A. Stroke volume increases with increasing afterload B. Ventricular preload describes the load against which the ventricle

must contract when it eject blood C. In normal hearts, ventricular inotropic state increases with increasing

heart rate because of changes in calcium availability D. Hypoxia , ischemia, and acidosis decrease cardiac contractility E. In failing hearts, right atrial pressure as assessed from the jugular

venous pulse is a good indicator of left ventricular filling pressure

17. Which of the following statements are True about atrial septal defects ? A. Sinus venosus defects are often accompanied by congenital

deformities of the mitral valve B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected

secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD

is due to shunt flow across the atrial septum

18. Which statements are correct about CABG : A. CABG prolongs survival in patients with greater than 70% left main

Stenosis , independent of anginal symptoms B. CABG prolongs survival in patients with three – vessel disease and

left ventricular systolic dysfunction C. Diabetic patients with multivessel coronary artery disease have a

better prognosis with multivessel angioplasty than with CABG D. Women have lower perioperative mortality than men E. Internal mammary grafts remain patent longer than saphenous vein

grafts

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MATCHING :

For the next 2 questions, choose for each numbered item, the most likely associated lettered item from those provided. Each item has only one answer

19. Select from the list below the cardiac events that correspond most closely to the components of the jugular venous waveform :

A. Opening of the tricuspid valve and right ventricular relaxation B. Right atrial relaxation C. Pulmonary valve opening D. Right atrial contraction E. Passive right atrial filling with a competent tricuspid valve

1. X-descent 2. V-wave 3. A-wave 4. Y-descent

20. Match the following palliative surgical shunts with their anatomic anastomoses :

A. Superior vena cava to right pulmonary artery B. Subclavian artery to pulmonary artery C. Ascending aorta to right pulmonary artery D. Ascending aorta to main pulmonary artery E. Descending aorta to left pulmonary artery

1. Classic Blalock – Taussig 2. Pott’s anastmosis 3. Classic Glenn 4. Waterston shunt

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II Cairo 3/5/2005 Time allowed : 2 and half hours Give short account on the following :

I. Limitations of total repair of Tetralogy of Fallot . II. Non transplant Surgery for dilated cardiomyopathy .

III. Diagnostic procedures used for diagnosis of mediastinal

tumors .

IV. Surgical management of Ebstein’s anomaly

V. Treatment of post-lobectomy broncho-pleural fistula

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 4/5/2005 Time allowed : 1 and half hours

COMMENTARY A 18 years old male involved in a motor-cycle accident, his examination showed that he is in shock but conscious, left sided flail chest, peripheral mild cyanosis and both lower limbs arterial pulsations were not felt. His hemoglobin is 6 gm/ 100 ml. Radiological examination showed simple fracture of his left humerus and right femur. Chest X-Ray showed multiple left sided fracture ribs and fracture of T4 and T5 thoracic vertebrae with massive left hemithorax opacity.

GOOD LUCK

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TRUE or FALSE Choose the single best answer to the following : Ventricular septal defects, either simple or combined with other anomalies, account for what percent of congenital heart disease? a) 5% b) 15% c) 25% d) 35% The incidence of bicuspid aortic valve is: a) 1 : 100 b) 1 : 500 c) 1 : 1000 d) 1: 5000

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TRUE or FALSE ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. The following criteria are correct for achalasia except: a) Dysphagia b) Retention of ingested food in the esophagus c) Radiologic evidence of dilated body of the esophagus. d) Vigorous peristalsis by manometry and cineradiography e)Carcinoma in association achalasia is uncommon All are considered to be types of hiatal hernias except: a) axial sliding b) paraesophagial c) combined d) short esophagus e) achalasia All are considered to be types of hiatal hernias except: a) axial sliding b) paraesophagial c) combined d) short esophagus e) achalasia

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TRUE or FALSE Choose the correct answer(s) of the following : Myocardial oxygen demand is dependent upon (more than one answer): a) cardiac output b) left ventricular systolic pressure c) heart rate d) left ventricular end-diastolic pressure e) ventricular wall thickness

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TRUE or FALSE Determine whether each choice is true or false. Any combination of answers, from all true to all false, may occur. TRUE or FALSE A 1, 2 &3 B 1 & 3 C 2 & 4 D 4 ONLY E all are correct Paraplegia following operation on descending thoracic aorta is Increased by preoperative shoch Increased by emergency surgery. Affected by the duration of cross-clamp time. Prevented by evoked somatosensory potential monitoring.

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TRUE or FALSE A 1 only B 2 only C both 1 & 2 D neither 1 nor 2 TRUE or FALSE PA/IVS PA/VSD Initial treatment is BTS. Suprasystemic RV pressure is common. Hypoplasia of RV & tricuspid valve is common. PA hypoplasia & MAPCAs from descending aorta are common.

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MATCHING Choose the most likely associated lettered item from those provided. Each item has only one answer : Match the following palliative surgical shunts with their anatomic anastomoses. Sup. Vena Cava – R. Pulmonary A. Subclavian A. – Pulmonary A. Ascending Aorta – R. Pulmonary A. Descending Aorta - L. Pulmonary A. 1) Classic Blalock-Taussig 2) Potts anastomosis 3) Classic Glenn 4) Waterston shunt Choose the most likely associated lettered item from those provided. Each item has only one answer : 13. In cases in which there is no bronchial obstruction , the area(s) most frequently involved in bronchiectasis is/are:

1) Basal segments of lower lobe. 2) Superior segments of lower lobe. 3) Lingula and right middle lobe. 4) Anterior segments of upper lobes.

11. In tuberculous pericarditis all are correct EXCEPT: a) Acounts for 5 to10% of all types of pericarditis. b) Is ten times more common in blacks. c) Has an insidious onset in most patients. d) Is the only cause of pulsus paradoxus. e) Is commonly associated with pleural effusion.

15. Comlication(s) of brochiectasis include(s):

1) Recurrent pulmonary infections. 2) Massivehemoptysis. 3) Empyema. 4) Brain abscess.

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 5/5/2005 Time allowed : 3 hours

ANATOMY

1. Emberyology, anatomy and surgical anatomy of the diaphragm.

2. Anatomy of the thoracic duct.

PATHOLOGY

1. Cardio-pulmonary reperfusion injury.

2. Bronchiectasis

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo 6/5/2006 Time allowed: 60 minutes

1. With hypovolemic shock, all the following are reduced except which one ?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

2. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is

Least reliable for a tumor located in the : A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

3. The condition that is least likely to be associated with respiratory distress in

the newborn is : A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

4. A right upper lobectomy with mediastinal L.N. dissection is done for

lung Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

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5. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is

Evident in all of the following except : A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

6. Hepatojugular ( abdominojugular ) reflux is found in patients with:

A. Right ventricular infarction B. Superior vena cava syndrome C. Left ventricular failure with secondary pulmonary hypertension D. Tricuspid regurgitation

7. Paradoxical ( reversed) splitting of S2 is caused by all of the following except:

A. Left bundle branch block B. Aortic stenosis C. Atrial septal defect D. WPW syndrome with a right - sided accessory pathway

8. Acute aortic dissection should be suspected in a patient with : A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

9. Which of the following ECG findings is specific for diagnosing pericarditis ?

A. Diffuse ST segment elevation B. ST segment elevation that is concave upwards C. ST segment elevation combined with T wave inversions D. PR segment depression

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10. Which of the following statements regarding cardioversion of atrial Fibrillation is not correct ?

A. The absence of thrombus on transthoracic echocardiogram allows Immediate, safe cardioversion

B. Patients who have had AF for less than 24 hours do not need anti – Coagulation before cardioversion

C. Patients who have had AF for more than 48 hours should receive Coumadin for 3 weeks before cardioversion

D. Maintenance of sinus rhythm with antiarrhythmic drugs does not Obviate the need for coumadin therapy

11. Coarctation of the aorta may be associated with all of the following except: A. Aneurysm of the circle of Willis B. Central cyanosis C. Hypertension D. Rib notching E. Bicuspid aortic valve

12. The combination of right heart failure, elevated venous pressure and a quiet heart is known as:

A. Whipple's triad B. Saint's triad C. Beck's triad D. Murphy's sign E. None of the above

FOR EACH OF THE FOLLOWING MULTIPLE CHOICE QUESTIONS, SELECT THE ONE MOST APPROPRIATE ANSWER: 13. Chest pain radiating into the left arm associated with further

radiation into the neck and jaw: A. Is frequently caused by esophageal trauma B. Most likely due to coronary artery disease C. Can be produced by a variety of lung diseases D. May be due to a fractured rib E. All of the above

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14. The sudden onset of persistent coughing, productive of copious amounts of thick brownish fluid, occurring three months following resection of the right lung suggests: A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Broncho-pleural fistula E. All of the above

15. Which of the following statements regarding anticoagulation for atrial fibrillation is not correct ?

a. Warfarin therapy for chronic AF reduces the incidence of stroke b. Anticoagulation is not necessary for patients with paroxysmal

AF because the risk thromboembolism is low c. Aspirin therapy reduces the incidence of stroke but is not as

effective as coumadin d. For patients younger than 65 years with lone AF, aspirin alone

is sufficient to prevent stroke because the risk of thromboembolism is low

16. When contemplating elective thoracotomy on a patient who has been on long-term corticosteroid therapy, it is best to : A. Discontinue steroids for one month prior to operation B. Continue the same dosage schedule throughout hospitalization

C. Give increased amounts of steroids during and immediately following operation

D. Use ACTH postoperatively E. Give prophylactic isoniazid and PAS

17. THE PURPOSE OF LEAVING A CHEST TUBE IN PLACE

FOLLOWING PNEUMONECTOMY IS TO: A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

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18. ONE OF THE CONTRA-INDICATIONS TO BRONCHOSCOPY IS THE PRESENCE OF: A. Endobronchial tuberculosis B. Active bleeding C. Aortic aneurysm D. Emphysema E. None of the above

19. THE MOST COMMON TOXIC ARRHYTHMIA ASSOCIATED

WITH DIGITALIS OVERDOSAGE IS: A. Atrial fibrillation B. Ventricular extrasystole C. Ventricular fibrillation D. Complete heart block E. None of the above

20. THE INDICATION FOR TRANSVENOUS INSERTION OF

CARDIAC PACEMAKER: A. Permanent heart block B. Intermittent symptomatic heart block C. Sinus bradycardia D. Post-surgical heart block

E. All of the above 21. MEDIASTINAL WIDENING AFTER CHEST TRAUMA IS A

PATHOGNOMONIC SIGN OF: A. Aortic injury D. Perforated esophagus B. Cardiac injury E. Bronchial tear

C. Pericardial effusion 22. THE ENTITY TERMED "SHOCK LUNG" IS USUALLY SEEN:

A. With multiple trauma B. With head injuries C. With hemorrhagic shock D. After Prolonged cardiopulmonary bypass E. All of the above

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23. PATIENTS WITH CARDIAC TAMPONADE ARE BEST MANAGED: A. Expectantly B. By pericardiocentesis followed by definitive thoracotomy if necessary C. By pericardiocentesis only D. By open thoracotomy and cardiorrhaphy E. By thoracotomy, only if blood loss is excessive 24. REPAIR OF A TRAUMATIC DIAPHRAGMATIC HERNIA: A. Should be considered an emergency procedure B. Should be performed as soon as the patient is out of shock C. Is almost always indicated if the patient is clinically stable D. Usually requires.a thoraco-abdominal approach E. All of the above 25. FOLLOWING SUDDEN DECELERATION, THE MOST COMMON SITE OF AORTIC INJURY IS:

A. Just distal to the origin of the left subclavian artery B. The dome of the aortic arch C. A point close to the annulus of the aortic valve D. Adjacent to the carotid artery E. Distal thoracic aorta

26. ACUTE MEDIASTINITIS IS MOST OFTEN DUE TO: A. Rupture of a mediastinal cyst B. Acute inflammatory processes originating in the lungs C. Perforation of the esophagus D. Blood-borne infections E. Tuberculosis 27. THE CHARACTERISTIC PHYSICAL SIGNS OF MEDIASTINAL EMPHYSEMA ARE: A. Subcutaneous emphysema B. Hamman's murmur C. Decreased heart sounds D. Crepitation E. All of the above .

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28. SUBSTERNAL GOITER: A. Should be removed via an anterior thoracotomy B. Should be removed via a posterior thoracotomy C. Can almost always be removed via a cervical approach D. Does not require removal E. Is frequently malignant 29. Lasers: A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours 30. PAIN IN THE SHOULDER AND ARM COMBINED WITH HORNER'S SYNDROME ON THE SAME SIDE SUGGESTS THE PRESENCE OF: A. A ganglioneuroma B. Aortic aneurysm C. Shoulder girdle syndrome D. Tumor (Pancoast) E. None of the above 31. THE TERM "EMPYEMA NECESSITANS" REFERS TO: A. A fulminating pleural infection B. Mediastinal extension of an empyema C. Metastatic foci of infection D. Secondary involvement and fistulaion through the chest wall E. Tuberculous empyema 32. BOCHDALECK HERNIA SHOULD BE TREATED BY: A. Immediate operation, unless there is a history of respiratory distress B. Emergency operation via thoraco abdominal approach C. Conservative measures until age six months D. Conservative measures as long as the patient is doing well E. Operation or medical management, depending on symptoms

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33. FOLLOWING REDUCTION OF A LARGE LEFT DIAPHRAGMATIC HERNIA IN AN INFANT, DIFFICULTY IS ENCOUNTERED IN CLOSING THE ABDOMEN. ONE SHOULD: A. Repair the hernia, close the abdomen in the usual way, and apply nasogastric suction B. Use Marlex mesh or Dacron as a fascial graft over the abdomen C. Leave the diaphragmatic defect open D. Close the diaphragmatic defect, but leave the abdominal fascia open E. None of the above 34. DISTAL STERNAL CLEFTS IN THE NEWBORN ARE ALMOST ALWAYS ASSOCIATED WITH: A. A deficiency in part of the diaphragm B. An intracardiae defect C. A defect in the pericardium D. A defect in the abdominal wall E . All of the above 35. THE MOST IMPORTANT CONSIDERATION IN

DETERMINING WHETHER OR NOT TO TREAT AN ATRIAL SEPTAL DEFECT IS: A. Conduction changes B. Magnitude of the shunt C. Paradoxical embolus D. Possibility of local infection E. Location of the defect

36. AT OPERATION FOR CORRECTION OF AN

INTERVENTRICULAR SEPTAL DEFECT, ONE FINDS A PERSISTENT LEFT SUPERIOR VENA CAVA. IN ORDER TO FACILITATE SATISFACTORY CARDIOPULMONARY BYPASS, ONE SHOULD: A. Tie off the vein B. Anastomose the vein to the right superior eava C. Cannulate the vein via a cervical approach D. Cannulate the vein via the coronary sinus E. Use deep hypothermia

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37. CONGESTIVE HEART FAILURE IS ALMOST NEVER SEEN IN INFANTS WITH:

A. Coarctation of the aorta B. Patent ductus arteriosus C. Tetralogy of Fallot

D. Total anomalous venous drainage E. Ebstein's malformation

In the following questions, ALL OF THE STATEMENTS ARE TRUE EXCEPT ONE, identify the incorrect statement:

38. SURGICAL REPAIR OF PECTUS EXCAVATUM IS CHARACTERIZED BY: A. Internal metal support necessary B. Wedge osteotomy in upper sternum C. Division of costal cartilages D. Substernal or Pleural drainage desirable E. Reattachment of rectus abdominis muscles 39. MORGAGNI HERNIA: A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

40. IN ORDER TO CLOSE THE DEFECTS IN THE CHEST WALL, MARLEX MESH IS USED BECAUSE IT:

A. Has a high tensile strength B. Is inert in the body C. Can be sterilized D. Is readily available E. Never gets infected

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41. THE SCIMITAR SYNDROME IS CHARACTERIZED BY:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

42. IN A CHILD WITH VALVULAR PULMONARY

STENOSIS AND INTACT VENTRICULAR SEPTUM, THE PRESENCE OF CYANOSIS MAY INDICATE: A. Congestive failure B. Urgent need for operation C. An anomaly of the tricuspid valve D. An interatrial septal defect E. A patent foramen ovale

43. THE PULSE PRESSURE IS WIDE IN:

A. Patent ductus with left to right shunt B. Rupture of aortic sinus aneurysm into the right heart C. Aorto-pulmonary window D. Aortic valve stenosis E. Anomalous pulmonary artery arising from aorta

44. THE MOST COMMON VALVULAR DEFECT RESULTING

FROM RHEUMATIC FEVER IS: A. Mitral stenosis B. Mitral insufficiency C. Aortic stenosis D. Aortic insufficiency E. Pulmonary stenosis

45. NITROGLYCERINE: A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

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TRUE OR FALSE : For the next 3 questions , determine whether each choice is true ( T ) or false ( F ): 46. Which of the following statements correctly characterize major determinants of cardiac performance ? A. Stroke volume increases with increasing afterload B. Ventricular preload describes the load against which the

ventricle must contract when it eject blood C. In normal hearts, ventricular inotropic state increases with

increasing heart rate because of changes in calcium availability D. Hypoxia , ischemia, and acidosis decrease cardiac contractility E. In failing hearts, right atrial pressure as assessed from the jugular venous pulse is a good indicator of left ventricular filling pressure 47. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of

uncorrected secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with

secundum ASD is due to shunt flow across the atrial septum

48. Which statements are correct about CABG : a. CABG prolongs survival in patients with greater than 70% left main Stenosis , independent of anginal symptoms b. CABG prolongs survival in patients with three – vessel disease and left ventricular systolic dysfunction c. Diabetic patients with multivessel coronary artery disease have a better prognosis with multivessel angioplasty than with CABG d. Women have lower perioperative mortality than men e. Internal mammary grafts remain patent longer than saphenous vein grafts

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MATCHING :

For the next 2 questions, choose for each numbered item, the most likely associated lettered item from those provided. Each item has only one answer

49. Select from the list below the cardiac events that correspond most closely to the components of the jugular venous waveform :

a. Opening of the tricuspid valve and right ventricular relaxation b. Right atrial relaxation c. Pulmonary valve opening d. Right atrial contraction e. Passive right atrial filling with a competent tricuspid valve

1. X-descent 2. V-wave 3. A-wave 4. Y-descent

50. Match the following palliative surgical shunts with their anatomic

anastomoses : a. Superior vena cava to right pulmonary artery

b. Subclavian artery to pulmonary artery c. Ascending aorta to right pulmonary artery d. Ascending aorta to main pulmonary artery e. Descending aorta to left pulmonary artery

1. Classic Blalock – Taussig 2. Pott’s anastmosis 3. Classic Glenn 4. Waterston shunt 5. Davidson shunt

GOOD LUCK

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AIN SHAMS UNIVERSITY MD Cardiothoracic Surgery Faculty of medicine Paper I Cairo 6/5/2006 Time allowed: 2 hours Give a short account on the following questions: 1. Hemostasis .

2. Nutrition of surgical infant patient.

3. Anticoagulation policy for:

a. Tricuspid valve replacement with a biological valve.

b. Palliative shunt procedures for cyanotic heart.

c. Mitral valve repair.

4. Indications and complications of lung transplant.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II Cairo 7/5/2006 Time allowed : 2 hours Give short account on the following :

1.Surgical management for ascending aortic aneurysm 2. surgery for managing TGA associated with VSD and LVOTO 3.Non transplant surgery for heart failure 4. Clinical picture and complications of para-esophageal hiatus hernia

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQ Cairo 7/5/2006 Time allowed: 60 minutes -------------------------------------------------------------------------------------------------------

1. The following are features of a tension pneumothorax:

A. Tracheal deviation towards the affected side B. Increased chest movement on the affected side C. Increased resonance of affected side D. Cardiac arrest E. Surgical emphysema 2. For a patient with Marfan’s syndrome and acute ascending dissection with associated aortic valvular incompetence and enlarged sinsuses of Valsalva, the appropriate operation would be: A. Resection of the origin of the dissection, and insertion of a Dacron tube graft. B. Resuspention of the aortic valve commissures and graft replacement of the ascending aorta. C. Replacement of the ascending aorta and aortic valve with a composite graft. D. Wrapping the ascending aorta. E. None of the above. 3. Massive hemoptysis with bronchiectasis predominantly comes from : a) Bronchial arteries b) Pulmonary arteries c) Pulmonary veins d) Arteriovenous fistula e) Rasmussen aneurysm 4. Which of the following statements concerning aneurysms of the thoracic aorta is true? A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are predominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not undergo operation. 5. With regard to bronchiectasis A. It usually occurs in adulthood B. Airway obstruction plays little role C. It usually follows measles or whooping cough D. It is associated with Kartagener's syndrome E. It may present with life-threatening haemoptysis

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 6. All of the following statements concerning tumors of the chest wall are correct EXCEPT: A. Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs. B. The most common primary malignant tumor of the chest wall is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated. 7. The following criteria are correct for achalasia EXCEPT: A. Dysphagia B. Retention of ingested food in the esophagus. C. Radiologic evidence of dilated body of the esophagus. D. Vigorous peristalsis by manometry and cineradiography. E. Carcinoma in association achalasia is uncommon 8. The Choussat-Fontan criteria for appropriateness of an atriopulmonary anastomosis include all of the following EXCEPT: A. Pulmonary artery pressure less than 15 mmHg. B. Pulmonary vascular resistance less than 4 units per square meter body surface area. C. Age less than 3 years. D. Ventricular ejection fraction 0.45 or greater. E. Normal sinus rhythm. 9. All are considered to be types of hiatal hernias EXCEPT: A. Axial sliding. B. Paraesophageal. C. Combined. D. Short esophagus. E. Achalasia.

10. All are correct for Pulmonary embolism Except: A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

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Choose the single best answer to the following : 11. The best treatment for the relief of increasing spontaneous mediastinal emphysema is: A. Thoracotomy B. Suprasternal decompression C. Subxiphoid decompression D. Needling the mediastinum E. None of the above 12. The first sign of Horner's syndrome is usually: A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above 13.When treating a child born with esophageal atresia and imperforate anus, it is advisable to: A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable 14.The most common site of spontaneous esophageal perforation (Boerhaave's syndrome) is: A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above 15. Of the following, the condition most frequently associated with congenital esophageal atresia is: A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract 16. If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has: A. A truncus arteriosus D. A coarctation of the aorta B. A pulmonary A-V fistula E. A coronary-ventricular fistula C. Aorto-pulmonary window

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17. Immediately following repair of an interventricular septal defect, complete heart block is noted, although ventricular rate is satisfactory. In this circumstance, one should A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing 18. A Taussig-Bing malformation is best treated by: A. Diversion of the septal defect only B. Detachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle 19. In an adult patient, the repair of coarctation requires some form of aortic replacement if: A. The anastmosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above 20. The most common findings associated with congenital tricuspid atresia are: A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis 21. The most common anatomic variation of coronary artery fistula connects: A. Right coronary artery to right atrium B. Right coronary artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle 22. Of the following, the lesion least likely to be associated with bacterial endocarditis is: A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

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23.Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total anomalous pulmonary venous drainage are all characterized by: A. inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above 24. Children with transposition of the great vessels with an intact ventricular septum: A. May have delayed surgical correction if systemic oxygen saturation is greater than 70% B. May never need total correction C. Are excellent candidates for total correction D. Need Senning operation at early infancy ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 25.Esophageal dilatation for the treatment of achalasia: A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment. 26. Zenker's diverticula: A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E. Causes dysphagia with liquids 27. Achalasia of the esophagus is characterized by: A. Painless vomiting B. Stenosis of cardio-esophageal junction C. Decreased peristaltic movements D. May be helped by balloon dilatation E. Abnormal or deficient ganglion cells 28.The esophagus may be affected in the following conditions: A. Myasthenia gravis B. pellagra C. Seleroderma D. Polyserositis E. Achlorhydria

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Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 29.Pain associated with ingestion of food during childhood is commonly associated with the presence of: A. Achalasia of the esophagus B. Congenital esophageal diverticulum 30.Leiomyosarcomas of the esophagus: A. Tend to ulcerate B. Are submucosal 31.Treatment of lyme burns of the esophagus during the acute phase: A. Corticosteroids B. Esophagoscopy 32. Presence of aberrant gastric type columnar cells: A. Barrett's ulcer B. Schatzki's ring

Determine whether each choice is true or false. Any combination of answers may occur. A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

33. Paraplegia following operation on descending thoracic aorta is : A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring. 34. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome? A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly. 35. Which of the following factors reduce(s) the five-year cure rate of lung cancer following treatment to less than 20%? A. Small cell anaplastic carcinoma. B. Positive superior mediastinal lymph odes. C. Stage III tumor. D. Tumor diameter greater than 3 cm.

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36. According to the TMN principles for staging lung cancers, which of the bronchogenic carcinomas described below is or are considered to be Stage I ? A. Large cell carcinoma 4 cm in diameter without lymph node metastases. B. Poorly differentiated adenocarcinoma without metastases to lymph nodes. C. Squamous cell carcinoma with atelectasis and extension to visceral pleura without lymph node metastases or pleural effusion. D. Alveolar cell carcinoma without metastases to the lymph nodes. 37. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve replacement include(s): A. Much greater resistance to infection. B. Satisfactory long-term durability in adolescents. C. Good hemodynamic performance in the 17 mm and 19 mm sizes relative to tilting disc valves. D. Low thromboembolic risk without systemic anticoagulation. 38. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for CABG include(s): A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm. In the following questions, each numbered item is to be matched with one lettered item. Each choice may be used only once: 39. A. Ostium secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect 1 Heart block and arrhythmia common 2 Absent superior rim 3 Most commonly encountered 4 Cyanosis in absence of failure 40. A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage 1 Abnormal coronary sinus 2 Complete repair least likely 3 Persistent left anterior cardinal vein 4 Persistent ductus venosus

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41. A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis 1 Parachute valve 2 Syncope 3 Waterston shunt 4 Brock procedure 42. Which of the following is TRUE regarding the etiology of lung abscess ? A. Hematologic seeding is the common mechanism for infection B. The posterior segment of the upper lobe and superior segment of the lower lobe on the right side are most commonly involved C. Periodic episodes of hemoptysis and foul sputum are uncommon D. Staph Species are the predominant organism 43. Which of the following statements is TRUE regarding myxoma morphology? A. These tumors are most commonly found in the right atrium B. Myxomas have a characteristically firm texture and rarely embolize C. They arise from multipotential mesenchymal cells D. Myxomas usually are attached to the free atrial or ventricular wall E. There is no malignant potential 44. Which of the following statements is TRUE regarding the natural history of CAD? A. Distal LAD lesions do not result in poorer survival compared to proximal lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 3-vessel disease have equivalent survival at 5 years 45. Which of the following statements is TRUE regarding operative management of post-infarct LV aneurysm? A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

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46. Which of the following statements is TRUE regarding results after resection of pulmonary metastases ? A. Partial resection of extensive pulmonary metastatic disease can improve survival B. Disease –free interval has not been shown to have prognostic value for survival C. Patients with a greater number of metastatic nodules have poorer survival D. CEA levels do not affect 5-year survival after resection of metastatic colon carcinoma E. Metastatic head and neck cancers have poor outcome after pulmonary resection 47.Which of the following statements is TRUE regarding operative management of congenital sinus of valsalva aneurysm? A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography. B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency. 48. Which of the following is TRUE for operations for congenital subvalvular aortic stenosis? A. Resection of muscle below the right coronary cusp should be avoided. B. The Konno procedure is preferred in the sitting of a normal valve and annulus. C. Early mortality is equivalent for the localized and the diffuse forms. D. Late death is usually secondary to bacterial endocarditis. E. The discrete form is associated with increased early and late risk for death. 49. What is the most common complication following bronchoplastic procedures for malignancy? A. Benign stricture B. Bronchopleural fistula C. Bronchpvascular fistula D. Local recurrence E. Pulmonary embolism 50. The most important factor influencing survival in a patient with a localized soft-tissue sarcoma of the chest wall is : A. Age B. Complete resection C. Histologic type D. Invasion of rib E. Tumor size GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 07 /05/2006 Time allowed : 1 and half hours

COMMENTARY A 40-year-old patient, undergoing lobectomy for removal of a solitary pulmonary nodule, develops cardiac arrest. The anesthetic gas mixture contained 75-80 percent 02. There were no warning signs of cardiac arrest detected beforehand. A preoperative ECG was reported to be within normal limits. The most likely cause of the patient's cardiac arrest is:

A. Undisclosed hemorrhage within the chest B. Massive myocardial infarction C. Inadequate pulmonary ventilation D. Undisclosed metastatic disease E. An electric shock from a defective electro-cautery unit

Comment. The mechanism of action contributing to the arrest can be explained by:

A. Resultant hypovolemic shock leading to insufficient coronary perfusion

B. Neurogenic collapse due to hemorrhage from a cerebral metastasis C. Ventricular fibrillation resulting from an electrical discharge during

the ventricular refractory period D. Atherosclerotic plaques within the ascending aorta or coronary vessels

dislodged during operation E. The development of severe hypercarbia and respiratory acidosis

Comment.

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Under such circumstances, in addition to instituting cardiac massage, one should:

A. Administer a rapidly-acting digitalis preparation B. Administer blood and other IV fluids in large amounts C. Obtain an EEG tracing to confirm asymmetrical activity D. Hyperventilate the lungs and begin cardiac massage E. Immediately ground the patient and apply a defibrillator

Comment. The most likely reason why premonitory signs were undetected was:

A. Hypercarbia produces no specific clinical signs in patients under general anesthesia

B. The onset of cardioneurogenic collapse is extremely rapid under such circumstances

C. Operating-room personnel were inattentive D. Acute severe hemorrhage will not always cause hypotension prior to

the onset of arrest E. None of the above

Comment.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology MCQ Cairo 09/05/2006 Time allowed : 60 minutes 1. THE DIAPHRAGM DEVELOPS:

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

2. THE DIAPHRAGM: A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front

of the esophagus D. Diaphragm projects higher Into the chest on the right

than on the left E. Lies entirely above the tenth rib. 3. THE BLOOD SUPPLY TO THE VISCERAL PLEURA IS FROM: A. Pulmonary artery B. The bronchial vessels C. The intercostal vessels D. The internal mammary arteries E. None of the above 4. Which of the following statements about diaphragmatic anatomy is TRUE? A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise from the lumbar vertebrae

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5. Which of the following statements is TRUE regarding anatomy of the thoracic outlet ? A. The distal section of the cervicoaxillary canal is the more critical

for compression syndromes B. The brachial plexus and subclavian artery are located in the

anteromedial compartment of the costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus

medius, and first rib D. Inspiration tilts the coracoid process inferiorly , placing tension on

the neurovascular bundle E. Bony abnormalities are present in the majority of patients

6. IN THE ERECT POSITION, THE SUPERIOR LIMIT OF THE ESOPHAGUS LIES AT THE LEVEL OF THE:

A. Inferior margin of the thyroid cartilage B. Fourth cervical vertebra C. Suprasternal notch D. Thoracic inlet E. Tubercle of the cricoid cartilage

7. THE ESSENTIAL FACTOR IN THE PATHOGENESIS OF AORTIC ANEURYSMS IS DAMAGE: A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis 8. THE NARROWEST PART OF THE ESOPHAGUS LIES AT THE LEVEL OF: A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

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9. A PERSISTENT LEFT SUPERIOR VENA CAVA USUALLY DRAINS INTO THE: A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava 10. Causes of hilar enlargement include: A. Sarcoidosis B. Lymphoma C. Hypertension D. Tuberculosis E. Caplan's syndrome 11. OF THE FOLLOWING, THE MOST COMMON BENIGN TUMOR OF THE ESOPHAGUS IS: A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma 12. THE ESOPHAGUS MAY BE AFFECTED IN THE FOLLOWING CONDITIONS: A. Myasthenia gravis B. Pellagra C. Seleroderma D. Polyserositis E. Achlorhydria 13. The azygos vein: A. Receives venous blood from the middle one-third of the oesophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

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14. PLEUROPERICARDIAL (SPRING WATER) CYSTS ARE MOST COMMONLY LOCATED: A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium 15. Which of the following statements is TRUE regarding the pathology of lung cancer? A. Squamous cell carcinoma occurs with equal frequency in smokers and nonsmokers. B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands. C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy. D. Alveolar cell carcinoma has the least favorable prognosis. E. Most cancers associated with pulmonary scars are squamous cell carcinomas 16. Which of the following statements is TRUE regarding the anatomy and pathophysiology of post-infarct left ventricular aneurysm? A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

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In the following questions, all of the statements are true except one. Identify the incorrect statement:

17. DURING EMBRYOLOGIC DEVELOPMENT OF THE HEART. A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

18. THE CAUSE OF DEATH IN PATIENTS WITH PATENT DUCTUS

ARTERIOSUS IS: A. Intractable congestive heart failure B. Subacute bacterial endocarditis C. Sudden late closure of the ductus D. Acute pulmonary edema . E. Pulmonary hypertension and cor- pulmonale

19. Which of the following statements is true regarding TOF morphology?

A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.

B. The bundle of His runs along the posteroinferior border of the VSD.

C. Additional VSDs are present in approximately 25% of patients.

D. The pulmonary valve is usually the narrowest part of the right ventricular outflow tract.

E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually normal in size.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW: A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

20. Underdevelopment of the main pulmonary artery is usually associated

with narrowing or stenosis of the outflow tract of the right ventricle BECAUSE both are derived from the conus.

21. The presence of a cervical rib does not produce symptoms in childhood

BECAUSE the rib is rudimentary at this age. 22. Patent ductus usually occurs as an isolated defect BECAUSE it does

not arise from the aortic arch system. 23. Bronchial foreign bodies more frequently occur in children BECAUSE

the right main stem bronchus is relatively straighter than the left. 24. About 70% or more of the total vital capacity is expired within the first

second of expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

25. A MODERATOR BAND IS USUALLY FOUND IN THE:

A. Left ventricle . B. Right ventricle

26. IN PATIENTS WITH ESOPHAGEAL ATRESIA:

A. In 90% of cases. the upper segment ends in a blind pouch and the distal part communicates directly with trachea B. Stenosis may develop after surgical correction

27. EUSTACHIAN VALVE:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

28. THE BUNDLE OF HIS PASSES CLOSER TO:

A. The right side of the interatrial septum B. The left side of the interatrial septum

29. THE SINUS VENOSUS FORMS:

A. The superior and inferior vena cava B. The right atrium

30. THE PARIETAL PLEURA:

A. Is very sensitive to pain B. Absorbs the pleural fluid

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31. HERNIAS THROUGH THE FORAMEN OF BOCKDALEK: A. Usually have a true sac B. Present anteriorly C. May be caused by a short esophagus D. Pass through the pleuroperitoneal canal E. Are associated with eventration of the diaphragm

32. THE KARTAGENER’S SYNDROME IS THE ASSOCIATION OF:

A. Situs inversus, bronchicetasis and pansinusitis

B. Situs inversus of the lungs with levocardia

C. Splenic agenesis syndrome with levocardia

D. Anomalous right pulmonary artery and bilobation of the lungs E. None of the above

IN THE FOLLOWING QUESTIONS, EACH NUMBERED ITEM IS TO BE MATCHED WITH ONE LETTERED ITEM. EACH CHOICE MAY BE USED ONLY ONCE:

33. A. Anterior mediastinum

B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia 34. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

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35. Complications of tracheostomy include: A. Anoxia B. Air embolism C. Tracheo-oesophageal fistula D. Hypotension E. Tracheal stenosis 36. THE BRONCHIAL MUCOSA IS NORMALLY MADE UP OF:

1. Simulated pseudostratified epithelium 2. Goblet cells 3. Basal cells 4. Adeno-cystic cells which constitute the germinal layer

37. THE ESOPHAGEAL HIATUS IS:

1. Located in the left crus of the diaphragm 2. At the level of T 9 to T 11 3. Ended with an anatomical sphincter 4. Located superior to the cardio-esophageal junction

38. THE ATRIOVENTFUCULAR (A-V) NODE:

1. Receives nerves from the right vagus 2. Its arterial supply is from the right coronary artery 3. Is located near the entrance of the superior vena cava 4. Is located near the coronary sinus

39. Lung cancer: A. Of the alveolar cell type is not typically associated with smoking B. Of the large cell type characteristically metastasizes early C. May present with the myasthenic syndrome D. Of the small cell type has the best 5-year survival of all types of lung

cancer when treated by excision E. May present with hypernatraemia due to hormone secretion by the

tumour

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40. Thrombosis: A. In the axillary vein is commoner on the right side B. In the superior vena cava may cause tinnitus C. In the venous system usually consists of fibrin and platelets D. In a proximal leg vein may be an indication for an inferior vena cava

filter if the patient also has a peptic ulcer E. Prophylaxis of DVT can be achieved by intravenous dextran 41. The inferior vena cava: A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins 42. The abdominal aorta: A. Passes behind the medial arcuate ligament of the diaphragm at the level

of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior

mesenteric artery 43. Carotid artery disease: A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid

plaque that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischaemic attack

commonly includes CT scan of the brain E. Surgery has been shown to be better than medical therapy in the

management of asymptomatic patients with stenoses greater than 70% 44. Cervical rib: A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

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45. In the root of the neck: A. Scalenus anterior arises from the anterior tubercles of the typical

cervical vertebrae B. The supreme intercostals vein lies lateral to the first thoracic nerve on

the neck of the first rib C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct 46. The subclavian artery: A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from

branches of the thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath

derived from the prevertebral fascia E. Becomes the axillary artery at the upper border of teres major 47. The oesophagus: A. Is crossed by the right pulmonary artery B. Inclines forwards and to the left at the oesophago-gastric junction C. Blood supply to the cervical part is from the inferior thyroid arteries D. The lower one-third is most easily approached from the left side E. The posterior vagal trunk is more closely applied to the oesophagus than

is the anterior trunk 48. The thoracic duct: A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

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49. Gastro-oesophageal reflux: A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic

than symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's

oesophagus E. Initial management may include increasing the number of meals eaten

per day 50. Achalasia: A. The cause is hypertrophy of the gastro-esophageal sphincter B. Dysphagia is mainly for solids C. Incidence is higher in males than females D. Manometry shows reduced pressure within the lower oesophagus E. Initial treatment is with H2 antagonists GOOD Luck

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 09/05/2006 Time allowed: 2 Hours

ANATOMY

1. Lymphatic drainage of the lungs.

2. Anatomy and embryology of fetal circulation.

PATHOLOGY

1. Give short account on pulmonary metastasis.

2. Pathogenesis of the acute dissection of the aorta.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo 12/05/2007 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

2. With hypovolemic shock, all the following are reduced except which one?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Paradoxical ( reversed) splitting of S2 is caused by all of the following except:

A. Left bundle branch block B. Aortic stenosis C. Atrial septal defect D. WPW syndrome with a right - sided accessory pathway

4. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

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5. In hypoplasia of the lung, the following are correct except:

A. The major abnormality is a decrease in the number of airway generations and pulmonary artery branchings

B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of

intrauterine growth D. Embryologic defects occur early and may be associated with other

syndromes E. If associated with diaphragmatic hernia, the hypoplastic lung should be

removed at surgery.

6. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

7. During CPR all the following are true except:

A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

8. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because

the risk thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as

coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient

to prevent stroke because the risk of thromboembolism is low

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9. The following statements regarding cardioversion of atrial Fibrillation is correct except:

A. The absence of thrombus on transthoracic echocardiogram allows Immediate, safe cardioversion

B. Patients who have had AF for less than 24 hours do not need anti –coagulation before cardioversion

C. Patients who have had AF for more than 48 hours should receive coumadin for 3 weeks before cardioversion

D. Maintenance of sinus rhythm with antiarrhythmic drugs does not obviate the need for coumadin therapy

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

10. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for a tumor located in the:

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

11. The condition that is least likely to be associated with respiratory distress in the newborn is :

A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

12. Of the following, the lesion least likely to be associated with bacterial

endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

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13. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

14. A right upper lobectomy with mediastinal L.N. dissection is done for lung

Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

15. The most sensitive index for assessing the presence of postoperative myocardial necrosis following coronary revascularization is:

A. The development of new Q waves on the electrocardiogram. B. The requirement for isotropic support in the perioperative period. C. Presence of new "hot-spot" images by technetium 99m pyrophosphate

myocardiall scintigraphy. D. Elevation in serum of MB-band creative phosphokinase. E. The development of complete left bundle branch block on the initial

postoperative electrocardiogram.

16. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

17. The utilization of blood versus crystalloid potassium cardioplegic solutions

differs in which of the following ways? A. The volume and frequency of and pressure at which the cardioplegic

solution is delivered

B. Superiority of a specific potassium ion concentration C. Alleged superiority of a blood vehicle because the heart is arrested in an

oxygenated environment D. Necessity for adjuvant use of calcium channel block- ing agents E. None of the above

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18. During shockable VF/ pulseless VT we give one shock of:

A. 150- 200 J biphasic or 360 J monophasic. B. 100 J biphasic or 360 J monophasic. C. 150- 360 J biphasic or 300 J monophasic. D. 150- 360 J biphasic or 260 J monophasic.

19. Systemic metabolic acidosis and increased mixed venous oxygen saturation are

characteristic of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

20. Which of the following agents has the highest potential for supraventricular arrhythmia?

A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

21. Which of the following causes the greatest increase in cardiac index at equipotent doses?

A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

22. Which of the following statements is true regarding antiarrhythmic agents?

A. Digoxin decreases the automaticity of the His-Purkinje system. B. Esmolol can be used to treat tet spells in the immediate postop period. C. Lidocaine treats ventricular tachycardia by slowing AV conduction. D. Procan SR does not need to be adjusted in the setting of renal

insufficiency. E. Atropine is ineffective in treating bradycardia secondary to beta

blockade.

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23. The most common valvular defect resulting from rheumatic fever is:

A. Mitral stenosis B. Mitral insufficiency C. Aortic stenosis D. Aortic insufficiency E. Pulmonary stenosis

24. Lasers:

A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours

25. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

26. The sudden onset of persistent coughing, productive of copious amounts of thick

brownish fluid, occurring three months following resection of the right lung suggests:

A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Broncho-pleural fistula E. All of the above

27. When contemplating elective thoracotomy on a patient who has been on long-term corticosteroid therapy, it is best to :

A. Discontinue steroids for one month prior to operation B. Continue the same dosage schedule throughout hospitalization

C. Give increased amounts of steroids during and immediately after operation

D. Use ACTH postoperatively E. Give prophylactic isoniazid and PAS

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28. The purpose of leaving a chest tube in place following pneumonectomy is to:

A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

29. One of the contra-indications to bronchoscopy is the presence of:

A. Endobronchial tuberculosis B. Active bleeding C. Aortic aneurysm D. Emphysema E. None of the above

30. The indication for transvenous insertion of cardiac pacemaker:

A. Permanent heart block B. Intermittent symptomatic heart block C. Sinus bradycardia D. Post-surgical heart block E. All of the above

31. Mediastinal widening after chest trauma is a pathognomonic sign of:

A. Aortic injury B. Cardiac injury C. Pericardial effusion D. Perforated esophagus E. Bronchial tear

32. The entity termed "shock lung" is usually seen:

A. With multiple trauma B. With head injuries C. With hemorrhagic shock D. After Prolonged cardiopulmonary bypass E. All of the above

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33. Patients with cardiac tamponade are best managed:

A. Expectantly B. By pericardiocentesis followed by definitive thoracotomy if necessary C. By pericardiocentesis only D. By open thoracotomy and cardiorrhaphy E. By thoracotomy, only if blood loss is excessive

34. Repair of a traumatic diaphragmatic hernia:

A. Should be considered an emergency procedure B. Should be performed as soon as the patient is out of shock C. Is almost always indicated if the patient is clinically stable D. Usually requires.a thoraco-abdominal approach E. All of the above

35. Following sudden deceleration, the most common site of aortic injury is:

A. Just distal to the origin of the left subclavian artery B. The dome of the aortic arch C. A point close to the annulus of the aortic valve D. Adjacent to the carotid artery E. Distal thoracic aorta

36. Acute mediastinitis is most often due to:

A. Rupture of a mediastinal cyst B. Acute inflammatory processes originating in the lungs C. Perforation of the esophagus D. Blood-borne infections E. Tuberculosis

37. Pain in the shoulder and arm combined with horner's syndrome on the same

side suggests the presence of:

A. A ganglioneuroma B. Aortic aneurysm C. Shoulder girdle syndrome D. Tumor (Pancoast) E. None of the above

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38. The term "empyema necessitans" refers to

A. A fulminating pleural infection B. Mediastinal extension of an empyema C. Metastatic foci of infection D. Secondary involvement and fistulaion through the chest wall E. Tuberculous empyema

TRUE OR FALSE : More than one answer. For the next 3 questions , determine whether each choice is true ( T ) or false ( F ): 39. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected

secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is

due to shunt flow across the atrial septum

40. Optimal myocardial protection afforded by hypothermic potassium cardioplegia is achieved when:

A. The myocardial temperature is kept to less than20C.

B. The potassium concentration of the cardioplegic solution is greater than 46 mEq per liter.

C. There is absence of electrocardiographic activity throughout the aortic cross-clamp period.

D. Steroids are added as adjuvants for membrane stabilization.

41. Intraoperative myocardial protection utilizing intermittent hypothermic

potassium cardioplegia has been shown to be efficacious in: A. Preserving myocardial high-energy phosphate compounds during

ischemic periods of 60 minutes.

B. Preserving preoperative left ventricular ejection fraction when measured one week following coronary revascularization.

C. Decreasing the incidence of perioperative infarction following coronary revascularization.

D. Decreasing the incidence of postoperative supaventricular arrhythmias.

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MATCHING: For The Next 2 Questions, The Two Lettered Headings Are Followed By A List Of Numbered Items. Answer By Using The Key Outlined Below: A. If the item is associated with A only B. If the item is associated with B only C. If the item is associated with both A and B D. If the item is associated with neither A nor

A. Heart as a pump B. Heart as a muscle

42. Starling's law 43. Maximal velocity of contraction 44. Ventricular volume 45. Adrenalin

A. Cardiac dilatation B. Cardiac hypertrophy

46. Best determined by X-ray examination 47. Best determined by electrocardiography 48. More characteristic of increased volume loads 49. More characteristic of increased resistance to outflow 50. Elevated end-diastolic pressure

GOOD LUCK

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AIN SHAMS UNIVERSITY MD Cardiothoracic Surgery Faculty of medicine Paper I Cairo 18/11/2006 Time allowed: 2 hours Give a short account on the following questions: 1. The new major changes in the guidelines for CPR in both

adults and children.

2. Shock after acute myocardial infarction.

3. Current indications for pulmonary artery banding.

4. Alternative sites for arterial cannulation.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQCairo 13/05/2007 Time allowed: 60 minutes

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

1. Which of the following statements is true regarding myxoma morphology?

A. These tumors are most commonly found in the right atrium B. Myxomas have a characteristically firm texture and rarely embolize C. They arise from multipotential mesenchymal cells D. Myxomas usually are attached to the free atrial or ventricular wall E. There is no malignant potential

2. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates

B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation

C. A successful outcome requires the production of complete and transmural lines of conduction block

D. Newer methods of producing lines of block such as cryoablation have been as effective as the traditional "cut and sew" method

E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

3. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal

sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are

electrically isolated from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather

than an empiric anatomic one

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4. Which of the following statements is true regarding the natural history of CAD?

A. Distal LAD lesions do not result in poorer survival compared to proximal lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect

outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 3-vessel disease have equivalent survival at 5 years

5. Which of the following is true regarding the etiology of lung abscess ?

A. Hematologic seeding is the common mechanism for infection B. The posterior segment of the upper lobe and superior segment of the lower lobe on the

right side are most commonly involved C. Periodic episodes of hemoptysis and foul sputum are uncommon D. Staph Species are the predominant organism

6. Which of the following statements is true regarding results after resection of pulmonary

metastases ?

A. Partial resection of extensive pulmonary metastatic disease can improve survival B. Disease –free interval has not been shown to have prognostic value for survival C. Patients with a greater number of metastatic nodules have poorer survival D. CEA levels do not affect 5-year survival after resection of metastatic colon carcinoma E. Metastatic head and neck cancers have poor outcome after pulmonary resection

7. Which of the following statements is true regarding operative management of congenital

sinus of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

8. Which of the following statements is true regarding congenital diaphragmatic hernias?

A. Bochdalek's hernia is more common in the posterior costal portion on the right side. B. Obstruction and strangulation are the typical presentation of an acute Bochdalek's

hernia. C. Most mortality for infants with Bochdalek's hernia can be attributed to increased

pulmonary vascular resistance. D. The stomach is the most common organ to be found in a Morgagni's hernia. E. Morgagni's hernia is best repaired through a right thoracotomy.

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9. Which of the following statements is true regarding the operative management of lung cancer?

A. A bloody pleural effusion is not a contraindication to surgery for peripherally located carcinomas.

B. Preoperative CT scanning can accurately predict the number of tumor nodules. C. Wedge resection is adequate therapy for most peripherally located carcinomas. D. Advanced age is no longer considered a risk factor for surgical treatment of lung

cancer. E. Only 25% of all patients with lung cancer will be operative candidates.

10. Which of the following is true for operations for congenital subvalvular aortic stenosis?

A. Resection of muscle below the right coronary cusp should be avoided. B. The Konno procedure is preferred in the sitting of a normal valve and annulus. C. Early mortality is equivalent for the localized and the diffuse forms. D. Late death is usually secondary to bacterial endocarditis. E. The discrete form is associated with increased early and late risk for death.

11. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome?

A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction.

B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than

thoracic outlet syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery

stenosis.

12. Which of the following statements is true regarding the clinical manifestations of pectus excavatum?

A. Most infants and children are symptomatic. B. Mitral valve prolapse is uncommonly associated with this disorder. C. Operative repair does not improve cardiac index at rest or during exercise. D. Asthma and recurrent pulmonary infections are uncommon. E. Pulmonary function tests can document obstructive pulmonary findings.

13. The following features are true for a tension pneumothorax:

A. Tracheal deviation towards the affected side B. Increased chest movement on the affected side C. Increased resonance of affected side D. Cardiac arrest E. Surgical emphysema

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14. Which of the following statements is true regarding operative management of post-infarct LV aneurysm?

A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot

formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

15. Which of the following statements is true regarding chest wall tumors?

A. Incisional biopsy will reliably diagnose most primary tumors. B. A 2-cm margin is adequately wide for resection of a chest wall tumor. C. Posterior chest wall defects greater than 5 cm should be reconstructed using prosthetic

material. D. Overall 5-year survival for resection of primary chest wall tumors is about 50%. E. Recurrent tumors can be excised with good long-term results.

16. Which of the following statements is true regarding neurogenic tumors of mediastinum?

A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial

presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

17. Which of the following statements concerning aneurysms of the thoracic aorta is true?

A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are predominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not

undergo operation.

18. Which of the following statements is true regarding thymomas and germ cell tumors?

A. Over 50% of myasthenia gravis patients will have a thymoma. B. The presence of myasthenia gravis is a risk factor for poor outcome. C. Blind biopsy or orchiectomy should be performed in patients with mediastinal germ

cell tumors. D. Cytoreductive resection should be performed prior to radiation therapy if a seminoma

is involving vital structures. E. Over 90% of nonseminomas will produce either AFP or B-HCG.

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 19. Concerning tumors of the chest wall, all are correct except:

A. Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs.

B. The most common primary malignant tumor is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated.

20. The following criteria are correct for achalasia except:

A. Dysphagia B. Retention of ingested food in the esophagus. C. Radiologic evidence of dilated body of the esophagus. D. Vigorous peristalsis by manometry and cineradiography. E. Carcinoma in association achalasia is uncommon

21. The Choussat-Fontan criteria for appropriateness of an atriopulmonary

anastomosis include all of the following except:

A. Pulmonary artery pressure less than 15 mmHg. B. Pulmonary vascular resistance less than 4 units/M2 body surface area. C. Age less than 3 years. D. Ventricular ejection fraction 0.45 or greater. E. Normal sinus rhythm.

22. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

23. Esophageal dilatation for the treatment of achalasia is characterized by except:

A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

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24. Zenker's diverticula is characterized by except:

A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E. Causes dysphagia with liquids

25. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

Choose The Single Best Answer To The Following : 26. The treatment for the relief of increasing spontaneous mediastinal emphysema is:

A. Thoracotomy B. Suprasternal decompression C. Subxiphoid decompression D. Needling the mediastinum E. None of the above

27. The first sign of Horner's syndrome is usually:

A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above

28. When treating a child born with esophageal atresia and imperforate anus, it is

advisable to:

A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable

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29. The most common site of spontaneous esophageal perforation (Boerhaave's syndrome) is:

A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above

30. Of the following, the condition most frequently associated with congenital

esophageal atresia is:

A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract

31. If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has:

A. A truncus arteriosus B. A pulmonary A-V fistula C. Aorto-pulmonary window D. A coarctation of the aorta E. A coronary-ventricular fistula

32. Immediately following repair of an interventricular septal defect, complete heart block

is noted, although ventricular rate is satisfactory. In this circumstance, one should

A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing

33. A Taussig-Bing malformation is best treated by:

A. Diversion of the septal defect only B. Detachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle

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34. In an adult patient, the repair of coarctation requires some form of aortic replacement if:

A. The anastmosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above

35. The most common findings associated with congenital tricuspid atresia are:

A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis

36. The most common anatomic variation of coronary artery fistula connects:

A. Right coronary artery to right atrium B. Right coronary artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle

37. Of the following, the lesion least likely to be associated with bacterial endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

38. Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total

anomalous pulmonary venous drainage are all characterized by:

A. Inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above

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Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 39. Treatment of lyme burns of the esophagus during the acute phase:

A. Corticosteroids B. Esophagoscopy

40. Pain associated with ingestion of food during childhood is commonly associated

with the presence of:

A. Achalasia of the esophagus B. Congenital esophageal diverticulum

41. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

42. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

Determine Whether Each Choice Is True Or False. Any Combination Of Answers May Occur.

A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

43. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

44. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

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45. According to the TMN principles for staging lung cancers, which of the bronchogenic carcinomas described below is or are considered to be Stage I ?

A. Large cell carcinoma 4 cm in diameter without lymph node metastases. B. Poorly differentiated adenocarcinoma without metastases to lymph nodes. C. Squamous cell carcinoma with atelectasis and extension to visceral pleura without

lymph node metastases or pleural effusion. D. Alveolar cell carcinoma without metastases to the lymph nodes.

46. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve

replacement include(s):

A. Much greater resistance to infection. B. Satisfactory long-term durability in adolescents. C. Good hemodynamic performance in the 17 mm and 19 mm sizes relative to tilting disc

valves. D. Low thromboembolic risk without systemic anticoagulation.

47. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for

CABG include(s):

A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once: 48. A. Ostium secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect 1. Heart block and arrhythmia common 2. Absent superior rim 3. Most commonly encountered 4. Cyanosis in absence of failure

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49. A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage 1. Abnormal coronary sinus 2. Complete repair least likely 3. Persistent left anterior cardinal vein 4. Persistent ductus venosus 50. A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis 1. Parachute valve 2. Syncope 3. Waterston shunt 4. Brock procedure

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II Cairo 19/11/2006 Time allowed: 2 hours Give short account on the following:

1. The new practice guidelines for the management of patients with mitral valve disease.

2. Evolution of surgery for total right heart bypass (Fontan’s operation).

3. Diagnosis and management of acute pulmonary embolism. 4. Esophageal perforation.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 14/05/2007 Time allowed: 1 and half hours

COMMENTARY For Each Of The Following Multiple-Choice Questions, Select The One Most Appropriate Answer, Based On The History Given Below & Comment on the Choice:

Following a large meal, a middle-aged man suddenly experiences sudden severe epigastric and substernal pain during an episode of vomiting. The pain radiates to the side of the chest and shoulder. He develops symptoms of shock shortly after coming to the emergency room.

1. A differential diagnosis would include all of the following except: A. Acute myocardial infarction B. Mallory-Weiss syndrome C. Spontaneous pneumothorax D. Status thymicolymphaticus E. Ruptured aortic aneurysm

2. Subsequent investigation reveals hydropneumothorax on the left, bloody gastric aspirate, crepitus in the jugular notch. The most likely diagnosis is: A. Perforated peptic ulcer B. Ruptured aortic aneurysm C. (Boorhaave's syndrome) Perforated esophagus D. Spontaneous pneumothorax E. Bronchogenic carcinoma

3. The treatment of choice is:

A. Laparotomy and closure of ulcer B. Thoracotomy and resection C. Thoracotomy and suture-closure of rupture D. Transfuse, antibiotics, operate after 24 hours E. Closed thoracotomy drainage, decompress GI tract

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper IV MCQ (ANA. & PATH.) Cairo 15/05/2007 Time allowed: 60 minutes

ANATOMY & EMBRYOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer: 1. Which of the following statements about diaphragmatic anatomy is true?

A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the

cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise

from the lumbar vertebrae

2. Which of the following is true regarding the diaphragmatic development?

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

3. Which of the following statements is true regarding anatomy of the thoracic

outlet?

A. The distal section of the cervicoaxillary canal is the more critical for compression syndromes

B. The brachial plexus and subclavian artery are located in the anteromedial compartment of the costoclavicular space

C. The borders of the scalene triangle are scalenus anticus, scalenus medius, and first rib

D. Inspiration tilts the coracoid process inferiorly , placing tension on the neurovascular bundle

E. Bony abnormalities are present in the majority of patients

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4. Which of the following is true regarding the lung? A. Is the only organ with a dual blood supply B. Will function satisfactorily after complete denervation C. Is inferior to the kidney in adjusting acid-base balance D. Does not possess a lymphatic system E. All of the above

5. Which of the following is true regarding the usual drainage of persistent left

superior vena cava?

A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava

6. Which of the following is true regarding the level of the narrowest part of the

esophagus?

A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

7. Which of the following is true regarding the azygos vein?

A. Receives venous blood from the middle one-third of the esophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

8. Which of the following statements is true regarding the lining of the normal

bronchial mucosa ?

A. Simulated pseudostratified epithelium B. Goblet cells C. Basal cells D. Adeno-cystic cells which constitute the germinal layer

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9. Which of the following statements is true regarding the atrio-ventricular (AV) node ?

A. Receives nerves from the right vagus B. Its arterial supply is from the right coronary artery C. Is located near the entrance of the superior vena cava D. Is located near the coronary sinus

10. Which of the following statements is true regarding the inferior vena cava?

A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins

11. Which of the following statements is true regarding the abdominal aorta?

A. Passes behind the medial arcuate ligament of the diaphragm at the level of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior

mesenteric artery 12. Which of the following statements is true regarding the thoracic duct?

A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

13. Which of the following statements is true regarding in the root of the neck?

A. Scalenus anterior arises from the anterior tubercles of the typical cervical vertebrae

B. The supreme intercostals vein lies lateral to the first thoracic nerve on the neck of the first rib

C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct

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14. Which of the following statements is true regarding the subclavian artery?

A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from branches

of the thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath

derived from the prevertebral fascia E. Becomes the axillary artery at the upper border of teres major

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

15. During embryologic development of the heart, the following occur except:

A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

16. The diaphragm

A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front of the

esophagus D. Diaphragm projects higher Into the chest on the right than on the left E. Lies entirely above the tenth rib.

ANSWER THE FOLLOWING 2 QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

17. Patent ductus usually occurs as an isolated defect BECAUSE it does not arise from

the aortic arch system.

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18. About 70% or more of the total vital capacity is expired within the first second of expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

ANSWER THE FOLLOWING 5 QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

19. The parietal pleura:

A. Is very sensitive to pain B. Absorbs the pleural fluid

20. A moderator band is usually found in the:

A. Left ventricle . B. Right ventricle

21. Eustachian valve:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

22. The bundle of his passes closer to:

A. The right side of the interatrial septum B. The left side of the interatrial septum

23. The sinus venosus forms:

A. The superior and inferior vena cava B. The right atrium

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In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once:

24. A. Anterior mediastinum B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia 25. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

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PATHOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

26. Which of the following is true regarding the essential factor in the pathogenesis

of aortic aneurysms is damage ?

A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis

27. Which of the following is true regarding the causes of hilar enlargement ?

A. Sarcoidosis B. Lymphoma C. Hypertension D. Tuberculosis E. Caplan's syndrome

28. Which of the following is true regarding, the most common benign tumor of the

esophagus ?

A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma

29. Pleuropericardial (spring water) cysts are most commonly located:

A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium

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30. Which of the following statements is true regarding the pathology of lung cancer?

A. Squamous cell carcinoma occurs with equal frequency in smokers and

nonsmokers. B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands. C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy. D. Alveolar cell carcinoma has the least favorable prognosis. E. E. Most cancers associated with pulmonary scars are squamous cell

carcinomas 31. Which of the following statements is true regarding the anatomy and

pathophysiology of post-infarct left ventricular aneurysm?

A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

32. Which of the following statements is true regarding cervical rib?

A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

33. Which of the following statements is true regarding gastro-oesophageal reflux?

A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic than

symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's

oesophagus E. Initial management may include increasing the number of meals eaten per day

34. Which of the following statements is true regarding achalasia?

A. The cause is hypertrophy of the gastro-esophageal sphincter B. Dysphagia is mainly for solids C. Incidence is higher in males than females D. Manometry shows reduced pressure within the lower oesophagus E. Initial treatment is with H2 antagonists

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35. Which of the following statements is true regarding TOF morphology?

A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.

B. The bundle of His runs along the posteroinferior border of the VSD. C. Additional VSDs are present in approximately 25% of patients. D. The pulmonary valve is usually the narrowest part of the right ventricular

outflow tract. E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually

normal in size.

36. Which of the following statements is true regarding hernias through the foramen of bockdalek?

A. Usually have a true sac B. Present anteriorly C. May be caused by a short esophagus D. Pass through the pleuroperitoneal canal E. Are associated with eventration of the diaphragm

37. Which of the following statements is true regarding the Kartagener’s syndrome?

A. Situs inversus, bronchicetasis and pansinusitis B. Situs inversus of the lungs with levocardia

C. Splenic agenesis syndrome with levocardia

D. Anomalous right pulmonary artery and bilobation of the lungs E. None of the above

38. Which of the following statements is true regarding lung cancer?

A. Of the alveolar cell type is not typically associated with smoking B. Of the large cell type characteristically metastasizes early C. May present with the myasthenic syndrome D. Of the small cell type has the best 5-year survival of all types of lung cancer

when treated by excision E. May present with hypernatraemia due to hormone secretion by the tumour

39. Which of the following statements is true regarding thrombosis?

A. In the axillary vein is commoner on the right side B. In the superior vena cava may cause tinnitus C. In the venous system usually consists of fibrin and platelets D. In a proximal leg vein may be an indication for an inferior vena cava filter if the

patient also has a peptic ulcer E. Prophylaxis of DVT can be achieved by intravenous dextran

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40. Which of the following statements is true regarding carotid artery disease?

A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid plaque

that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischaemic attack commonly

includes CT scan of the brain E. Surgery has been shown to be better than medical therapy in the management of

asymptomatic patients with stenoses greater than 70%

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

41. Esophageal hiatus hernia in infants:

A. May be an important cause of vomiting B. Is often associated with constipation C. Can be demonstrated during the first week of life D. May be associated with pyloric stenosis E. Is frequently accompanied by gastrointestinal bleeding

42. Bronchogenic cysts:

A. Are lined by pseudostratified columnar epithelium B. Usually appear as air-filled cavities C. Do not cause hemoptysis D. Frequently become infected E. Mostly occur close to the hilum

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

43. Underdevelopment of the main pulmonary artery is usually associated with

narrowing or stenosis of the outflow tract of the right ventricle BECAUSE both are derived from the conus.

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44. The presence of a cervical rib does not produce symptoms in childhood BECAUSE

the rib is rudimentary at this age. 45. Bronchial foreign bodies more frequently occur in children BECAUSE the right

main stem bronchus is relatively straighter than the left. 46. Positive sputum cultures for Aspergillus must be interpreted with caution BECAUSE

the organism is often present in sputum as a harmless saprophyte. 47. Tumourlets are epithelial proliferations which are usually associated with

bronchiectatic lobes BECAUSE these microscopic lesions are never found in the absence of damage to the lungs.

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

48. Blood supply of tuberculous lesions

A. Pulmonary arteries B. Brochial arteries

49. Benign pulmonary tumors:

A. Tumourlets B. Hamartomas

50. Development of lung abscess in:

A. Alveolar cysts B. Bronchogenic cysts

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 21/11/2006 Time allowed: 2 Hours

ANATOMY

1. Fibrous skeleton of the heart.

2. Surgical anatomy of the trachea .

PATHOLOGY

1. Give short account on types and staging of bronchogenic carcinoma.

2. Pathology of graft rejection.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo 10/05/2008 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

2. With hypovolemic shock, all the following are reduced except which one ?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

4. Paradoxical ( reversed) splitting of S2 is caused by all of the following except:

A. Left bundle branch block B. Aortic stenosis C. Atrial septal defect D. WPW syndrome with a right - sided accessory pathway

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5. Coarctation of the aorta may be associated with all of the following except:

A. Aneurysm of the circle of Willis B. Central cyanosis C. Hypertension D. Rib notching E. Bicuspid aortic valve

6. Surgical repair of pectus excavatum is characterized by except:

A. Internal metal support necessary B. Wedge osteotomy in upper sternum C. Division of costal cartilages D. Substernal or Pleural drainage desirable E. Reattachment of rectus abdominis muscles

7. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

8. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

9. In hypoplasia of the lung, the following are correct except:

A. The major abnormality is a decrease in the number of airway generations and pulmonary artery branchings

B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of

intrauterine growth D. Embryologic defects occur early and may be associated with other

syndromes E. If associated with diaphragmatic hernia, the hypoplastic lung should be

removed at surgery.

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10. During CPR all the following are true except: A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

11. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because

the risk thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as

coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient

to prevent stroke because the risk of thromboembolism is low 12. The following statements regarding cardioversion of atrial Fibrillation is

correct except:

A. The absence of thrombus on transthoracic echocardiogram allows Immediate, safe cardioversion

B. Patients who have had AF for less than 24 hours do not need anti –coagulation before cardioversion

C. Patients who have had AF for more than 48 hours should receive coumadin for 3 weeks before cardioversion

D. Maintenance of sinus rhythm with antiarrhythmic drugs does not obviate the need for coumadin therapy

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

13. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for a tumor located in the :

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

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14. The condition that is least likely to be associated with respiratory distress in the newborn is :

A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

15. Of the following, the lesion least likely to be associated with bacterial

endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

16. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

17. A right upper lobectomy with mediastinal L.N. dissection is done for lung

Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

18. The most sensitive index for assessing the presence of postoperative myocardial necrosis following coronary revascularization is:

A. The development of new Q waves on the electrocardiogram. B. The requirement for isotropic support in the perioperative period. C. Presence of new "hot-spot" images by technetium 99m pyrophosphate

myocardiall scintigraphy. D. Elevation in serum of MB-band creative phosphokinase. E. The development of complete left bundle branch block on the initial

postoperative electrocardiogram.

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19. Hepatojugular ( abdominojugular ) reflux is found in patients with:

A. Right ventricular infarction B. Superior vena cava syndrome C. Left ventricular failure with secondary pulmonary hypertension D. Tricuspid regurgitation

20. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

21. The combination of right heart failure, elevated venous pressure and a quiet

heart is known as:

A. Whipple's triad B. Saint's triad C. Beck's triad D. Murphy's sign E. None of the above

22. During shockable VF/ pulseless VT we give one shock of:

A. 150- 200 J biphasic or 360 J monophasic. B. 100 J biphasic or 360 J monophasic. C. 150- 360 J biphasic or 300 J monophasic. D. 150- 360 J biphasic or 260 J monophasic.

23. Systemic metabolic acidosis and increased mixed venous oxygen saturation are

characteristic of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

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24. Which of the following agents has the highest potential for supraventricular arrhythmia?

A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

25. Which of the following causes the greatest increase in cardiac index at equipotent doses?

A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

26. Which of the following statements is true regarding antiarrhythmic agents?

A. Digoxin decreases the automaticity of the His-Purkinje system. B. Esmolol can be used to treat tet spells in the immediate postop period. C. Lidocaine treats ventricular tachycardia by slowing AV conduction. D. Procan SR does not need to be adjusted in the setting of renal

insufficiency. E. Atropine is ineffective in treating bradycardia secondary to beta

blockade.

27. The most common valvular defect resulting from rheumatic fever is:

A. Mitral stenosis B. Mitral insufficiency C. Aortic stenosis D. Aortic insufficiency E. Pulmonary stenosis

28. Lasers:

A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours

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29. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

30. The sudden onset of persistent coughing, productive of copious amounts of thick

brownish fluid, occurring three months following resection of the right lung suggests:

A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Broncho-pleural fistula E. All of the above

31. When contemplating elective thoracotomy on a patient who has been on long-term corticosteroid therapy, it is best to :

A. Discontinue steroids for one month prior to operation B. Continue the same dosage schedule throughout hospitalization

C. Give increased amounts of steroids during and immediately after operation

D. Use ACTH postoperatively E. Give prophylactic isoniazid and PAS

32. The purpose of leaving a chest tube in place following pneumonectomy is to:

A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

33. One of the contra-indications to bronchoscopy is the presence of:

A. Endobronchial tuberculosis B. Active bleeding C. Aortic aneurysm D. Emphysema E. None of the above

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34. The most common toxic arrhythmia associated with digitalis overdosage is:

A. Atrial fibrillation B. Ventricular extrasystole C. Ventricular fibrillation D. Complete heart block E. None of the above

35. The indication for transvenous insertion of cardiac pacemaker:

A. Permanent heart block B. Intermittent symptomatic heart block C. Sinus bradycardia D. Post-surgical heart block E. All of the above

36. Mediastinal widening after chest trauma is a pathognomonic sign of:

A. Aortic injury B. Cardiac injury C. Pericardial effusion D. Perforated esophagus E. Bronchial tear

37. The entity termed "shock lung" is usually seen:

A. With multiple trauma B. With head injuries C. With hemorrhagic shock D. After Prolonged cardiopulmonary bypass E. All of the above

38. Patients with cardiac tamponade are best managed:

A. Expectantly B. By pericardiocentesis followed by definitive thoracotomy if necessary C. By pericardiocentesis only D. By open thoracotomy and cardiorrhaphy E. By thoracotomy, only if blood loss is excessive

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39. Repair of a traumatic diaphragmatic hernia:

A. Should be considered an emergency procedure B. Should be performed as soon as the patient is out of shock C. Is almost always indicated if the patient is clinically stable D. Usually requires.a thoraco-abdominal approach E. All of the above

40. Following sudden deceleration, the most common site of aortic injury is:

A. Just distal to the origin of the left subclavian artery B. The dome of the aortic arch C. A point close to the annulus of the aortic valve D. Adjacent to the carotid artery E. Distal thoracic aorta

41. Acute mediastinitis is most often due to:

A. Rupture of a mediastinal cyst B. Acute inflammatory processes originating in the lungs C. Perforation of the esophagus D. Blood-borne infections E. Tuberculosis

42. The characteristic physical signs of mediastinal emphysema are:

A. Subcutaneous emphysema B. Hamman's murmur C. Decreased heart sounds D. Crepitation E. All of the above .

43. Pain in the shoulder and arm combined with horner's syndrome on the same side suggests the presence of:

A. A ganglioneuroma B. Aortic aneurysm C. Shoulder girdle syndrome D. Tumor (Pancoast) E. None of the above

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44. The term "empyema necessitans" refers to

A. A fulminating pleural infection B. Mediastinal extension of an empyema C. Metastatic foci of infection D. Secondary involvement and fistulaion through the chest wall E. Tuberculous empyema

45. Bochdaleck hernia should be treated by:

A. Immediate operation, unless there is a history of respiratory distress B. Emergency operation via thoraco abdominal approach C. Conservative measures until age six months D. Conservative measures as long as the patient is doing well E. Operation or medical management, depending on symptoms

TRUE OR FALSE : More than one answer. For the next 3 questions , determine whether each choice is true ( T ) or false ( F ): 46. Which statements are correct about CABG :

A. CABG prolongs survival in patients with greater than 70% left main stenosis, independent of anginal symptoms

B. CABG prolongs survival in patients with three – vessel disease and left ventricular systolic dysfunction

C. Diabetic patients with multivessel coronary artery disease have a better prognosis with multivessel angioplasty than with CABG

D. Women have lower perioperative mortality than men E. Internal mammary grafts remain patent longer than saphenous vein grafts

47. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected

secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is

due to shunt flow across the atrial septum

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48. Which of the following statements correctly characterize major determinants of cardiac performance ?

A. Stroke volume increases with increasing afterload B. Ventricular preload describes the load against which the ventricle must

contract when it eject blood C. In normal hearts, ventricular inotropic state increases with increasing

heart rate because of changes in calcium availability D. Hypoxia , ischemia, and acidosis decrease cardiac contractility E. In failing hearts, right atrial pressure as assessed from the

jugular venous pulse is a good indicator of left ventricular filling pressure MATCHING : For The Next 2 Questions, Choose For Each Numbered Item, The Most Likely Associated Lettered Item From Those Provided. Each Item Has Only One Answer 49. Match the following palliative surgical shunts with their anatomic

anastomoses :

A. Superior vena cava to right pulmonary artery B. Subclavian artery to pulmonary artery C. Ascending aorta to right pulmonary artery D. Ascending aorta to main pulmonary artery E. Descending aorta to left pulmonary artery

1. Classic Blalock – Taussig shunt 2. Pott’s anastmosis 3. Classic Glenn shunt 4. Waterston shunt 5. Davidson shunt

50. Select from the list below the cardiac events that correspond most closely to the components of the jugular venous waveform :

A. Opening of the tricuspid valve and right ventricular relaxation B. Right atrial relaxation C. Pulmonary valve opening D. Right atrial contraction E. Passive right atrial filling with a competent tricuspid valve

1. X-descent 2. V-wave 3. A-wave 4. Y-descent

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQCairo 11/05/2008 Time allowed: 60 minutes

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

1. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates

B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation

C. A successful outcome requires the production of complete and transmural lines of conduction block

D. Newer methods of producing lines of block such as cryoablation have been as effective as the traditional "cut and sew" method

E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

2. Which of the following is true regarding the etiology of lung abscess ?

A. Hematologic seeding is the common mechanism for infection B. The posterior segment of the upper lobe and superior segment of the lower lobe on the

right side are most commonly involved C. Periodic episodes of hemoptysis and foul sputum are uncommon D. Staph Species are the predominant organism

3. Which of the following statements is true regarding myxoma morphology?

A. These tumors are most commonly found in the right atrium B. Myxomas have a characteristically firm texture and rarely embolize C. They arise from multipotential mesenchymal cells D. Myxomas usually are attached to the free atrial or ventricular wall E. There is no malignant potential

4. Which of the following statements is true regarding the natural history of CAD?

A. Distal LAD lesions do not result in poorer survival compared to proximal lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect

outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 3-vessel disease have equivalent survival at 5 years

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5. Which of the following statements is true regarding results after resection of pulmonary

metastases ?

A. Partial resection of extensive pulmonary metastatic disease can improve survival B. Disease –free interval has not been shown to have prognostic value for survival C. Patients with a greater number of metastatic nodules have poorer survival D. CEA levels do not affect 5-year survival after resection of metastatic colon carcinoma E. Metastatic head and neck cancers have poor outcome after pulmonary resection

6. Which of the following statements is true regarding operative management of congenital

sinus of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

7. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal

sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are

electrically isolated from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather

than an empiric anatomic one

8. Which of the following statements is true regarding congenital diaphragmatic hernias?

A. Bochdalek's hernia is more common in the posterior costal portion on the right side. B. Obstruction and strangulation are the typical presentation of an acute Bochdalek's

hernia. C. Most mortality for infants with Bochdalek's hernia can be attributed to increased

pulmonary vascular resistance. D. The stomach is the most common organ to be found in a Morgagni's hernia. E. Morgagni's hernia is best repaired through a right thoracotomy.

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9. Which of the following statements is true regarding the operative management of lung cancer?

A. A bloody pleural effusion is not a contraindication to surgery for peripherally located carcinomas.

B. Preoperative CT scanning can accurately predict the number of tumor nodules. C. Wedge resection is adequate therapy for most peripherally located carcinomas. D. Advanced age is no longer considered a risk factor for surgical treatment of lung

cancer. E. Only 25% of all patients with lung cancer will be operative candidates.

10. Which of the following is true for operations for congenital subvalvular aortic stenosis?

A. Resection of muscle below the right coronary cusp should be avoided. B. The Konno procedure is preferred in the sitting of a normal valve and annulus. C. Early mortality is equivalent for the localized and the diffuse forms. D. Late death is usually secondary to bacterial endocarditis. E. The discrete form is associated with increased early and late risk for death.

11. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome?

A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction.

B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than

thoracic outlet syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery

stenosis.

12. Which of the following statements is true regarding the clinical manifestations of pectus excavatum?

A. Most infants and children are symptomatic. B. Mitral valve prolapse is uncommonly associated with this disorder. C. Operative repair does not improve cardiac index at rest or during exercise. D. Asthma and recurrent pulmonary infections are uncommon. E. Pulmonary function tests can document obstructive pulmonary findings.

13. The following features are true for a tension pneumothorax:

A. Tracheal deviation towards the affected side B. Increased chest movement on the affected side C. Increased resonance of affected side D. Cardiac arrest E. Surgical emphysema

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14. Which of the following statements is true regarding operative management of post-infarct LV aneurysm?

A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot

formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

15. Which of the following statements is true regarding chest wall tumors?

A. Incisional biopsy will reliably diagnose most primary tumors. B. A 2-cm margin is adequately wide for resection of a chest wall tumor. C. Posterior chest wall defects greater than 5 cm should be reconstructed using prosthetic

material. D. Overall 5-year survival for resection of primary chest wall tumors is about 50%. E. Recurrent tumors can be excised with good long-term results.

16. Which of the following statements is true regarding neurogenic tumors of mediastinum?

A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial

presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

17. Which of the following statements concerning aneurysms of the thoracic aorta is true?

A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are predominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not

undergo operation.

18. Which of the following statements is true regarding thymomas and germ cell tumors?

A. Over 50% of myasthenia gravis patients will have a thymoma. B. The presence of myasthenia gravis is a risk factor for poor outcome. C. Blind biopsy or orchiectomy should be performed in patients with mediastinal germ

cell tumors. D. Cytoreductive resection should be performed prior to radiation therapy if a seminoma

is involving vital structures. E. Over 90% of nonseminomas will produce either AFP or B-HCG.

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 19. Concerning tumors of the chest wall, all are correct except:

A. Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs.

B. The most common primary malignant tumor is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated.

20. The following criteria are correct for achalasia except:

A. Dysphagia B. Retention of ingested food in the esophagus. C. Radiologic evidence of dilated body of the esophagus. D. Vigorous peristalsis by manometry and cineradiography. E. Carcinoma in association achalasia is uncommon

21. The Choussat-Fontan criteria for appropriateness of an atriopulmonary

anastomosis include all of the following except:

A. Pulmonary artery pressure less than 15 mmHg. B. Pulmonary vascular resistance less than 4 units/M2 body surface area. C. Age less than 3 years. D. Ventricular ejection fraction 0.45 or greater. E. Normal sinus rhythm.

22. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

23. Esophageal dilatation for the treatment of achalasia is characterized by except:

A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

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24. Zenker's diverticula is characterized by except:

A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E. Causes dysphagia with liquids

25. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

Choose The Single Best Answer To The Following : 26. The treatment for the relief of increasing spontaneous mediastinal emphysema is:

A. Thoracotomy B. Suprasternal decompression C. Subxiphoid decompression D. Needling the mediastinum E. None of the above

27. The first sign of Horner's syndrome is usually:

A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above

28. When treating a child born with esophageal atresia and imperforate anus, it is

advisable to:

A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable

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29. The most common site of spontaneous esophageal perforation (Boerhaave's

syndrome) is:

A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above

30. Of the following, the condition most frequently associated with congenital

esophageal atresia is:

A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract

31. If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has:

A. A truncus arteriosus B. A pulmonary A-V fistula C. Aorto-pulmonary window D. A coarctation of the aorta E. A coronary-ventricular fistula

32. Immediately following repair of an interventricular septal defect, complete heart block

is noted, although ventricular rate is satisfactory. In this circumstance, one should

A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing

33. A Taussig-Bing malformation is best treated by:

A. Diversion of the septal defect only B. Detachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle

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34. In an adult patient, the repair of coarctation requires some form of aortic replacement if:

A. The anastmosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above

35. The most common findings associated with congenital tricuspid atresia are:

A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis

36. The most common anatomic variation of coronary artery fistula connects:

A. Right coronary artery to right atrium B. Right coronary artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle

37. Of the following, the lesion least likely to be associated with bacterial endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

38. Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total

anomalous pulmonary venous drainage are all characterized by:

A. Inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above

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Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 39. Pain associated with ingestion of food during childhood is commonly associated

with the presence of:

A. Achalasia of the esophagus B. Congenital esophageal diverticulum

40. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

41. Treatment of lyme burns of the esophagus during the acute phase: A. Corticosteroids B. Esophagoscopy

42. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

Determine Whether Each Choice Is True Or False. Any Combination Of Answers May Occur.

A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

43. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

44. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

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45. According to the TMN principles for staging lung cancers, which of the bronchogenic carcinomas described below is or are considered to be Stage I ?

A. Large cell carcinoma 4 cm in diameter without lymph node metastases. B. Poorly differentiated adenocarcinoma without metastases to lymph nodes. C. Squamous cell carcinoma with atelectasis and extension to visceral pleura without

lymph node metastases or pleural effusion. D. Alveolar cell carcinoma without metastases to the lymph nodes.

46. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve

replacement include(s):

A. Much greater resistance to infection. B. Satisfactory long-term durability in adolescents. C. Good hemodynamic performance in the 17 mm and 19 mm sizes relative to tilting disc

valves. D. Low thromboembolic risk without systemic anticoagulation.

47. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for

CABG include(s):

A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once: 48. A. Ostium secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect 1. Heart block and arrhythmia common 2. Absent superior rim 3. Most commonly encountered 4. Cyanosis in absence of failure

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49. A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage 1. Abnormal coronary sinus 2. Complete repair least likely 3. Persistent left anterior cardinal vein 4. Persistent ductus venosus 50. A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis 1. Parachute valve 2. Syncope 3. Waterston shunt 4. Brock procedure

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 12/05/2008 Time allowed: 1 and half hours

COMMENTARY For Each Of The Following SIX Multiple-Choice Questions, Select The One Most Appropriate Answer, Based On The History Given Below & Comment on the Choice:

A 37 weeks estimated gestational age baby girl was delivered by emergency C-section and weighed 2410 grams. Her Apgar scores were 9 and 9. This baby was diagnosed in utero with tricuspid atresia with a hypoplastic right ventricle and a ventricular septal defect. The baby was weaned from 1 L of O2 within one hour of delivery. 1. Which of the following BEST indicates the patient’s preoperative risk factors?

A. None B. Prematurity 32--35 Weeks C. Preoperative mechanical ventilatory support D. Preoperative shock

A preoperative echocardiogram showed situs solitus with tricuspid atresia, a ventricular septal, mild to moderate valvular pulmonary stenosis, bilateral superior vena cava, and normal ventricular function. At this point, it was felt that the patient could potentially not need surgery until it was time for intervention at 6 months of age. The baby was kept in hospital to observe to see if the baby could eat and thrive. On day 10 of life, the baby began having increasing episodes of desaturations with feedings. On day of life 12, the patient began to exhibit need for increasing oxygen requirement and required intubation and initiation of mechanical ventilatory support. On day 14 of life, patient went to the OR for an intervention. 2. What is the patient’s primary procedure?

A. Bidirectional cavopulmonary anastomosis (BDCPA) (bidirectional Glenn) B. Bilateral bidirectional cavopulmonary anastomosis (BBDCPA) (bilateral bidirectional Glenn) C. Shunt, Systemic to pulmonary, Central (from aorta or to main pulmonary artery) D. Shunt, Systemic to pulmonary, Modified Blalock Taussig Shunt (MBTS)

Three days post-op, the patient was noted to have tachypnea. By chest x-ray, the patient was noted to have an elevated right hemidiaphragm. Fluoroscopy confirmed paradoxical movement of the right hemidiaphragm. 3. What is the patient’s postoperative complication?

A. Diaphragm paralysis B. Pleural effusion requiring drainage C. Phrenic nerve injury/paralyzed diaphragm D. Wound infection

Seven days after the modified Blalock-Taussig shunt, the patient was taken back to surgery for tachypnea with feeds. 4. For the second operation, what is the patient’s primary procedure?

A. Bilateral bidirectional cavopulmonary anastomosis (BBDCPA) (bilateral bidirectional Glenn) B. Diaphragm plication C. Shunt, Systemic to pulmonary, Central (from aorta or to main pulmonary artery) D. Shunt, Systemic to pulmonary, Modified Blalock Taussig Shunt (MBTS)

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Seven months later the patient was evaluated by cardiac catheterization and was found to have suitable hemodynamics for progression to a second stage operation. 5. For the third operation, what is the patient’s primary procedure? A. Bilateral bidirectional cavopulmonary anastomosis (BBDCPA) (bilateral bidirectional Glenn) B. Atrial Septectomy C. Pulmonary arterioplasty D. Shunt ligation and takedown

She subsequently underwent a forth operation at 26 months of age. 6. For the forth operation, what is the patient’s primary procedure?

A. Extra-cardiac total cavo-pulmonary anastomosis or connection B. Intra-cardiac total cavo-pulmonary anastomosis or connection

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology MCQ Cairo 09/05/2006 Time allowed : 60 minutes 1. THE DIAPHRAGM DEVELOPS:

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

2. THE DIAPHRAGM: A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front

of the esophagus D. Diaphragm projects higher Into the chest on the right

than on the left E. Lies entirely above the tenth rib. 3. THE BLOOD SUPPLY TO THE VISCERAL PLEURA IS FROM: A. Pulmonary artery B. The bronchial vessels C. The intercostal vessels D. The internal mammary arteries E. None of the above 4. Which of the following statements about diaphragmatic anatomy is TRUE? A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise from the lumbar vertebrae

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5. Which of the following statements is TRUE regarding anatomy of the thoracic outlet ? A. The distal section of the cervicoaxillary canal is the more critical

for compression syndromes B. The brachial plexus and subclavian artery are located in the

anteromedial compartment of the costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus

medius, and first rib D. Inspiration tilts the coracoid process inferiorly , placing tension on

the neurovascular bundle E. Bony abnormalities are present in the majority of patients

6. IN THE ERECT POSITION, THE SUPERIOR LIMIT OF THE ESOPHAGUS LIES AT THE LEVEL OF THE:

A. Inferior margin of the thyroid cartilage B. Fourth cervical vertebra C. Suprasternal notch D. Thoracic inlet E. Tubercle of the cricoid cartilage

7. THE ESSENTIAL FACTOR IN THE PATHOGENESIS OF AORTIC ANEURYSMS IS DAMAGE: A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis 8. THE NARROWEST PART OF THE ESOPHAGUS LIES AT THE LEVEL OF: A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

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9. A PERSISTENT LEFT SUPERIOR VENA CAVA USUALLY DRAINS INTO THE: A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava 10. Causes of hilar enlargement include: A. Sarcoidosis B. Lymphoma C. Hypertension D. Tuberculosis E. Caplan's syndrome 11. OF THE FOLLOWING, THE MOST COMMON BENIGN TUMOR OF THE ESOPHAGUS IS: A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma 12. THE ESOPHAGUS MAY BE AFFECTED IN THE FOLLOWING CONDITIONS: A. Myasthenia gravis B. Pellagra C. Seleroderma D. Polyserositis E. Achlorhydria 13. The azygos vein: A. Receives venous blood from the middle one-third of the oesophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

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14. PLEUROPERICARDIAL (SPRING WATER) CYSTS ARE MOST COMMONLY LOCATED: A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium 15. Which of the following statements is TRUE regarding the pathology of lung cancer? A. Squamous cell carcinoma occurs with equal frequency in smokers and nonsmokers. B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands. C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy. D. Alveolar cell carcinoma has the least favorable prognosis. E. Most cancers associated with pulmonary scars are squamous cell carcinomas 16. Which of the following statements is TRUE regarding the anatomy and pathophysiology of post-infarct left ventricular aneurysm? A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

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In the following questions, all of the statements are true except one. Identify the incorrect statement:

17. DURING EMBRYOLOGIC DEVELOPMENT OF THE HEART. A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

18. THE CAUSE OF DEATH IN PATIENTS WITH PATENT DUCTUS

ARTERIOSUS IS: A. Intractable congestive heart failure B. Subacute bacterial endocarditis C. Sudden late closure of the ductus D. Acute pulmonary edema . E. Pulmonary hypertension and cor- pulmonale

19. Which of the following statements is true regarding TOF morphology?

A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.

B. The bundle of His runs along the posteroinferior border of the VSD.

C. Additional VSDs are present in approximately 25% of patients.

D. The pulmonary valve is usually the narrowest part of the right ventricular outflow tract.

E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually normal in size.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW: A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

20. Underdevelopment of the main pulmonary artery is usually associated

with narrowing or stenosis of the outflow tract of the right ventricle BECAUSE both are derived from the conus.

21. The presence of a cervical rib does not produce symptoms in childhood

BECAUSE the rib is rudimentary at this age. 22. Patent ductus usually occurs as an isolated defect BECAUSE it does

not arise from the aortic arch system. 23. Bronchial foreign bodies more frequently occur in children BECAUSE

the right main stem bronchus is relatively straighter than the left. 24. About 70% or more of the total vital capacity is expired within the first

second of expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

25. A MODERATOR BAND IS USUALLY FOUND IN THE:

A. Left ventricle . B. Right ventricle

26. IN PATIENTS WITH ESOPHAGEAL ATRESIA:

A. In 90% of cases. the upper segment ends in a blind pouch and the distal part communicates directly with trachea B. Stenosis may develop after surgical correction

27. EUSTACHIAN VALVE:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

28. THE BUNDLE OF HIS PASSES CLOSER TO:

A. The right side of the interatrial septum B. The left side of the interatrial septum

29. THE SINUS VENOSUS FORMS:

A. The superior and inferior vena cava B. The right atrium

30. THE PARIETAL PLEURA:

A. Is very sensitive to pain B. Absorbs the pleural fluid

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31. HERNIAS THROUGH THE FORAMEN OF BOCKDALEK: A. Usually have a true sac B. Present anteriorly C. May be caused by a short esophagus D. Pass through the pleuroperitoneal canal E. Are associated with eventration of the diaphragm

32. THE KARTAGENER’S SYNDROME IS THE ASSOCIATION OF:

A. Situs inversus, bronchicetasis and pansinusitis

B. Situs inversus of the lungs with levocardia

C. Splenic agenesis syndrome with levocardia

D. Anomalous right pulmonary artery and bilobation of the lungs E. None of the above

IN THE FOLLOWING QUESTIONS, EACH NUMBERED ITEM IS TO BE MATCHED WITH ONE LETTERED ITEM. EACH CHOICE MAY BE USED ONLY ONCE:

33. A. Anterior mediastinum

B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia 34. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

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35. Complications of tracheostomy include: A. Anoxia B. Air embolism C. Tracheo-oesophageal fistula D. Hypotension E. Tracheal stenosis 36. THE BRONCHIAL MUCOSA IS NORMALLY MADE UP OF:

1. Simulated pseudostratified epithelium 2. Goblet cells 3. Basal cells 4. Adeno-cystic cells which constitute the germinal layer

37. THE ESOPHAGEAL HIATUS IS:

1. Located in the left crus of the diaphragm 2. At the level of T 9 to T 11 3. Ended with an anatomical sphincter 4. Located superior to the cardio-esophageal junction

38. THE ATRIOVENTFUCULAR (A-V) NODE:

1. Receives nerves from the right vagus 2. Its arterial supply is from the right coronary artery 3. Is located near the entrance of the superior vena cava 4. Is located near the coronary sinus

39. Lung cancer: A. Of the alveolar cell type is not typically associated with smoking B. Of the large cell type characteristically metastasizes early C. May present with the myasthenic syndrome D. Of the small cell type has the best 5-year survival of all types of lung

cancer when treated by excision E. May present with hypernatraemia due to hormone secretion by the

tumour

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40. Thrombosis: A. In the axillary vein is commoner on the right side B. In the superior vena cava may cause tinnitus C. In the venous system usually consists of fibrin and platelets D. In a proximal leg vein may be an indication for an inferior vena cava

filter if the patient also has a peptic ulcer E. Prophylaxis of DVT can be achieved by intravenous dextran 41. The inferior vena cava: A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins 42. The abdominal aorta: A. Passes behind the medial arcuate ligament of the diaphragm at the level

of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior

mesenteric artery 43. Carotid artery disease: A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid

plaque that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischaemic attack

commonly includes CT scan of the brain E. Surgery has been shown to be better than medical therapy in the

management of asymptomatic patients with stenoses greater than 70% 44. Cervical rib: A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

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45. In the root of the neck: A. Scalenus anterior arises from the anterior tubercles of the typical

cervical vertebrae B. The supreme intercostals vein lies lateral to the first thoracic nerve on

the neck of the first rib C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct 46. The subclavian artery: A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from

branches of the thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath

derived from the prevertebral fascia E. Becomes the axillary artery at the upper border of teres major 47. The oesophagus: A. Is crossed by the right pulmonary artery B. Inclines forwards and to the left at the oesophago-gastric junction C. Blood supply to the cervical part is from the inferior thyroid arteries D. The lower one-third is most easily approached from the left side E. The posterior vagal trunk is more closely applied to the oesophagus than

is the anterior trunk 48. The thoracic duct: A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

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49. Gastro-oesophageal reflux: A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic

than symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's

oesophagus E. Initial management may include increasing the number of meals eaten

per day 50. Achalasia: A. The cause is hypertrophy of the gastro-esophageal sphincter B. Dysphagia is mainly for solids C. Incidence is higher in males than females D. Manometry shows reduced pressure within the lower oesophagus E. Initial treatment is with H2 antagonists GOOD Luck

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I: MCQ Cairo 16/05/2009 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. In primary seminoma of the mediastinum, all of the following are true except:

A. It occurs in both men and women. B. Optimum therapy includes operation. C. Radiation therapy should be limited to the mediastinum. D. The overall 5-year survival is 50 to 60%. E. The tumor is known to be extremely radio- sensitive.

2. With hypovolemic shock, all the following are reduced except which one ?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

4. Paradoxical ( reversed) splitting of S2 is caused by all of the following except: A. Left bundle branch block B. Aortic stenosis C. Atrial septal defect D. WPW syndrome with a right - sided accessory pathway

5. Coarctation of the aorta may be associated with all of the following except: A. Aneurysm of the circle of Willis B. Central cyanosis C. Hypertension D. Rib notching E. Bicuspid aortic valve

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6. Surgical repair of pectus excavatum is characterized by except:

A. Internal metal support necessary B. Wedge osteotomy in upper sternum C. Division of costal cartilages D. Substernal or Pleural drainage desirable E. Reattachment of rectus abdominis muscles

7. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

8. The scimitar syndrome is characterized by except: A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

9. In hypoplasia of the lung, the following are correct except: A. The major abnormality is a decrease in the number of airway generations and pulmonary

artery branchings B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of intrauterine growth D. Embryologic defects occur early and may be associated with other syndromes E. If associated with diaphragmatic hernia, the hypoplastic lung should be removed at

surgery.

10. During CPR all the following are true except: A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

11. The following statements regarding anticoagulation for atrial fibrillation are correct

except: A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because the risk

thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient to prevent

stroke because the risk of thromboembolism is low

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12. The following statements regarding cardioversion of atrial Fibrillation is correct except:

A. The absence of thrombus on transthoracic echocardiogram allows Immediate, safe cardioversion

B. Patients who have had AF for less than 24 hours do not need anti –coagulation before cardioversion

C. Patients who have had AF for more than 48 hours should receive coumadin for 3 weeks before cardioversion

D. Maintenance of sinus rhythm with antiarrhythmic drugs does not obviate the need for coumadin therapy

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

13. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for a tumor located in the :

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

14. The condition that is least likely to be associated with respiratory distress in

the newborn is : A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

15. Of the following, the lesion least likely to be associated with bacterial endocarditis is:

a. Bicuspid aortic valve b. Interatrial septal secundum defect c. Interventricular septal defect d. Pulmonary valvular stenosis e. Tetralogy of Fallot

16. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

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17. A right upper lobectomy with mediastinal L.N. dissection is done for lung Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

18. The most sensitive index for assessing the presence of postoperative myocardial necrosis following coronary revascularization is:

A. The development of new Q waves on the electrocardiogram. B. The requirement for isotropic support in the perioperative period. C. Presence of new "hot-spot" images by technetium myocardial scintigraphy. D. Elevation in serum of MB-band creative phosphokinase. E. The development of complete left bundle branch block on the initial postoperative

electrocardiogram.

19. Mediastinoscopy is contraindicated in the presence of: A. Prior laryngectomy B. Histoplasmosis . C. Superior vena cava syndrome D. Pectus excavatum E. None of the above

20. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

21. The combination of RV failure, elevated venous pressure and a quiet heart is known as:

A. Whipple's triad B. Saint's triad C. Beck's triad D. Murphy's sign E. None of the above

22. During shockable VF/ pulseless VT we give one shock of:

A. 150- 200 J biphasic or 360 J monophasic. B. 100 J biphasic or 360 J monophasic. C. 150- 360 J biphasic or 300 J monophasic. D. 150- 360 J biphasic or 260 J monophasic.

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23. Systemic metabolic acidosis and increased mixed venous oxygen saturation are characteristic of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

24. Which of the following agents has the highest potential for supraventricular arrhythmia? A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

25. Which of the following causes the greatest increase in cardiac index at equipotent doses? A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

26. Which of the following statements is true regarding antiarrhythmic agents? A. Digoxin decreases the automaticity of the His-Purkinje system. B. Esmolol can be used to treat tet spells in the immediate postop period. C. Lidocaine treats ventricular tachycardia by slowing AV conduction. D. Procan SR does not need to be adjusted in the setting of renal insufficiency. E. Atropine is ineffective in treating bradycardia secondary to beta blockade.

27. The most common valvular defect resulting from rheumatic fever is: A. Mitral stenosis B. Mitral insufficiency C. Aortic stenosis D. Aortic insufficiency E. Pulmonary stenosis

28. Lasers:

a. Produce coherent light b. Use photon energy c. Are usually polychromatic light d. All use visible light e. May be used to treat photosensitive tumours

29. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure

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D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

30. The sudden onset of persistent coughing, productive of copious amounts of thick brownish fluid, occurring three months following resection of the right lung suggests:

A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Broncho-pleural fistula E. All of the above

31. When contemplating elective thoracotomy on a patient who has been on long-term corticosteroid therapy, it is best to :

A. Discontinue steroids for one month prior to operation B. Continue the same dosage schedule throughout hospitalization C. Give increased amounts of steroids during and immediately after operation D. Use ACTH postoperatively E. Give prophylactic isoniazid and PAS

32. The purpose of leaving a chest tube in place following pneumonectomy is to: A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

33. One of the contra-indications to bronchoscopy is the presence of:

A. Endobronchial tuberculosis B. Active bleeding C. Aortic aneurysm D. Emphysema E. None of the above

34. The most common toxic arrhythmia associated with digitalis overdosage is:

A. Atrial fibrillation B. Ventricular extrasystole C. Ventricular fibrillation D. Complete heart block E. None of the above

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35. The indication for transvenous insertion of cardiac pacemaker: A. Permanent heart block B. Intermittent symptomatic heart block C. Sinus bradycardia D. Post-surgical heart block E. All of the above

36. Mediastinal widening after chest trauma is a pathognomonic sign of:

A. Aortic injury B. Cardiac injury C. Pericardial effusion D. Perforated esophagus E. Bronchial tear

37. The entity termed "shock lung" is usually seen:

A. With multiple trauma B. With head injuries C. With hemorrhagic shock D. After Prolonged cardiopulmonary bypass E. All of the above

38. Patients with cardiac tamponade are best managed: A. Expectantly B. By pericardiocentesis followed by definitive thoracotomy if necessary C. By pericardiocentesis only D. By open thoracotomy and cardiorrhaphy E. By thoracotomy, only if blood loss is excessive

39. Following sudden deceleration, the most common site of aortic injury is: A. Just distal to the origin of the left subclavian artery B. The dome of the aortic arch C. A point close to the annulus of the aortic valve D. Adjacent to the carotid artery E. Distal thoracic aorta

40. Acute mediastinitis is most often due to: A. Rupture of a mediastinal cyst B. Acute inflammatory processes originating in the lungs C. Perforation of the esophagus D. Blood-borne infections E. Tuberculosis

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41. The characteristic physical signs of mediastinal emphysema are: A. Subcutaneous emphysema B. Hamman's murmur C. Decreased heart sounds D. Crepitation E. All of the above .

42. Pain in the shoulder and arm combined with horner's syndrome on the same side suggests

the presence of: A. A ganglioneuroma B. Aortic aneurysm C. Shoulder girdle syndrome D. Superior sulcus tumor (Pancoast) E. None of the above

43. The term "empyema necessitans" refers to

A. A fulminating pleural infection B. Mediastinal extension of an empyema C. Metastatic foci of infection D. Secondary involvement and fistulaion through the chest wall E. Tuberculous empyema

TRUE OR FALSE : More than one answer. For the next 3 questions , determine whether each choice is true ( T ) or false ( F ):

44. Which statements are correct about CABG : A. CABG prolongs survival in patients with greater than 70% left main

stenosis, independent of anginal symptoms B. CABG prolongs survival in patients with three – vessel disease and left ventricular

systolic dysfunction C. Diabetic patients with multivessel coronary artery disease have a better prognosis with

multivessel angioplasty than with CABG D. Women have lower perioperative mortality than men E. Internal mammary grafts remain patent longer than saphenous vein grafts

45. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is due to shunt

flow across the atrial septum

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46. Which of the following statements correctly characterize major determinants of cardiac performance ?

A. Stroke volume increases with increasing afterload B. Ventricular preload describes the load against which the ventricle must contract when it

eject blood C. In normal hearts, ventricular inotropic state increases with increasing heart rate because

of changes in calcium availability D. Hypoxia , ischemia, and acidosis decrease cardiac contractility E. In failing hearts, right atrial pressure as assessed from the jugular venous pulse is a good

indicator of left ventricular filling pressure

One Or More Of The Four Answers To Each Of The Following Questions May Be Correct. Use This Code To Select The Most Appropriate Answer: A B C D E (1-3) (I & 3) (2 & 4) (4) (1-4)

47. Chest tomography is useful to: 1. Show calcification in pulmonary nodules 2. Demonstrate multiple pulmonary metastases 3. Define the extent of a bronchial carcinoid 4. Rule out mediastinal node involvement by carcinoma

48. Carcinoid tumors of the airways:

1. Do not produce carcinoid syndrome 2. Occur in the trachea in about 25% of patients 3. Are uniformly visible by flexible bronchoscopy 4. May metastasize to lymph nodes

MATCHING : For The Next 2 Questions, Choose For Each Numbered Item, The Most Likely Associated Lettered Item From Those Provided. Each Item Has Only One Answer

49. Match the following palliative surgical shunts with their anatomic anastomoses : A. Superior vena cava to right pulmonary artery B. Subclavian artery to pulmonary artery C. Ascending aorta to right pulmonary artery D. Ascending aorta to main pulmonary artery E. Descending aorta to left pulmonary artery

1. Classic Blalock – Taussig shunt 2. Pott’s anastmosis 3. Classic Glenn shunt 4. Waterston shunt 5. Davidson shunt

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50. Select from the list below the cardiac events that correspond most closely to the components of the jugular venous waveform :

A. Opening of the tricuspid valve and right ventricular relaxation B. Right atrial relaxation C. Pulmonary valve opening D. Right atrial contraction E. Passive right atrial filling with a competent tricuspid valve

1. X-descent 2. V-wave 3. A-wave 4. Y-descent

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper I Cairo 16/5/2009 Time allowed: 2 hours

 

Answer all the following questions:

1. Neurological complications after open heart surgery. Discuss:

A) Etiology.

B) Manifestations.

C) Management.

2. Management of pulmonary secondaries.

3. Heparin induced thrombocytopenia. Discuss.

4. The lungs as predictor of the outcome in cardiac surgery. Discuss.

 

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II: MCQ Cairo 17/05/2009 Time allowed: 60 minutes

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

1. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation C. A successful outcome requires the production of complete and transmural lines of conduction block D. Newer methods of producing lines of block such as cryoablation have been as effective as the

traditional "cut and sew" method E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

2. Which of the following is true regarding the etiology of lung abscess ? A. Hematologic seeding is the common mechanism for infection B. The posterior segment of the upper lobe and superior segment of the lower lobe on the right side are

most commonly involved C. Periodic episodes of hemoptysis and foul sputum are uncommon D. Staph Species are the predominant organism

3. Which of the following statements is true regarding myxoma morphology?

A. These tumors are most commonly found in the right atrium B. Myxomas have a characteristically firm texture and rarely embolize C. They arise from multipotential mesenchymal cells D. Myxomas usually are attached to the free atrial or ventricular wall E. There is no malignant potential

4. Which of the following statements is true regarding the natural history of CAD? A. Distal LAD lesions do not result in poorer survival compared to proximal lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 3-vessel disease have equivalent survival at 5 years

5. Which of the following statements is true regarding results after resection of pulmonary metastases ? A. Partial resection of extensive pulmonary metastatic disease can improve survival B. Disease –free interval has not been shown to have prognostic value for survival C. Patients with a greater number of metastatic nodules have poorer survival D. CEA levels do not affect 5-year survival after resection of metastatic colon carcinoma E. Metastatic head and neck cancers have poor outcome after pulmonary resection

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6. Which of the following statements is true regarding operative management of congenital sinus of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography. B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

7. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are electrically isolated

from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather than an empiric

anatomic one

8. Which of the following statements is true regarding congenital diaphragmatic hernias? A. Bochdalek's hernia is more common in the posterior costal portion on the right side. B. Obstruction and strangulation are the typical presentation of an acute Bochdalek's hernia. C. Most mortality for infants with Bochdalek's hernia can be attributed to increased pulmonary vascular

resistance. D. The stomach is the most common organ to be found in a Morgagni's hernia. E. Morgagni's hernia is best repaired through a right thoracotomy.

9. Which of the following statements is true regarding the operative management of lung cancer? A. A bloody pleural effusion is not a contraindication to surgery for peripherally located carcinomas. B. Preoperative CT scanning can accurately predict the number of tumor nodules. C. Wedge resection is adequate therapy for most peripherally located carcinomas. D. Advanced age is no longer considered a risk factor for surgical treatment of lung cancer. E. Only 25% of all patients with lung cancer will be operative candidates.

10. Which of the following is true for operations for congenital subvalvular aortic stenosis? A. Resection of muscle below the right coronary cusp should be avoided. B. The Konno procedure is preferred in the sitting of a normal valve and annulus. C. Early mortality is equivalent for the localized and the diffuse forms. D. Late death is usually secondary to bacterial endocarditis. E. The discrete form is associated with increased early and late risk for death.

11. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome? A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction. B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than thoracic outlet

syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery stenosis.

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12. Which of the following statements is true regarding the clinical manifestations of pectus excavatum? A. Most infants and children are symptomatic. B. Mitral valve prolapse is uncommonly associated with this disorder. C. Operative repair does not improve cardiac index at rest or during exercise. D. Asthma and recurrent pulmonary infections are uncommon. E. Pulmonary function tests can document obstructive pulmonary findings.

13. The following features are true for a tension pneumothorax:

A. Tracheal deviation towards the affected side B. Increased chest movement on the affected side C. Increased resonance of affected side D. Cardiac arrest E. Surgical emphysema

14. Which of the following statements is true regarding operative management of post-infarct LV

aneurysm? A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

15. Which of the following statements is true regarding chest wall tumors? A. Incisional biopsy will reliably diagnose most primary tumors. B. A 2-cm margin is adequately wide for resection of a chest wall tumor. C. Posterior chest wall defects greater than 5 cm should be reconstructed using prosthetic material. D. Overall 5-year survival for resection of primary chest wall tumors is about 50%. E. Recurrent tumors can be excised with good long-term results.

16. Which of the following statements is true regarding neurogenic tumors of mediastinum? A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

17. Which of the following statements concerning aneurysms of the thoracic aorta is true? A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are predominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not undergo operation.

18. Which of the following statements is true regarding thymomas and germ cell tumors? A. Over 50% of myasthenia gravis patients will have a thymoma. B. The presence of myasthenia gravis is a risk factor for poor outcome.

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C. Blind biopsy or orchiectomy should be performed in patients with mediastinal germ cell tumors. D. Cytoreductive resection should be performed prior to radiation therapy if a seminoma is involving

vital structures. E. Over 90% of nonseminomas will produce either AFP or B-HCG.

ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 19. Concerning tumors of the chest wall, all are correct except:

A. Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs.

B. The most common primary malignant tumor is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated.

20. The following criteria are correct for achalasia except:

A. Dysphagia B. Retention of ingested food in the esophagus. C. Radiologic evidence of dilated body of the esophagus. D. Vigorous peristalsis by manometry and cineradiography. E. Carcinoma in association achalasia is uncommon

21. The Choussat-Fontan criteria for appropriateness of an atriopulmonary anastomosis include

all of the following except: A. Pulmonary artery pressure less than 15 mmHg. B. Pulmonary vascular resistance less than 4 units/M2 body surface area. C. Age less than 3 years. D. Ventricular ejection fraction 0.45 or greater. E. Normal sinus rhythm.

22. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

23. Esophageal dilatation for the treatment of achalasia is characterized by except: A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

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24. Zenker's diverticula is characterized by except: A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E. Causes dysphagia with liquids

25. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

Choose The Single Best Answer To The Following : 26. The treatment for the relief of increasing spontaneous mediastinal emphysema is:

A. Thoracotomy B. Suprasternal decompression C. Subxiphoid decompression D. Needling the mediastinum E. None of the above

27. The first sign of Horner's syndrome is usually:

A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above

28. When treating a child born with esophageal atresia and imperforate anus, it is advisable to:

A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable

29. The most common site of spontaneous esophageal perforation (Boerhaave's syndrome) is:

A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above

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30. Of the following, the condition most frequently associated with congenital esophageal atresia is:

A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract

31. If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has:

A. A truncus arteriosus B. A pulmonary A-V fistula C. Aorto-pulmonary window D. A coarctation of the aorta E. A coronary-ventricular fistula

32. Immediately following repair of an interventricular septal defect, complete heart block is noted,

although ventricular rate is satisfactory. In this circumstance, one should A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing

33. A Taussig-Bing malformation is best treated by:

A. Diversion of the septal defect only B. Detachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle

34. In an adult patient, the repair of coarctation requires some form of aortic replacement if:

A. The anastmosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above

35. The most common findings associated with congenital tricuspid atresia are:

A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis

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36. The most common anatomic variation of coronary artery fistula connects: A. Right coronary artery to right atrium B. Right coronary artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle

37. Of the following, the lesion least likely to be associated with bacterial endocarditis is: A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

38. Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total anomalous pulmonary

venous drainage are all characterized by: A. Inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above

Determine Whether Each Choice Is True Or False. Any Combination Of Answers, May Occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 39. Pain associated with ingestion of food during childhood is commonly associated with the

presence of: A. Achalasia of the esophagus B. Congenital esophageal diverticulum

40. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

41. Treatment of lyme burns of the esophagus during the acute phase: A. Corticosteroids B. Esophagoscopy

42. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

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Determine Whether Each Choice Is True Or False. Any Combination Of Answers May Occur. A B C D E

1, 2 &3 1 & 3 2 &4 4 ONLY all are correct 43. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

44. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

45. According to the TMN principles for staging lung cancers, which of the bronchogenic carcinomas

described below is or are considered to be Stage I ? A. Large cell carcinoma 4 cm in diameter without lymph node metastases. B. Poorly differentiated adenocarcinoma without metastases to lymph nodes. C. Squamous cell carcinoma with atelectasis and extension to visceral pleura without lymph node

metastases or pleural effusion. D. Alveolar cell carcinoma without metastases to the lymph nodes.

46. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve replacement

include(s): A. Much greater resistance to infection. B. Satisfactory long-term durability in adolescents. C. Good hemodynamic performance in the 17 mm and 19 mm sizes relative to tilting disc valves. D. Low thromboembolic risk without systemic anticoagulation.

47. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for CABG

include(s): A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

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In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once: 48. A. Ostium secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect 1. Heart block and arrhythmia common 2. Absent superior rim 3. Most commonly encountered 4. Cyanosis in absence of failure 49. A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage 1. Abnormal coronary sinus 2. Complete repair least likely 3. Persistent left anterior cardinal vein 4. Persistent ductus venosus 50. A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis 1. Parachute valve 2. Syncope 3. Waterston shunt 4. Brock procedure

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper II Cairo 17/5/2009 Time allowed: 2 hours

 

Answer all the following questions:

1. Surgeons’ choices to face a failing heart coming off bypass.

2. Myocardial protection in open heart surgery. Discuss:

A) Evolution.

B) Current status.

C) Advantages and disadvantages.

3. Recoarctation of the aorta. Discuss:

A) Age at initial intervention.

B) Type of coarctation.

C) Method of the first intervention.

D) Optimal reintervention.

4. Successful Blalock Taussing shunt in the first 3 months of life.

A) Reintervention within few months.

B) Optimal time for 2nd stage palliation or final repair.

 

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper III Cairo 18/5/2009 Time allowed: 2 hours

 

Commentary 1

A 57 years old man suffered recurrent angina. Coronary angiography

done and revealed 3 vessel disease. Coronary artery bypass done using

the traditional open heart procedures. The post operative course showed

fast ambulance and returned to his job after a month with full recovery.

During routine follow up after 6 months echocardiography done that

revealed an interatrial shunt.

Discuss.

Commentary 2

A 57 years old lady suffered dyspnea and very mild tinge of hemoptysis.

Then she complained of dyspnea at rest. Chest X-ray revealed bilateral

lung mottling and an evident left atrial shadow.

Coronary angiography was recommended.

Discuss.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper IV: MCQ Cairo 19/05/2009 Time allowed: 60 minutes

ANATOMY &EMBRYOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer: 1. Which of the following is TRUE regarding the diaphragmatic development?

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

2. Which of the following is TRUE regarding the blood supply to the visceral pleura? A. Pulmonary artery B. The bronchial vessels C. The intercostal vessels D. The internal mammary arteries E. None of the above

3. Which of the following statements about diaphragmatic anatomy is TRUE? A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise from the lumbar

vertebrae 4. Which of the following statements is TRUE regarding anatomy of the thoracic outlet ?

A. The distal section of the cervicoaxillary canal is the more critical for compression syndromes B. The brachial plexus and subclavian artery are located in the anteromedial compartment of the

costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus medius, and first rib D. Inspiration tilts the coracoid process inferiorly , placing tension on the neurovascular bundle E. Bony abnormalities are present in the majority of patients

5. Which of the following is TRUE regarding the level of the narrowest part of the esophagus ?

A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

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6. Which of the following is TRUE regarding the usual drainage of persistent left superior vena

cava ? A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava

7. Which of the following is TRUE regarding the azygos vein?

A. Receives venous blood from the middle one-third of the oesophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

8. Which of the following statements is TRUE regarding the lining of the normal bronchial

mucosa ? A. Simulated pseudostratified epithelium B. Goblet cells C. Basal cells D. Adeno-cystic cells which constitute the germinal layer

9. Which of the following statements is TRUE regarding the atrio-ventricular (AV) node ? A. Receives nerves from the right vagus B. Its arterial supply is from the right coronary artery C. Is located near the entrance of the superior vena cava D. Is located near the coronary sinus

10. Which of the following statements is TRUE regarding the inferior vena cava? A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins

11. Which of the following statements is TRUE regarding the abdominal aorta?

A. Passes behind the medial arcuate ligament of the diaphragm at the level of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior mesenteric artery

12. Which of the following statements is TRUE regarding in the root of the neck?

A. Scalenus anterior arises from the anterior tubercles of the typical cervical vertebrae B. The supreme intercostals vein lies lateral to the first thoracic nerve on the neck of the first rib

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C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct

13. Which of the following statements is TRUE regarding the subclavian artery?

A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from branches of the

thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath derived from the

prevertebral fascia E. Becomes the axillary artery at the upper border of teres major

14. Which of the following statements is TRUE regarding the thoracic duct?

A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

15. During embryologic development of the heart, the following occur except:

A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

16. The diaphragm A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front of the esophagus D. Diaphragm projects higher Into the chest on the right than on the left E. Lies entirely above the tenth rib.

ANSWER THE FOLLOWING 2 QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

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17. Patent ductus usually occurs as an isolated defect BECAUSE it does not arise from the aortic arch system.

18. About 70% or more of the total vital capacity is expired within the first second of expiration

BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

ANSWER THE FOLLOWING 5 QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

19. A moderator band is usually found in the:

A. Left ventricle . B. Right ventricle

20. Eustachian valve:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

21. The bundle of his passes closer to:

A. The right side of the interatrial septum B. The left side of the interatrial septum

22. The sinus venosus forms:

A. The superior and inferior vena cava B. The right atrium

23. The parietal pleura:

A. Is very sensitive to pain B. Absorbs the pleural fluid

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once:

24. A. Anterior mediastinum

B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

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1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia 25. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

PATHOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

26. Which of the following is TRUE regarding the essential factor in the pathogenesis of aortic

aneurysms is damage ? A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis

27. Which of the following is TRUE regarding the causes of hilar enlargement ?

A. Sarcoidosis B. Lymphoma C. Hypertension D. Tuberculosis E. Caplan's syndrome

28. Which of the following is TRUE regarding, the most common benign tumor of the esophagus ?

A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma

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29. Pleuropericardial (spring water) cysts are most commonly located: A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium

30. Which of the following statements is TRUE regarding the pathology of lung cancer?

A. Squamous cell carcinoma occurs with equal frequency in smokers and nonsmokers. B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands. C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy. D. Alveolar cell carcinoma has the least favorable prognosis. E. E. Most cancers associated with pulmonary scars are squamous cell carcinomas

31. Which of the following statements is TRUE regarding the anatomy and pathophysiology of

post-infarct left ventricular aneurysm? A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

32. Which of the following statements is TRUE regarding cervical rib?

A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

33. Which of the following statements is TRUE regarding gastro-oesophageal reflux? A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic than symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's oesophagus E. Initial management may include increasing the number of meals eaten per day

34. Which of the following statements is TRUE regarding achalasia?

A. The cause is hypertrophy of the gastro-esophageal sphincter B. Dysphagia is mainly for solids C. Incidence is higher in males than females D. Manometry shows reduced pressure within the lower oesophagus E. Initial treatment is with H2 antagonists

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35. Which of the following statements is true regarding TOF morphology? A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in

tetralogy of Fallot. B. The bundle of His runs along the posteroinferior border of the VSD. C. Additional VSDs are present in approximately 25% of patients. D. The pulmonary valve is usually the narrowest part of the right ventricular outflow tract. E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually normal in size.

36. Which of the following statements is true regarding hernias through the foramen of bockdalek?

A. Usually have a true sac B. Present anteriorly C. May be caused by a short esophagus D. Pass through the pleuroperitoneal canal E. Are associated with eventration of the diaphragm

37. Which of the following statements is true regarding the Kartagener’s syndrome?

A. Situs inversus, bronchicetasis and pansinusitis B. Situs inversus of the lungs with levocardia

C. Splenic agenesis syndrome with levocardia

D. Anomalous right pulmonary artery and bilobation of the lungs E. None of the above

38. Which of the following statements is true regarding lung cancer?

A. Of the alveolar cell type is not typically associated with smoking B. Of the large cell type characteristically metastasizes early C. May present with the myasthenic syndrome D. Of the small cell type has the best 5-year survival of all types of lung cancer when treated by

excision E. May present with hypernatraemia due to hormone secretion by the tumour

39. Which of the following statements is true regarding thrombosis?

A. In the axillary vein is commoner on the right side B. In the superior vena cava may cause tinnitus C. In the venous system usually consists of fibrin and platelets D. In a proximal leg vein may be an indication for an inferior vena cava filter if the patient also

has a peptic ulcer E. Prophylaxis of DVT can be achieved by intravenous dextran

40. Which of the following statements is true regarding carotid artery disease? A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid plaque that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischaemic attack commonly includes CT scan

of the brain E. Surgery has been shown to be better than medical therapy in the management of asymptomatic

patients with stenoses greater than 70%

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In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

41. Esophageal hiatus hernia in infants:

A. May be an important cause of vomiting B. Is often associated with constipation C. Can be demonstrated during the first week of life D. May be associated with pyloric stenosis E. Is frequently accompanied by gastrointestinal bleeding

42. Bronchogenic cysts: A. Are lined by pseudostratified columnar epithelium B. Usually appear as air-filled cavities C. Do not cause hemoptysis D. Frequently become infected E. Mostly occur close to the hilum

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

43. Underdevelopment of the main pulmonary artery is usually associated with narrowing or stenosis of

the outflow tract of the right ventricle BECAUSE both are derived from the conus. 44. The presence of a cervical rib does not produce symptoms in childhood BECAUSE the rib is

rudimentary at this age. 45. Bronchial foreign bodies more frequently occur in children BECAUSE the right main stem

bronchus is relatively straighter than the left. 46. Positive sputum cultures for Aspergillus must be interpreted with caution BECAUSE the organism

is often present in sputum as a harmless saprophyte. 47. Tumourlets are epithelial proliferations which are usually associated with bronchiectatic lobes

BECAUSE these microscopic lesions are never found in the absence of damage to the lungs.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

48. Blood supply of tuberculous lesions A. Pulmonary arteries B. Brochial arteries

49. Invasion of chest wall: A. Tuberculosis B. Actinomycosis

50. Involvement of major bronchi:

A. Epidermoid carcinoma B. Adenocarcinoma

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper II Cairo 19/5/2009 Time allowed: 60 minutes

 

Anatomy

Answer all the following questions:

1. Thoracic duct.

2. Anatomy and embryology of the diaphragm

Pathology

Answer all the following questions:

1. Bronchiectasis.

2. Left sided cardiac tumours.

 

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ

Cairo 08/05/2010 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. The following are histologically neuro-endocrine types of lung cancer except:

A. Bronchoalveolar Lung cancer B. Typical Carcinoid C. Atypical Carcinoid D. Large call carcinoma E. Small cell Lung cancer

2. With hypovolemic shock, all the following are reduced except which one?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

4. In hypoplasia of the lung, the following are correct except:

A. The major abnormality is a decrease in the number of airway generations and pulmonary artery branchings

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B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of intrauterine growth D. Embryologic defects occur early and may be associated with other syndromes E. If associated with diaphragmatic hernia, the hypoplastic lung should be removed at

surgery.

5. During CPR all the following are true except:

A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

6. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because the risk

thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient to prevent

stroke because the risk of thromboembolism is low

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

7. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for a tumor located in the:

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

8. The condition that is least likely to be associated with respiratory distress in the newborn is:

A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation

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C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

9. An 18-year old patient suffers an attack of a first time right side primary pneumothorax. An intercostal drain in inserted and results in full expansion of the lung and the patient is discharged home on the next day. During consultation in the follow up clinic, he asks you about the percentage of recurrence of another pneumothorax. What is the most appropriate answer?

A. 5% B. 10% C. 30% D. 60% E. 90%

10. According to results of the NETT trial, patient with emphysema who would benefit most from Lung Volume Reduction Surgery are:

A. Lower Lobe Emphysema with FEV1 more than 20% B. Patients with FEV1 less than 20% C. Upper lobe Emphysema with poor exercise tolerance D. Patients with good exercise tolerance and FEV1 less than 20% E. Patients with diffuse emphysema and FEV1 more than 20%

In The Following Questions, all of the statements are true one, Identify The Correct or True Statement:

11. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

12. A right upper lobectomy with mediastinal L.N. dissection is done for lung Carcinoma. The

pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

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A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

13. Which histological type of mesothelioma carries the best prognosis?

A. Epitheloid B. Sarcomatoid C. Mixed D. Small cell type E. Desmoplastic

14. The following increase the amount of calcium in cardiac muscle:

A. Halothane B. Adrenaline C. Diltiazem D. Nifedipine E. Trimetaphan

15. A post thoractomy patient is having a paravertebral catheter running for analgesia. The nurse calls you on an emergency basis due to cardiovascular collapse. You suspect a local anesthetic overdose. What is the immediate antidote?

A. Atropine B. Naloxone C. Deltizem D. Lipid Emulsion E. Epinephrine

16. During shockable VF/ pulseless VT we give one shock of:

A. 150- 200 J biphasic or 360 J monophasic. B. 100 J biphasic or 360 J monophasic. C. 150- 360 J biphasic or 300 J monophasic. D. 150- 360 J biphasic or 260 J monophasic.

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17. Systemic metabolic acidosis and increased mixed venous oxygen saturation are characteristic of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

18. Which of the following agents has the highest potential for supraventricular arrhythmia?

A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

19. Which of the following causes the greatest increase in cardiac index at equipotent doses?

A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

20. Regarding Pulmonary vascular resistance, which of the following is correct:

A. It is decreased in chronic hypoxia B. It has a value approximately one-sixth that of the systemic circulation C. It can be measured using a flow-directed balloon catheter with a thermistor tip D. It is increased by isoprenaline E. It is decreased by 5-hydroxytryptamine (5-HT)

21. The carotid body contains both chemoreceptors and baroreceptors. There are stimulated

under certain circumstances to maintain homeostasis. Which one of the following anatomical regions of the brain is stimulated by neuronal transmission from the carotid body?

A. The basal ganglia B. The cerebellum C. The hypothalamus D. The pineal gland E. The posterior pituitary gland

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22. A 62 year old man presents with an acute coronary syndrome and coronary angiography shows significant three vessel disease. He is kept in hospital for surgery but there are a number of patients waiting and it is three weeks before he goes to theatre. He initially makes an uneventful recovery and blood tests are normal. He is ready for discharge on day six and the nurse practitioner telephones you to say that his platelet count is 50x109/l. You are concerned that he may have heparin induced thrombocytopenia. Which of the following is true of heparin induced thrombocytopenia?

A. It is associated with IgM antibodies B. It is more common with unfractionated heparin C. It is treated with a platelet infusion D. It leads to arterial thrombosis more commonly than venous thrombosis E. It occurs in less than 1% of patients

23. A 70 year old male smoker presents with cough and haemoptysis. A CT scan of the chest shows a 3cm lesion in the left upper lobe. A needle biopsy of the lesion reveals squamous cell carcinoma. What is the T stage of this tumour?

A. TX B. T1 C. T2 D. T3 E. T4

24. A 37 year old man presents with dysphagia and achalasia is diagnosed. Which one of the

following features is present in achalasia?

A. Fibrosis associated with a least moderate oesophagitis B. Lack of sensitivity of the lower oesophageal sphincter to gastrin C. Loss of ganglion cells in Auerbach’s plexus D. Low pressures within the lower oesophageal sphincter E. Vigorous peristalsis in the body of the oesophagus

25. Which of the following statements is true regarding spontaneous pneumothorax?

A. Primary spontaneous pneumothorax typically occurs in tall, thin, older adults. B. Osteogenic sarcoma is the most common malignant cause of secondary spontaneous

pneumothorax in children. C. Catamenial pneumothorax typically occurs during the end of menses when a patient is

taking oral contraceptives. D. Hemothorax occurs in up to 20% of patients with spontaneous pneumothorax. E. Pleurectomy is preferred over mechanical pleurodesis for recurrent pneumothorax.

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26. Regarding Warfarin, the following is true:

A. It has a rapid onset of action B. It is readily excreted in the urine C. It is antagonised by salicylate D. It is potentiated by metronidazole E. is potentiated by barbiturates

27. Which of the following statements is true regarding empyema?

A. Transitional empyemas should be treated with immediate thoracotomy and debridement to prevent progression to the chronic phase.

B. Most empyemas now occur after thoracic surgical procedures. C. Chest CT or US are useful to localize collections for drainage. D. Thoracentesis usually returns purulent material with high yield for the causative

organism. E. Bronchoscopy is unnecessary as the process is extrapleural

28. Which of the following statements is true regarding lung abscess? A. The most common locations for abscess formation are the posterior segment of the lower

lobe and superior segment of the upper lobe. B. Most lung abscesses are caused by aerobic organisms from an aggressive pneumonia. C. Most opportunistic lung abscesses follow the typical pattern, with community-acquired

organisms forming a single abscess cavity. D. A primary abscess secondary to gram-negative organisms should be promptly treated

with chest tube drainage. E. A thick-walled cavity associated with persistent symptoms after 5 weeks of medical

treatment should be surgically resected.

29. According to results of the NETT trial, patient with emphysema who would benefit most from Lung Volume Reduction Surgery are:

A. Lower Lobe Emphysema with FEV1 more than 20% B. Patients with FEV1 less than 20% C. Upper lobe Emphysema with poor exercise tolerance D. Patients with good exercise tolerance and FEV1 less than 20% E. Patients with diffuse emphysema and FEV1 more than 20%

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30. . In a study of 88 births to women with a history of thrombocytopenia, the same condition was recorded in 20% of babies (95% confidence interval 13% to 30%). Which statement is correct?

A. 5% of such women have a probability of having a baby with thrombocytopenia which is not between 13% and 30%.

B. The rate of thrombocytopenia in 95% of samples of the same size will be between 13% and 30%.

C. If the sample were increased to 880 births, the 95% confidence interval would be narrower.

D. We would be likely to observe data like the sample if between 13% and 30% of births to such women in the area had thrombocytopenia.

E. It would impossible to get these data if the rate for all women was 10%.

31. Lasers:

A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours

32. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

33. The purpose of leaving a chest tube in place following pneumonectomy is to:

A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

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34. Which of the following waves is a negative deflection on the Central venous pressure waveform?

A. a wave B. x wave C. c wave D. v wave E. p wave.

35. In what cardiac pathology is this type of LV/RV trace found on cardiac catheterization?

A. Mitral stenosis

B. Constrictive pericarditis

C. Aortic stenosis

D. Aortic regurgitation

E. Ischemic heart disease

36. Repair of a traumatic diaphragmatic hernia:

A. Should be considered an emergency procedure B. Should be performed as soon as the patient is out of shock C. Is almost always indicated if the patient is clinically stable D. Usually requires.a thoraco-abdominal approach E. All of the above

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37. A 32-year old male suffers a road traffic accident and sustains multiple injuries. What is the best management for his thoracic injury?

A. Conservative management B. Intercostal drain C. Ascending Aorta replacement D. Repair with end to end anastomosis E. Endovascular stenting

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38. A 56 year old male performs a pulmonary function test with the following result:

FEV1= 1.8L (86%), FVC = 1.9L (56%), FEV1/FVC = 96% DLCO 62%. The picture is suggestive of:

A. Obstructive lung disease

B. Restrictive Lung disease

C. Mixed Lung disease

D. Pulmonary haemorrhage

E. Normal Lung Functions

39. Which letter indicates the point in the cardiac cycle that the mitral valve opens?

A. A B. B C. C D. D E. F

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TRUE OR FALSE : More than one answer. For the next question , determine whether each choice is true ( T ) or false ( F ): 40. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is due to shunt

flow across the atrial septum

In The Following Questions, all of the statements are INCORRECT one, Identify The Incorrect Statement:

41. In a double blind clinical trial, the following is incorrect:

A. The patients know which treatment they receive.

B. Each patient receives a placebo.

C. The patients do not know they are in a trial.

D. Each patient receives both treatments

E. The clinician assessing the patients' condition does not know which treatment the patient has received.

42. Regarding the median estimated from a sample, the following is incorrect

A. It is not always equal to an actual observation.

B. It is close to the mean if the distribution is symmetrical.

C. It is less than the mean if the distribution is positively skewed.

D. It is the most frequently occurring value.

E. It is greater than or equal to at least 50% of the observations.

43. Regarding the standard deviation, which statement is incorrect?

A. It is a measure of variability.

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B. The square root of the variance.

C. Twice the standard error.

D. In the same units as the observations.

MATCHING: For The Following Question, The Two Lettered Headings Are Followed By A List Of Numbered Items. Answer By Using The Key Outlined Below: A. If the item is associated with A only B. If the item is associated with B only C. If the item is associated with both A and B D. If the item is associated with neither A nor

A. Heart as a pump B. Heart as a muscle

44. Starling's law 45. Maximal velocity of contraction 46. Ventricular volume 47. Adrenalin

In The Following Question, Each Numbered Item Is To Be Matched With One Lettered Item. Each option may be used once, more than once or not at all. Thoracic anatomy

A. Azygos vein B. Descending thoracic aorta C. Inferior vena cava D. Left main bronchus E. Left superior vena cava F. Ligamentum arteriosum G. Long thoracic nerve of Bell H. Esophagus I. Phrenic nerve J. Phreno-esophageal ligament K. Stellate ganglion L. Supreme intercostals vein M. Thoracic duct

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N. Thymus O. Vagus nerve

From the list of options above, choose which structure is best described as follows. Each option may be used once, more than once or not at all. 48. It is typically invaded by superior sulcus tumor of the lung. 49. It is at particular risk of damage when applying radio-frequency current during surgery to correct

atrial arrhythmia. 50. It is a common source of major hemorrhage during mediastinoscopy.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQ

Cairo 09/05/2010 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because the risk

thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient to prevent

stroke because the risk of thromboembolism is low 2. Esophageal dilatation for the treatment of achalasia is characterized by except:

A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

3. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

4. The following are surgical options for DORV with subpulmonary VSD (Taussig-Bing Heart) except:

A. Intraventricular tunnel VSD to Aorta B. Close VSD to pulmonary artery plus arterial switch procedure (Jatene)

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C. Intraventricular tunnel VSD to aorta with pulmonary artery repositioned anterior to aorta and RVOT patch (Lecompte)

D. Complex intraventricular tunnel VSD to aorta with infundibular resection (Kawashima) E. Complex interventricular conduit VSD to aorta with RVOT patch (Doty)

In The Following Questions, All Of The Statements Are True Except One, Identify The Incorrect Or False Statement:

5. Which of the following is incorrect regarding aortic dissections?

A. Men are twice as likely affected as women B. A Stanford A type aortic dissection involves the ascending aorta C. Both Debakey type I&II dissections involve the ascending aorta D. Aortic dissections occur in otherwise healthy women during the first trimester of

pregnancy. E. With successful surgery the 10 year survival is 40-50%.

6. Regarding cardiac allograft rejection, which statement is false:

A. Depletion of CD4+ cells in cardiac allograft recipients prolongs allograft survival B. CMV infection in cardiac transplant recipients is associated with an increased incidence

of rejection. C. Cardiac allograft vasculopathy is a major cause of morbidity and mortality in the first

year after transplantation. D. Acute cardiac allograft rejection is diagnosed by right ventricular endomyocardial biopsy. E. Cardiac allograft vasculopathy is diagnosed by cardiac catheterization with intravascular

ultrasound

7. Regarding Aortic root enlargement, which statement is incorrect?

A. The Konno Rastan is a posterior enlargement of the aortic root B. The Konno Rastan may damage the first septal artery C. The Nick Procedure involves extending the aortotomy through the posterior commisure

into the interleaflet triangle. D. Posterior aortic root enlargement techniques can be used without an additional risk E. The Manougian’s technique enlarges the root towards the anterior mitral valve leaflet

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8. Regarding the Ross procedure, which statement is incorrect?

A. It is replacement of the patient’s diseased aortic valve with his own pulmonary valve B. Longevity of the pulmonary autograft in the aortic position is superior to that of a porcine

bioprosthesis C. The pulmonary valve has the potential to grow with the child D. It requires long term anticoagulation E. It is useful in young patients with Marfan’s Syndrome

9. Regarding cerebral protection in aortic surgery, which statement is incorrect?

A. Cerebral metabolism is reduced approximately 5-7% for each degree centigrade

B. Deep hypothermic circulatory arrest at 15 degrees eliminates the metabolic needs of the brain.

C. Moderate levels of hypothermia, in contrast to deep hypothermia, permits a shorter perfusion time.

D. Retrograde cerebral perfusion is used at flow rates that maintain central venous pressure in arrange of 15-25mmHg

E. Antegrade selective cerebral perfusion during moderate hypothermia 25 degrees requires a perfusion volume of 10ml/kg/min.

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

10. After repair of a partial anomalous pulmonary venous drainage with 2 anomalous veins draining into the SVC, its noticed that the CVP is 25mmHg and the RA pressure is 6mmHg. TEE reveals no obstruction in pulmonary venous drainage. The most appropriate next step is:

A. Ligation of the azygos vein B. Implantation of the anomalous veins directly into the SVC C. Transection of the SVC and implantation into the RA appendage D. Placing a stent in the SVC E. Enlargement of the intracardiac pericardial patch

11. A 72-year old man underwent a mitral valve repair for ischemic cardiomyopathy and a single saphenous vein graft to the first diagonal for a planned 70% lesion. Operative technique included 2 stage venous cannulation, direct aortic perfusion and LV venting through the right superior PV. Myocardial protection included intermittent cold cardioplegia, topical cooling using a systemic jacket and systemic hypothermia. Which area of the myocardium is likely to be most inadequately cooled?

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A. Free right ventricular wall B. Interatrial septum C. Left ventricular subendocardium D. Lateral LV wall E. Diaphragmatic LV surface

12. Which one of the following cardiac tumours occurs primarily in the adult age group rather

than children? A. Rhabdomyoma B. Fibroma C. Purkinjie tumours D. Sarcomas E. Hamartoma

13. After repair of a partial anomalous pulmonary venous drainage with 2 anomalous veins draining into the SVC, its noticed that the CVP is 25mmHg and the RA pressure is 6mmHg. TEE reveals no obstruction in pulmonary venous drainage. The most appropriate next step is:

F. Ligation of the azygos vein G. Implantation of the anomalous veins directly into the SVC H. Transection of the SVC and implantation into the RA appendage I. Placing a stent in the SVC J. Enlargement of the intracardiac pericardial patch

14. Which of the following is the strongest contraindication to performing a bidirectional Glenn procedure?

A. Age of 4 month B. Bilateral SVC C. Interrupted IVC D. PV resistance of 6 woods units E. Oxygen sat of 70%.

15. A 2 day old neonate underwent a repair of an obstructed TAPVD with ligation of the vertical vein. After weaning from CPB blood pressure is 50/30 PAP 55/32. LA pressure 12 mmHg. PO2 70mmHg, CO2 32mmHg Ph 7.48. Echo cardiogram reveals no anastmotic obstruction. The most appropriate next step is:

A. Add epinephrine infusion B. Open an atrial fenestration C. Reopen the vertical vein

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D. Start inhaled nitric oxide E. Decrease the ventilator rate

16. A 50-year old patient who has no history of cardiac disease presents with dyspnea. Echocardiogram reveals the following picture. What is the most common diagnosis?

A. LA thrombus B. Atrial myxoma C. Atrial sarcoma D. Cardiac metastasis E. Primary cardiac lymphoma

17. A 3.5kg has a prenatal diagnosis of congenital aortic stenosis. Echo reveals a stenotic bicuspid valve, aortic annulus of 5mm (Z score -2), mitral annulus 6mm (Z score -4) and non apex forming LV. The best management is:

A. Konno-Ross procedure B. Fontan procedure C. Balloon aortic valvotomy D. Open aortic valvotomy E. Norwood procedure

18. A newborn underwent repair of type B interrupted aortic arch and a VSD. After hospital discharge which complication is most likely to occur?

A. Subaortic stenosis B. Pulmonary hypertension C. Complete heart block. D. Residual VSD E. Recurrent arch obstruction

In The Following Questions, all of the statements are true one, Identify The Correct or True Statement:

19. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates

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B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation

C. A successful outcome requires the production of complete and transmural lines of conduction block

D. Newer methods of producing lines of block such as cryoablation have been as effective as the traditional "cut and sew" method

E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

20. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are electrically

isolated from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather than

an empiric anatomic one

21. Which of the following statements is true regarding operative management of congenital sinus

of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

22. Which of the following statements is true regarding operative management of TAPVC?

A. Separate implantation of each pulmonary vein to the left atrium provides the most reliable reconstruction.

B. A secundum ASD can be closed with simple suture in these patients. C. The azygous vein can be mobilized and anastomosed directly to the left atrium in this

type of supracardiac TAPVC. D. The coronary sinus can be unroofed into the left atrium to correct cardiac TAPVC. E. Ligation of the vertical vein during infracardiac TAPVC repair should be done

immediately prior to discontinuing CPB.

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23. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome?

A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction. B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than thoracic

outlet syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery

stenosis.

24. Which of the following statements is true regarding operative management of post-infarct LV aneurysm?

A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot

formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

25. Which of the following statements is true regarding neurogenic tumors of mediastinum?

A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

26. The SYNTAX trial is the first randomized controlled trial to compare DES with CABG. What is the mean number of stents performed in the PTCA arm in the SYNTAX?

A. 1 B. 2 C. 3 D. 4 E. 5

27. A 35 year -old presents to a local cardiology department with breathlessness. He has no previous cardiac history and no previous operation. Further investigation reveals a systolic murmur and echocardiography confirms a ventricular septal defect. Which of the following statements regarding this condition is true?

A. A perimembranous location is most likely

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B. Endocardial defects often affect the tricuspid valve C. It is likely to be secondary to ischaemic heart disease D. Muscular defects are often associated with other cardiac defects E. Subarterial defects may affect the non coronary aortic cusp

28. How much percent does being a female add on the additive EuroScore as a risk of mortality after cardiac surgery?

A. A.0% B. B.1% C. C.2% D. D.3% E. E.4%

29. Regarding ventricular remodeling procedure, which statement is correct?

A. The Batisata attempts to specifically restore ventricular contour B. The Batisata is associated with good clinical outcome regarding morbidity and mortality C. The Dor procedure attempts to remove as much muscle tissue as possible. D. The Dor procedure attempts to restore the left ventricular cavity to a circular shape. E. These operations are performed concomitantly with CABG

30. A 14 month old infant with AVSD underwent cardiac catheterization. Results show balanced ventricles but PAP is 90/40mmHg and Qp/Qs is 1.5:1 which changes to 2:1 with administration of oxygen. Management of this child is

A. Complete repair of AVSD B. PA banding C. Evaluation for pulmonary transplantation D. Evaluation for heart and lung transplant E. Thoracoscopic lung biopsy.

31. A 2-month year old infant was diagnosed with restrictive VSD. 2 months later his congestive heart failure seemed out of proportion to the defect. What associated defect would increase his left to right shunting?

A. Pulmonary hypertension

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B. Pulmonary stenosis C. Coarctation of the aorta D. Aortic prolapsed E. Double chamber right ventricle

32. A 2-month old 5kg child presents with multiple apical VSDs. A PA band is performed. What is the optimum size of the band.

A. 21mm B. 23mm C. 25mm D. 27mm E. 29mm

33. A 2 year old child presents with cyanosis. An echo is performed and shows the following:

What is the diagnosis?

A. TGA B. Tetralogy of Fallot C. Tricuspid atresia D. HOCM E. Severe Pulmonary stenosis

34. A 3-year old child is undergoing repair of a low ASD through a mini-sternotomy. After weaning from bypass Blood pressure is 95/55, Aortic oxygen sat 78%, heart rate 90/min and CVP 8mmHg. What is the most common cause of this problem?

A. Diversion of IVC blood to the left atrium B. PAPVD C. Pulmonary hypertension D. Undiagnosed severe PS E. Left SVC to coronary sinus

35. According to the Euroscore, what is highest risk in patients undergoing cardiac surgery?

A. Preoperative Cardiogenic Shock B. Poor Ejection Fraction C. Preoperative renal failure D. Severe peripheral vascular disease E. Ischemic VSD.

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TRUE OR FALSE : More than one answer. For the next 2 questions , determine whether each choice is true ( T ) or false ( F ): 36. Which of the following statements are true about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is due to shunt

flow across the atrial septum

37. Optimal myocardial protection afforded by hypothermic potassium cardioplegia is achieved when:

A. The myocardial temperature is kept to less than 20C.

B. The potassium concentration of the cardioplegic solution is greater than 46 mEq per liter.

C. There is absence of electrocardiographic activity throughout the aortic cross-clamp period.

D. Steroids are added as adjuvants for membrane stabilization.

Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 38. Pain associated with ingestion of food during childhood is commonly associated with the

presence of:

A. Achalasia of the esophagus B. Congenital esophageal diverticulum

39. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

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40. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

Determine Whether Each Choice Is True Or False. Any combination of answers may occur.

A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

41. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

42. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

43. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for CABG

include(s):

A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each choice may be used only once:

A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage

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44. Abnormal coronary sinus 45. Complete repair least likely 46. Persistent left anterior cardinal vein 47. Persistent ductus venosus

In The Following Question, Each Numbered Item Is To Be Matched With One Lettered Item. Each option may be used once, more than once or not at all.

Indications for valve surgery

A. Aortic annular abscess B. Aortic valve vegetation >2mm C. Asymptomatic patient with AR and aortic root diameter of 40 mm D. Asymptomatic patient with AR and decline in EF from 0.60 to 0.40 during stress echo E. Asymptomatic patient with AR and EDD of 55 mm F. Asymptomatic patient with AR, EF 0.60 and ESD of 40 mm G. Asymptomatic patient with aortic valve area of 1.2 cm2 H. Asymptomatic patient with aortic valve area of 1.6 cm2 and TIAs I. Dyspnic patient with aortic valve area of 0.8 cm2 but no hypotension on exercise J. Dyspnic patient with aortic valve area of 2.5 cm2 K. P-R interval of 0.20 sec L. Persistent pyrexia and leucocytosis after three days of antibiotics M. Planned CABG with an aortic valve gradient of 10 mmHg N. Proteinuria and microscopic hematuria O. Symptomatic patient with AR and EF 0.45

From the list of options above, choose which would be an indication for valve surgery in the following situations. Each option may be used once, more than once or not at all. 48. Chronic severe aortic regurgitation. 49. Aortic stenosis. 50. Native aortic valve endocarditis without hemodynamic compromise.

GOOD LUCK

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جامعة عين شمس –كلية الطب امتحان الدكتوراة / جراحة القلب والصدر

2010دورمايو ساعة ونصف -الوقت :

A-67year-old man with long – standing HTN presents to the emergency room (ER) with sudden –onset chest pain described as ripping in quality,which has sub-sided since its onset .He underwent a cardiac catheterization 1 year previously due to an abnormal treadmill ECG that showed only a 50% lesion in the mid-left anterior descending coronary artery .His medication include aspirin,gemfibrozil,and nifedipine.other medical problems include O2-dependent chronic obstructive pulmonary disease . Physical Examination:- He appears diaphoretic BP is 106/54 mm Hg in the right arm and 72/35 mm Hg in the left arm the jugular venous pressure is elevated The heart sounds are muffled ,and there is no audible systolic or diastolic murmur . The pulses are absent in the left arm The ECG on presentation shows ST elevation in the inferior

leads and very low voltage The CXR show cardiomegaly ,with a globular-shaped and heatt

and interstitial edema.

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What is the first medication that should be given to this patient ?

Ọ A thrombolytic therapy Ọ B sodium nitroprusside Ọ C IV ganglionic blocking agent Ọ D none of the above Which of the following is the first diagnostic test that should be

performed ? Ọ A cardiac enzymes Ọ B MRI of the aorta Ọ C CT of the Chest Ọ D TTE or TEE Ọ E Cardiac catheterization What interventions should be performed next for the

management of this patient ? Ọ A cardiac catheterization Ọ B emergent aortic surgery Ọ C Swan – Ganz catheterization Ọ D pericardiocentesis

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A 42-year-old man is undergo oesophagectomy. While mobilizing the oesophagus in the neck , for anastomosis with the stomach tube on the left side, the operating surgeon must be careful about avoiding injury to which of the following vital structures ? Ọ A Innominate artery Ọ B Innominate vein Ọ C Internal carotid arttery Ọ D Sympathetic chain Ọ E Thoracic duct While performing left pneumonectomy the surgeon must avoid injury which of the following vital structures that leaves an impression on mediastinal surface of the left lung ? Ọ A Aortic arch Ọ B Azygos vein Ọ C Innominate artery Ọ D Inferior vena cava Ọ E Superior vena cava

A 32 –year – old man was shot in the chest . The bullet punctured a vessel that courses across the mediastinum in an almost horizontal fashion Which of the following vessels was injured ?

Ọ A Left subclavian artery Ọ B Left subclavian vein Ọ C Left brachiocephalic vein Ọ D Left internal jugular vein Ọ E Left common carotid artery

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A 76-year-old man presented in a surgical outpatient clinic with oedema of the left upper limb due to poor venous return . Examination revealed an aneurysm of the ascending aorta that was impinging on a large vein lying immediately anterosuperior to it .Which of the following veins was most likely to be obstructed ? Ọ A Azygos Ọ B Internal thoracic Ọ C Left brachiocephalic Ọ D Left superior intercostal Ọ E Right brachiocephalic

While performing oesophagectomy through a right tgoracotomy the surgeon suddenly noticed a gush of blood .After controlling the haemorrhage he realised that there was tear in a large venous structure located in the posterior mediastinum that empties into the superior vena cava .Which of the following venous structures was most likely to be injured ?

Ọ A Azygos vein Ọ B Basilic vein Ọ C Brachiocephalic vein Ọ D Cephalic vein Ọ E External jugular vein While excising a tumour of the thymus gland the surgeon accidentally injured a vein lying immediately posterior to the thymus .Which of the following vessels is most likely to be injured ? Ọ A Left brachiocephalic vein Ọ B Left Pulmonary vein Ọ C Left bronchial vein Ọ D Right Pulmonary artery Ọ E Right superior intercostal vein

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An anatomy demonstrator is teaching medical students about the right lung .Which of the following statements regarding the right lung made by the demonstrator is CORRECT ?

Ọ A It is slightly smaller than the left lung Ọ B It has lingular segmental bronchus Ọ C It occupies the right most portion of the mediastium Ọ D It s upper lobar bronchus lies behind and above the right Pulmonary artery Ọ E It has the right phrenic nerve passing posterior to its lung root

While mobilising the descending aorta repair an aortic coarctation in a 3-week – old baby a surgeon accidentally cuts the first aortic intercostal arteries Which of the following structures might be depriver of its main source of blood supply as a results of this iatrogenic injury ?

Ọ A First posterior intercostal space Ọ B First anterior intercostal space Ọ C Left bronchus Ọ D Right bronchus Ọ E Fibrous pericadium

A 78-year-old man with pseudobulbar palsy lying supine in bed,aspirates one of his tablets into his lungs while swallowing.it would be most likely to end up in whitch of the following bronchopulmonary segments ? Ọ A Anterior segmental bronchus of the right superior lobe Ọ B Medical segmental bronchus of the right middle lobe Ọ C Superior segmental bronchus of the right inferior lobe Ọ D Medical basal segmental bronchus of the Left inferior lobe Ọ E Inferior segmental bronchus of the lingular lobe

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A medical student is observing a respiratory physician perform a flexible bronchoscopy .As she passes the bronchoscope down the trachea she asks the medical student to identify a cartilaginous structure that resembles a ship's keel and separates the right and left main stem bronchi .This structure the :

Ọ A Carina Ọ B Cricoid cartilage Ọ C Costal cartilage Ọ D Pulmonary ligament Ọ E Tracheal ring A patient has a tumour crossing the minor (horizontal ) fissure .This fissure separates :

Ọ A The lower lobe from the lingual Ọ B The Upper lobe from the lingual Ọ C The lower lobe from both the middle and Upper lobes Ọ D The lower lobe from the middle lobe Ọ E The middle lobe from the upper lobe An 82 -year-old man who has been bedridden and lying supine for mant weeks in a nursing home has developed a right lung abscess that is draining by gravity into one particular region of the lung .Where is the most likely site of fluid accumulation ?

Ọ A Apical segment of the upper lobe Ọ B Lingula Ọ C Lower lobe Ọ D Middle lobe Ọ E Superior segment of the lower lobe

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During agross anatomy exam a medical student was asked to identify the left lung .Which of the following features found only in the left lung will this student use to to identify the left lung ?

Ọ A Cardiac notch Ọ B Horizontal fissure Ọ C Oblique fissure Ọ D Superior lobar bronchus Ọ E The lobes

A 40-year- old patient with sarcoidosis has enlarged tracheobronchial lymph nodes .Which the following nerves would be most vulnerable to irritation in this patient ?

Ọ A Right phrenic Ọ B Left phrenic Ọ C Right recurrent laryngeal Ọ D Left recurrent laryngeal Ọ E Right vagus A 26 -year-old man involved in a bar brawl was stabbed in a part of the left lung that might partially fill the costomediastinal recess in full inspiration . Where was the knife stuck in this man ?

Ọ A Apex Ọ B Cupola Ọ C Hilum Ọ D Lingula Ọ E Middle lobe

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A 50 -year-old man underwent exploratory thoracotomy for resection of aright lung tumour . on entering the chest the surgeon decided that the tumour was not resectable as it was crossing the oblique fissure .The oblique fissure of the right lung separates what structures ?

Ọ A Lower lobe from lingual Ọ B Lower lobe from Upper lobe only Ọ C Lower lobe from both Upper and middle lobes Ọ D Lower lobe from middle lobe only Ọ E Upper lobe from middle lobe A 32 -year-old man was stabbed in the back during abar fight with a knife that just nicked his left lung halfway between its apex and the diaphragmatic surface .Which part of the lung was most likely to be injured ?

Ọ A Hilum Ọ B Inferior lobe Ọ C Lingula Ọ D Middle lobe Ọ E Superior lobe A 3 -year-old boy is brought in with coughing ,and his mother tells you that he had been playing with some beads and had apparently aspirated one Where would you expect it most likely to be ?

Ọ A Apicoposterior segmental bronchus of the left lung Ọ B Left main bronchus Ọ C Lingular segment of the left lung Ọ D Right main bronchus Ọ E Terminal bronchiole of the right lung , lower lobe

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During a demonstration on anatomy of the lung the tutor asked one of the medical students to pass his index finer posteriorly inferior to the root of the left lung and identify the structure that is blocking the passage of the finger .Which structure would most likely be responsible for this ?

Ọ A Costodiaphragmatic recess Ọ B Cupola Ọ C Inferior vena cava Ọ D Left Pulmonary vein Ọ E Pulmonary ligament A patient with a malignant mesothelioma is to undergo pleuropnumonectomy ,which involves removal of the entire pleura and the lung on the affected side .Which of the following layers provides a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall ?

Ọ A Deep fascia Ọ B Endothoracic fascia Ọ C Parietal pleura Ọ D Visceral pleura Ọ E Transversus thoracis muscle fascia After cardiac surgery a patient is noticed to have a small effusion in the lowest extent of the pleural cavity,into which lung tissue dose not extend this part of the pleural cavity is known as the: Ọ A Costodiaphragmatic recess Ọ B Costomediastinal recess Ọ C Cupola Ọ D Infrior mediastinum Ọ E Pulmonary ligament

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A medical student was asked by the supervising consultant to identify the sternal angle.The sternal angle is a landmark for locating the level of the : Ọ A Costal margin Ọ B Jugular notch Ọ C Second costal cartilage Ọ D Sternoclavicular joint Ọ E Xiphoid process A JOH is about to perform her first thoracentesis ( remove fluid from the pleural cavity ) . If you were supervising where would you ask here to insert the aspiration needle to avoid injuring the lung or neurovascular elements ? Ọ A The top of interspace 8 in the midclavicular line Ọ B The bottom of interspace 8 in the midclavicular line Ọ C The top of interspace 9 in the midaxillary line Ọ D The bottom of interspace 9 in the midaxillary line Ọ E The top of interspace 11 in the scapular line

A 28 –year – old man was stabbed in the left chest .The tip of the knife entered the pleural space just above the cardiac notch. The lung was spared as it would only occupy this space during deep inspiration.Which of the following structures was pierced by the knife ?

Ọ A Anterior mediastinum Ọ B Costodiaphragmatic recess Ọ C Costomediastinal recess Ọ D Cupola Ọ E Pulmonary ligament

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A patient has loculated fluid in his right chest ,which can be easily aspirated if the aspiration needle is inserted through the body wall just above the ninth rib the midaxillary line.Where is this fluid located ?

Ọ A Costodiaphragmatic recess Ọ B Costomediastinal recess Ọ C Cupola Ọ D Hilar reflection Ọ E Pulmonary ligament A 34 –year – old woman with history of cough and weight loss for over a month is noticed to have a rounded opacity in the pleural cavity near the cardiac notch on her chest X-ray . The opacity is most likely to be present in the :

Ọ A Costodiaphragmatic recess Ọ B Costomediastinal recess Ọ C Cupola Ọ D Hilum Ọ E Pulmonary ligament A 25 –year – old motorcyclist involved in a road traffic accident fractured a structure that articulates with the tubercle of the seventh rib .Which of the following structures is fractured ?

Ọ A Body of vertebra T6 Ọ B Body of vertebra T7 Ọ C Body of vertebra T8 Ọ D Transverse process of vertebra T6 Ọ E Transverse process of vertebra T7

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A 28 –year – old man suffered agunshot wound, which entred immediately superior to the upper edge of the left clavicle near its head .He was in extreme pain which was interpreted by the A&E physician as a likely indicator of a collapsed lung following disruption of the pleura .If that was true , what portion of the pleura was most likely to be punctured?

Ọ A Costal pleura Ọ B Cupola Ọ C Hilar reflection Ọ D Mediastinal pleura Ọ E Pulmonary ligament A specialist registrar is performing her first ductus arteriosus ligation .The consultant supervising her instructs her to be careul when placing a clamp on the ducts to avoid injury to an important structure immediately dorsal to it.To which of the following structures the consultant referring ? Ọ A Accessory hemiazygos vein Ọ B Left internal thoracic artery Ọ C Left phrenic nerve Ọ D Left recurrent laryngeal nerve Ọ E Thoracic duct

While performing thymectomy to remove a malignant thymoma ,the surgeon is careful to avoid damaging an important nerve Lying on and partly curving posteriorly around the arch of the sorta.Which of the following nerves is the surgeon trying to preserve ? Ọ A Left phrenic Ọ B Left sympathetic trunk Ọ C Left vagus Ọ D Right phrenic Ọ E Right sympathetic trunk

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In a 6-week- old boy with a large subaortic ventricular septal defect , the cardiac surgeon decides to perform pulmonary artery banding through a left thoractomy , as the child is not fit for surgical closure .To pass the tape around the pulmonary artery , the surgeon initially passes his index finger immediately behind the two great arteries in the pericardial sac to mobilize both the great arteries.The surgeon’s index finger is inserted into which space ? Ọ A Cardiac notch Ọ B Coronary sinus Ọ C Oblique pericardial Sinus Ọ D Coronary sulcus Ọ E Transverse pericardial Sinus During pericardiectomy,sudden bleeding was noticed due to accidental injury to a major vascular structure in the pericardium .The surgeon inserted his left index finger through the transverse pericardial sinus,pulled forward on the large vessels lying ventral with his thumb to control bleeding .Which vessels were these ? Ọ A Pulmonary trunk and brachiocephalic trunk Ọ B Pulmonary trunk and aorta Ọ C Pulmonary trunk and superior vena cava Ọ D Superior vena cava and aorta Ọ E Superior vena cava and right Pulmonary artery

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A patient with a cystic swelling in his left chest underwent a computer tomography-guided biopsy .The radiologist inserted

the biopsy needle into the ninth intercostal space along the midaxillary line to aspirate the swelling and obtain tissue for histological diagnosis .The swelling is most likely to be in

which space ? Ọ A Cardiac notch Ọ B Costodiaphragmatic recess Ọ C Costomediastinal recess Ọ D Cupola Ọ E Oblique pericardial Sinus

A victim of anterior chest stabbing received a stab in a structure that is in close Proximity to ehere the first rib articulates with the sternum. The structure most likely to be injyred is the :

Ọ A Nipple Ọ B Root of the lung Ọ C Sternal angle Ọ D Sternoclavicular joint Ọ E Xiphoid process A victim of anterior chest stabbing was brought to A&E with impending cardiac tamponade There was a single puncture wound in the anterior chest 2 cm lateral to the left sternal border .An emergency thoracotomy revealed clots in the pericardium ,with apuncture wound in the right ventricle .To evacute clots from the pericardial cavity the surgeon slipped his hand behind the heart can be extended upwards until stopped by aline of Pericardial reflecation that forms the : Ọ A Cardiac notch Ọ B Costomediastinal recess Ọ C Hillar reflection Ọ D Oblique pericardial sinus Ọ E Transverse sinus

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A25 -year-old man was stabbed in thr right supraclavicular fossa .The knife punctured the portion of the parietal pleura that extends above the first rib .This portion of the parietal pleura is called the :- Ọ A Costodiaphragmatic recess Ọ B Costomediastinal recess Ọ C Costocervical recess Ọ D Cupola Ọ E Endothoracic fascia

Which of the following statements regarding the Venous drainage of the heart is Correct ?

Ọ A The coronary sinus drains into the left atrium Ọ B The anterior cardiac veins begin over the anterior surface of the left ventricle , cross over the atrioventricular groove( coronary groove) and directly drain into the left atrium Ọ C The great cardiac vein is the largest tributary of the coronary sinus and this vein starts at the apex of the heart and ascends with the anterior ventricular branch of the left coronary artery Ọ D The middle and small cardiac vein drain most of the areas supplied by the left coronary Ọ E The coronary sinus drains into the great cardiac vein

A patient presents with a clinically significant atrial septal defect (ASD).The ASD is most likely to be due to incomplete closure of Which one of the following structures :

Ọ A Foramen ovale Ọ B Ligamentum arteriosus Ọ C Ductus arteriosus Ọ D Sinus venarum Ọ E Coronary sinus

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A patient presents with a right bundle branch block due to blockage in the atrioventricular (AV) nodle artery .part of the right bundle branch of the AV bundle is carried by which structure ?

Ọ A Pectinate muscles Ọ B Anterior papillary muscle of the left ventricle Ọ C Moderator band ( septomarginal trabecula) Ọ D Crista terminalis Ọ E Chordae tendineae You are asked to insert a chest drain anteriorly in the second intercostal space.To enter the right space you must cooectly idently the second costal cartilage.The second costal cartilage can be located by palpating the : Ọ A Costal margin Ọ B Sternal angle Ọ C Sternal notch Ọ D Sternoclavicular joint Ọ E Xiphoid process After posterolateral thoracotomy surgeons like to infiltrate local anaesthetic both above and below the incision to block the nerves supplying the thoracic wall.The thoracic wall is innervated by the : Ọ A Dorsal primary rami Ọ B Intercostal nerves Ọ C Lateral pectoral nerves Ọ D Medial pectoral nerves Ọ E Thoracodorsal nerves

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An SHO has been asked to aspirate Some pleural fluid for culture and sensitivity from the left pleural space of a 65-year-old man who has post –pneumonic effusion . if the SHO wants to aspirate the fluid with the patient sitting up in bed , where would the fluid tend to accumulate ? Ọ A Costodiaphragmatic recess Ọ B Costomediastinal recess Ọ C Cupola Ọ D Hillar reflection Ọ E Middle mediastinum While performing a surgical procedure in the mid – region of the thorax the surgeon accidentally injured an important structure that lies immediately anterior to the thoracic duct . Which of the following structures was most likely to be injured ? Ọ A Aorta Ọ B Azygos vein Ọ C Oesophagus Ọ D Superior vena cava Ọ E Trachea A 42-year-old man was diagnosed with a tumour of the posterior mediastinum.Such a tumour is most likely to compress which of the following structure? Ọ A Arch of the aorta Ọ B Oesophagus Ọ C Inferior vena cava Ọ D Pulmonary trunk Ọ E Trachea

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While performing extended mediastinal lymph node dissection for a squamous – cell carcinoma of the right upper lobe bronchus , a patient’s right sympathetic trunk was accidentally severed just cranial to the level of spinal nerve T1 . Which function would be left intact in the affected region ? Ọ A Arrector pili muscle activity Ọ B Dilation / constriction of blood vessels Ọ C Sweet production Ọ D Visceral reflex activity Ọ E Voluntary muscle activity A 76-year-old man with a complaint of dull chest pain of 3 months’ duration ,with a normal electrocardiogram and cardiac enzymes , underwent a computed tomographic scan , which showed a mass lesion involving a structure in the middle mediastinum .Which of the following structures could be involved ? Ọ A Aortic arch Ọ B Ascending aorta Ọ C Descending aorta Ọ D Oesophagus Ọ E Thoracic duct During investigation for chest pain in a 32-year-old man computed tomography showed a large mass in the posterior mediastinum . Which of the following structures could be involved ? Ọ A Aortic arch Ọ B Ascending aorta Ọ C Innominate artery Ọ D Lymph glands Ọ E Superior vena cava

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Which of the following vertebrae is the lowest limit of the superior mediastinum ? Ọ A first Lumbar Ọ B Fourth thoracic Ọ C Second thoracic Ọ D Seventh cervical Ọ E Third thoracic

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper IV MCQ (ANA. & PATH.)

Cairo 11/05/2010 Time allowed: 60 minutes

ANATOMY & EMBRYOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer: 1. Which of the following statements about diaphragmatic anatomy is true?

A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise from the lumbar

vertebrae

2. Which of the following is true regarding the diaphragmatic development?

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

3. Which of the following statements is true regarding anatomy of the thoracic outlet?

A. The distal section of the cervicoaxillary canal is the more critical for compression syndromes B. The brachial plexus and subclavian artery are located in the anteromedial compartment of the

costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus medius, and first rib D. Inspiration tilts the coracoid process inferiorly , placing tension on the neurovascular bundle E. Bony abnormalities are present in the majority of patients

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4. Which of the following is true regarding the lung? A. Is the only organ with a dual blood supply B. Will function satisfactorily after complete denervation C. Is inferior to the kidney in adjusting acid-base balance D. Does not possess a lymphatic system E. All of the above

5. Which of the following is true regarding the usual drainage of persistent left superior vena

cava?

A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava

6. Which of the following is true regarding the level of the narrowest part of the esophagus?

A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

7. Which of the following is true regarding the azygos vein?

A. Receives venous blood from the middle one-third of the esophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

8. Which of the following statements is true regarding the lining of the normal bronchial mucosa?

A. Simulated pseudostratified epithelium B. Goblet cells C. Basal cells D. Adenocystic cells which constitute the germinal layer

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9. Which of the following statements is true regarding the atrio-ventricular (AV) node ?

A. Receives nerves from the right vagus B. Its arterial supply is from the right coronary artery C. Is located near the entrance of the superior vena cava D. Is located near the coronary sinus

10. Which of the following statements is true regarding the inferior vena cava?

A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins

11. Which of the following statements is true regarding the abdominal aorta?

A. Passes behind the medial arcuate ligament of the diaphragm at the level of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior mesenteric artery

12. Which of the following statements is true regarding the thoracic duct?

A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

13. Which of the following statements is true regarding in the root of the neck?

A. Scalenus anterior arises from the anterior tubercles of the typical cervical vertebrae B. The supreme intercostals vein lies lateral to the first thoracic nerve on the neck of the first rib C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct

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14. Which of the following statements is true regarding the subclavian artery?

A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from branches of the

thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath derived from the

prevertebral fascia E. Becomes the axillary artery at the upper border of teres major

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

15. During embryologic development of the heart, the following occur except:

A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

16. The diaphragm

A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front of the esophagus D. Diaphragm projects higher Into the chest on the right than on the left E. Lies entirely above the tenth rib.

ANSWER THE FOLLOWING 2 QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect

B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

17. Patent ductus usually occurs as an isolated defect BECAUSE it does not arise from the aortic arch

system.

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18. About 70% or more of the total vital capacity is expired within the first second of expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

ANSWER THE FOLLOWING 5 QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A is correct

B. If only B is correct C. If both A and B are correct D. If neither A nor B is correct

19. The parietal pleura:

A. Is very sensitive to pain B. Absorbs the pleural fluid

20. A moderator band is usually found in the: A. Left ventricle . B. Right ventricle

21. Eustachian valve:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

22. The bundle of his passes closer to:

A. The right side of the interatrial septum B. The left side of the interatrial septum

23. The sinus venosus forms:

A. The superior and inferior vena cava B. The right atrium

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In The Following Two Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each choice may be used only once:

24. A. Anterior mediastinum B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia 25. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

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PATHOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

26. Which of the following statements is true regarding the anatomy and pathophysiology of post-

infarct left ventricular aneurysm?

A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

27. Which of the following statements is true regarding cervical rib?

A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

28. Which of the following statements is true regarding gastro-esophageal reflux?

A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic than symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's esophagus E. Initial management may include increasing the number of meals eaten per day

29. Which of the following statements is true regarding carotid artery disease?

A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid plaque that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischemic attack commonly includes CT scan of

the brain E. Surgery has been shown to be better than medical therapy in the management of asymptomatic

patients with stenoses greater than 70%

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In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

30. Esophageal hiatus hernia in infants:

A. May be an important cause of vomiting B. Is often associated with constipation C. Can be demonstrated during the first week of life D. May be associated with pyloric stenosis E. Is frequently accompanied by gastrointestinal bleeding

31. Bronchogenic cysts:

A. Are lined by pseudostratified columnar epithelium B. Usually appear as air-filled cavities C. Do not cause hemoptysis D. Frequently become infected E. Mostly occur close to the hilum

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect

B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

32. Underdevelopment of the main pulmonary artery is usually associated with narrowing or stenosis of

the outflow tract of the right ventricle BECAUSE both are derived from the conus. 33. The presence of a cervical rib does not produce symptoms in childhood BECAUSE the rib is

rudimentary at this age. 34. Bronchial foreign bodies more frequently occur in children BECAUSE the right main stem

bronchus is relatively straighter than the left.

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35. Tumourlets are epithelial proliferations which are usually associated with bronchiectatic lobes BECAUSE these microscopic lesions are never found in the absence of damage to the lungs.

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

36. Blood supply of tuberculous lesions

A. Pulmonary arteries B. Bronchial arteries

37. Benign pulmonary tumors:

A. Tumorlets B. Hamartomas

38. Development of lung abscess in:

A. Alveolar cysts B. Bronchogenic cysts

For Each Of The Matching Questions Below, Choose The One Lettered Item That Best Applies To The Numbered Item. Each lettered item may be used more than once:

A. Azygos lobe B. Congenital bronchial atreria C. Pulmonary sequestration

39. May lie below diaphragm 40. Obstructive emphysema 41. Incomplete fissure 42. Mediastinal shift 43. Anomalous artery 44. Lower lobes not involved

A. Heterotaxia B. Arrested development C. Persistence of fetal structures

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45. Left superior vena cava 46. Situs inversus 47. Ostium primum defect 48. Right aortic arch 49. Isolated dextrocardia 50. Patent ductus arteriosus

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo /11/2005 Time allowed : 30 minutes During the course of a pulmonary resection, a patient exhibits severe generalized bleeding. He has not receive blood. The most likely cause is:

A. Loss of fibrinogen and activation of fibrinolysin B. Unsuspected biliary cirrhosis C. Idiopathic thrombocytopenic purpura D. Undetected air embolism E. Peripheral vasodilatation due to anesthetic agent

In the treatment of a child with postintubation laryngeal edema, corticosteroids:

A. Should be given in a single large dose B. Frequently cause secondary infection C. May lead to perforation D. Should be employed topically E. Are contraindicated

The combination of right heart failure, elevated venous pressure and a quiet heart is known as:

A. Whipple's triad B. Saint's triad C. Beek's triad D. Murphy's sign E. None of the above

A common error in surgical treatment of ostium primum defect is:

A. Development of post-surgical complete heart block B. Dehiseence of the patch C. Injury to the tricuspid valve tissue D. Inadequate correction of mitral insufficiency E. Overlooking the presence of a ventricular septal defect

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The combination of right heart failure, elevated venous pressure and a quiet heart is known as: A. Whipple's triad B. Saint's triad C. Beek's triad D. Murphy's sign E. None of the above

A common error in surgical treatment of ostium primum defect is:

A. Development of post-surgical complete heart block B. Dehiscence of the patch C. Injury to the tricuspid valve tissue D. Inadequate correction of mitral insufficiency E. Overlooking the presence of a ventricular septal defect

The following chemotherapeutic agents are used in the treatment of

tuberculosis: A. Viomycin D. Pyrazinamide B. Cycloserine E. Ethambutal C. Pyridoxine

A major hemolytic reaction during the course of a blood transfusion is

characterized by: A. A bleeding tendency occurs in 30 percent of cases B. Peripheral vascular collapse may occur C. Hemoglobinemia can be found immediately D. Hyperbilirubinemia can be detected within twenty minutes E. Renal insufficiency is a common sequela

A. Isoniazid B. Ethambutal C. Ethionamide

422. Hepatic dysfunction 423. Peripheral neuritis 424. Vestibular nerve ataxia

A. Hypochloremic alkalosis B. Hypokalemic alkalosis C. Ifyponatremic acidosis

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425. Trousseau's sign 426. Gastric suction 427. Pancreatic fistula

A. 02 concentration approximately 25-30 percent B- 02 concentration approximately 40-60 percent C- 02 concentration approximately 75-80 percent D. 02 concentration over 80 percent

428. Use of oxygen tent 429. -Use of nasal catheter 430. Use of tight fitting face mask 431. Pressure cycled ventilator

A. Digitalis B. Bishydroxycournarin C. Heparin D. Norepinephrine E. Old blood

432. Protamine sulfate 433. -Calcium chloride 434. Phenoxybenzarnine 435. Potassium chloride 436. Vitamin KI

A. Phentolamine B. Angiotensin C. Dopamine D. Serotonin E. Bradykinin

437. Precursor of epinephrine 438. Carried in thrornbocytes 439. Powerful adrenolytic agent 440. Polypeptide formed by plasma globulin 441. Precursor activated by ischemic renal tissue THE CHOICE OF ANESTHETIC AGENT IN BRONCHOSCOPING A

NEW- BORN IS MOST FREQUENTLY:

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A. Fluothane D. Pentothal B. Ether E. No anesthetic agent

2. C. Cyclopropane 3.

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

. When incompatible blood is administered during the course of an

operation, symptoms may not be detected BECAUSE they are usually masked in Patients receiving a general anesthetic.

. The gross pathology of a rejected cardiac transplant is that of a congested and hemorrhagic heart BECAUSE rejection in this organ

consists chiefly of damages to the capillary and venules. . The lung is more important than the kidney in regulating acid-base balance BECAUSE the kidney excretes 45 mM. of fixed acid per day,

while the lung removes 12,000-20, 000 mM. CO2. . Pulmonarv scintillation scan is useful in confirrnim the presence of

massive pulmonary embolism BECAUSE in these patients the plain chest film may be essentially normal.

. Halothane is often used as an anesthetic agent for children BECAUSE it causes no stimulation of respiratory secretary activity . Pacing with paired stimulation can be used to potentiate myocardial contractility BECAUSE this technique introduces a very premature extrasystole into each cycle.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

. Cardiac defibrillation is done preferably with:

A. Direct current (DC) electrical shock B. Alternating current (AC) electrical shock

. The value of digitalis in treatment of:

A. Atrial fibrillation with fast ventricular response B. Paroxysmal atrial tachveardia

. The rate of oxygen release:

A. Upon shift of oxy-hemoglobin curve to the right B. In the presence of metabolic acidosis

. The permeability of the cell membrane to:

A. Na+ ions B. K+ ions

. Digitalis requirement:

A. Prior to cardiac surgery B. On the day following cardiac operation

. The incidence during cardiac catheterization of:

A. Myocardial infaretion B. Renal shutdown

. Rate of fall in acute water intoxication:

A. Na+ ion concentration B. Serum osmolality

. The type of congenital heart lesions requiring prosthetic valve

replacement: A. Mitral valve lesions B. Aortic valve lesions

. Incidence of complications associated with blood transfusions:

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A. Hemolytic reactions B. Allergic reactions

MAXIMUM DOSE OF

A. Xylocaine B. Pontocaine C. Cyclaine

. 40 mg of I or 2% solution . 400 mg of 2 or 4% solution . 400 mg of 5% solution

FOR EACH OF THE FOLLOWING MULTIPLE CHOICE QUESTIONS, SELECT THE ONE MOST APPROPRIATE ANSWER:

. To be effective, the preoperative medication given subcutaneously or

intramuscularly must be administered at least: A. Ten minutes before surgery B. Thirty minutes before surgery C. Forty-five to sixty minutes before surgery D. Ninety minutes before surgery E. in the operating room

. The usual bacterial growth on blood cultures obtained from patients

with subacute bacterial endocarditis would reveal: A. Staphylococaus aureus B. Streptococcus viridans C. Hemophilus influenzae D. Diplococcus pneurnoniae E. All of the above

. Chest pain radiating into the left arm associated with further

radiation into the neck and jaw: A. Is frequently caused by esophageal trauma B. Most likely due to coronary artery disease C. Can be produced by a variety of lung diseases D. May be due to a fractured rib E. All of the above

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. The sudden onset of persistent coughing, productive of copious amounts of thick brownish fluid, occurring three months following resection of the right lung suggests: A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Bronchopleural fistula E. All of the above

Which one of the following vasopressors has the least direct effect on the heart ?

A. Dopamine B. Vasopressin C. Dobutamine D. Norepinephrine E. Epinephrine

4. With hypovolemic shock, all the following are reduced except which one ?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

5. Myocardial oxygen demand is dependant upon ( more than one answer ) :

A. Cardiac output B. Left ventricular systolic pressure C. Heart rate D. Left ventricular end – diastolic pressure E. Left ventricular wall thickness

6. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is

Least reliable for a tumor located in the : A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

7. The condition that is least likely to be associated with respiratory distress in

the newborn is : A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

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8. A right upper lobectomy with mediastinal L.N. dissection is done for lung Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with One of the three brochial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

9. Which of the following statements regarding myomectomy for hypertrophic

Cardiomyopathy is correct ? A. It reduces the incidence of sudden death B. It has a success rate of 90% for relieving symptoms & reducing

outflow tract obstruction C. It is widely applicable in patients with hypertrophic cardiomyopathy D. It may exacerbate the mitral regurgitation associated with

hypertrophic cardiomyopathy

10. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is Evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

11. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

12. Which of the following statements regarding anticoagulation for atrial

Fibrillation is not correct ? A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF

because the risk thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective

as coumadin D. For patients younger than 65 years with lone AF, aspirin alone is

sufficient to prevent stroke because the risk of thromboembolism is low

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13. Which of the following ECG findings is specific for diagnosing pericarditis ? A. Diffuse ST segment elevation B. ST segment elevation that is concave upwards C. ST segment elevation combined with T wave inversions D. PR segment depression 14. Which of the following statements regarding cardioversion of atrial

Fibrillation is not correct ? A. The absence of thrombus on transthoracic echocardiogram allows

Immediate, safe cardioversion B. Patients who have had AF for less than 24 hours do not need anti –

Coagulation before cardioversion C. Patients who have had AF for more than 48 hours should receive

Coumadin for 3 weeks before cardioversion D. Maintenance of sinus rhythm with antiarrhythmic drugs does not

Obviate the need for coumadin therapy

15. Which of the following statements regarding Marfan syndrome is not Correct ?

A. Mitral valve prolapse and rupture may occur as a result of elongation of the chordae tendinae

B. Aortic regurgitation may occur as a result of aortic dilatation C. Complications of ascending aortic aneurysm account for more than

90% of deaths from Marfan syndrome D. Operation is advisable in symptomatic patients with an ascending

aneurysm greater than 6 cm ; asymptomatic patients should be followed with serial imaging studies

16. Coarctation of the aorta may be associated with all of the following except:

A. Aneurysm of the circle of Willis B. Central cyanosis C. Hypertension D. Rib notching E. Bicuspid aortic valve

17. All the following statements about the coronary circulation are true except:

A. Heart rate is the most important determinant of myocardial oxygen Consumption

B. Coronary perfusion of the left ventricle occurs mainly during diastole C. The subendocardial region of the myocardium is more sensitive to

ischemia D. A 50% coronary stenosis on angiography corresponds approximately

to a 75% reduction in cross-sectional area

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E. The abnormal coronary vasodilator response to shear stress and mediators such as acetylcholine is due to deficient prostacyclin production in diseased coronary arteries

TRUE OR FALSE : For the next 3 questions , determine whether each choice is true ( T ) or false ( F ):

18. Which of the following statements correctly characterize major determinants of cardiac performance ?

A. Stroke volume increases with increasing afterload B. Ventricular preload describes the load against which the ventricle

must contract when it eject blood C. In normal hearts, ventricular inotropic state increases with increasing

heart rate because of changes in calcium availability D. Hypoxia , ischemia, and acidosis decrease cardiac contractility E. In failing hearts, right atrial pressure as assessed from the jugular

venous pulse is a good indicator of left ventricular filling pressure

19. Which of the following statements are True about atrial septal defects ? A. Sinus venosus defects are often accompanied by congenital

deformities of the mitral valve B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected

secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD

is due to shunt flow across the atrial septum

20. Which statements are correct about CABG : A. CABG prolongs survival in patients with greater than 70% left main

Stenosis , independent of anginal symptoms B. CABG prolongs survival in patients with three – vessel disease and

left ventricular systolic dysfunction C. Diabetic patients with multivessel coronary artery disease have a

better prognosis with multivessel angioplasty than with CABG D. Women have lower perioperative mortality than men E. Internal mammary grafts remain patent longer than saphenous vein

grafts

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MATCHING :

For the next 2 questions, choose for each numbered item, the most likely associated lettered item from those provided. Each item has only one answer

21. Select from the list below the cardiac events that correspond most closely to the components of the jugular venous waveform :

A. Opening of the tricuspid valve and right ventricular relaxation B. Right atrial relaxation C. Pulmonary valve opening D. Right atrial contraction E. Passive right atrial filling with a competent tricuspid valve

1. X-descent 2. V-wave 3. A-wave 4. Y-descent

22. Match the following palliative surgical shunts with their anatomic anastomoses :

A. Superior vena cava to right pulmonary artery B. Subclavian artery to pulmonary artery C. Ascending aorta to right pulmonary artery D. Ascending aorta to main pulmonary artery E. Descending aorta to left pulmonary artery

1. Classic Blalock – Taussig 2. Pott’s anastmosis 3. Classic Glenn 4. Waterston shunt

GOOD LUCK

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AIN SHAMS UNIVERSITY MD Cardiothoracic Surgery Faculty of medicine Paper I Cairo 12/11/2005 Time allowed: 2 hours I . Give short account on different modalities of management of atrial fibrillation .

II. Give short account on the following :

1. Blood conservation in cardiac surgery . 2. Cyanosis on feeding in a newly born babies .

3. Uses of Stem cells in cardiac surgery .

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQ Cairo 00/11/2005 Time allowed: 45 minutes Choose the single best answer to the following :

The best treatment for the relief of increasing spontaneous mediastinal emphysema is: A. Thoracotomy B. Suprasternal decompression C. Submiphoid decompression D. Needling the mediastinum E. None of the above The first sign of Horner's syndrome is usually: A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above When treating a child born with esophageal atresia and imperforate anus, it is advisable to: A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable In esophageal reconstruction operations using the right colon, thoracotomy: A. Is best accomplished via a median sternotomy B. Is usually made on the right side C. Is usually made on the left side D. Is usually made bilaterally E. Is unnecessary .

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A Schatzic's ring when found in a symptomatic patient is almost always associated with: A. Achalasia B. Carcinoma C. Hiatus hernia D. Anemia E. Diverticula The most common site of spontaneous esophageal perforation (Boerhaave's syndrome) is: A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above Of the following, the condition most frequently associated with congenital esophageal atresia is: A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has: A. A truncus arteriosus B. A pulmonary A-V fistula C. Aorto-pulmonary window D. A coarctation of the aorta E. A coronary-ventricular fistula Immediately following repair of an interventricular septal defect, a

complete heart block is noted, although ventricuiar rate is satisfactory. In this circumstance, one should: A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing

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A Taussig-Bing malformation is best treated by:

A. Diversion of the septal defect only B. Dettachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle

In an adult patient, the repair of coarctation requires some form of

aortic replacement if: A. The anastamosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above

The most common findings associated with congenital tricuspid atresia

are: A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis

The most common anatomic variation of coronary artery fistula

connects: A. Right coronary artery to right atrium B. Right coronarv artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle

Of the following, the lesion least likely to be associated with bacterial

endocarditis is: A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

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Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total anomalous pulmonary venous drainage are all characterized by: A. inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above

Children with transposition of the great vessels with an intact

ventricular septum: 1. May have delayed surgical correction if systemic oxygen saturation is greater than 70% 2. May never need total correction 3. Are excellent candidates for total correction 4. Need Senning operation at early infancy

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement.

Esophageal dilatation for the treatment of achalasia: A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D- It cannot be employed if the esophagus is very tortuous E- Relief Of dysphagia may occur after a single course of treatment. Zenker's dfverticula: A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E- Causes dysphagia with liquids Achalasia of the esophagus is characterized by: A. Painless vomiting B. Stenosis of cardio-esophageal junction C. Decreased peristaltic movements D. May be helped by balloon dilatation E. Abnormal or deficient ganglion cells The esophagus may be affected in the following conditions: A.Myasthenia gravis B.pellagra C.Seleroderma D.Polyserositir, E. Achlorhydria

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Determine whether each choice is true or false. Any combination of answers may occur. A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct . Paraplegia following operation on descending thoracic aorta is

1) Increased by preoperative shock. 2) Increased by emergency surgery. 3) Affected by the duration of cross-clamp time. 4) Prevented by evoked somatosensory potential monitoring.

. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

1) Coarctation of the aorta. 2) Bicuspid aortic valve. 3) Patent ducts arteriosus. 4) Ebstein’s anomaly.

. Which of the following factors reduce(s) the five-ear cure rate of lung cancer following treatment to less than 20%?

1) Small cell anaplastic carcinoma. 2) Positive superior mediastinal lymph odes. 3) Stage III tumor. 4) Tumor diameter greater than 3 cm.

. According to the TMN principles for staging lug cancers, which of the bronchogenic carcinomas described below is orare considered to be Stage I ?

1) Large cell carcinoma 4 cm in diameter without lymph node metastases. 2) Poorly differentiated adenocarcinoma without metastases to lymph nodes. 3) Squamous cell carcinoma with atelectasis and extension to visceral pleura without

lymph node metastases or pleural effusion. 4) Alveolar cell carcinoma without metastases to the lymph nodes.

. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve replacement include(s):

1) Much greater resistance to infection. 2) Satisfactory long-term durabilityi adolescents. 3) Good hemodyamic performance in the 17 mm and 19 mm sizes relative to

tilting disc valves. 4) Low thromboembolic risk without systemic anticoagulation.

. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for CABG include(s):

1) Chest wall dysesthesias. 2) Respiratory insufficiency. 3) Increased incidence of mediastinits in diabetic patients. 4) Paresis or paresthesias of the arm.

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Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 Pain associated with ingestion of food during childhood is commonly associated with the presence of: A. Achalasia of ft esophagus B. Congenital esophageal diverticulum In achalasia, a vagal defect when demonstrable is: A. Preganglionic B. Postganglionic Leiomyosarcomas of the esophagus: A. Tend to ulcerate B. Are submucosal Treatment of lye burns of the esophagus during the acute phase: A. Corticosteroids B. Esophagoseopy If the handle of an esophagoscope is held upward during an examination, the lip of the instrument will be: A. Anterior B. Posterior Presence of aberrant gastric type columnar cells: A. Barrett's ulcer B. Schatzki's ring . Not related to the size of tumor . Involvement of bulbar and ocular musculature . More dramatic response to neostigmine . Peripheral paresthesias and muscle pain . Precedes discovery of tumor . In the majority remains after the removal of the tumor A.True myasthenia gravis B. Myoneuropathy associated with nonmetastatic bronchogenic carcinoma

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

Chylothorax developing after repair of:

A. Coarctation of aorta B. Patent ductus arteriosus

Presence of a right aortic arch:

A. Pulmonic stenosis with an interventricular septal defect B. Pulmonic stenosis without an interventricular septal defect

The choice of material for intra-atrial baffle:

A. Pericardium B. Teflon or dacron graft

Incidence of:

A. Supravalvular aortic stenosis B. Subvalvular aortic stenosis

Incidence of subacute bacterial endocarditis:

A. Small interventricular septal defects B. Large interventricular septal defects

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In the following questions, each numbered item is to bematichef) with one lettered item. Each choice may be used only once:

A. Ostiun, secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect

. Heart block and arrhythmia common

. Absent superior rim - Most commonly encountered . Cyanosis in absence of failure

A. Lutembacher syndrome B. Splenic agenesis C. Ebstein's malformation D. Tetralogy of Fallot

. Paroxysmal atrial tachycardia

. Mitral stenosis - Right ventricular hypertrophy . Malformation of great vessels

A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage

. Abnormal coronary sinus

. Complete repair least likely

. Persistent left anterior cardinal vein

. Persistent ductus venosus

A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis

. Parachute valve

. Syncope

. Waterston shunt

. Brock procedure

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Answer the following questions by using the key outlined below: A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false All thymomas should be resected BECAUSE they may cause myasthenia gravis. Silver clips are used for division and tying of vagal and sympathetic nerve trunks BECAUSE it prevents regeneration and decreases the incidence of neuralgia. Teratodermoid tumors of the mediastinum should always be resected BECAUSE by the time of removal 10-20% of them have undergone malignant degeneration. Patients who develop aneurysms of the left ventricle usually die from

hemorrhage BECAUSE the aneurysm will rupture due to weakness of the stretched ventricular wall.

Electrical stimulation of carotid sinus nerve is used to alleviate the attacks of angina pectoris BECAUSE stimulation of this nerve inhibits the sympathetic efferent impulses to the cerebral medulla.

The chronic hemolysis associated with ball-valve prostheses is greater when the valve is in the aortic rather than the mitral region BECAUSE all patients with aortic prostheses have a "built-in" stenosis.

It is difficult to distinguish pathologically patients with Marfan's syndrome

from those with annuloectasia BECAUSE cystic rnedial necrosis Is common to both conditions.

It is frequently difficult to differentiate clinically the presence of coronary

atherosclerosis in association with aortic valvular stenosis BECAUSE there is no reliable clinical method of detecting the former when the patient has symptoms due to the latter.

Following mitrat commissurotomy, the pressure in the pulmonary artery may not fall immediately BECAUSE the patient may have developed secondary changes in the pulmonary arterioles.

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II Cairo 13/11/2005 Time allowed : 2 hours I. Give short account on the following :

A. Techniques for spinal cord protection during thoracic aorta surgery . B. Left ventricular assist devices .

C. Scimitar syndrome .

II. Difference in surgical management strategies in the following :

A. Degenerative MR VS ischemic MR .

B. Anterior aortic dissection VS posterior aortic dissection .

C. Pulmonary atresia / VSD VS pulmonary atresia / IVS .

D. Pulmonary Small CC VS pulmonary non-small CC .

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 14 /11/2005 Time allowed : 1 & half hours

COMMENTARY 9 years–old boy presented to the cardiology clinic with dyspnea, and palpitations, he had a previous history of patent ductus arteriosus ligation at the age of 3 months. His examination revealed significant signs of hyperdynamic circulation, gross cardiomegaly and loud machinary murmur allover the precordium. Repeated expert echocardiographic studies showed large residual PDA, however, its exact site was not confirmed. The surgeon decided to operate without waiting for cardiac catheterization. The surgical plan was to explore through median sternotomy, using a cell saver device, controlled hypotensive anaesthetic management with a standby CPB. Exploration revealed large communication between the ascending aorta and the main pulmonary artery. Surgery was completed effectively without complications. Comment.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 15/11/2005 Time allowed : 30 mins 1. THE DIAPHRAGM DEVELOPS:

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

2. THE DIAPHRAGM: A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front

of the esophagus D. Diaphragm projects higher Into the chest on the right

than on the left E. Lies entirely above the tenth rib

3. Which of the following statements is TRUE regarding anatomy of the

thoracic outlet ? A. The distal section of the cervicoaxillary canal is the more critical

for compression syndromes B. The brachial plexus and subclavian artery are located in the

anteromedial compartment of the costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus

medius, and first rib D. Inspiration tilts the coracoid process inferiorly , placing tension on

the neurovascular bundle E. Bony abnormalities are present in the majority of patients

4. IN THE ERECT POSITION, THE SUPERIOR LIMIT OF THE ESOPHAGUS LIES AT THE LEVEL OF THE:

A. Inferior margin of the thyroid cartilage B. Fourth cervical vertebra C. Suprasternal notch D. Thoracic inlet E. Tubercle of the cricoid cartilage

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5. THE ESSENTIAL FACTOR IN THE PATHOGENESIS OF AORTIC ANEURYSMS IS DAMAGE: A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis 6. THE MOST COMMON TYPE OF DISSECTING ANEURYSM ACCORDING TO De BAKEY CLASSIFICATION IS : A. Type I B. Type 2 C. Type 3 D. Type I and 2 combined E. Equal incidence for all types 7. THE NARROWEST PART OF THE ESOPHAGUS LIES AT THE LEVEL OF: A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob 8. A PERSISTENT LEFT SUPERIOR VENA CAVA USUALLY DRAINS INTO THE: A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava 9. AN ANEURYSM OF THE CORONARY ARTERY MAY: A. Cause distal thrombosis B. Rupture C. Be induced by trauma D. Cause angina E. All of the above

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10. PRIMARY MALIGNANT NEOPLASMS ARISING IN THE MEDIASTINUM ARE USUALLY: A. Of lymphoblastic origin B. Connective tissue tumors C. Epithelial tumors D. of nervous tissue origin E. None of the above 11. OF THE FOLLOWING, THE MOST COMMON BENIGN TUMOR OF THE ESOPHAGUS IS: A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma 12. THE ESOPHAGUS MAY BE AFFECTED IN THE FOLLOWING CONDITIONS: A. Myasthenia gravis B. Pellagra C. Seleroderma D. Polyserositis E. Achlorhydria 13. AMONG MEDLASTINAL TUMORS, THE COMPLICATIONS OF MALIGNANT CHANGE AND DEVELOPMENT OF FISTULOUS COMMUNICATIONS ARE PARTICULARLY CHARACTERISTIC OF: A. Teratoid tumors B. Lymphomas C. Thymomas D. Myxomas E. Ganglioneuromas 14. PLEUROPERICARDIAL (SPRING WATER) CYSTS ARE MOST COMMONLY LOCATED: A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium

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15. Which of the following statements is TRUE regarding the pathology of lung cancer?

A. Squamous cell carcinoma occurs with equal frequency in smokers and nonsmokers.

B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands.

C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy.

D. Alveolar cell carcinoma has the least favorable prognosis.

E. Most cancers associated with pulmonary scars are squamous cell carcinomas 16. Which of the following statements is TRUE regarding the anatomy and pathophysiology of post-infarct left ventricular aneurysm?

A. The inner wall of the aneurysm retains its trabeculations.

B. Mural thrombus is uncommon.

C. Calcification may occur in the adherent pericardium.

D. Most posterior aneurysms are true aneurysms.

E. Most patients with left ventricular aneurysms have single vessel LAD disease.

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In the following questions, all of the statements are true except one. Identify the incorrect statement:

17. DURING EMBRYOLOGIC DEVELOPMENT OF THE HEART. A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

18. THE CAUSE OF DEATH IN PATIENTS WITH PATENT DUCTUS

ARTERIOSUS IS: A. Intractable congestive heart failure B. Subacute bacterial endocarditis C. Sudden late closure of the ductus D. Acute pulmonary edema . E. Pulmonary hypertension and cor- pulmonale

19. Which of the following statements is true regarding TOF morphology?

A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.

B. The bundle of His runs along the posteroinferior border of the VSD.

C. Additional VSDs are present in approximately 25% of patients.

D. The pulmonary valve is usually the narrowest part of the right ventricular outflow tract.

E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually normal in size.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW: A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

20. Underdevelopment of the main pulmonary artery is usually associated

with narrowing or stenosis of the outflow tract of the right ventricle BECAUSE both are derived from the conus.

21. The presence of a cervical rib does not produce symptoms in childhood

BECAUSE the rib is rudimentary at this age. 22. Patent ductus usually occurs as an isolated defect BECAUSE it does

not arise from the aortic arch system. E 23. Bronchial foreign bodies more frequently occur in children BECAUSE

the right main stem bronchus is relatively straighter than the left. 24. About 70% or more of the total vital capacity is expired within the first

second of expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

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ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

25. A MODERATOR BAND IS USUALLY FOUND IN THE: A. Left ventricle . B. Right ventricle

26. IN PATIENTS WITH ESOPHAGEAL ATRESIA:

A. In 90% of cases. the upper segment ends in a blind pouch and the distal part communicates directly with trachea B. Stenosis may develop after surgical correction

27. EUSTACHIAN VALVE:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

28. THE BUNDLE OF HIS PASSES CLOSER TO:

A. The right side of the interatrial septum B. The left side of the interatrial septum

29. THE SINUS VENOSUS FORMS:

A. The superior and inferior vena cava B. The right atrium

30. THE PARIETAL PLEURA:

A. Is very sensitive to pain B. Absorbs the pleural fluid

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 15/11/2005 Time allowed: 2 & half hours

ANATOMY

1. Cardiac conduction system.

2. Anatomy of the first rib.

PATHOLOGY

1. Give short account on apoptosis and necrosis.

2. Pathogenesis and pathology of Bronchiectasis.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo 18/11/2006 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

2. With hypovolemic shock, all the following are reduced except which one ?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

4. Paradoxical ( reversed) splitting of S2 is caused by all of the following except:

A. Left bundle branch block B. Aortic stenosis C. Atrial septal defect D. WPW syndrome with a right - sided accessory pathway

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5. Coarctation of the aorta may be associated with all of the following except:

A. Aneurysm of the circle of Willis B. Central cyanosis C. Hypertension D. Rib notching E. Bicuspid aortic valve

6. Surgical repair of pectus excavatum is characterized by except:

A. Internal metal support necessary B. Wedge osteotomy in upper sternum C. Division of costal cartilages D. Substernal or Pleural drainage desirable E. Reattachment of rectus abdominis muscles

7. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

8. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

9. In hypoplasia of the lung, the following are correct except:

A. The major abnormality is a decrease in the number of airway generations and pulmonary artery branchings

B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of

intrauterine growth D. Embryologic defects occur early and may be associated with other

syndromes E. If associated with diaphragmatic hernia, the hypoplastic lung should be

removed at surgery.

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10. During CPR all the following are true except: A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

11. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because

the risk thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as

coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient

to prevent stroke because the risk of thromboembolism is low 12. The following statements regarding cardioversion of atrial Fibrillation is

correct except:

A. The absence of thrombus on transthoracic echocardiogram allows Immediate, safe cardioversion

B. Patients who have had AF for less than 24 hours do not need anti –coagulation before cardioversion

C. Patients who have had AF for more than 48 hours should receive coumadin for 3 weeks before cardioversion

D. Maintenance of sinus rhythm with antiarrhythmic drugs does not obviate the need for coumadin therapy

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

13. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for a tumor located in the :

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

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14. The condition that is least likely to be associated with respiratory distress in the newborn is :

A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

15. Of the following, the lesion least likely to be associated with bacterial

endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

16. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

17. A right upper lobectomy with mediastinal L.N. dissection is done for lung

Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

18. The most sensitive index for assessing the presence of postoperative myocardial necrosis following coronary revascularization is:

A. The development of new Q waves on the electrocardiogram. B. The requirement for isotropic support in the perioperative period. C. Presence of new "hot-spot" images by technetium 99m pyrophosphate

myocardiall scintigraphy. D. Elevation in serum of MB-band creative phosphokinase. E. The development of complete left bundle branch block on the initial

postoperative electrocardiogram.

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19. Hepatojugular ( abdominojugular ) reflux is found in patients with:

A. Right ventricular infarction B. Superior vena cava syndrome C. Left ventricular failure with secondary pulmonary hypertension D. Tricuspid regurgitation

20. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

21. The combination of right heart failure, elevated venous pressure and a quiet

heart is known as:

A. Whipple's triad B. Saint's triad C. Beck's triad D. Murphy's sign E. None of the above

22. During shockable VF/ pulseless VT we give one shock of:

A. 150- 200 J biphasic or 360 J monophasic. B. 100 J biphasic or 360 J monophasic. C. 150- 360 J biphasic or 300 J monophasic. D. 150- 360 J biphasic or 260 J monophasic.

23. Systemic metabolic acidosis and increased mixed venous oxygen saturation are

characteristic of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

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24. Which of the following agents has the highest potential for supraventricular arrhythmia?

A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

25. Which of the following causes the greatest increase in cardiac index at equipotent doses?

A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

26. Which of the following statements is true regarding antiarrhythmic agents?

A. Digoxin decreases the automaticity of the His-Purkinje system. B. Esmolol can be used to treat tet spells in the immediate postop period. C. Lidocaine treats ventricular tachycardia by slowing AV conduction. D. Procan SR does not need to be adjusted in the setting of renal

insufficiency. E. Atropine is ineffective in treating bradycardia secondary to beta

blockade.

27. The most common valvular defect resulting from rheumatic fever is:

A. Mitral stenosis B. Mitral insufficiency C. Aortic stenosis D. Aortic insufficiency E. Pulmonary stenosis

28. Lasers:

A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours

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29. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

30. The sudden onset of persistent coughing, productive of copious amounts of thick

brownish fluid, occurring three months following resection of the right lung suggests:

A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Broncho-pleural fistula E. All of the above

31. When contemplating elective thoracotomy on a patient who has been on long-term corticosteroid therapy, it is best to :

A. Discontinue steroids for one month prior to operation B. Continue the same dosage schedule throughout hospitalization

C. Give increased amounts of steroids during and immediately after operation

D. Use ACTH postoperatively E. Give prophylactic isoniazid and PAS

32. The purpose of leaving a chest tube in place following pneumonectomy is to:

A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

33. One of the contra-indications to bronchoscopy is the presence of:

A. Endobronchial tuberculosis B. Active bleeding C. Aortic aneurysm D. Emphysema E. None of the above

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34. The most common toxic arrhythmia associated with digitalis overdosage is:

A. Atrial fibrillation B. Ventricular extrasystole C. Ventricular fibrillation D. Complete heart block E. None of the above

35. The indication for transvenous insertion of cardiac pacemaker:

A. Permanent heart block B. Intermittent symptomatic heart block C. Sinus bradycardia D. Post-surgical heart block E. All of the above

36. Mediastinal widening after chest trauma is a pathognomonic sign of:

A. Aortic injury B. Cardiac injury C. Pericardial effusion D. Perforated esophagus E. Bronchial tear

37. The entity termed "shock lung" is usually seen:

A. With multiple trauma B. With head injuries C. With hemorrhagic shock D. After Prolonged cardiopulmonary bypass E. All of the above

38. Patients with cardiac tamponade are best managed:

A. Expectantly B. By pericardiocentesis followed by definitive thoracotomy if necessary C. By pericardiocentesis only D. By open thoracotomy and cardiorrhaphy E. By thoracotomy, only if blood loss is excessive

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39. Repair of a traumatic diaphragmatic hernia:

A. Should be considered an emergency procedure B. Should be performed as soon as the patient is out of shock C. Is almost always indicated if the patient is clinically stable D. Usually requires.a thoraco-abdominal approach E. All of the above

40. Following sudden deceleration, the most common site of aortic injury is:

A. Just distal to the origin of the left subclavian artery B. The dome of the aortic arch C. A point close to the annulus of the aortic valve D. Adjacent to the carotid artery E. Distal thoracic aorta

41. Acute mediastinitis is most often due to:

A. Rupture of a mediastinal cyst B. Acute inflammatory processes originating in the lungs C. Perforation of the esophagus D. Blood-borne infections E. Tuberculosis

42. The characteristic physical signs of mediastinal emphysema are:

A. Subcutaneous emphysema B. Hamman's murmur C. Decreased heart sounds D. Crepitation E. All of the above .

43. Pain in the shoulder and arm combined with horner's syndrome on the same side suggests the presence of:

A. A ganglioneuroma B. Aortic aneurysm C. Shoulder girdle syndrome D. Tumor (Pancoast) E. None of the above

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44. The term "empyema necessitans" refers to

A. A fulminating pleural infection B. Mediastinal extension of an empyema C. Metastatic foci of infection D. Secondary involvement and fistulaion through the chest wall E. Tuberculous empyema

45. Bochdaleck hernia should be treated by:

A. Immediate operation, unless there is a history of respiratory distress B. Emergency operation via thoraco abdominal approach C. Conservative measures until age six months D. Conservative measures as long as the patient is doing well E. Operation or medical management, depending on symptoms

TRUE OR FALSE : More than one answer. For the next 3 questions , determine whether each choice is true ( T ) or false ( F ): 46. Which statements are correct about CABG :

A. CABG prolongs survival in patients with greater than 70% left main stenosis, independent of anginal symptoms

B. CABG prolongs survival in patients with three – vessel disease and left ventricular systolic dysfunction

C. Diabetic patients with multivessel coronary artery disease have a better prognosis with multivessel angioplasty than with CABG

D. Women have lower perioperative mortality than men E. Internal mammary grafts remain patent longer than saphenous vein grafts

47. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected

secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is

due to shunt flow across the atrial septum

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48. Which of the following statements correctly characterize major determinants of cardiac performance ?

A. Stroke volume increases with increasing afterload B. Ventricular preload describes the load against which the ventricle must

contract when it eject blood C. In normal hearts, ventricular inotropic state increases with increasing

heart rate because of changes in calcium availability D. Hypoxia , ischemia, and acidosis decrease cardiac contractility E. In failing hearts, right atrial pressure as assessed from the

jugular venous pulse is a good indicator of left ventricular filling pressure MATCHING : For The Next 2 Questions, Choose For Each Numbered Item, The Most Likely Associated Lettered Item From Those Provided. Each Item Has Only One Answer 49. Match the following palliative surgical shunts with their anatomic

anastomoses :

A. Superior vena cava to right pulmonary artery B. Subclavian artery to pulmonary artery C. Ascending aorta to right pulmonary artery D. Ascending aorta to main pulmonary artery E. Descending aorta to left pulmonary artery

1. Classic Blalock – Taussig shunt 2. Pott’s anastmosis 3. Classic Glenn shunt 4. Waterston shunt 5. Davidson shunt

50. Select from the list below the cardiac events that correspond most closely to the components of the jugular venous waveform :

A. Opening of the tricuspid valve and right ventricular relaxation B. Right atrial relaxation C. Pulmonary valve opening D. Right atrial contraction E. Passive right atrial filling with a competent tricuspid valve

1. X-descent 2. V-wave 3. A-wave 4. Y-descent

GOOD LUCK

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AIN SHAMS UNIVERSITY MD Cardiothoracic Surgery Faculty of medicine Paper I Cairo 18/11/2006 Time allowed: 2 hours Give a short account on the following questions: 1. The new major changes in the guidelines for CPR in both

adults and children.

2. Shock after acute myocardial infarction.

3. Current indications for pulmonary artery banding.

4. Alternative sites for arterial cannulation.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQCairo 19/11/2006 Time allowed: 60 minutes

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

1. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates

B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation

C. A successful outcome requires the production of complete and transmural lines of conduction block

D. Newer methods of producing lines of block such as cryoablation have been as effective as the traditional "cut and sew" method

E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

2. Which of the following is true regarding the etiology of lung abscess ?

A. Hematologic seeding is the common mechanism for infection B. The posterior segment of the upper lobe and superior segment of the lower lobe on the

right side are most commonly involved C. Periodic episodes of hemoptysis and foul sputum are uncommon D. Staph Species are the predominant organism

3. Which of the following statements is true regarding myxoma morphology?

A. These tumors are most commonly found in the right atrium B. Myxomas have a characteristically firm texture and rarely embolize C. They arise from multipotential mesenchymal cells D. Myxomas usually are attached to the free atrial or ventricular wall E. There is no malignant potential

4. Which of the following statements is true regarding the natural history of CAD?

A. Distal LAD lesions do not result in poorer survival compared to proximal lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect

outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 3-vessel disease have equivalent survival at 5 years

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5. Which of the following statements is true regarding results after resection of pulmonary

metastases ?

A. Partial resection of extensive pulmonary metastatic disease can improve survival B. Disease –free interval has not been shown to have prognostic value for survival C. Patients with a greater number of metastatic nodules have poorer survival D. CEA levels do not affect 5-year survival after resection of metastatic colon carcinoma E. Metastatic head and neck cancers have poor outcome after pulmonary resection

6. Which of the following statements is true regarding operative management of congenital

sinus of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

7. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal

sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are

electrically isolated from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather

than an empiric anatomic one

8. Which of the following statements is true regarding congenital diaphragmatic hernias?

A. Bochdalek's hernia is more common in the posterior costal portion on the right side. B. Obstruction and strangulation are the typical presentation of an acute Bochdalek's

hernia. C. Most mortality for infants with Bochdalek's hernia can be attributed to increased

pulmonary vascular resistance. D. The stomach is the most common organ to be found in a Morgagni's hernia. E. Morgagni's hernia is best repaired through a right thoracotomy.

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9. Which of the following statements is true regarding the operative management of lung cancer?

A. A bloody pleural effusion is not a contraindication to surgery for peripherally located carcinomas.

B. Preoperative CT scanning can accurately predict the number of tumor nodules. C. Wedge resection is adequate therapy for most peripherally located carcinomas. D. Advanced age is no longer considered a risk factor for surgical treatment of lung

cancer. E. Only 25% of all patients with lung cancer will be operative candidates.

10. Which of the following is true for operations for congenital subvalvular aortic stenosis?

A. Resection of muscle below the right coronary cusp should be avoided. B. The Konno procedure is preferred in the sitting of a normal valve and annulus. C. Early mortality is equivalent for the localized and the diffuse forms. D. Late death is usually secondary to bacterial endocarditis. E. The discrete form is associated with increased early and late risk for death.

11. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome?

A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction.

B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than

thoracic outlet syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery

stenosis.

12. Which of the following statements is true regarding the clinical manifestations of pectus excavatum?

A. Most infants and children are symptomatic. B. Mitral valve prolapse is uncommonly associated with this disorder. C. Operative repair does not improve cardiac index at rest or during exercise. D. Asthma and recurrent pulmonary infections are uncommon. E. Pulmonary function tests can document obstructive pulmonary findings.

13. The following features are true for a tension pneumothorax:

A. Tracheal deviation towards the affected side B. Increased chest movement on the affected side C. Increased resonance of affected side D. Cardiac arrest E. Surgical emphysema

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14. Which of the following statements is true regarding operative management of post-infarct LV aneurysm?

A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot

formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

15. Which of the following statements is true regarding chest wall tumors?

A. Incisional biopsy will reliably diagnose most primary tumors. B. A 2-cm margin is adequately wide for resection of a chest wall tumor. C. Posterior chest wall defects greater than 5 cm should be reconstructed using prosthetic

material. D. Overall 5-year survival for resection of primary chest wall tumors is about 50%. E. Recurrent tumors can be excised with good long-term results.

16. Which of the following statements is true regarding neurogenic tumors of mediastinum?

A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial

presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

17. Which of the following statements concerning aneurysms of the thoracic aorta is true?

A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are predominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not

undergo operation.

18. Which of the following statements is true regarding thymomas and germ cell tumors?

A. Over 50% of myasthenia gravis patients will have a thymoma. B. The presence of myasthenia gravis is a risk factor for poor outcome. C. Blind biopsy or orchiectomy should be performed in patients with mediastinal germ

cell tumors. D. Cytoreductive resection should be performed prior to radiation therapy if a seminoma

is involving vital structures. E. Over 90% of nonseminomas will produce either AFP or B-HCG.

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 19. Concerning tumors of the chest wall, all are correct except:

A. Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs.

B. The most common primary malignant tumor is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated.

20. The following criteria are correct for achalasia except:

A. Dysphagia B. Retention of ingested food in the esophagus. C. Radiologic evidence of dilated body of the esophagus. D. Vigorous peristalsis by manometry and cineradiography. E. Carcinoma in association achalasia is uncommon

21. The Choussat-Fontan criteria for appropriateness of an atriopulmonary

anastomosis include all of the following except:

A. Pulmonary artery pressure less than 15 mmHg. B. Pulmonary vascular resistance less than 4 units/M2 body surface area. C. Age less than 3 years. D. Ventricular ejection fraction 0.45 or greater. E. Normal sinus rhythm.

22. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

23. Esophageal dilatation for the treatment of achalasia is characterized by except:

A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

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24. Zenker's diverticula is characterized by except:

A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E. Causes dysphagia with liquids

25. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

Choose The Single Best Answer To The Following : 26. The treatment for the relief of increasing spontaneous mediastinal emphysema is:

A. Thoracotomy B. Suprasternal decompression C. Subxiphoid decompression D. Needling the mediastinum E. None of the above

27. The first sign of Horner's syndrome is usually:

A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above

28. When treating a child born with esophageal atresia and imperforate anus, it is

advisable to:

A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable

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29. The most common site of spontaneous esophageal perforation (Boerhaave's

syndrome) is:

A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above

30. Of the following, the condition most frequently associated with congenital

esophageal atresia is:

A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract

31. If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has:

A. A truncus arteriosus B. A pulmonary A-V fistula C. Aorto-pulmonary window D. A coarctation of the aorta E. A coronary-ventricular fistula

32. Immediately following repair of an interventricular septal defect, complete heart block

is noted, although ventricular rate is satisfactory. In this circumstance, one should

A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing

33. A Taussig-Bing malformation is best treated by:

A. Diversion of the septal defect only B. Detachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle

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34. In an adult patient, the repair of coarctation requires some form of aortic replacement if:

A. The anastmosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above

35. The most common findings associated with congenital tricuspid atresia are:

A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis

36. The most common anatomic variation of coronary artery fistula connects:

A. Right coronary artery to right atrium B. Right coronary artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle

37. Of the following, the lesion least likely to be associated with bacterial endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

38. Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total

anomalous pulmonary venous drainage are all characterized by:

A. Inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above

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Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 39. Pain associated with ingestion of food during childhood is commonly associated

with the presence of:

A. Achalasia of the esophagus B. Congenital esophageal diverticulum

40. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

41. Treatment of lyme burns of the esophagus during the acute phase: A. Corticosteroids B. Esophagoscopy

42. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

Determine Whether Each Choice Is True Or False. Any Combination Of Answers May Occur.

A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

43. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

44. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

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45. According to the TMN principles for staging lung cancers, which of the bronchogenic carcinomas described below is or are considered to be Stage I ?

A. Large cell carcinoma 4 cm in diameter without lymph node metastases. B. Poorly differentiated adenocarcinoma without metastases to lymph nodes. C. Squamous cell carcinoma with atelectasis and extension to visceral pleura without

lymph node metastases or pleural effusion. D. Alveolar cell carcinoma without metastases to the lymph nodes.

46. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve

replacement include(s):

A. Much greater resistance to infection. B. Satisfactory long-term durability in adolescents. C. Good hemodynamic performance in the 17 mm and 19 mm sizes relative to tilting disc

valves. D. Low thromboembolic risk without systemic anticoagulation.

47. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for

CABG include(s):

A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once: 48. A. Ostium secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect 1. Heart block and arrhythmia common 2. Absent superior rim 3. Most commonly encountered 4. Cyanosis in absence of failure

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49. A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage 1. Abnormal coronary sinus 2. Complete repair least likely 3. Persistent left anterior cardinal vein 4. Persistent ductus venosus 50. A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis 1. Parachute valve 2. Syncope 3. Waterston shunt 4. Brock procedure

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II Cairo 19/11/2006 Time allowed: 2 hours Give short account on the following:

1. The new practice guidelines for the management of patients with mitral valve disease.

2. Evolution of surgery for total right heart bypass (Fontan’s operation).

3. Diagnosis and management of acute pulmonary embolism. 4. Esophageal perforation.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 20/11/2006 Time allowed: 1 and half hours

COMMENTARY For Each Of The Following Multiple-Choice Questions, Select The One Most Appropriate Answer, Based On The History Given Below & Comment on the Choice:

The patient is a 52-year-old male with far-advanced bilateral active tuberculosis. He has large cavities in the right upper lobe. Sputum has remained positive, despite six months of therapy with isoniazid and streptomycin. There has been some decrease in the extent of strings, and nodular infiltrates in the left upper lobe. 1. The most likely source of viable bacilli is:

A. Left upper lobe B. Right upper lobe C. Endobronchial disease D. Both upper lobes E. Both lungs

2. In this case, one would most probably recommend:

A. Collapse therapy on the right side B. Collapse therapy on the left side C. Resectional therapy on the right side D. Resectional therapy on the left side E. Resection of left upper lobe; collapse of right upper lobe

3. An additional antimicrobial agent has been added) to the therapeutic regimen.

one should then proceed with operation: A. Immediately B. In about three weeks C. In about three months D. If no change in sputum occurs after six months E. Only if the patient converts to sputum-negative

4. If the proposed operative procedure proves successful, one would anticipate: A. Almost immediate conversion to sputum-negative B. Conversion to sputum-negative within three to six months C. Performing additional surgery at a later date D. Discontinuing chemotherapy after three months E. Complete eradication of all disease

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper IV MCQ (ANA. & PATH.) Cairo 21/11/2006 Time allowed: 60 minutes

ANATOMY & EMBRYOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer: 1. Which of the following is TRUE regarding the diaphragmatic development?

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

2. Which of the following is TRUE regarding the blood supply to the visceral

pleura?

A. Pulmonary artery B. The bronchial vessels C. The intercostal vessels D. The internal mammary arteries E. None of the above

3. Which of the following statements about diaphragmatic anatomy is TRUE?

A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the

cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise

from the lumbar vertebrae

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4. Which of the following statements is TRUE regarding anatomy of the thoracic outlet ?

A. The distal section of the cervicoaxillary canal is the more critical for

compression syndromes B. The brachial plexus and subclavian artery are located in the anteromedial

compartment of the costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus medius, and

first rib D. Inspiration tilts the coracoid process inferiorly , placing tension on the

neurovascular bundle E. Bony abnormalities are present in the majority of patients

5. Which of the following is TRUE regarding the level of the narrowest part of the

esophagus ?

A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

6. Which of the following is TRUE regarding the usual drainage of persistent left

superior vena cava ?

A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava

7. Which of the following is TRUE regarding the azygos vein?

A. Receives venous blood from the middle one-third of the oesophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

8. Which of the following statements is TRUE regarding the lining of the normal

bronchial mucosa ?

A. Simulated pseudostratified epithelium B. Goblet cells C. Basal cells D. Adeno-cystic cells which constitute the germinal layer

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9. Which of the following statements is TRUE regarding the atrio-ventricular

(AV) node ?

A. Receives nerves from the right vagus B. Its arterial supply is from the right coronary artery C. Is located near the entrance of the superior vena cava D. Is located near the coronary sinus

10. Which of the following statements is TRUE regarding the inferior vena cava?

A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins

11. Which of the following statements is TRUE regarding the abdominal aorta?

A. Passes behind the medial arcuate ligament of the diaphragm at the level of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior

mesenteric artery 12. Which of the following statements is TRUE regarding in the root of the neck?

A. Scalenus anterior arises from the anterior tubercles of the typical cervical vertebrae

B. The supreme intercostals vein lies lateral to the first thoracic nerve on the neck of the first rib

C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct

13. Which of the following statements is TRUE regarding the subclavian artery?

A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from branches

of the thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath

derived from the prevertebral fascia E. Becomes the axillary artery at the upper border of teres major

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14. Which of the following statements is TRUE regarding the thoracic duct?

A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

15. During embryologic development of the heart, the following occur except:

A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

16. The diaphragm

A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front of the

esophagus D. Diaphragm projects higher Into the chest on the right than on the left E. Lies entirely above the tenth rib.

ANSWER THE FOLLOWING 2 QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

17. Patent ductus usually occurs as an isolated defect BECAUSE it does not arise from

the aortic arch system. 18. About 70% or more of the total vital capacity is expired within the first second of

expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

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ANSWER THE FOLLOWING 5 QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

19. A moderator band is usually found in the:

A. Left ventricle . B. Right ventricle

20. Eustachian valve:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

21. The bundle of his passes closer to:

A. The right side of the interatrial septum B. The left side of the interatrial septum

22. The sinus venosus forms:

A. The superior and inferior vena cava B. The right atrium

23. The parietal pleura:

A. Is very sensitive to pain B. Absorbs the pleural fluid

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once:

24. A. Anterior mediastinum

B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia

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25. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

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PATHOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

26. Which of the following is TRUE regarding the essential factor in the

pathogenesis of aortic aneurysms is damage ?

A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis

27. Which of the following is TRUE regarding the causes of hilar enlargement ?

A. Sarcoidosis B. Lymphoma C. Hypertension D. Tuberculosis E. Caplan's syndrome

28. Which of the following is TRUE regarding, the most common benign tumor of

the esophagus ?

A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma

29. Pleuropericardial (spring water) cysts are most commonly located:

A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium

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30. Which of the following statements is TRUE regarding the pathology of lung cancer?

A. Squamous cell carcinoma occurs with equal frequency in smokers and

nonsmokers. B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands. C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy. D. Alveolar cell carcinoma has the least favorable prognosis. E. E. Most cancers associated with pulmonary scars are squamous cell

carcinomas 31. Which of the following statements is TRUE regarding the anatomy and

pathophysiology of post-infarct left ventricular aneurysm?

A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

32. Which of the following statements is TRUE regarding cervical rib?

A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

33. Which of the following statements is TRUE regarding gastro-oesophageal reflux?

A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic than

symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's

oesophagus E. Initial management may include increasing the number of meals eaten per day

34. Which of the following statements is TRUE regarding achalasia?

A. The cause is hypertrophy of the gastro-esophageal sphincter B. Dysphagia is mainly for solids C. Incidence is higher in males than females D. Manometry shows reduced pressure within the lower oesophagus E. Initial treatment is with H2 antagonists

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35. Which of the following statements is true regarding TOF morphology?

A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.

B. The bundle of His runs along the posteroinferior border of the VSD. C. Additional VSDs are present in approximately 25% of patients. D. The pulmonary valve is usually the narrowest part of the right ventricular

outflow tract. E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually

normal in size.

36. Which of the following statements is true regarding hernias through the foramen of bockdalek?

A. Usually have a true sac B. Present anteriorly C. May be caused by a short esophagus D. Pass through the pleuroperitoneal canal E. Are associated with eventration of the diaphragm

37. Which of the following statements is true regarding the Kartagener’s

syndrome?

A. Situs inversus, bronchicetasis and pansinusitis B. Situs inversus of the lungs with levocardia

C. Splenic agenesis syndrome with levocardia

D. Anomalous right pulmonary artery and bilobation of the lungs E. None of the above

38. Which of the following statements is true regarding lung cancer?

A. Of the alveolar cell type is not typically associated with smoking B. Of the large cell type characteristically metastasizes early C. May present with the myasthenic syndrome D. Of the small cell type has the best 5-year survival of all types of lung cancer

when treated by excision E. May present with hypernatraemia due to hormone secretion by the tumour

39. Which of the following statements is true regarding thrombosis?

A. In the axillary vein is commoner on the right side B. In the superior vena cava may cause tinnitus C. In the venous system usually consists of fibrin and platelets D. In a proximal leg vein may be an indication for an inferior vena cava filter if the

patient also has a peptic ulcer E. Prophylaxis of DVT can be achieved by intravenous dextran

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40. Which of the following statements is true regarding carotid artery disease?

A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid plaque

that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischaemic attack commonly

includes CT scan of the brain E. Surgery has been shown to be better than medical therapy in the management of

asymptomatic patients with stenoses greater than 70%

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

41. Esophageal hiatus hernia in infants:

A. May be an important cause of vomiting B. Is often associated with constipation C. Can be demonstrated during the first week of life D. May be associated with pyloric stenosis E. Is frequently accompanied by gastrointestinal bleeding

42. Bronchogenic cysts:

A. Are lined by pseudostratified columnar epithelium B. Usually appear as air-filled cavities C. Do not cause hemoptysis D. Frequently become infected E. Mostly occur close to the hilum

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

43. Underdevelopment of the main pulmonary artery is usually associated with

narrowing or stenosis of the outflow tract of the right ventricle BECAUSE both are derived from the conus.

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44. The presence of a cervical rib does not produce symptoms in childhood BECAUSE

the rib is rudimentary at this age. 45. Bronchial foreign bodies more frequently occur in children BECAUSE the right

main stem bronchus is relatively straighter than the left. 46. Positive sputum cultures for Aspergillus must be interpreted with caution BECAUSE

the organism is often present in sputum as a harmless saprophyte. 47. Tumourlets are epithelial proliferations which are usually associated with

bronchiectatic lobes BECAUSE these microscopic lesions are never found in the absence of damage to the lungs.

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

48. Blood supply of tuberculous lesions

A. Pulmonary arteries B. Brochial arteries

49. Benign pulmonary tumors:

A. Tumourlets B. Hamartomas

50. Development of lung abscess in:

A. Alveolar cysts B. Bronchogenic cysts

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 21/11/2006 Time allowed: 2 Hours

ANATOMY

1. Fibrous skeleton of the heart.

2. Surgical anatomy of the trachea .

PATHOLOGY

1. Give short account on types and staging of bronchogenic carcinoma.

2. Pathology of graft rejection.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo 12/05/2007 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

2. With hypovolemic shock, all the following are reduced except which one?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Paradoxical ( reversed) splitting of S2 is caused by all of the following except:

A. Left bundle branch block B. Aortic stenosis C. Atrial septal defect D. WPW syndrome with a right - sided accessory pathway

4. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

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5. In hypoplasia of the lung, the following are correct except:

A. The major abnormality is a decrease in the number of airway generations and pulmonary artery branchings

B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of

intrauterine growth D. Embryologic defects occur early and may be associated with other

syndromes E. If associated with diaphragmatic hernia, the hypoplastic lung should be

removed at surgery.

6. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

7. During CPR all the following are true except:

A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

8. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because

the risk thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as

coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient

to prevent stroke because the risk of thromboembolism is low

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9. The following statements regarding cardioversion of atrial Fibrillation is correct except:

A. The absence of thrombus on transthoracic echocardiogram allows Immediate, safe cardioversion

B. Patients who have had AF for less than 24 hours do not need anti –coagulation before cardioversion

C. Patients who have had AF for more than 48 hours should receive coumadin for 3 weeks before cardioversion

D. Maintenance of sinus rhythm with antiarrhythmic drugs does not obviate the need for coumadin therapy

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

10. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for a tumor located in the:

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

11. The condition that is least likely to be associated with respiratory distress in the newborn is :

A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

12. Of the following, the lesion least likely to be associated with bacterial

endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

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13. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

14. A right upper lobectomy with mediastinal L.N. dissection is done for lung

Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

15. The most sensitive index for assessing the presence of postoperative myocardial necrosis following coronary revascularization is:

A. The development of new Q waves on the electrocardiogram. B. The requirement for isotropic support in the perioperative period. C. Presence of new "hot-spot" images by technetium 99m pyrophosphate

myocardiall scintigraphy. D. Elevation in serum of MB-band creative phosphokinase. E. The development of complete left bundle branch block on the initial

postoperative electrocardiogram.

16. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

17. The utilization of blood versus crystalloid potassium cardioplegic solutions

differs in which of the following ways? A. The volume and frequency of and pressure at which the cardioplegic

solution is delivered

B. Superiority of a specific potassium ion concentration C. Alleged superiority of a blood vehicle because the heart is arrested in an

oxygenated environment D. Necessity for adjuvant use of calcium channel block- ing agents E. None of the above

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18. During shockable VF/ pulseless VT we give one shock of:

A. 150- 200 J biphasic or 360 J monophasic. B. 100 J biphasic or 360 J monophasic. C. 150- 360 J biphasic or 300 J monophasic. D. 150- 360 J biphasic or 260 J monophasic.

19. Systemic metabolic acidosis and increased mixed venous oxygen saturation are

characteristic of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

20. Which of the following agents has the highest potential for supraventricular arrhythmia?

A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

21. Which of the following causes the greatest increase in cardiac index at equipotent doses?

A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

22. Which of the following statements is true regarding antiarrhythmic agents?

A. Digoxin decreases the automaticity of the His-Purkinje system. B. Esmolol can be used to treat tet spells in the immediate postop period. C. Lidocaine treats ventricular tachycardia by slowing AV conduction. D. Procan SR does not need to be adjusted in the setting of renal

insufficiency. E. Atropine is ineffective in treating bradycardia secondary to beta

blockade.

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23. The most common valvular defect resulting from rheumatic fever is:

A. Mitral stenosis B. Mitral insufficiency C. Aortic stenosis D. Aortic insufficiency E. Pulmonary stenosis

24. Lasers:

A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours

25. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

26. The sudden onset of persistent coughing, productive of copious amounts of thick

brownish fluid, occurring three months following resection of the right lung suggests:

A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Broncho-pleural fistula E. All of the above

27. When contemplating elective thoracotomy on a patient who has been on long-term corticosteroid therapy, it is best to :

A. Discontinue steroids for one month prior to operation B. Continue the same dosage schedule throughout hospitalization

C. Give increased amounts of steroids during and immediately after operation

D. Use ACTH postoperatively E. Give prophylactic isoniazid and PAS

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28. The purpose of leaving a chest tube in place following pneumonectomy is to:

A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

29. One of the contra-indications to bronchoscopy is the presence of:

A. Endobronchial tuberculosis B. Active bleeding C. Aortic aneurysm D. Emphysema E. None of the above

30. The indication for transvenous insertion of cardiac pacemaker:

A. Permanent heart block B. Intermittent symptomatic heart block C. Sinus bradycardia D. Post-surgical heart block E. All of the above

31. Mediastinal widening after chest trauma is a pathognomonic sign of:

A. Aortic injury B. Cardiac injury C. Pericardial effusion D. Perforated esophagus E. Bronchial tear

32. The entity termed "shock lung" is usually seen:

A. With multiple trauma B. With head injuries C. With hemorrhagic shock D. After Prolonged cardiopulmonary bypass E. All of the above

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33. Patients with cardiac tamponade are best managed:

A. Expectantly B. By pericardiocentesis followed by definitive thoracotomy if necessary C. By pericardiocentesis only D. By open thoracotomy and cardiorrhaphy E. By thoracotomy, only if blood loss is excessive

34. Repair of a traumatic diaphragmatic hernia:

A. Should be considered an emergency procedure B. Should be performed as soon as the patient is out of shock C. Is almost always indicated if the patient is clinically stable D. Usually requires.a thoraco-abdominal approach E. All of the above

35. Following sudden deceleration, the most common site of aortic injury is:

A. Just distal to the origin of the left subclavian artery B. The dome of the aortic arch C. A point close to the annulus of the aortic valve D. Adjacent to the carotid artery E. Distal thoracic aorta

36. Acute mediastinitis is most often due to:

A. Rupture of a mediastinal cyst B. Acute inflammatory processes originating in the lungs C. Perforation of the esophagus D. Blood-borne infections E. Tuberculosis

37. Pain in the shoulder and arm combined with horner's syndrome on the same

side suggests the presence of:

A. A ganglioneuroma B. Aortic aneurysm C. Shoulder girdle syndrome D. Tumor (Pancoast) E. None of the above

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38. The term "empyema necessitans" refers to

A. A fulminating pleural infection B. Mediastinal extension of an empyema C. Metastatic foci of infection D. Secondary involvement and fistulaion through the chest wall E. Tuberculous empyema

TRUE OR FALSE : More than one answer. For the next 3 questions , determine whether each choice is true ( T ) or false ( F ): 39. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected

secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is

due to shunt flow across the atrial septum

40. Optimal myocardial protection afforded by hypothermic potassium cardioplegia is achieved when:

A. The myocardial temperature is kept to less than20C.

B. The potassium concentration of the cardioplegic solution is greater than 46 mEq per liter.

C. There is absence of electrocardiographic activity throughout the aortic cross-clamp period.

D. Steroids are added as adjuvants for membrane stabilization.

41. Intraoperative myocardial protection utilizing intermittent hypothermic

potassium cardioplegia has been shown to be efficacious in: A. Preserving myocardial high-energy phosphate compounds during

ischemic periods of 60 minutes.

B. Preserving preoperative left ventricular ejection fraction when measured one week following coronary revascularization.

C. Decreasing the incidence of perioperative infarction following coronary revascularization.

D. Decreasing the incidence of postoperative supaventricular arrhythmias.

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MATCHING: For The Next 2 Questions, The Two Lettered Headings Are Followed By A List Of Numbered Items. Answer By Using The Key Outlined Below: A. If the item is associated with A only B. If the item is associated with B only C. If the item is associated with both A and B D. If the item is associated with neither A nor

A. Heart as a pump B. Heart as a muscle

42. Starling's law 43. Maximal velocity of contraction 44. Ventricular volume 45. Adrenalin

A. Cardiac dilatation B. Cardiac hypertrophy

46. Best determined by X-ray examination 47. Best determined by electrocardiography 48. More characteristic of increased volume loads 49. More characteristic of increased resistance to outflow 50. Elevated end-diastolic pressure

GOOD LUCK

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AIN SHAMS UNIVERSITY MD Cardiothoracic Surgery Faculty of medicine Paper I Cairo 18/11/2006 Time allowed: 2 hours Give a short account on the following questions: 1. The new major changes in the guidelines for CPR in both

adults and children.

2. Shock after acute myocardial infarction.

3. Current indications for pulmonary artery banding.

4. Alternative sites for arterial cannulation.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQCairo 13/05/2007 Time allowed: 60 minutes

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

1. Which of the following statements is true regarding myxoma morphology?

A. These tumors are most commonly found in the right atrium B. Myxomas have a characteristically firm texture and rarely embolize C. They arise from multipotential mesenchymal cells D. Myxomas usually are attached to the free atrial or ventricular wall E. There is no malignant potential

2. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates

B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation

C. A successful outcome requires the production of complete and transmural lines of conduction block

D. Newer methods of producing lines of block such as cryoablation have been as effective as the traditional "cut and sew" method

E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

3. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal

sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are

electrically isolated from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather

than an empiric anatomic one

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4. Which of the following statements is true regarding the natural history of CAD?

A. Distal LAD lesions do not result in poorer survival compared to proximal lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect

outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 3-vessel disease have equivalent survival at 5 years

5. Which of the following is true regarding the etiology of lung abscess ?

A. Hematologic seeding is the common mechanism for infection B. The posterior segment of the upper lobe and superior segment of the lower lobe on the

right side are most commonly involved C. Periodic episodes of hemoptysis and foul sputum are uncommon D. Staph Species are the predominant organism

6. Which of the following statements is true regarding results after resection of pulmonary

metastases ?

A. Partial resection of extensive pulmonary metastatic disease can improve survival B. Disease –free interval has not been shown to have prognostic value for survival C. Patients with a greater number of metastatic nodules have poorer survival D. CEA levels do not affect 5-year survival after resection of metastatic colon carcinoma E. Metastatic head and neck cancers have poor outcome after pulmonary resection

7. Which of the following statements is true regarding operative management of congenital

sinus of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

8. Which of the following statements is true regarding congenital diaphragmatic hernias?

A. Bochdalek's hernia is more common in the posterior costal portion on the right side. B. Obstruction and strangulation are the typical presentation of an acute Bochdalek's

hernia. C. Most mortality for infants with Bochdalek's hernia can be attributed to increased

pulmonary vascular resistance. D. The stomach is the most common organ to be found in a Morgagni's hernia. E. Morgagni's hernia is best repaired through a right thoracotomy.

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9. Which of the following statements is true regarding the operative management of lung cancer?

A. A bloody pleural effusion is not a contraindication to surgery for peripherally located carcinomas.

B. Preoperative CT scanning can accurately predict the number of tumor nodules. C. Wedge resection is adequate therapy for most peripherally located carcinomas. D. Advanced age is no longer considered a risk factor for surgical treatment of lung

cancer. E. Only 25% of all patients with lung cancer will be operative candidates.

10. Which of the following is true for operations for congenital subvalvular aortic stenosis?

A. Resection of muscle below the right coronary cusp should be avoided. B. The Konno procedure is preferred in the sitting of a normal valve and annulus. C. Early mortality is equivalent for the localized and the diffuse forms. D. Late death is usually secondary to bacterial endocarditis. E. The discrete form is associated with increased early and late risk for death.

11. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome?

A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction.

B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than

thoracic outlet syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery

stenosis.

12. Which of the following statements is true regarding the clinical manifestations of pectus excavatum?

A. Most infants and children are symptomatic. B. Mitral valve prolapse is uncommonly associated with this disorder. C. Operative repair does not improve cardiac index at rest or during exercise. D. Asthma and recurrent pulmonary infections are uncommon. E. Pulmonary function tests can document obstructive pulmonary findings.

13. The following features are true for a tension pneumothorax:

A. Tracheal deviation towards the affected side B. Increased chest movement on the affected side C. Increased resonance of affected side D. Cardiac arrest E. Surgical emphysema

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14. Which of the following statements is true regarding operative management of post-infarct LV aneurysm?

A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot

formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

15. Which of the following statements is true regarding chest wall tumors?

A. Incisional biopsy will reliably diagnose most primary tumors. B. A 2-cm margin is adequately wide for resection of a chest wall tumor. C. Posterior chest wall defects greater than 5 cm should be reconstructed using prosthetic

material. D. Overall 5-year survival for resection of primary chest wall tumors is about 50%. E. Recurrent tumors can be excised with good long-term results.

16. Which of the following statements is true regarding neurogenic tumors of mediastinum?

A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial

presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

17. Which of the following statements concerning aneurysms of the thoracic aorta is true?

A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are predominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not

undergo operation.

18. Which of the following statements is true regarding thymomas and germ cell tumors?

A. Over 50% of myasthenia gravis patients will have a thymoma. B. The presence of myasthenia gravis is a risk factor for poor outcome. C. Blind biopsy or orchiectomy should be performed in patients with mediastinal germ

cell tumors. D. Cytoreductive resection should be performed prior to radiation therapy if a seminoma

is involving vital structures. E. Over 90% of nonseminomas will produce either AFP or B-HCG.

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 19. Concerning tumors of the chest wall, all are correct except:

A. Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs.

B. The most common primary malignant tumor is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated.

20. The following criteria are correct for achalasia except:

A. Dysphagia B. Retention of ingested food in the esophagus. C. Radiologic evidence of dilated body of the esophagus. D. Vigorous peristalsis by manometry and cineradiography. E. Carcinoma in association achalasia is uncommon

21. The Choussat-Fontan criteria for appropriateness of an atriopulmonary

anastomosis include all of the following except:

A. Pulmonary artery pressure less than 15 mmHg. B. Pulmonary vascular resistance less than 4 units/M2 body surface area. C. Age less than 3 years. D. Ventricular ejection fraction 0.45 or greater. E. Normal sinus rhythm.

22. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

23. Esophageal dilatation for the treatment of achalasia is characterized by except:

A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

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24. Zenker's diverticula is characterized by except:

A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E. Causes dysphagia with liquids

25. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

Choose The Single Best Answer To The Following : 26. The treatment for the relief of increasing spontaneous mediastinal emphysema is:

A. Thoracotomy B. Suprasternal decompression C. Subxiphoid decompression D. Needling the mediastinum E. None of the above

27. The first sign of Horner's syndrome is usually:

A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above

28. When treating a child born with esophageal atresia and imperforate anus, it is

advisable to:

A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable

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29. The most common site of spontaneous esophageal perforation (Boerhaave's syndrome) is:

A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above

30. Of the following, the condition most frequently associated with congenital

esophageal atresia is:

A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract

31. If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has:

A. A truncus arteriosus B. A pulmonary A-V fistula C. Aorto-pulmonary window D. A coarctation of the aorta E. A coronary-ventricular fistula

32. Immediately following repair of an interventricular septal defect, complete heart block

is noted, although ventricular rate is satisfactory. In this circumstance, one should

A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing

33. A Taussig-Bing malformation is best treated by:

A. Diversion of the septal defect only B. Detachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle

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34. In an adult patient, the repair of coarctation requires some form of aortic replacement if:

A. The anastmosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above

35. The most common findings associated with congenital tricuspid atresia are:

A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis

36. The most common anatomic variation of coronary artery fistula connects:

A. Right coronary artery to right atrium B. Right coronary artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle

37. Of the following, the lesion least likely to be associated with bacterial endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

38. Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total

anomalous pulmonary venous drainage are all characterized by:

A. Inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above

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Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 39. Treatment of lyme burns of the esophagus during the acute phase:

A. Corticosteroids B. Esophagoscopy

40. Pain associated with ingestion of food during childhood is commonly associated

with the presence of:

A. Achalasia of the esophagus B. Congenital esophageal diverticulum

41. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

42. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

Determine Whether Each Choice Is True Or False. Any Combination Of Answers May Occur.

A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

43. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

44. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

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45. According to the TMN principles for staging lung cancers, which of the bronchogenic carcinomas described below is or are considered to be Stage I ?

A. Large cell carcinoma 4 cm in diameter without lymph node metastases. B. Poorly differentiated adenocarcinoma without metastases to lymph nodes. C. Squamous cell carcinoma with atelectasis and extension to visceral pleura without

lymph node metastases or pleural effusion. D. Alveolar cell carcinoma without metastases to the lymph nodes.

46. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve

replacement include(s):

A. Much greater resistance to infection. B. Satisfactory long-term durability in adolescents. C. Good hemodynamic performance in the 17 mm and 19 mm sizes relative to tilting disc

valves. D. Low thromboembolic risk without systemic anticoagulation.

47. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for

CABG include(s):

A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once: 48. A. Ostium secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect 1. Heart block and arrhythmia common 2. Absent superior rim 3. Most commonly encountered 4. Cyanosis in absence of failure

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49. A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage 1. Abnormal coronary sinus 2. Complete repair least likely 3. Persistent left anterior cardinal vein 4. Persistent ductus venosus 50. A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis 1. Parachute valve 2. Syncope 3. Waterston shunt 4. Brock procedure

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II Cairo 19/11/2006 Time allowed: 2 hours Give short account on the following:

1. The new practice guidelines for the management of patients with mitral valve disease.

2. Evolution of surgery for total right heart bypass (Fontan’s operation).

3. Diagnosis and management of acute pulmonary embolism. 4. Esophageal perforation.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 12/11/2007 Time allowed: 1 and half hours

COMMENTARY For Each Of The Following Multiple-Choice Questions, Select The One Most Appropriate Answer, Based On The History Given Below & Comment on the Choice:

A 25 year-old man presents with a hard mass over the left chest.

1. All of the following statements concerning tumors of the chest wall are correct except: A. Osteochondromas of the rib occur most frequently at the costochondral junctions of the upper

ribs. B. The most common primary malignant tumor of the chest wall is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated.

2. Which of the following statements is true regarding chest wall tumors?

A. Incisional biopsy will reliably diagnose most primary tumors. B. A 2-cm margin is adequately wide for resection of a chest wall tumor. C. Posterior chest wall defects greater than 5 cm should be reconstructed using prosthetic material. D. Overall 5-year survival for resection of primary chest wall tumors is about 50%. E. Recurrent tumors can be excised with good long-term results.

3. Chest x-rays show a lytic lesion involving the ribs with periosteal proliferation similar to "onion

peel" there is a small pleural effusion on the same side and a hazy round coin lesion in the left upper lobe. The diagnosis is:

A. Myeloma B. Chondrosareama C. Endothelioma (Ewing's Sarcoma) D. Metastatic pulmonary carcinoma E. Eosinophilic granuloma

4. The choice of treatment for this lesion is primarily:

A. Surgical excision B. Chemotherapy C. Radiotherapy D. None available E. Conservative management

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper IV MCQ (ANA. & PATH.) Cairo 19/11/2007 Time allowed: 60 minutes

ANATOMY & EMBRYOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer: 1. Which of the following statements about diaphragmatic anatomy is true?

A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the

cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise

from the lumbar vertebrae

2. Which of the following is true regarding the diaphragmatic development?

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

3. Which of the following statements is true regarding anatomy of the thoracic

outlet?

A. The distal section of the cervicoaxillary canal is the more critical for compression syndromes

B. The brachial plexus and subclavian artery are located in the anteromedial compartment of the costoclavicular space

C. The borders of the scalene triangle are scalenus anticus, scalenus medius, and first rib

D. Inspiration tilts the coracoid process inferiorly , placing tension on the neurovascular bundle

E. Bony abnormalities are present in the majority of patients

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4. Which of the following is true regarding the lung? A. Is the only organ with a dual blood supply B. Will function satisfactorily after complete denervation C. Is inferior to the kidney in adjusting acid-base balance D. Does not possess a lymphatic system E. All of the above

5. Which of the following is true regarding the usual drainage of persistent left

superior vena cava?

A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava

6. Which of the following is true regarding the level of the narrowest part of the

esophagus?

A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

7. Which of the following is true regarding the azygos vein?

A. Receives venous blood from the middle one-third of the esophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

8. Which of the following statements is true regarding the lining of the normal

bronchial mucosa ?

A. Simulated pseudostratified epithelium B. Goblet cells C. Basal cells D. Adeno-cystic cells which constitute the germinal layer

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9. Which of the following statements is true regarding the atrio-ventricular (AV) node ?

A. Receives nerves from the right vagus B. Its arterial supply is from the right coronary artery C. Is located near the entrance of the superior vena cava D. Is located near the coronary sinus

10. Which of the following statements is true regarding the inferior vena cava?

A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins

11. Which of the following statements is true regarding the abdominal aorta?

A. Passes behind the medial arcuate ligament of the diaphragm at the level of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior

mesenteric artery 12. Which of the following statements is true regarding the thoracic duct?

A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

13. Which of the following statements is true regarding in the root of the neck?

A. Scalenus anterior arises from the anterior tubercles of the typical cervical vertebrae

B. The supreme intercostals vein lies lateral to the first thoracic nerve on the neck of the first rib

C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct

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14. Which of the following statements is true regarding the subclavian artery?

A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from branches

of the thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath

derived from the prevertebral fascia E. Becomes the axillary artery at the upper border of teres major

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

15. During embryologic development of the heart, the following occur except:

A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

16. The diaphragm

A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front of the

esophagus D. Diaphragm projects higher Into the chest on the right than on the left E. Lies entirely above the tenth rib.

ANSWER THE FOLLOWING 2 QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

17. Patent ductus usually occurs as an isolated defect BECAUSE it does not arise from

the aortic arch system.

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18. About 70% or more of the total vital capacity is expired within the first second of expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

ANSWER THE FOLLOWING 5 QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

19. The parietal pleura:

A. Is very sensitive to pain B. Absorbs the pleural fluid

20. A moderator band is usually found in the:

A. Left ventricle . B. Right ventricle

21. Eustachian valve:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

22. The bundle of his passes closer to:

A. The right side of the interatrial septum B. The left side of the interatrial septum

23. The sinus venosus forms:

A. The superior and inferior vena cava B. The right atrium

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In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once:

24. A. Anterior mediastinum B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia 25. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

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PATHOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

26. Which of the following is true regarding the essential factor in the pathogenesis

of aortic aneurysms is damage ?

A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis

27. Which of the following is true regarding the causes of hilar enlargement ?

A. Sarcoidosis B. Lymphoma C. Hypertension D. Tuberculosis E. Caplan's syndrome

28. Which of the following is true regarding, the most common benign tumor of the

esophagus ?

A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma

29. Pleuropericardial (spring water) cysts are most commonly located:

A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium

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30. Which of the following statements is true regarding the pathology of lung cancer?

A. Squamous cell carcinoma occurs with equal frequency in smokers and

nonsmokers. B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands. C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy. D. Alveolar cell carcinoma has the least favorable prognosis. E. E. Most cancers associated with pulmonary scars are squamous cell

carcinomas 31. Which of the following statements is true regarding the anatomy and

pathophysiology of post-infarct left ventricular aneurysm?

A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

32. Which of the following statements is true regarding cervical rib?

A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

33. Which of the following statements is true regarding gastro-oesophageal reflux?

A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic than

symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's

oesophagus E. Initial management may include increasing the number of meals eaten per day

34. Which of the following statements is true regarding achalasia?

A. The cause is hypertrophy of the gastro-esophageal sphincter B. Dysphagia is mainly for solids C. Incidence is higher in males than females D. Manometry shows reduced pressure within the lower oesophagus E. Initial treatment is with H2 antagonists

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35. Which of the following statements is true regarding TOF morphology?

A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.

B. The bundle of His runs along the posteroinferior border of the VSD. C. Additional VSDs are present in approximately 25% of patients. D. The pulmonary valve is usually the narrowest part of the right ventricular

outflow tract. E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually

normal in size.

36. Which of the following statements is true regarding hernias through the foramen of bockdalek?

A. Usually have a true sac B. Present anteriorly C. May be caused by a short esophagus D. Pass through the pleuroperitoneal canal E. Are associated with eventration of the diaphragm

37. Which of the following statements is true regarding the Kartagener’s syndrome?

A. Situs inversus, bronchicetasis and pansinusitis B. Situs inversus of the lungs with levocardia

C. Splenic agenesis syndrome with levocardia

D. Anomalous right pulmonary artery and bilobation of the lungs E. None of the above

38. Which of the following statements is true regarding lung cancer?

A. Of the alveolar cell type is not typically associated with smoking B. Of the large cell type characteristically metastasizes early C. May present with the myasthenic syndrome D. Of the small cell type has the best 5-year survival of all types of lung cancer

when treated by excision E. May present with hypernatraemia due to hormone secretion by the tumour

39. Which of the following statements is true regarding thrombosis?

A. In the axillary vein is commoner on the right side B. In the superior vena cava may cause tinnitus C. In the venous system usually consists of fibrin and platelets D. In a proximal leg vein may be an indication for an inferior vena cava filter if the

patient also has a peptic ulcer E. Prophylaxis of DVT can be achieved by intravenous dextran

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40. Which of the following statements is true regarding carotid artery disease?

A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid plaque

that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischaemic attack commonly

includes CT scan of the brain E. Surgery has been shown to be better than medical therapy in the management of

asymptomatic patients with stenoses greater than 70%

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

41. Esophageal hiatus hernia in infants:

A. May be an important cause of vomiting B. Is often associated with constipation C. Can be demonstrated during the first week of life D. May be associated with pyloric stenosis E. Is frequently accompanied by gastrointestinal bleeding

42. Bronchogenic cysts:

A. Are lined by pseudostratified columnar epithelium B. Usually appear as air-filled cavities C. Do not cause hemoptysis D. Frequently become infected E. Mostly occur close to the hilum

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

43. Underdevelopment of the main pulmonary artery is usually associated with

narrowing or stenosis of the outflow tract of the right ventricle BECAUSE both are derived from the conus.

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44. The presence of a cervical rib does not produce symptoms in childhood BECAUSE

the rib is rudimentary at this age. 45. Bronchial foreign bodies more frequently occur in children BECAUSE the right

main stem bronchus is relatively straighter than the left. 46. Positive sputum cultures for Aspergillus must be interpreted with caution BECAUSE

the organism is often present in sputum as a harmless saprophyte. 47. Tumourlets are epithelial proliferations which are usually associated with

bronchiectatic lobes BECAUSE these microscopic lesions are never found in the absence of damage to the lungs.

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

48. Blood supply of tuberculous lesions

A. Pulmonary arteries B. Brochial arteries

49. Benign pulmonary tumors:

A. Tumourlets B. Hamartomas

50. Development of lung abscess in:

A. Alveolar cysts B. Bronchogenic cysts

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 21/11/2006 Time allowed: 2 Hours

ANATOMY

1. Fibrous skeleton of the heart.

2. Surgical anatomy of the trachea .

PATHOLOGY

1. Give short account on types and staging of bronchogenic carcinoma.

2. Pathology of graft rejection.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ Cairo 15/11/2008 Time allowed: 60 minutes

In The Following Questions, all of the statements are true EXCEPT one, Identify The Incorrect Statement:

1. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

2. With hypovolemic shock, all the following are reduced except which one ?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Kussmaul’s sign ( an inspiratory increase in the jugular venous pressure ) is evident in all of the following except :

A. Right ventricular infarction B. Constrictive pericarditis C. Pulmonary embolism D. Tricuspid regurgitation

4. Paradoxical ( reversed) splitting of S2 is caused by all of the following except:

A. Left bundle branch block B. Aortic stenosis C. Atrial septal defect D. WPW syndrome with a right - sided accessory pathway

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5. Coarctation of the aorta may be associated with all of the following except:

A. Aneurysm of the circle of Willis B. Central cyanosis C. Hypertension D. Rib notching E. Bicuspid aortic valve

6. Surgical repair of pectus excavatum is characterized by except:

A. Internal metal support necessary B. Wedge osteotomy in upper sternum C. Division of costal cartilages D. Substernal or Pleural drainage desirable E. Reattachment of rectus abdominis muscles

7. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

8. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

9. In hypoplasia of the lung, the following are correct except:

A. The major abnormality is a decrease in the number of airway generations and pulmonary artery branchings

B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of

intrauterine growth D. Embryologic defects occur early and may be associated with other

syndromes E. If associated with diaphragmatic hernia, the hypoplastic lung should be

removed at surgery.

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10. During CPR all the following are true except: A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

11. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because

the risk thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as

coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient

to prevent stroke because the risk of thromboembolism is low 12. The following statements regarding cardioversion of atrial Fibrillation is

correct except:

A. The absence of thrombus on transthoracic echocardiogram allows Immediate, safe cardioversion

B. Patients who have had AF for less than 24 hours do not need anti –coagulation before cardioversion

C. Patients who have had AF for more than 48 hours should receive coumadin for 3 weeks before cardioversion

D. Maintenance of sinus rhythm with antiarrhythmic drugs does not obviate the need for coumadin therapy

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

13. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for a tumor located in the :

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

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14. The condition that is least likely to be associated with respiratory distress in the newborn is :

A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

15. Of the following, the lesion least likely to be associated with bacterial

endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

16. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

17. A right upper lobectomy with mediastinal L.N. dissection is done for lung

Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

18. The most sensitive index for assessing the presence of postoperative myocardial necrosis following coronary revascularization is:

A. The development of new Q waves on the electrocardiogram. B. The requirement for isotropic support in the perioperative period. C. Presence of new "hot-spot" images by technetium 99m pyrophosphate

myocardiall scintigraphy. D. Elevation in serum of MB-band creative phosphokinase. E. The development of complete left bundle branch block on the initial

postoperative electrocardiogram.

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19. Hepatojugular ( abdominojugular ) reflux is found in patients with:

A. Right ventricular infarction B. Superior vena cava syndrome C. Left ventricular failure with secondary pulmonary hypertension D. Tricuspid regurgitation

20. Acute aortic dissection should be suspected in a patient with :

A. Anterior chest pain B. Intrascapular pain C. Diastolic hypertension with an aortic insufficiency murmur D. All of the above E. None of the above

21. The combination of right heart failure, elevated venous pressure and a quiet

heart is known as:

A. Whipple's triad B. Saint's triad C. Beck's triad D. Murphy's sign E. None of the above

22. During shockable VF/ pulseless VT we give one shock of:

A. 150- 200 J biphasic or 360 J monophasic. B. 100 J biphasic or 360 J monophasic. C. 150- 360 J biphasic or 300 J monophasic. D. 150- 360 J biphasic or 260 J monophasic.

23. Systemic metabolic acidosis and increased mixed venous oxygen saturation are

characteristic of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

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24. Which of the following agents has the highest potential for supraventricular arrhythmia?

A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

25. Which of the following causes the greatest increase in cardiac index at equipotent doses?

A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

26. Which of the following statements is true regarding antiarrhythmic agents?

A. Digoxin decreases the automaticity of the His-Purkinje system. B. Esmolol can be used to treat tet spells in the immediate postop period. C. Lidocaine treats ventricular tachycardia by slowing AV conduction. D. Procan SR does not need to be adjusted in the setting of renal

insufficiency. E. Atropine is ineffective in treating bradycardia secondary to beta

blockade.

27. The most common valvular defect resulting from rheumatic fever is:

A. Mitral stenosis B. Mitral insufficiency C. Aortic stenosis D. Aortic insufficiency E. Pulmonary stenosis

28. Lasers:

A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours

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29. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

30. The sudden onset of persistent coughing, productive of copious amounts of thick

brownish fluid, occurring three months following resection of the right lung suggests:

A. Recurrent carcinoma B. Congestive failure C. Acute pneumonitis in the remaining lung D. Broncho-pleural fistula E. All of the above

31. When contemplating elective thoracotomy on a patient who has been on long-term corticosteroid therapy, it is best to :

A. Discontinue steroids for one month prior to operation B. Continue the same dosage schedule throughout hospitalization

C. Give increased amounts of steroids during and immediately after operation

D. Use ACTH postoperatively E. Give prophylactic isoniazid and PAS

32. The purpose of leaving a chest tube in place following pneumonectomy is to:

A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

33. One of the contra-indications to bronchoscopy is the presence of:

A. Endobronchial tuberculosis B. Active bleeding C. Aortic aneurysm D. Emphysema E. None of the above

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34. The most common toxic arrhythmia associated with digitalis overdosage is:

A. Atrial fibrillation B. Ventricular extrasystole C. Ventricular fibrillation D. Complete heart block E. None of the above

35. The indication for transvenous insertion of cardiac pacemaker:

A. Permanent heart block B. Intermittent symptomatic heart block C. Sinus bradycardia D. Post-surgical heart block E. All of the above

36. Mediastinal widening after chest trauma is a pathognomonic sign of:

A. Aortic injury B. Cardiac injury C. Pericardial effusion D. Perforated esophagus E. Bronchial tear

37. The entity termed "shock lung" is usually seen:

A. With multiple trauma B. With head injuries C. With hemorrhagic shock D. After Prolonged cardiopulmonary bypass E. All of the above

38. Patients with cardiac tamponade are best managed:

A. Expectantly B. By pericardiocentesis followed by definitive thoracotomy if necessary C. By pericardiocentesis only D. By open thoracotomy and cardiorrhaphy E. By thoracotomy, only if blood loss is excessive

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39. Repair of a traumatic diaphragmatic hernia:

A. Should be considered an emergency procedure B. Should be performed as soon as the patient is out of shock C. Is almost always indicated if the patient is clinically stable D. Usually requires.a thoraco-abdominal approach E. All of the above

40. Following sudden deceleration, the most common site of aortic injury is:

A. Just distal to the origin of the left subclavian artery B. The dome of the aortic arch C. A point close to the annulus of the aortic valve D. Adjacent to the carotid artery E. Distal thoracic aorta

41. Acute mediastinitis is most often due to:

A. Rupture of a mediastinal cyst B. Acute inflammatory processes originating in the lungs C. Perforation of the esophagus D. Blood-borne infections E. Tuberculosis

42. The characteristic physical signs of mediastinal emphysema are:

A. Subcutaneous emphysema B. Hamman's murmur C. Decreased heart sounds D. Crepitation E. All of the above .

43. Pain in the shoulder and arm combined with horner's syndrome on the same side suggests the presence of:

A. A ganglioneuroma B. Aortic aneurysm C. Shoulder girdle syndrome D. Tumor (Pancoast) E. None of the above

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44. The term "empyema necessitans" refers to

A. A fulminating pleural infection B. Mediastinal extension of an empyema C. Metastatic foci of infection D. Secondary involvement and fistulaion through the chest wall E. Tuberculous empyema

45. Bochdaleck hernia should be treated by:

A. Immediate operation, unless there is a history of respiratory distress B. Emergency operation via thoraco abdominal approach C. Conservative measures until age six months D. Conservative measures as long as the patient is doing well E. Operation or medical management, depending on symptoms

TRUE OR FALSE : More than one answer. For the next 3 questions , determine whether each choice is true ( T ) or false ( F ): 46. Which statements are correct about CABG :

A. CABG prolongs survival in patients with greater than 70% left main stenosis, independent of anginal symptoms

B. CABG prolongs survival in patients with three – vessel disease and left ventricular systolic dysfunction

C. Diabetic patients with multivessel coronary artery disease have a better prognosis with multivessel angioplasty than with CABG

D. Women have lower perioperative mortality than men E. Internal mammary grafts remain patent longer than saphenous vein grafts

47. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected

secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is

due to shunt flow across the atrial septum

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48. Which of the following statements correctly characterize major determinants of cardiac performance ?

A. Stroke volume increases with increasing afterload B. Ventricular preload describes the load against which the ventricle must

contract when it eject blood C. In normal hearts, ventricular inotropic state increases with increasing

heart rate because of changes in calcium availability D. Hypoxia , ischemia, and acidosis decrease cardiac contractility E. In failing hearts, right atrial pressure as assessed from the

jugular venous pulse is a good indicator of left ventricular filling pressure MATCHING : For The Next 2 Questions, Choose For Each Numbered Item, The Most Likely Associated Lettered Item From Those Provided. Each Item Has Only One Answer 49. Match the following palliative surgical shunts with their anatomic

anastomoses :

A. Superior vena cava to right pulmonary artery B. Subclavian artery to pulmonary artery C. Ascending aorta to right pulmonary artery D. Ascending aorta to main pulmonary artery E. Descending aorta to left pulmonary artery

1. Classic Blalock – Taussig shunt 2. Pott’s anastmosis 3. Classic Glenn shunt 4. Waterston shunt 5. Davidson shunt

50. Select from the list below the cardiac events that correspond most closely to the components of the jugular venous waveform :

A. Opening of the tricuspid valve and right ventricular relaxation B. Right atrial relaxation C. Pulmonary valve opening D. Right atrial contraction E. Passive right atrial filling with a competent tricuspid valve

1. X-descent 2. V-wave 3. A-wave 4. Y-descent

GOOD LUCK

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AIN SHAMS UNIVERSITY MD Cardiothoracic Surgery Faculty of medicine Paper I Cairo 15/11/2008 Time allowed: 2 hours Give a short account on the following questions: 1. Non-malignant dysphagia.

2. Surgical management of complications after percutaneous coronary intervention (PCI).

3. Current surgical management of ascending aortic aneurysms.

4. Algorithm for management of chylothorax in adults.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQCairo 16/11/2008 Time allowed: 60 minutes

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

1. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates

B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation

C. A successful outcome requires the production of complete and transmural lines of conduction block

D. Newer methods of producing lines of block such as cryoablation have been as effective as the traditional "cut and sew" method

E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

2. Which of the following is true regarding the etiology of lung abscess ?

A. Hematologic seeding is the common mechanism for infection B. The posterior segment of the upper lobe and superior segment of the lower lobe on the

right side are most commonly involved C. Periodic episodes of hemoptysis and foul sputum are uncommon D. Staph Species are the predominant organism

3. Which of the following statements is true regarding myxoma morphology?

A. These tumors are most commonly found in the right atrium B. Myxomas have a characteristically firm texture and rarely embolize C. They arise from multipotential mesenchymal cells D. Myxomas usually are attached to the free atrial or ventricular wall E. There is no malignant potential

4. Which of the following statements is true regarding the natural history of CAD?

A. Distal LAD lesions do not result in poorer survival compared to proximal lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect

outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 3-vessel disease have equivalent survival at 5 years

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5. Which of the following statements is true regarding results after resection of pulmonary

metastases ?

A. Partial resection of extensive pulmonary metastatic disease can improve survival B. Disease –free interval has not been shown to have prognostic value for survival C. Patients with a greater number of metastatic nodules have poorer survival D. CEA levels do not affect 5-year survival after resection of metastatic colon carcinoma E. Metastatic head and neck cancers have poor outcome after pulmonary resection

6. Which of the following statements is true regarding operative management of congenital

sinus of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B. Direct suture closure of the aneurysm orifice is preferred to patch closure. C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

7. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal

sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are

electrically isolated from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather

than an empiric anatomic one

8. Which of the following statements is true regarding congenital diaphragmatic hernias?

A. Bochdalek's hernia is more common in the posterior costal portion on the right side. B. Obstruction and strangulation are the typical presentation of an acute Bochdalek's

hernia. C. Most mortality for infants with Bochdalek's hernia can be attributed to increased

pulmonary vascular resistance. D. The stomach is the most common organ to be found in a Morgagni's hernia. E. Morgagni's hernia is best repaired through a right thoracotomy.

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9. Which of the following statements is true regarding the operative management of lung cancer?

A. A bloody pleural effusion is not a contraindication to surgery for peripherally located carcinomas.

B. Preoperative CT scanning can accurately predict the number of tumor nodules. C. Wedge resection is adequate therapy for most peripherally located carcinomas. D. Advanced age is no longer considered a risk factor for surgical treatment of lung

cancer. E. Only 25% of all patients with lung cancer will be operative candidates.

10. Which of the following is true for operations for congenital subvalvular aortic stenosis?

A. Resection of muscle below the right coronary cusp should be avoided. B. The Konno procedure is preferred in the sitting of a normal valve and annulus. C. Early mortality is equivalent for the localized and the diffuse forms. D. Late death is usually secondary to bacterial endocarditis. E. The discrete form is associated with increased early and late risk for death.

11. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome?

A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction.

B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than

thoracic outlet syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery

stenosis.

12. Which of the following statements is true regarding the clinical manifestations of pectus excavatum?

A. Most infants and children are symptomatic. B. Mitral valve prolapse is uncommonly associated with this disorder. C. Operative repair does not improve cardiac index at rest or during exercise. D. Asthma and recurrent pulmonary infections are uncommon. E. Pulmonary function tests can document obstructive pulmonary findings.

13. The following features are true for a tension pneumothorax:

A. Tracheal deviation towards the affected side B. Increased chest movement on the affected side C. Increased resonance of affected side D. Cardiac arrest E. Surgical emphysema

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14. Which of the following statements is true regarding operative management of post-infarct LV aneurysm?

A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot

formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms

15. Which of the following statements is true regarding chest wall tumors?

A. Incisional biopsy will reliably diagnose most primary tumors. B. A 2-cm margin is adequately wide for resection of a chest wall tumor. C. Posterior chest wall defects greater than 5 cm should be reconstructed using prosthetic

material. D. Overall 5-year survival for resection of primary chest wall tumors is about 50%. E. Recurrent tumors can be excised with good long-term results.

16. Which of the following statements is true regarding neurogenic tumors of mediastinum?

A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial

presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

17. Which of the following statements concerning aneurysms of the thoracic aorta is true?

A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are predominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not

undergo operation.

18. Which of the following statements is true regarding thymomas and germ cell tumors?

A. Over 50% of myasthenia gravis patients will have a thymoma. B. The presence of myasthenia gravis is a risk factor for poor outcome. C. Blind biopsy or orchiectomy should be performed in patients with mediastinal germ

cell tumors. D. Cytoreductive resection should be performed prior to radiation therapy if a seminoma

is involving vital structures. E. Over 90% of nonseminomas will produce either AFP or B-HCG.

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ALL of the statements are correct EXCEPT one. Identify the INCORRECT statement. 19. Concerning tumors of the chest wall, all are correct except:

A. Osteosarcomas of the rib occur most frequently at the costochondral junctions of the upper ribs.

B. The most common primary malignant tumor is chondrosarcoma. C. Fibrous dysplasia is the most common primary benign tumor of the rib. D. Benign tumors of the bony thorax are more common than malignant tumors. E. For most primary tumors of the chest wall, a wide excisional biopsy is indicated.

20. The following criteria are correct for achalasia except:

A. Dysphagia B. Retention of ingested food in the esophagus. C. Radiologic evidence of dilated body of the esophagus. D. Vigorous peristalsis by manometry and cineradiography. E. Carcinoma in association achalasia is uncommon

21. The Choussat-Fontan criteria for appropriateness of an atriopulmonary

anastomosis include all of the following except:

A. Pulmonary artery pressure less than 15 mmHg. B. Pulmonary vascular resistance less than 4 units/M2 body surface area. C. Age less than 3 years. D. Ventricular ejection fraction 0.45 or greater. E. Normal sinus rhythm.

22. All are correct for pulmonary embolism except:

A. Usually results in arterial hypercapnia B. Usually produces s1 Q3 T3 changes on ECG C. May be diagnosed by spiral CT D. Is treated by low molecular weight heparins E. Is diagnosed by a matched ventilation perfusion defect F. Usually results in arterial hypoxia

23. Esophageal dilatation for the treatment of achalasia is characterized by except:

A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

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24. Zenker's diverticula is characterized by except:

A. Originates posteriorly on the cervical esophagus B. Results from incoordination between two sets of constrictor muscles C. Is a true hernia D. Is more frequent in females E. Causes dysphagia with liquids

25. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

Choose The Single Best Answer To The Following : 26. The treatment for the relief of increasing spontaneous mediastinal emphysema is:

A. Thoracotomy B. Suprasternal decompression C. Subxiphoid decompression D. Needling the mediastinum E. None of the above

27. The first sign of Horner's syndrome is usually:

A. Pupillary dilatation B. Partial ptosis of eyelid C. Enophthalmos D. Warmth and dryness of face E. None of the above

28. When treating a child born with esophageal atresia and imperforate anus, it is

advisable to:

A. Repair both defects simultaneously B. Repair esophagus first, rectum later C. Repair rectum first, esophagus later D. Perform a gastrostomy and colostomy E. Avoid operation, since the child is incurable

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29. The most common site of spontaneous esophageal perforation (Boerhaave's

syndrome) is:

A. Near the cricothyroid ligament B. Upper third C. Middle third D. Lower third E. None of the above

30. Of the following, the condition most frequently associated with congenital

esophageal atresia is:

A. Prematurity B. Atrial septal defect C. Ventricular septal defect D. Patent ductus arteriosus E. Anomalies of the intestinal tract

31. If a patient has a continuous murmur over the pulmonary area and no ductus is found at operation, it is most probable that he has:

A. A truncus arteriosus B. A pulmonary A-V fistula C. Aorto-pulmonary window D. A coarctation of the aorta E. A coronary-ventricular fistula

32. Immediately following repair of an interventricular septal defect, complete heart block

is noted, although ventricular rate is satisfactory. In this circumstance, one should

A. Administer a slow drip of isoproterenol B. Insert myocardial electrodes C. Insert a permanent pacemaker D. Give intravenous digitalis E. Do nothing

33. A Taussig-Bing malformation is best treated by:

A. Diversion of the septal defect only B. Detachment and reversal of aorta and pulmonary arteries C. There is no corrective procedure for this anomaly D. Diversion of VSD simultaneously with Mustard operation E. Methods similar to double outlet right ventricle

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34. In an adult patient, the repair of coarctation requires some form of aortic replacement if:

A. The anastmosis is smaller than the diameter of aortic arch B. The ends can not be approximated C. There is sclerosis of the aortic wall D. The distal aorta is aneurysmal E. All of the above

35. The most common findings associated with congenital tricuspid atresia are:

A. Aortic stenosis; mitral regurgitation B. Interatrial septal defect and interventricular septal defect C. Interatrial septal defect; hypoplastic right ventricle D. Interventricular septal defect: coarctation of the aorta E. Patent ductus arteriosus, pulmonic stenosis

36. The most common anatomic variation of coronary artery fistula connects:

A. Right coronary artery to right atrium B. Right coronary artery and greater cardiac vein C. Left coronary artery to left ventricle D. Left coronary artery to right ventricle E. Right coronary artery with right ventricle

37. Of the following, the lesion least likely to be associated with bacterial endocarditis is:

A. Bicuspid aortic valve B. Interatrial septal secundum defect C. Interventricular septal defect D. Pulmonary valvular stenosis E. Tetralogy of Fallot

38. Transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, and total

anomalous pulmonary venous drainage are all characterized by:

A. Inability of patient to survive beyond infancy B. Decreased pulmonary blood flow C. The presence of cyanosis D. Not completely correctable by present techniques E. All of the above

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Determine whether each choice is true or false. Any combination of answers, may occur. A B C D 1 only 2 only Both 1 &2 Neither 1 nor 2 39. Pain associated with ingestion of food during childhood is commonly associated

with the presence of:

A. Achalasia of the esophagus B. Congenital esophageal diverticulum

40. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

41. Treatment of lyme burns of the esophagus during the acute phase: A. Corticosteroids B. Esophagoscopy

42. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

Determine Whether Each Choice Is True Or False. Any Combination Of Answers May Occur.

A B C D E 1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

43. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

44. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

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45. According to the TMN principles for staging lung cancers, which of the bronchogenic carcinomas described below is or are considered to be Stage I ?

A. Large cell carcinoma 4 cm in diameter without lymph node metastases. B. Poorly differentiated adenocarcinoma without metastases to lymph nodes. C. Squamous cell carcinoma with atelectasis and extension to visceral pleura without

lymph node metastases or pleural effusion. D. Alveolar cell carcinoma without metastases to the lymph nodes.

46. Advantage(s) of porcine bioprostheses (over mechanical prostheses) for aortic valve

replacement include(s):

A. Much greater resistance to infection. B. Satisfactory long-term durability in adolescents. C. Good hemodynamic performance in the 17 mm and 19 mm sizes relative to tilting disc

valves. D. Low thromboembolic risk without systemic anticoagulation.

47. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for

CABG include(s):

A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once: 48. A. Ostium secundum defect B. Ostium Primum defect C. Common atrium D. Sinus venosus defect 1. Heart block and arrhythmia common 2. Absent superior rim 3. Most commonly encountered 4. Cyanosis in absence of failure

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49. A. Supracardiac type of total anomalous pulmonary venous drainage B. Cardiac type of total anomalous pulmonary venous drainage C. Infracardiac type of total anomalous pulmonary venous drainage D. Mixed type of total anomalous pulmonary venous drainage 1. Abnormal coronary sinus 2. Complete repair least likely 3. Persistent left anterior cardinal vein 4. Persistent ductus venosus 50. A. Tricuspid stenosis B. Pulmonic stenosis C. Mitral stenosis D. Aortic stenosis 1. Parachute valve 2. Syncope 3. Waterston shunt 4. Brock procedure

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II Cairo 16/11/2008 Time allowed: 2 hours Give short account on the following:

1. The lungs as a predictor of the outcome in cardiac surgery.

2. The etiology and management of left ventricular aneurysms.

3. Evolution of surgery for total right heart bypass (Fontan’s operation).

4. Surgical options to face a failing heart coming of cardiopulmonary bypass.

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Commentary Cairo 17/11/2008 Time allowed: 1 and half hours

COMMENTARY

For Each Of The Following Multiple-Choice Questions, Select The One Most Appropriate Answer, Based On The History Given Below & Comment on and justify the Choice:

A 23-year-old man was referred to our department for a symptom-less mediastinal cystic mass.

1) The initial discovery of a mediastinal tumor most often occurs in a patient who: A. Complains of cough B. Has been losing weight C. Develops symptoms of congestive failure D. Speaks hoarsely E. Is asymptomatic

2) Which of the following statements is true regarding the mediastinal tumors?

A. Usually cystic in nature B. Usually encountered in adult life C. A frequent cause of esophageal obstruction D. Occasionally of testicular

3) Which of the following statements is true regarding primary cysts of the mediastinum?

A. Most of these patients are symptomatic and present with chest pain. B. Surgical excision is recommended for a bronchogenic cyst only if there is respiratory compromise or

recurrent pneumonitis. C. Most pericardial cysts occur at the left pericardiophrenic angle. D. Patients with vertebral anomalies should be evaluated for possible spinal cord involvement by an enteric

cyst. E. Enteric cysts are the most common primary cysts and are usually located in the middle compartment.

On computed tomographic scan the mass measured 16 x 12 x 18 cm. The lesion occupied the entire anterior and left part of the mediastinum and a significant portion of the left hemithorax. Left lung parenchyma was compressed. Hilar and mediastinal structures were compressed and slightly dislocated but no radiologic signs of infiltration were present.

Global spirometry showed a mild reduction in the forced vital capacity in 1 second value that proved to be 2.89 L (81% of the predicted value). Blood gas analysis did not show any anomaly.

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4) Which of the following statements is true regarding thymomas and germ cell tumors?

A. Over 50% of myasthenia gravis patients will have a thymoma. B. The presence of myasthenia gravis is a risk factor for poor outcome. C. Blind biopsy or orchiectomy should be performed in patients with mediastinal germ cell tumors. D. Cytoreductive resection should be performed prior to radiation therapy if a seminoma is involving

vital structures. E. Over 90% of nonseminomas will produce either AFP or B-HCG.

Blood test analysis did not show any abnormalities. In particular, all the checked tumor markers (carcinoembryonic antigen, tissue polypeptidic antigen, -fetoprotein, and ß-human choriogonadotropin) were within the normal range.

The more consistent diagnosis (based on computed tomographic appearance and serological status) was that of a mediastinal mature cystic teratoma.

5) The choice of treatment for this lesion is primarily: A. Surgical excision B. Chemotherapy C. Radiotherapy D. None available E. Conservative management

GOOD LUCK

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AIN-SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper IV MCQ (ANA. & PATH.) Cairo 18/11/2008 Time allowed: 60 minutes

ANATOMY & EMBRYOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer: 1. Which of the following is TRUE regarding the diaphragmatic development?

A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

2. Which of the following is TRUE regarding the blood supply to the visceral

pleura?

A. Pulmonary artery B. The bronchial vessels C. The intercostal vessels D. The internal mammary arteries E. None of the above

3. Which of the following statements about diaphragmatic anatomy is TRUE?

A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the

cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise

from the lumbar vertebrae

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4. Which of the following statements is TRUE regarding anatomy of the thoracic outlet ?

A. The distal section of the cervicoaxillary canal is the more critical for

compression syndromes B. The brachial plexus and subclavian artery are located in the anteromedial

compartment of the costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus medius, and

first rib D. Inspiration tilts the coracoid process inferiorly , placing tension on the

neurovascular bundle E. Bony abnormalities are present in the majority of patients

5. Which of the following is TRUE regarding the level of the narrowest part of the

esophagus ?

A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

6. Which of the following is TRUE regarding the usual drainage of persistent left

superior vena cava ?

A. Coronary sinus B. Left atrium C. Right atrium D. Inferior vena cava E. Right superior vena cava

7. Which of the following is TRUE regarding the azygos vein?

A. Receives venous blood from the middle one-third of the oesophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

8. Which of the following statements is TRUE regarding the lining of the normal

bronchial mucosa ?

A. Simulated pseudostratified epithelium B. Goblet cells C. Basal cells D. Adeno-cystic cells which constitute the germinal layer

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9. Which of the following statements is TRUE regarding the atrio-ventricular

(AV) node ?

A. Receives nerves from the right vagus B. Its arterial supply is from the right coronary artery C. Is located near the entrance of the superior vena cava D. Is located near the coronary sinus

10. Which of the following statements is TRUE regarding the inferior vena cava?

A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins

11. Which of the following statements is TRUE regarding the abdominal aorta?

A. Passes behind the medial arcuate ligament of the diaphragm at the level of T12 B. Bifurcates at the supracristal plane C. Lies in front of the left lumbar veins D. Normally measures 3 cm in diameter E. The right renal artery is given off at a level just below that of the inferior

mesenteric artery 12. Which of the following statements is TRUE regarding in the root of the neck?

A. Scalenus anterior arises from the anterior tubercles of the typical cervical vertebrae

B. The supreme intercostals vein lies lateral to the first thoracic nerve on the neck of the first rib

C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct

13. Which of the following statements is TRUE regarding the subclavian artery?

A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from branches

of the thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath

derived from the prevertebral fascia E. Becomes the axillary artery at the upper border of teres major

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14. Which of the following statements is TRUE regarding the thoracic duct?

A. Passes from left to right behind the oesophagus B. Lies anterior to the intercostals branches of the aorta C. Enters the left brachiocephalic vein D. Passes behind the vagus nerve in the root of the neck E. Commences at the level of the 12th thoracic vertebra

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

15. During embryologic development of the heart, the following occur except:

A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

16. The diaphragm

A. Attaches posteriorly at a lower level on the right than on the left B. Has decussating fibers which cross the midline in front of the aorta C. Has decussating fibers which cross the midline in front of the

esophagus D. Diaphragm projects higher Into the chest on the right than on the left E. Lies entirely above the tenth rib.

ANSWER THE FOLLOWING 2 QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

17. Patent ductus usually occurs as an isolated defect BECAUSE it does not arise from

the aortic arch system. 18. About 70% or more of the total vital capacity is expired within the first second of

expiration BECAUSE a normally compliant lung allows the rapid decrease in lung volume from maximum expansion.

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ANSWER THE FOLLOWING 5 QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If only A Is correct B. If only B Is correct C. If both A and B are correct D. If neither A nor B is correct

19. A moderator band is usually found in the:

A. Left ventricle . B. Right ventricle

20. Eustachian valve:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

21. The bundle of his passes closer to:

A. The right side of the interatrial septum B. The left side of the interatrial septum

22. The sinus venosus forms:

A. The superior and inferior vena cava B. The right atrium

23. The parietal pleura:

A. Is very sensitive to pain B. Absorbs the pleural fluid

In The Following Questions, Each Numbered Item Is To Be Matched With One Lettered Item. Each Choice May Be Used Only Once:

24. A. Anterior mediastinum

B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

1. Carina 2. Thymic remnants 3. Trachea 4. Sympathetic ganglia

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25. A. Right pulmonary artery

B. Left pulmonary artery C. Main pulmonary artery D. D. Aorta

1. Lies superior to bronchus 2. Drains left ventricle in corrected transposition 3. Lies anterior to upper lobe bronchus 4. Lies adjacent to fold of Marshall

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PATHOLOGY

For Each Of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

26. Which of the following is TRUE regarding the essential factor in the

pathogenesis of aortic aneurysms is damage ?

A. To the intimal layer B. To the medial layer C. To the adventitial layer D. To all layers E. Due to atherosclerosis

27. Which of the following is TRUE regarding the causes of hilar enlargement ?

A. Sarcoidosis B. Lymphoma C. Hypertension D. Tuberculosis E. Caplan's syndrome

28. Which of the following is TRUE regarding, the most common benign tumor of

the esophagus ?

A. Leiomyoma B. Lipoma C. Rhabdomyoma D. Fibroma E. Myxoma

29. Pleuropericardial (spring water) cysts are most commonly located:

A. Right side, anteriorly B. Right side, posteriorly C. Left side, anteriorly D. Left side, posteriorly E. Anywhere alongside the pericardium

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30. Which of the following statements is TRUE regarding the pathology of lung cancer?

A. Squamous cell carcinoma occurs with equal frequency in smokers and

nonsmokers. B. Adenocarcinoma infrequently metastasizes to the liver and adrenal glands. C. Oat-cell carcinoma is treated primarily with radiation and chemotherapy. D. Alveolar cell carcinoma has the least favorable prognosis. E. E. Most cancers associated with pulmonary scars are squamous cell

carcinomas 31. Which of the following statements is TRUE regarding the anatomy and

pathophysiology of post-infarct left ventricular aneurysm?

A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

32. Which of the following statements is TRUE regarding cervical rib?

A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

33. Which of the following statements is TRUE regarding gastro-oesophageal reflux?

A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic than

symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's

oesophagus E. Initial management may include increasing the number of meals eaten per day

34. Which of the following statements is TRUE regarding achalasia?

A. The cause is hypertrophy of the gastro-esophageal sphincter B. Dysphagia is mainly for solids C. Incidence is higher in males than females D. Manometry shows reduced pressure within the lower oesophagus E. Initial treatment is with H2 antagonists

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35. Which of the following statements is true regarding TOF morphology?

A. Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.

B. The bundle of His runs along the posteroinferior border of the VSD. C. Additional VSDs are present in approximately 25% of patients. D. The pulmonary valve is usually the narrowest part of the right ventricular

outflow tract. E. Although the infundibulum is hypoplastic, the pulmonary annulus is usually

normal in size.

36. Which of the following statements is true regarding hernias through the foramen of bockdalek?

A. Usually have a true sac B. Present anteriorly C. May be caused by a short esophagus D. Pass through the pleuroperitoneal canal E. Are associated with eventration of the diaphragm

37. Which of the following statements is true regarding the Kartagener’s

syndrome?

A. Situs inversus, bronchicetasis and pansinusitis B. Situs inversus of the lungs with levocardia

C. Splenic agenesis syndrome with levocardia

D. Anomalous right pulmonary artery and bilobation of the lungs E. None of the above

38. Which of the following statements is true regarding lung cancer?

A. Of the alveolar cell type is not typically associated with smoking B. Of the large cell type characteristically metastasizes early C. May present with the myasthenic syndrome D. Of the small cell type has the best 5-year survival of all types of lung cancer

when treated by excision E. May present with hypernatraemia due to hormone secretion by the tumour

39. Which of the following statements is true regarding thrombosis?

A. In the axillary vein is commoner on the right side B. In the superior vena cava may cause tinnitus C. In the venous system usually consists of fibrin and platelets D. In a proximal leg vein may be an indication for an inferior vena cava filter if the

patient also has a peptic ulcer E. Prophylaxis of DVT can be achieved by intravenous dextran

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40. Which of the following statements is true regarding carotid artery disease?

A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid plaque

that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischaemic attack commonly

includes CT scan of the brain E. Surgery has been shown to be better than medical therapy in the management of

asymptomatic patients with stenoses greater than 70%

In The Following Questions, All Of The Statements Are True Except One. Identify The Incorrect Statement:

41. Esophageal hiatus hernia in infants:

A. May be an important cause of vomiting B. Is often associated with constipation C. Can be demonstrated during the first week of life D. May be associated with pyloric stenosis E. Is frequently accompanied by gastrointestinal bleeding

42. Bronchogenic cysts:

A. Are lined by pseudostratified columnar epithelium B. Usually appear as air-filled cavities C. Do not cause hemoptysis D. Frequently become infected E. Mostly occur close to the hilum

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW

A. If both statement and reason are true and related cause and effect B. If both statement and reason are true but not related cause and effect C. If the statement is true and the reason is false D. If the statement is false and the reason is true E. If both statement and reason are false

43. Underdevelopment of the main pulmonary artery is usually associated with

narrowing or stenosis of the outflow tract of the right ventricle BECAUSE both are derived from the conus.

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44. The presence of a cervical rib does not produce symptoms in childhood BECAUSE

the rib is rudimentary at this age. 45. Bronchial foreign bodies more frequently occur in children BECAUSE the right

main stem bronchus is relatively straighter than the left. 46. Positive sputum cultures for Aspergillus must be interpreted with caution BECAUSE

the organism is often present in sputum as a harmless saprophyte. 47. Tumourlets are epithelial proliferations which are usually associated with

bronchiectatic lobes BECAUSE these microscopic lesions are never found in the absence of damage to the lungs.

ANSWER THE FOLLOWING QUESTIONS BY USING THE KEY OUTLINED BELOW:

A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

48. Blood supply of tuberculous lesions

A. Pulmonary arteries B. Brochial arteries

49. Benign pulmonary tumors:

A. Tumourlets B. Hamartomas

50. Development of lung abscess in:

A. Alveolar cysts B. Bronchogenic cysts

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Anatomy & Pathology Cairo 18/11/2008 Time allowed: 2 Hours

ANATOMY

1. The dynamic anatomy of the aortic valve complex.

2. The embryology & anatomy of the thoracic duct.

PATHOLOGY

1. The pathology of left-sided cardiac tumors.

2. The pathology of bronchiectasis.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper I – MCQ Cairo 14/11/2009 Time allowed: 60 minutes

 

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For Each of The Following Multiple Choice Questions, Select The One Most

Appropriate Answer:

1- The carotid body contains both chemoreceptors and baroreceptors. They are

stimulated under certain circumstances to maintain homeostasis. Which one

of the following anatomical regions of the brain is stimulated by neuronal

transmission from the carotid body?

A) The basal ganglia.

B) The cerebellum.

C) The hypothalamus.

D) The pineal gland.

E) The posterior pituitary gland.

2- A 62-year old man presents with an acute coronary syndrome and coronary

angiography shows significant three vessel disease. He is kept in hospital for

surgery but there are a number of patients waiting and it is three weeks

before he goes to theatre. He initially makes an uneventful recovery and

blood tests are normal. He is ready for discharge on day six and the nurse

practitioner telephones you to say that his platelet count is 50x109/l. You are

concerned that he may have heparin induced thrombocytopenia. Which of

the following is TRUE of heparin induced thrombocytopenia?

A) It is associated with IgM antibodies.

B) It is more common with unfractionated heparin.

C) It is treated with a platelet infusion.

D) It leads to arterial thrombosis more commonly than venous thrombosis.

E) It occurs in less than 1% of patients.

3- A 70-year old male smoker presents with cough and hemoptysis. A CT scan

of the chest shows a 3 cm lesion in the left upper lobe. A needle biopsy of the

lesion reveals squamous cell carcinoma. What is the T stage of this tumour?

A) TX.

B) T1.

C) T2.

D) T3.

E) T4.

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4- A 37-year old man presents with dysphagia and achalasia is diagnosed.

Which one of the following features is present in achalasia?

A) Fibrosis associated with a least moderate esophagitis.

B) Lack of sensitivity of the lower esophageal sphincter to gastrin.

C) Loss of ganglion cells in Auerbach’s plexus.

D) Low pressures within the lower esophageal sphincter.

E) Vigorous peristalsis in the body of the esophagus.

5- Which of the following statements is TRUE regarding spontaneous

pneumothorax?

A) Primary spontaneous pneumothorax typically occurs in tall, thin, older adults.

B) Osteogenic sarcoma is the most common malignant cause of secondary

spontaneous pneumothorax in children.

C) Catamenial pneumothorax typically occurs during the end of menses when a

patient is taking oral contraceptives.

D) Hemothorax occurs in up to 20% of patients with spontaneous pneumothorax.

E) Pleurectomy is preferred over mechanical pleurodesis for recurrent

pneumothorax.

6- Which of the following statements is TRUE regarding diffuse obstructive

emphysema?

A) Type A is associated with frequent and severe wheezing.

B) Cyanosis is common in both types.

C) Type B demonstrates pulmonary fibrosis on chest film.

D) Vital capacity is severely reduced in both types.

E) Cor-pulmonale is common with type A.

7- Which of the following statements is TRUE regarding empyema?

A) Transitional empyemas should be treated with immediate thoracotomy and

debridement to prevent progression to the chronic phase.

B) Most empyemas now occur after thoracic surgical procedures.

C) Chest CT or US are useful to localize collections for drainage.

D) Thoracentesis usually returns purulent material with high yield for the

causative organism.

E) Bronchoscopy is unnecessary as the process is extrapleural.

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8- Which of the following statements is TRUE regarding bronchiectasis?

A) Congenital immunodeficiency disorders are the most common cause of

bronchiectasis.

B) The disease process characteristically involves the superior lobar segments.

C) Chest X-ray typically shows the classic honeycomb pattern of cystic spaces.

D) Surgical therapy should be avoided in patients with multiple segment

involvement.

E) Hemoptysis is most common in pediatric patients and can be life-threatening.

9- Which of the following statements is TRUE regarding lung abscess?

A) The most common locations for abscess formation are the posterior segment of

the lower lobe and superior segment of the upper lobe.

B) Most lung abscesses are caused by aerobic organisms from an aggressive

pneumonia.

C) Most opportunistic lung abscesses follow the typical pattern, with community-

acquired organisms forming a single abscess cavity.

D) A primary abscess secondary to gram-negative organisms should be promptly

treated with chest tube drainage.

E) A thick-walled cavity associated with persistent symptoms after 5 weeks of

medical treatment should be surgically resected.

10- According to results of the NETT trial, patients with emphysema who would

benefit most from lung volume reduction surgery are:

A) Lower lobe emphysema with FEV1 more than 20%.

B) Patients with FEV1 less than 20%.

C) Upper lobe emphysema with poor exercise tolerance.

D) Patients with good exercise tolerance and FEV1 less than 20%.

E) Patients with diffuse emphysema and FEV1 more than 20%.

11- The following are histologically neuro-endocrine types of lung cancer

EXCEPT:

A) Bronchoalveolar lung cancer.

B) Typical carcinoid.

C) Atypical carcinoid.

D) Large cell carcinoma.

E) Small cell lung cancer.

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12- The increased resistance of the internal thoracic artery and its long term patency is attributed to the following:

A) A dense vasa vasorum. B) Increased response of its smooth muscle cells to platelet derived growth factor. C) A dense non-fenestrated internal elastic lamina. D) Increased production of nitric oxide and decreased production of prostacylin. E) A very thick media layer.

13- The first randomized controlled trial to compare medical treatment in

comparison with extrapleural pleural pneumonectomy in treatment of mesothelioma is:

A) MRC OEO2 Trial. B) MARS I trial. C) MARS II trial. D) MESO VATS trial. E) The BIG LUNG trial.

14- Which of the following statements is TRUE regarding the pathogenesis and

diagnosis of pulmonary metastases?

A) Less than 10% of patients at autopsy have metastatic disease confined to the lungs.

B) Endobronchial lesions are always primary lung tumors. C) CT scan can underestimate the number of malignant nodules by up to 75%. D) A solitary lesion is more likely to be metastatic if the primary tumor is breast

carcinoma. E) Percutaneous biopsy should be performed in order to plan operative

management. 15- Which of the following statements is TRUE regarding results after resection

of pulmonary metastases?

A) Partial resection of extensive pulmonary metastatic disease can improve survival.

B) Disease-free interval has not been shown to have prognostic value for survival.

C) Patients with a greater number of metastatic nodules have poorer survival. D) CEA levels do not affect 5-year survival after resection of metastatic colon

carcinoma. E) Metastatic head and neck cancers have poor outcome after pulmonary

resection.

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16- Shown is an arterial line trace on an IABP. Which type of IABP Timing Errors does this show?

A) Early inflation. B) Early deflation. C) Late inflation. D) Late deflation. E) There is no error, this is optimum.

17- A patient with a 5 cm left lower lung lobe squamous cell carcinoma and a

malignant pleural effusion is in which stage of lung cancer according to the new TNM classification implemented in March 2009?

A) IIIa. B) III b. C) IV a. D) IV b. E) Stage II.

18- Which of the following statements is TRUE regarding symptoms of thoracic

outlet syndrome?

A) Vascular signs are more common than neurologic signs. B) Pain and paresthesias are present in over 90% of patients. C) Neurogenic symptoms most commonly occur along the median nerve

distribution. D) The onset of symptoms is characteristically sudden and occurs after trauma. E) Raynaud's phenomenon presents as bilateral, symmetric blanching of fingers

followed by cyanosis and rubor. 19- Which of the following statements is TRUE regarding the diagnosis of

thoracic outlet syndrome?

A) The Adson test is positive when the radial pulse is diminished after arm hyperabduction.

B) A cervical rib is best identified using cervical CT scanning. C) A nerve conduction velocity above 60 m/sec is normal. D) Decreased velocity across the elbow indicates ulnar nerve entrapment rather

than thoracic outlet syndrome. E) Peripheral angiography should be performed in all cases to exclude subclavian

artery stenosis.

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20- Middle-aged man with chest discomfort. Where is this process located?

A) Anterior mediastinum. B) Posterior mediastinum. C) Middle mediastinum. D) Anterior and posterior mediastinum.

21- CT angiogram of the chest:

A 77-year old woman presents with chest pain following surgery and central line placement. What is the cause of the chest pain?

A) Contrast extravasation. B) Aortic dissection. C) Pulmonary embolus. D) Empyema. E) Sternal fracture.

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22- Heller’s index is a measure of severity in cases of pectus excavatum. What

value is considered severe pectus?

A) 1

B) 1.5

C) 2

D) 2.5

E) 3.5

23- The only licensed Beta blocker to be used in heart failure is:

A) Atenolol.

B) Carvedilol.

C) Esmolol.

D) Bisoprolol.

E) Propanolol.

24- Regarding Dopamine, all the following are true EXCEPT:

A) Increases cardiac output.

B) In high doses causes peripheral vasodilatation.

C) Increases renal blood flow.

D) Increases ventricular excitability.

E) Increases splanchnic blood flow.

25- In the cardiac cycle, which of the following is CORRECT?

A) Left ventricular volume is maximal at the end of atrial systole.

B) The mitral valve closes by contraction of the papillary muscles.

C) The left ventricular pressure is maximal just before the aortic valve opens.

D) The ejection fraction is about 85%.

E) The dicrotic notch is due to rebound of the mitral valve.

26- Regarding pulmonary vascular resistance, which of the following is

CORRECT?

A) Is decreased in chronic hypoxia.

B) Has a value approximately one-sixth that of the systemic circulation.

C) Can be measured using a flow-directed balloon catheter with a thermistor tip.

D) Is increased by isoprenaline.

E) Is decreased by 5-hydroxytryptamine (5-HT).

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27- Which histological type of mesothelioma carries the best prognosis?

A) Epitheloid.

B) Sarcomatoid.

C) Mixed.

D) Small cell type.

E) Desmoplastic.

28- In the electrocardiogram at a heart rate of 80 per minute:

A) The PR interval should be less than 0.2 s and greater than 0.12 s.

B) The QRS complex should last less than 0.02 s.

C) The T wave is normally greater than 1 mV.

D) There will be an interval of 0.75 s between the end of one complex and the

beginning of the next.

E) The T wave is ventricular depolarization.

29- The following increases the amount of calcium in cardiac muscle:

A) Halothane.

B) Adrenaline.

C) Diltiazem.

D) Nifedipine.

E) Trimetaphan.

30- A post-thoractomy patient is having a paravertebral catheter running for

analgesia. The nurse calls you on an emergency basis due to cardiovascular

collapse. You suspect a local anesthetic overdose. What is the immediate

antidote?

A) Atropine.

B) Naloxone.

C) Deltizem.

D) Lipid emulsion.

E) Epinephrine.

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31- An 18-year old patient suffers an attack of a first time right side primary pneumothorax. An intercostal drain is inserted and results in full expansion of the lung and the patient is discharged home on the next day. During consultation in the follow up clinic, he asks you about the percentage of recurrence of another pneumothorax. What is the most appropriate answer?

A) 5%. B) 10%. C) 30%. D) 60%. E) 90%.

32- Regarding Warfarin, the following is true:

A) Has a rapid onset of action. B) Is readily excreted in the urine. C) Is antagonized by salicylates. D) Is potentiated by metronidazole. E) Is potentiated by barbiturates.

33- In a double blind clinical trial, the following is INCORRECT:

A) The patients know which treatment they receive. B) Each patient receives a placebo. C) The patients do not know they are in a trial. D) Each patient receives both treatments. E) The clinician assessing the patients' condition does not know which treatment

the patient has received.

34- Regarding the median estimated from a sample, the following is INCORRECT:

A) Is not always equal to an actual observation. B) Is close to the mean if the distribution is symmetrical. C) Is less than the mean if the distribution is positively skewed. D) Is the most frequently occurring value. E) Is greater than or equal to at least 50% of the observations.

35- Regarding the standard deviation, which statement is INCORRECT?

A) A measure of variability. B) The square root of the variance. C) Twice the standard error. D) In the same units as the observations.

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36- In a study of 88 births to women with a history of thrombocytopenia, the same condition was recorded in 20% of babies (95% confidence interval 13% to 30%). Which statement is CORRECT?

A) 5% of such women have a probability of having a baby with thrombocytopenia which is not between 13% and 30%.

B) The rate of thrombocytopenia in 95% of samples of the same size will be between 13% and 30%.

C) If the sample were increased to 880 births, the 95% confidence interval would be narrower.

D) We would be likely to observe data like the sample if between 13% and 30% of births to such women in the area had thrombocytopenia.

E) It would be impossible to get these data if the rate for all women was 10%. 37- A 42-year old Egyptian man presents to the emergency department with

hemoptysis, what is the most common cause?

A) TB. B) Lung cancer. C) Bronchiectasis. D) Lung abscess. E) Hypertension.

38- A 56-year old male performs a pulmonary function test with the following

result: FEV1= 1.8L (86%), FVC = 1.9L (56%), FEV1/FVC = 96% DLCO 62%. The picture is suggestive of:

A) Obstructive lung disease. B) Restrictive lung disease. C) Mixed lung disease. D) Pulmonary hemorrhage. E) Normal lung functions.

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39- A 32-year old male suffers a road traffic accident and sustains multiple

injuries. What is the best management for his thoracic injury?

A) Conservative management.

B) Intercostal drain.

C) Ascending aorta replacement.

D) Repair with end to end anastomosis.

E) Endovascular stenting.

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40- Which letter indicates the point in the cardiac cycle that the mitral valve

opens?

A) A.

B) B.

C) C.

D) D.

E) F.

41- Which of the following is NOT affected by the preload in the heart muscle?

A) End systolic volume.

B) End diastolic volume.

C) Stroke volume.

D) Ejection fraction.

E) Cardiac output.

    

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From the list of options below, choose which structure is best described as

follows. Each option may be used once, more than once or not at all.

 

THORACIC ANATOMY  

A) Azygos vein.

B) Descending thoracic aorta.

C) Inferior vena cava.

D) Left main bronchus.

E) Left superior vena cava.

F) Ligamentum arteriosum.

G) Long thoracic nerve of Bell.

H) Esophagus.

I) Phrenic nerve.

J) Phreno-esophageal ligament.

K) Stellate ganglion.

L) Supreme intercostals vein.

M) Thoracic duct.

N) Thymus.

O) Vagus nerve.  

42- It is typically invaded by superior sulcus tumour of the lung.

43- It is at particular risk of damage when applying radio-frequency current

during surgery to correct atrial arrhythmia.

44- It is a common source of major hemorrhage during mediastinoscopy.  

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From the list below, choose the most appropriate option for each of the questions

below. Each option may be used once, more than once or not all.

LUNG  

A) 6 minute walk test.

B) Computerized tomography.

C) Cylindrical bronchiectasis.

D) Cystic (saccular) bronchiectasis.

E) Flexible bronchoscopy.

F) Hemophilus influenza.

G) Moraxella catarrhalis.

H) PA chest X-ray.

I) PET scan.

J) Pseudomonas aeruginosa.

K) Staphylococcus aureus.

L) Streptococcus pneumonia.

M) Traction bronchiectasis.

N) Trap sputum specimen.

O) Varicose bronchiectasis.  

A 35-year old patient is referred with a history typical of bronchiectasis.  

45- What is the most sensitive test for bronchiectasis?

46- What is the most common form of bronchiectasis in the western world?

47- In bronchiectasis, clinical deterioration is most rapid when infection with

which organism occurs?  

 

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From the list below, choose the most appropriate option for each of the following

questions. Each option may be used once, more than once or not at all.

MEDIASTINUM  

A) Anterior mediastinum.

B) Hernia through foramen of Bochdalek.

C) Lymphoma.

D) Median sternotomy.

E) Middle mediastinum.

F) Neurilemmoma (Schwannoma).

G) Neuroblastoma.

H) Neuroendocrine carcinoma.

I) Parathyroid adenoma.

J) Pericardial cyst.

K) Posterior mediastinum.

L) Right thoractomy.

M) Thoracic inlet.

N) Trans-cervical incision.

O) VATS.  

48- Hernias through the foramen of Morgagni are found in which compartment?

49- Which is the most common posterior mediastinal mass?

50- Which is the initial approach for resection of a retrosternal goitre?

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper I Cairo 14/11/2009 Time allowed: 2 hours

 

Answer all the following questions:

1- Pulmonary solitary arteriovenous fistula. Discuss:

Pathology, diagnosis and treatment.

2- Hemoptysis. Discuss:

Causes, diagnosis and treatment.

3- Surgical options in the management of moderate to severe ischemic mitral regurge.

4- Pulmonary hypertension. Discuss:

Etiology and management.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper II – MCQ Cairo 15/11/2009 Time allowed: 60 minutes

 

1  

For Each of The Following Multiple Choice Questions, Select The One Most

Appropriate Answer:

1- A 10-month old child complains of dyspnea. The following X-ray was done.

What is the diagnosis?

A) Unroofed coronary sinus.

B) Coarctation of the Aorta.

C) Scimatar syndrome.

D) SVC Syndrome.

E) Anomalous systemic venous drainage.

2- Which of the following statements is TRUE regarding the pathophysiology of

TOF?

A) Spells are triggered by any event that increases pulmonary vascular

resistance.

B) RVH in the neonatal period represents significant overload of the right

ventricle.

C) Branch pulmonary artery stenosis can be identified with echocardiography.

D) Cyanosis at birth indicates a fixed obstruction to pulmonary flow.

E) All patients should have pulmonary artery pressures and PVR measured

during catheterization.

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3- Which of the following statements is TRUE regarding management of TOF?

A) Operative repair should be delayed until oxygen saturation falls below 65%. B) Operative repair is not indicated if hypoxemic spells can be controlled with

propranolol. C) Shunting is indicated with anomalous origin of the left anterior descending

coronary artery. D) Leaving the VSD open provides a "safety valve" for the hypoplastic

pulmonary system. E) A patent foramen ovale should be closed in the neonatal patient to prevent

right ventricular failure. 4- Which of the following statements is TRUE regarding the clinical features of

congenital sinus of Valsalva aneurysm?

A) Aortic insufficiency is uncommon. B) Myocardial ischemia can occur from coronary artery compression. C) Less than 25% of patients have an associated congenital lesion. D) VSDs are most commonly associated with left coronary sinus aneurysms. E) Rupture of these aneurysms is easily recognized by the acute onset of

symptoms. 5- Which of the following statements is TRUE regarding operative management

of congenital sinus of Valsalva aneurysm?

A) Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B) Direct suture closure of the aneurysm orifice is preferred to patch closure. C) VSD repair is best performed through the aorta. D) Reoperation is primarily for progressive aortic insufficiency.

6- Which of the following statements is TRUE regarding the clinical

presentation of Ebstein's anomaly?

A) The lesion is more common in females. B) Up to 50% of patients diagnosed in infancy will not survive past 2 years of

age. C) Palpitations are unusual except in the setting of WPW. D) Cyanosis at birth indicates fixed RVOTO in these patients. E) The majority of patients do not have a decline in their functional NHYA class.

7- Which of the following statements is TRUE regarding operative management

of Ebstein's anomaly?

A) Elective repair should be delayed in all patients until functional status deteriorates to NYHA class III or IV.

B) Small associated atrial septal defects should be closed by simple suture. C) Short papillary muscles on the anterior leaflet do not preclude valve repair. D) Sutures should be placed on the ventricular side of coronary sinus during valve

replacement to avoid injury to the conduction system.

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8- Which of the following statements is TRUE regarding the clinical presentation of TAPVC?

A) Survival is dependent on the amount of left-to-right shunting. B) Severe cyanosis and distress indicates severe pulmonary venous obstruction

rather than pulmonary hypertension. C) Severe pulmonary venous obstruction is most likely to occur in patients with

supracardiac TAPVC. D) Infants with non-obstructed TAPVC can be expectantly managed. E) All patients should have prompt catheterization to delineate the anatomy of

TAPVC. 9- Which of the following statements is TRUE regarding operative management

of TAPVC?

A) Separate implantation of each pulmonary vein to the left atrium provides the most reliable reconstruction.

B) A secundum ASD can be closed with simple suture in these patients. C) The azygos vein can be mobilized and anastomosed directly to the left atrium

in this type of supracardiac TAPVC. D) The coronary sinus can be unroofed into the left atrium to correct cardiac

TAPVC. E) Ligation of the vertical vein during infracardiac TAPVC repair should be done

immediately prior to discontinuing CPB. 10- The following are surgical options for DORV with subpulmonary VSD

(Taussig-Bing Heart) EXCEPT:

A) Intraventricular tunnel VSD to Aorta. B) Close VSD to pulmonary artery plus arterial switch procedure (Jatene). C) Intraventricular tunnel VSD to aorta with pulmonary artery

repositioned anterior to aorta and RVOT patch (Lecompte). D) Complex intraventricular tunnel VSD to aorta with infundibular resection

(Kawashima). E) Complex interventricular conduit VSD to aorta with RVOT patch (Doty).

11- Patients who benefit most from the Fontan procedure have the following

features EXCEPT:

A) Age > 2 years. B) RV morphology. C) Mean PAP < 15 mmHg. D) PVR < 2 units. E) Large unobstructed Pas.

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12- After repair of a partial anomalous pulmonary venous drainage with 2 anomalous veins draining into the SVC, it is noticed that the CVP is 25mmHg and the RA pressure is 6mmHg. TEE reveals no obstruction in pulmonary venous drainage. The most appropriate next step is:

A) Ligation of the azygos vein. B) Implantation of the anomalous veins directly into the SVC. C) Transection of the SVC and implantation into the RA appendage. D) Placing a stent in the SVC. E) Enlargement of the intracardiac pericardial patch.

13- A 14-month old infant with AVSD underwent cardiac catheterization. Results

show balanced ventricles but PAP is 90/40mmHg and Qp/Qs is 1.5:1 which changes to 2:1 with administration of oxygen. Management of this child is:

A) Complete repair of AVSD. B) PA banding. C) Evaluation for pulmonary transplantation. D) Evaluation for heart and lung transplant. E) Thoracoscopic lung biopsy.

14- Which of the following is the strongest contraindication to performing a

bidirectional Glenn procedure?

A) Age of 4 month. B) Bilateral SVC. C) Interrupted IVC. D) PV resistance of 6 woods units. E) Oxygen sat of 70%.

 15-  A 2-day old neonate underwent a repair of an obstructed TAPVD with

ligation of the vertical vein. After weaning from CPB blood pressure is 50/30 PAP 55/32. LA pressure 12 mmHg. PO2 70mmHg, CO2 32mmHg Ph 7.48. Echocardiogram reveals no anastomotic obstruction. The most appropriate next step is:

A) Add epinephrine infusion. B) Open an atrial fenestration. C) Reopen the vertical vein. D) Start inhaled nitric oxide. E) Decrease the ventilator rate.

16- A 2-month old infant was diagnosed with restrictive VSD. 2 months later his

congestive heart failure seemed out of proportion to the defect. What associated defect would increase his left to right shunting?

A) Pulmonary hypertension. B) Pulmonary stenosis. C) Coarctation of the aorta. D) Aortic prolapse. E) Double chamber right ventricle.

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17- A 1-year old child is undergoing closure of 2 VSDs one is peri-membranous and the other an apical muscular VSD. On exposure from the tricuspid valve, the peri-membranous one is well visualized and closed while the apical is not seen and left. Post bypass TEE shows a well closed peri-membranous VSD and a persistent apical one. Oxygen saturations are as follow: SVC 55%, PA 85%, and Aorta 100%. Which is the correct statement?

A) Qp/Qs ratio is 1:2. B) Most of the left to right shunt is eliminated. C) A pulmonary artery band should be placed. D) Add a vasodilator and take the patient back to ITU. E) Do a right ventriclotomy and close the apical VSD.

18- A 3.5 kg newborn has a prenatal diagnosis of congenital aortic stenosis. Echo

reveals a stenotic bicuspid valve, aortic annulus of 5mm (Z score -2), mitral annulus 6mm (Z score -4) and non apex forming LV. The best management is:

A) Konno-Ross procedure. B) Fontan procedure. C) Balloon aortic valvotomy. D) Open aortic valvotomy. E) Norwood procedure.

19- Which of the following increases the risk of spinal cord injury during repair

of coarctation of the aorta?

A) Aberrant right subclavian artery from the descending aorta. B) Body core temperature of 35.5 during the repair. C) Distal aortic pressure 55mmHg distal to the clamp. D) Total aortic cross clamp time of 28 minutes. E) Absence of PDA.

20- A newborn underwent repair of type B interrupted aortic arch and a VSD.

After hospital discharge which complication is most likely to occur?

A) Subaortic stenosis. B) Pulmonary hypertension. C) Complete heart block. D) Residual VSD. E) Recurrent arch obstruction.

21- Significant coronary artery stenosis is most commonly seen in the following

congenital anomalies:

A) Tetralogy of Fallot. B) Anomalous origin of left coronary artery from PA. C) TGA. D) Pulmonary atresia/intact ventricular septum. E) Hypoplastic left heart syndrome.

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22- A 2-month old 5kg child presents with multiple apical VSDs. A PA band is performed. What is the optimum size of the band?

A) 21mm. B) 23mm. C) 25mm. D) 27mm. E) 29mm.

23- A 2-year old child presents with cyanosis. An echo is performed and shows

the following:

What is the diagnosis?

A) TGA. B) Tetralogy of Fallot. C) Tricuspid atresia. D) HOCM. E) Severe Pulmonary stenosis.

24- A 3-year old child is undergoing repair of a low ASD through a mini-

sternotomy. After weaning from bypass Blood pressure is 95/55, Aortic oxygen sat 78%, Heart rate 90/min and CVP 8mmHg. What is the most common cause of this problem?

A) Diversion of IVC blood to the left atrium. B) PAPVD. C) Pulmonary hypertension. D) Undiagnosed severe PS. E) Left SVC to coronary sinus.

25- The most common indication for EARLY reoperation after TOF repair is:

A) Branch pulmonary artery stenosis. B) Residual VSD. C) Tricuspid regurgitation. D) Pulmonary regurgitation. E) Right ventricular outflow stenosis.

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26- A 35-year old man presents to a local cardiology department with breathlessness. He has no previous cardiac history and no previous operation. Further investigation reveals a systolic murmur and echocardiography confirms a ventricular septal defect. Which of the following statements regarding this condition is TRUE?

A) A perimembranous location is most likely. B) Endocardial defects often affect the tricuspid valve. C) It is likely to be secondary to ischemic heart disease. D) Muscular defects are often associated with other cardiac defects. E) Subarterial defects may affect the non coronary aortic cusp.

27- A 50-year old patient who has no history of cardiac disease presents with

dyspnea. Echocardiogram reveals the following picture. What is the most common diagnosis?

A) LA thrombus. B) Atrial myxoma. C) Atrial sarcoma. D) Cardiac metastasis. E) Primary cardiac lymphoma.

28- How much percent does being a female add on the additive EuroScore as a

risk of mortality after cardiac surgery?

A) 0%. B) 1%. C) 2%. D) 3%. E) 4%.

29- According to the Euroscore, what is highest risk in patients undergoing

cardiac surgery?

A) Preoperative cardiogenic shock. B) Poor ejection fraction. C) Preoperative renal failure. D) Severe peripheral vascular disease. E) Ischemic VSD.

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30- The SYNTAX trial is the first randomized controlled trial to compare DES

with CABG. What is the mean number of stents performed in the PTCA arm

in the SYNTAX?

A) 1.

B) 2.

C) 3.

D) 4.

E) 5.

31- Which of the following statements is TRUE regarding the natural history of

grafts?

A) Complete revascularization decreases the late frequency of ventricular

arrhythmia.

B) About 1/3 of vein grafts will have an important reduction in flow at 3 years.

C) The 5-10% of IMA grafts that develop stenoses will eventually occlude,

requiring reoperation.

D) Bilateral IMA grafting has been shown to increase survival when compared to

single IMA grafting.

E) Native coronary stenoses proximal to a vein graft do not progress over time.

32- Which of the following statements is TRUE regarding reoperation for

coronary artery disease?

A) 25% of patients will require reoperation at 10 years.

B) Native vessel disease progression is the most common cause for reoperation.

C) 10-year survival after CAB reoperation is less than 50%.

D) Younger age at first CAB increases the risk for second CAB.

E) Use of the IMA lengthens the time between first and second CAB, but does

not reduce the prevalence of reoperation.

33- Which of the following statements is TRUE regarding indications for CAB?

A) A 50% left main stenosis can be treated with either PTCA or CAB.

B) Patients with 3-vessel disease, good LV function, and mild ischemia should

undergo prompt operation.

C) CAB is indicated with 2-vessel disease and depressed LV function.

D) Depression of LV function below 20% is an indication for CAB.

E) Acute hemodynamic instability after acute MI is a contraindication to

emergent CAB.

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34- A 72-year old man underwent a mitral valve repair for ischemic

cardiomyopathy and a single saphenous vein graft to the first diagonal for a

planned 70% lesion. Operative technique included 2 stage venous

cannulation, direct aortic perfusion and LV venting through the right

superior PV. Myocardial protection included intermittent cold cardioplegia,

topical cooling using a systemic jacket and systemic hypothermia. Which

area of the myocardium is likely to be most inadequately cooled?

A) Free right ventricular wall.

B) Interatrial septum.

C) Left ventricular subendocardium.

D) Lateral LV wall.

E) Diaphragmatic LV surface.

35- Regarding intravascular air, which of the following statements is CORRECT?

A) Air embolism is the most common cause of RV dysfunction post-bypass.

B) Air embolism through the arterial line can be prevented with centrifugal

pumps.

C) The blood solubility of nitrogen is more than carbon dioxide.

D) Cerebral air embolism is the most common cause of postoperative cerebral

stroke.

E) Treatment with hyperbaric oxygen is not effective in treatment of suspected

early cerebral air embolism.

36- Myocardial oxygen requirement is greatest in which of the following states:

A) Arrested with warm blood cardioplegia.

B) Vented, arrested, normothermic.

C) Vented, arrested, hypothermic.

D) Vented, fibrillating, normothermic.

E) Topical hypothermia, Ventricular fibrillation.

37- Which of the following is INCORRECT regarding aortic dissections?

A) Men are twice as likely affected as women.

B) A Stanford A type aortic dissection involves the ascending aorta.

C) Both Debakey type I&II dissections involve the ascending aorta.

D) Aortic dissections occur in otherwise healthy women during the first trimester

of pregnancy.

E) With successful surgery the 10-year survival is 40-50%.

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38- Regarding cardiac allograft rejection, which statement is FALSE?

A) Depletion of CD4+ cells in cardiac allograft recipients prolongs allograft survival.

B) CMV infection in cardiac transplant recipients is associated with an increased incidence of rejection.

C) Cardiac allograft vasculopathy is a major cause of morbidity and mortality in the first year after transplantation.

D) Acute cardiac allograft rejection is diagnosed by right ventricular endomyocardial biopsy.

E) Cardiac allograft vasculopathy is diagnosed by cardiac catheterization with intravascular ultrasound.

39- Regarding cardiac contusions:

A) They are most often caused by sharp cardiac injuries as a stab wound. B) They affect the LV more than the RV. C) They are histologically characterized by necrosis of myocardial muscle cells. D) A cardiac contusion is characterized by elevation of troponin C. E) The ECG is characterized by ST segment and T wave abnormalities.

40- Regarding Systolic anterior motion of the mitral valve, which statement is

INCORRECT:

A) Is explained by the Venturi effect acting on the anterior mitral leaflet. B) Is associated with primary abnormalities of the mitral apparatus. C) Does not occur before aortic valve opening. D) Is sensitive to changes in ventricular volume. E) May be decreased in mitral valve repair by transfer of more posterior leaflet

chordae to the anterior leaflet. 41- Regarding Aortic root enlargement, which statement is INCORRECT?

A) The Konno Rastan is a posterior enlargement of the aortic root. B) The Konno Rastan may damage the first septal artery. C) The Nick procedure involves extending the aortotomy through the posterior

commisure into the interleaflet triangle. D) Posterior aortic root enlargement techniques can be used without an additional

risk. E) The Manougian’s technique enlarges the root towards the anterior mitral valve

leaflet. 42- Regarding the Ross procedure, which statement is INCORRECT?

A) It is replacement of the patient’s diseased aortic valve with his own pulmonary valve.

B) Longevity of the pulmonary autograft in the aortic position is superior to that of a porcine bioprosthesis.

C) The pulmonary valve has the potential to grow with the child. D) It requires long term anticoagulation. E) It is useful in young patients with Marfan’s Syndrome.

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43- Regarding ventricular remodeling procedure, which statement is CORRECT?

A) The Batisata attempts to specifically restore ventricular contour.

B) The Batisata is associated with good clinical outcome regarding morbidity and

mortality.

C) The Dor procedure attempts to remove as much muscle tissue as possible.

D) The Dor procedure attempts to restore the left ventricular cavity to a circular

shape.

E) These operations are performed concomitantly with CABG.

44- Regarding cerebral protection in aortic surgery, which statement is

INCORRECT?

A) Cerebral metabolism is reduced approximately 5-7% for each degree

centigrade.

B) Deep hypothermic circulatory arrest at 15 degrees eliminates the metabolic

needs of the brain.

C) Moderate levels of hypothermia, in contrast to deep hypothermia, permits a

shorter perfusion time.

D) Retrograde cerebral perfusion is used at flow rates that maintain central

venous pressure in arrange of 15-25mmHg.

E) Antegrade selective cerebral perfusion during moderate hypothermia 25

degrees requires a perfusion volume of 10ml/kg/min.

45- Which of the following waves is a negative deflection on the central venous

pressure waveform?

A) a wave.

B) x wave.

C) c wave.

D) v wave.

E) p wave.

46- Which one of the following cardiac tumors occurs primarily in the adult age

group rather than children?

A) Rhabdomyoma.

B) Fibroma.

C) Purkinjie tumors.

D) Sarcomas.

E) Hamartoma.

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47- In what cardiac pathology is this type of LV/RV trace found on cardiac

cauterization?

A) Mitral stenosis.

B) Constrictive pericarditis.

C) Aortic stenosis.

D) Aortic regurgitation.

E) Ischemic heart disease.

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From the list of options below, choose which would be an indication for valve

surgery in the following situations. Each option may be used once, more than

once or not at all.

A) Aortic annular abscess.

B) Aortic valve vegetation > 2mm.

C) Asymptomatic patient with AR and aortic root diameter of 40 mm.

D) Asymptomatic patient with AR and decline in EF from 0.60 to 0.40 during

stress echo.

E) Asymptomatic patient with AR and EDD of 55 mm.

F) Asymptomatic patient with AR, EF 0.60 and ESD of 40 mm.

G) Asymptomatic patient with aortic valve area of 1.2 cm2.

H) Asymptomatic patient with aortic valve area of 1.6 cm2 and TIAs.

I) Dyspnoeic patient with aortic valve area of 0.8 cm2 but no hypotension on

exercise.

J) Dyspnoeic patient with aortic valve area of 2.5 cm2.

K) P-R interval of 0.20 sec.

L) Persistent pyrexia and leucocytosis after three days of antibiotics.

M) Planned CABG with an aortic valve gradient of 10 mmHg.

N) Proteinuria and microscopic hematuria.

O) Symptomatic patient with AR and EF 0.45.

48- Chronic severe aortic regurgitation.

49- Aortic stenosis.

50- Native aortic valve endocarditis without hemodynamic compromise.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper II Cairo 15/11/2009 Time allowed: 2 hours

 

Answer all the following questions:

1- Hemodynamics, disadvantages and timing of subsequent repair in:

A) MBT shunt for univentricular heart. B) Bidirectional Glenn.

2- Discuss the early and late complications after total correction of Fallot’s tetralogy.

3- New staging in cancer lung.

4- Total anomalous pulmonary venous drainage. Discuss:

Types and management.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper III Cairo 16/11/2009 Time allowed: 2 hours

 

Commentary

A previously healthy 28-year-old man presented to the hospital because

of 1 month of progressive exertional dyspnea, weakness, and weight loss.

One day prior to hospitalization, he was unable to climb 1 flight of stairs

because of shortness of breath. On examination, he appeared fatigued

with mild respiratory distress at rest. His blood pressure was 110/70

mmHg without pulsus paradoxus. His heart rate was 110 beats/min and

regular. The jugular veins were distended without Kussmaul’s sign.

Pulmonary auscultation revealed scant bibasilar rales. The heart sounds

were distant. There was mild bilateral ankle edema. As part of the

evaluation during hospitalization, he underwent cardiac magnetic

resonance imaging. A short-axis view at the midventricular level is

shown in the figure below.

Discuss.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper IV – MCQ Cairo 17/11/2009 Time allowed: 60 minutes

 

1  

For Each of The Following Multiple Choice Questions, Select The One Most Appropriate Answer:

1- A 44-year old man developed chylothorax following trans-hiatal esophagectomy. The chylothorax was attributed to iatrogenic injury to the thoracic duct. The thoracic duct:

A) Is the common trunk of all the lymphatic vessels on the right side of the head, neck and thorax.

B) Varies in length from 38 to 45 cm. C) Extends from the first sacral vertebra to the root of the neck. D) Enters the thorax through the vena caval hiatus of the thoracoabdominal

diaphragm. E) Has no valve to ensure free flow of chyle.

2- A 65-year old man with a left-sided hemothorax following trauma had an X-

ray to confirm the presence of blood in the left pleural space. In the erect posture, the fluid would tend to accumulate in which part of the pleural space?

A) Costodiaphragmatic recess. B) Costomediastinal recess. C) Copula. D) Hilar reflection. E) Middle mediastinum.

3- A patient with a pleural effusion is to undergo aspiration of fluid from the

pleural space. From superficial to deep, identify the correct order of structures the needle must pass before it enters the pleural cavity:

A) External intercostals – innermost intercostals – internal intercostals – parietal pleura.

B) External intercostals – internal intercostals – parietal pleura – innermost intercostals.

C) Parietal pleura – innermost intercostals – internal intercostals – external intercostals.

D) External intercostals – internal intercostals – innermost intercostals – parietal pleura.

E) External intercostals – internal intercostals – innermost intercostals – visceral pleura.

4- While removing a mass from the back, the thoracodorsal nerve (C6-C8) is

accidentally injured. Which muscle is most likely to be affected?

A) Serratus posterior inferior. B) Serratus anterior. C) Levator scapulas. D) Longissimus. E) Latissimus dorsi.

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5- Which of the following statements regarding the venous drainage of the heart is correct?

A) The coronary sinus drains into the left atrium. B) The anterior cardiac veins begin over the anterior surface of the left ventricle,

cross over the atrioventricular groove (coronary groove) and directly drain into the left atrium.

C) The great cardiac vein is the largest tributary of the coronary sinus and this vein starts at the apex of the heart and ascends with the anterior ventricular branch of the left coronary artery.

D) The middle and small cardiac veins drain most of the areas supplied by the left coronary.

E) The coronary sinus drains into the great cardiac vein. 6- A patient presents with a clinically significant atrial septal defect (ASD). The

ASD is most likely to be due to incomplete closure of which one of the following structures:

A) Foramen ovale. B) Ligamentum arteriosus. C) Ductus arteriosus. D) Sinus venarum. E) Coronary sinus.

7- A patient presents with a right bundle branch block due to blockage in the

atrioventricular (AV) nodal artery. Part of the right bundle branch of the AV bundle is carried by which structure?

A) Pectinate muscles. B) Anterior papillary muscle of the left ventricle. C) Moderator band (septomarginal trabecula). D) Crista terminalis. E) Chordae tendineae.

8- After posterolateral thoracotomy, surgeons like to infiltrate local anesthetic

both above and below the incision to block the nerves supplying the thoracic wall. The thoracic wall is innervated by the:

A) Dorsal primary rami. B) Intercostals nerves. C) Lateral pectoral nerves. D) Medial pectoral nerves. E) Thoracodorsal nerves.

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9- A corporal injured in a roadside explosion in Basra was found to have multiple small metal fragments in his thoracic cavity. He also had a pericardial effusion suggestive of a tear in the pericardium. He underwent emergency thoracotomy in the field hospital, which revealed that the pericardium was torn inferiorly. The surgeon began to explore for fragments in the pericardial sac. Slipping his hand under the heart apex, he slid his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His fingertips were then in the:

A) Coronary sinus. B) Coronary sulcus. C) Costomediastinal recess. D) Oblique pericardial sinus. E) Transverse sinus.

10- A victim of anterior chest stabbing received a stab in a structure that is in

close proximity to where the first rib articulates with the sternum. The structure most likely to be injured is the:

A) Nipple. B) Root of the lung. C) Sternal angle. D) Sternoclavicular joint. E) Xiphoid process.

11- A victim of anterior chest stabbing was brought to the ER with impending

cardiac temponade. There was a single puncture wound in the anterior chest 2 cm lateral to the left sternal border. An emergency thoracotomy revealed clots in the pericardium, with a puncture wound in the right ventricle. To evacuate clots from the pericardial cavity the surgeon slipped his hand behind the heart and extended upwards until stopped by a line of pericardial reflection that forms the:

A) Cardiac notch. B) Costomediastinal recess. C) Hilar reflection. D) Oblique pericardial sinus. E) Transverse sinus.

12- A 25-year old man was stabbed in the right supraclavicular fossa. The knife

punctured the portion of the parietal pleura that extends above the first rib. This portion of the parietal pleura is called the:

A) Costodiaphragmatic recess. B) Costomediastinal recess. C) Costocervical recess. D) Copula. E) Endothoracic fascia.

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13- While performing thymectomy to remove a malignant thymoma, the surgeon is careful to avoid damaging an important nerve lying on and partly curving posteriorly around the arch of the aorta. Which of the following nerves is the surgeon trying to preserve?

A) Left phrenic. B) Left sympathetic trunk. C) Left vagus. D) Right phrenic. E) Right sympathetic trunk.

14- During pericardiectomy, sudden bleeding was noticed due to accidental

injury to a major vascular structure in the pericardium. The surgeon inserted his left index finger through the transverse pericardial sinus, pulled forward on the two large vessels lying ventral to his finger and compressed these vessels with his thumb to control bleeding. Which vessels were these?

A) Cardiac notch. B) Coronary sinus. C) Oblique pericardial sinus. D) Coronary sulcus. E) Transverse pericardial sinus.

15- A 34-year old woman with history of cough and weight loss for over a month

is noticed to have a rounded opacity in the pleural cavity near the cardiac notch on her chest X-ray. The opacity is most likely to be present in the:

A) Costodiaphragmatic recess. B) Costomediastinal recess. C) Copula. D) Hilum. E) Pulmonary ligament.

16- A specialist registrar is performing her first ductus arteriosus ligation. The

consultant supervising her instructs her to be careful when placing a clamp on the ducts to avoid injury to an important structure immediately dorsal to it. To which of the following structures the consultant is referring?

A) Accessory hemiazygos vein. B) Left internal thoracic artery. C) Left phrenic nerve. D) Left recurrent laryngeal nerve. E) Thoracic duct.

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17- During a demonstration on anatomy of the lung, the tutor asked one of the

medical students to pass his index finger posteriorly inferior to the root of the

left lung and identify the structure that is blocking the passage of the finger.

Which structure would most likely be responsible for this?

A) Costodiaphragmatic recess.

B) Copula.

C) Inferior vena cava.

D) Left pulmonary vein.

E) Pulmonary ligament.

18- An anatomy demonstrator is teaching medical students about the right lung.

Which of the following statements regarding the right lung made by the

demonstrator is CORRECT?

A) It is slightly smaller than the left lung.

B) It has lingular segmental bronchus.

C) It occupies the right most portion of the mediastinum.

D) Its upper lobar bronchus lies behind and above the right pulmonary artery.

E) It has the right phrenic nerve passing posterior to its lung root.

19- While mobilizing the descending aorta during repair of an aortic coarctation

in a 3-week old baby a surgeon accidentally cuts the first aortic intercostals

arteries. Which of the following structures might be deprived of its main

source of blood supply as a result of this iatrogenic injury?

A) First posterior intercostal space.

B) First anterior intercostal space.

C) Left bronchus.

D) Right bronchus.

E) Fibrous pericardium. 20- An 82-year old man who has been bedridden and lying supine for many

weeks in a nursing home, has developed a right lung abscess that is draining by gravity into one particular region of the lung. Where is the most likely site of fluid accumulation?

A) Apical segment of the upper lobe. B) Lingula. C) Lower lobe. D) Middle lobe. E) Superior segment of the lower lobe.

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21- A 32-year old man was shot in the chest. The bullet punctured a vessel that

courses across the mediastinum in an almost horizontal fashion. Which of the

following vessels was injured?

A) Left subclavian artery.

B) Left subclavian vein.

C) Left brachiocephalic vein.

D) Left internal jugular vein.

E) Left common carotid artery.

22- While performing esophagectomy through a right thoracotomy the surgeon

suddenly noticed a gush of blood. After controlling the hemorrhage, he

realized that there was a tear in a large venous structure located in the

posterior mediastinum that empties into the superior vena cava. Which of the

following venous structures was most likely to be injured?

A) Azygos vein.

B) Basilic vein.

C) Brachiocephalic vein.

D) Cephalic vein.

E) External jugular vein.

23- While excising a tumor of the thymus gland, the surgeon accidentally injured

a vein lying immediately posterior to the thymus. Which of the following

vessels is most likely to be in injured?

A) Left brachiocephalic vein.

B) Left pulmonary vein.

C) Left bronchial vein.

D) Right pulmonary artery.

E) Right superior intercostal vein.

24- While performing a surgical procedure in the mid-region of the thorax, the

surgeon accidentally injured an important structure that lies immediately

anterior to the thoracic duct. Which of the following structures was most

likely to be injured?

A) Aorta.

B) Azygos vein.

C) Esophagus.

D) Superior vena cava.

E) Trachea.

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25- A 42-year old man was diagnosed with a tumor of the posterior mediastinum.

Such a tumor is most likely to compress which of the following structure?

A) Arch of the aorta.

B) Esophagus.

C) Inferior vena cava.

D) Pulmonary trunk.

E) Trachea.

26- While performing extended mediastinal lymph node dissection for a

squamous cell carcinoma of the right upper lobe bronchus, a patient’s right

sympathetic trunk was accidentally severed just cranial to the level of spinal

nerve T1. Which function would be left intact in the affected region?

A) Erector pili muscle activity.

B) Dilation/constriction of blood vessels.

C) Sweat production.

D) Visceral reflex activity.

E) Voluntary muscle activity.

27- A 76-year old man with a complaint of dull chest pain of 3 months’ duration,

with a normal electrocardiogram and cardiac enzymes, underwent a

computed tomographic scan, which showed a mass lesion involving a

structure in the middle mediastinum. Which of the following structures could

be involved?

A) Aortic arch.

B) Ascending aorta.

C) Descending aorta.

D) Esophagus.

E) Thoracic duct.

28- During investigation for chest pain in a 32-year old man computed

tomography showed a large mass in the posterior mediastinum. Which of the

following structures could be involved?

A) Aortic arch.

B) Ascending aorta.

C) Innominate artery

D) Lymph glands.

E) Superior vena cava.

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29- A 42-year old man is undergoing esophagectomy. While mobilizing the

esophagus in the neck, for anastomosis with the stomach tube on the left side,

the operating surgeon must be careful about avoiding injury to which of the

following vital structures?

A) Innominate artery.

B) Innominate vein.

C) Internal carotid artery.

D) Sympathetic chain.

E) Thoracic duct.

30- While performing left pneumonectomy, the surgeon must avoid injury to

which of the following vital structures that leaves an impression on the

mediastinal surface of the left lung?

A) Aortic arch.

B) Azygos vein.

C) Innominate artery.

D) Inferior vena cava.

E) Superior vena cava.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic SurgeryFaculty of Medicine Paper IV Cairo 17/11/2009 Time allowed: 60 minutes

 

Anatomy and Pathology

Answer all the following questions:

1- Anatomy and embryology of the interatrial septum.

2- Anatomy and pathology of congenital diaphragmatic hernia.

3- Blood supply of the conduction system of the heart.

4- Pathology of bronchogenic carcinoma.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I MCQ

Cairo 07/11/2010 Time allowed: 90 minutes

DIRECTIONS: In the following questions, all of the statements are true except one, identify the incorrect statement:

1. The following are histologically neuro-endocrine types of lung cancer except:

A. Bronchoalveolar lung cancer B. Typical Carcinoid C. Atypical Carcinoid D. Large call carcinoma E. Small cell Lung cancer

2. With hypovolemic shock, all the following are reduced except which one?

A. Central venous pressure B. Mean arterial pressure C. Systemic vascular resistance D. Cardiac output E. Pulmonary capillary wedge pressure

3. Morgagni hernia is characterized by except:

A. Always has a peritoneal sac B. Does not produce symptoms in childhood C. May contain transverse colon D. Surgical treatment may be delayed after diagnosis has been established E. Is repaired through a midline abdominal incision

4. In hypoplasia of the lung, the following are correct except:

A. The major abnormality is a decrease in the number of airway generations and pulmonary artery branchings

B. Two general causes: diaphragmatic hernia or primary embryologic defect C. Hernia interferes with alveolar development during last 2 months of intrauterine growth D. Embryologic defects occur early and may be associated with other syndromes

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E. If associated with diaphragmatic hernia, the hypoplastic lung should be removed at surgery.

5. During CPR all the following are true except:

A. Give adrenaline 1 mg every 3- 5 minute B. Consider: amiodarone 300 mg indextrose, Mg++, K+ C. Atropine 3 mg once/ pacing. D. Atropine 3 mg twice/ pacing.

6. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because the risk

thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient to prevent

stroke because the risk of thromboembolism is low 7. All of the following concerning aspergillosis are correct except:

A. May occur in a cavitary form. B. May produce necrotizing bronchopneumonia or abscess formation. C. Frequently occurs in irnmunosuppressed patients or in those with antecedent pulmonary

disease. D. Diagnosis can be firmly established by the presence of Aspergillus in a patient's sputum. E. May cause bronchopulmonary hypersensitivity reactions and resemble asthmatic

bronchitis

DIRECTIONS: For each of the following multiple choice questions, select the one most appropriate answer:

8. In a full-term infant, the esophagus should readily permit passage of: A. A #12-#16 F catheter B. A #16-#20 F catheter C. A #20-#24 F catheter D. A #24-#28 F catheter E. A #28-#32 F catheter

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9. Cervical mediastinoscopy for preoperative assessment of lung carcinoma is Least reliable for

a tumor located in the:

A. Right upper lobe B. Right middle lobe C. Right lower lobe D. Left upper lobe E. Left lower lobe

10. Mediastinoscopy is contraindicated in the presence of: A. Prior laryngectomy. B. Histoplasmosis. C. Superior vena cava syndrome. D. Pectus excavatum E. None of the above

11. The condition that is least likely to be associated with respiratory distress in the newborn is:

A. Congenital lobar emphysema B. Congenital cystic adenomatoid malformation C. Bronchogenic cyst D. Morgagni hernia E. Bochdalek hernia

12. An 18-year old patient suffers an attack of a first time right side primary pneumothorax. An intercostal drain in inserted and results in full expansion of the lung and the patient is discharged home on the next day. During consultation in the follow up clinic, he asks you about the percentage of recurrence of another pneumothorax. What is the most appropriate answer?

A. 5% B. 10% C. 30% D. 60% E. 90%

13. According to results of the NETT trial, patient with emphysema who would benefit most from Lung Volume Reduction Surgery are:

A. Lower Lobe Emphysema with FEV1 more than 20% B. Patients with FEV1 less than 20%

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C. Upper lobe Emphysema with poor exercise tolerance D. Patients with good exercise tolerance and FEV1 less than 20% E. Patients with diffuse emphysema and FEV1 more than 20%

14. Which of the following statements concerning aneurysms of the thoracic aorta is true?

A. The chest roentgenogram is helpful in the diagnosis of ascending aortic aneurysms. B. Atherosclerotic aneurysms are multiple in approximately one-third of patients. C. Aneurysms of the ascending aorta are pre- dominantly atherosclerotic. D. These aneurysms are usually associated with chest or back pain. E. Myocardial infarction is the most common cause of death in patients who do not

undergo operation. 15. If blood entering the normal arterial circulation of the heart is 100% saturated with oxygen,

oxygen saturation of blood in the coronary sinus can be expected to be approximately:

A. 75%. B. 60%. C. 50%. D. 35%. E. Less than 20%.

16. Which anticoagulation treatment plan(s) is/are appropriate for a 72-year-old man with a mechanical heart valve in place who takes Coumadin (warfarin) and now requires elective left colon resection?

A. Discontinuation of Coumadin therapy on the day of the operation. B. Discontinuation of Coumadin therapy on the day of the operation with replacement of

clotting factors with fresh frozen plasma (FFP) before the start of the surgical procedure. C. Discontinuation of Coumadin therapy 5 days before operation with no further

anticoagulation therapy before surgery. D. Discontinuation of Coumadin therapy 5 days before operation with the institution of

intravenous heparin as the prothrombin time normalizes. E. Discontinuation of Coumadin therapy 2 days before operation followed by large doses of

aspirin.

17. Adequate flow during cardiopulmonary bypass is best indicated by: A. Systemic blood pressure of 90/50 mm. Hg. B. Arterial PO 2 of 230 mm. Hg. C. Mixed venous hemoglobin saturation of 78%. D. Central venous pressure of 1 mm. Hg. E. Plasma lactate value of 6 mg. per dl.

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18. Which of the following does not typically occur during the first few minutes of

cardiopulmonary bypass?

A. Interstitial fluid increases. B. Blood flow becomes nonpulsatile. C. Platelet count decreases. D. Complement is activated. E. Systemic vascular resistance falls.

19. Which of the following is not a major indications for instituting intra-aortic balloon pumping?

A. Medically refractory angina. B. Acute papillary muscle rupture. C. Left main coronary artery lesion. D. Ventricular failure after cardiac surgery. E. PTCA failure.

20. Permanent artificial hearts are being developed that are electrically powered. Wireless techniques are used to transmit the electrical energy across the body wall using the principle of:

A. Infrared sensor. B. Inductive coupling. C. Thermionic coupling. D. High-pressure liquid chromatography (HPLC). E. Infrared spectroscopy.

DIRECTIONS: In the following questions, all of the statements are false ones, identify the correct or true statement:

21. In cardiopulmonary resuscitation (CPR) the compression : ventilation ratio is:

A. 30:2. B. 40:2. C. 30:3. D. 40:3.

22. Which is not true of cardiopulmonary resuscitation (CPR)?

A. Closed chest massage is as effective as open chest massage. B. The success rate for out-of-hospital resuscitation may be as high as 30% to 60%. C. The most common cause of sudden death is ischemic heart disease. D. Standard chest massage generally provides less than 15% of normal coronary and

cerebral blood flow.

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23. A right upper lobectomy with mediastinal L.N. dissection is done for lung Carcinoma. The pathology reveals a 3.7 cm cancer in the apical segment with 0ne of the three bronchial nodes positive for tumor. The TNM staging here is:

A. T1 N1 Mo B. T2 N1 Mo C. T1 N2 Mo D. T2 N2 Mo E. T1 No Mo

24. Which histological type of mesothelioma carries the best prognosis?

A. Epitheloid B. Sarcomatoid C. Mixed D. Small cell type E. Desmoplastic

25. The following increase the amount of calcium in cardiac muscle:

A. Halothane B. Adrenaline C. Diltiazem D. Nifedipine E. Trimetaphan

26. During shockable VF/ pulseless VT we give one shock of:

21 150- 200 J biphasic or 360 J monophasic. 22 100 J biphasic or 360 J monophasic. 23 150- 360 J biphasic or 300 J monophasic. 24 150- 360 J biphasic or 260 J monophasic.

27. Systemic metabolic acidosis and increased mixed venous oxygen saturation are characteristic

of toxicity from which agent?

A. Phenylephrine B. Milrinone C. Nitroglycerine D. Nitroprusside E. Digoxin

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28. Which of the following agents has the highest potential for supraventricular arrhythmia?

A. Isoproterenol B. Phenylephrine C. Epinephrine D. Dopamine E. Dobutamine

29. Which of the following causes the greatest increase in cardiac index at equipotent doses?

A. Dopamine B. Dobutamine C. Epinephrine D. Isoproterenol

30. Regarding Pulmonary vascular resistance, which of the following is correct:

A. It is decreased in chronic hypoxia B. It has a value approximately one-sixth that of the systemic circulation C. It can be measured using a flow-directed balloon catheter with a thermistor tip D. It is increased by isoprenaline E. It is decreased by 5-hydroxytryptamine (5-HT)

31. The carotid body contains both chemoreceptors and baroreceptors. There are stimulated

under certain circumstances to maintain homeostasis. Which one of the following anatomical regions of the brain is stimulated by neuronal transmission from the carotid body?

A. The basal ganglia B. The cerebellum C. The hypothalamus D. The pineal gland E. The posterior pituitary gland

32. Which of the following statements is true regarding spontaneous pneumothorax?

A. Primary spontaneous pneumothorax typically occurs in tall, thin, older adults. B. Osteogenic sarcoma is the most common malignant cause of secondary spontaneous

pneumothorax in children. C. Catamenial pneumothorax typically occurs during the end of menses when a patient is

taking oral contraceptives. D. Hemothorax occurs in up to 20% of patients with spontaneous pneumothorax. E. Pleurectomy is preferred over mechanical pleurodesis for recurrent pneumothorax.

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33. Regarding Warfarin, the following is true:

A. It has a rapid onset of action B. It is readily excreted in the urine C. It is antagonized by salicylate D. It is potentiated by metronidazole E. is potentiated by barbiturates

34. Which of the following statements is true regarding empyema?

A. Transitional empyemas should be treated with immediate thoracotomy and debridement to prevent progression to the chronic phase.

B. Most empyemas now occur after thoracic surgical procedures. C. Chest CT or US are useful to localize collections for drainage. D. Thoracentesis usually returns purulent material with high yield for the causative

organism. E. Bronchoscopy is unnecessary as the process is extrapleural

35. Which of the following statements is true regarding lung abscess?

A. The most common locations for abscess formation are the posterior segment of the lower lobe and superior segment of the upper lobe.

B. Most lung abscesses are caused by aerobic organisms from an aggressive pneumonia. C. Most opportunistic lung abscesses follow the typical pattern, with community-acquired

organisms forming a single abscess cavity. D. A primary abscess secondary to gram-negative organisms should be promptly treated

with chest tube drainage. E. A thick-walled cavity associated with persistent symptoms after 5 weeks of medical

treatment should be surgically resected.

36. According to results of the NETT trial, patient with emphysema who would benefit most from Lung Volume Reduction Surgery are:

A. Lower Lobe Emphysema with FEV1 more than 20% B. Patients with FEV1 less than 20% C. Upper lobe Emphysema with poor exercise tolerance D. Patients with good exercise tolerance and FEV1 less than 20% E. Patients with diffuse emphysema and FEV1 more than 20%

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37. Lasers:

A. Produce coherent light B. Use photon energy C. Are usually polychromatic light D. All use visible light E. May be used to treat photosensitive tumours

38. Nitroglycerine:

A. Increases work of the heart B. Increases the heart rate C. Decreases the left ventricular end-diastolic pressure D. Decreases myocardial oxygen utilization E. Does not alter coronary blood flow

39. The purpose of leaving a chest tube in place following pneumonectomy is to:

A. Drain off fluid B. Drain off air C. Detect a bronchial leak D. Adjust pressure within +2 and - 10 E. Add antibiotic solutions

40. Which of the following waves is a negative deflection on the Central venous pressure

waveform? A. a wave B. x wave C. c wave D. v wave E. p wave.

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41. In what cardiac pathology is this type of LV/RV trace found on cardiac catheterization?

A. Mitral stenosis B. Constrictive pericarditis C. Aortic stenosis D. Aortic regurgitation E. Ischemic heart disease

42. A 56 year old male performs a pulmonary function test with the following result:

FEV1= 1.8L (86%), FVC = 1.9L (56%), FEV1/FVC = 96% DLCO 62%. The picture is suggestive of:

A. Obstructive lung disease B. Restrictive Lung disease C. Mixed Lung disease D. Pulmonary haemorrhage E. Normal Lung Functions

43. Which letter indicates the point in the cardiac cycle that the mitral valve opens?

A. A B. B C. C D. D E. F

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DIRECTIONS: More than one answer. For the next question , determine whether each choice is true ( T ) or false ( F ): 44. Which of the following statements are True about atrial septal defects ?

A. Sinus venosus defects are often accompanied by congenital deformities of the mitral valve

B. Atrial arrhythmias are common in adults with ASD C. Eisenmenger’s syndrome is a frequent complication of uncorrected secundum ASD D. Patients with ASD are at increased risk of stroke E. The systolic murmur typically heard in patients with secundum ASD is due to shunt flow

across the atrial septum.

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DIRECTIONS: There are four-choices for the answer to each of the following questions; one or more may be correct. Use this code to select the most appropriate response: A B C D E (1-3) (I & 3) (2 & 4) (4) (1-4)

45. Chest tomography is useful to:

A. Show calcification in pulmonary nodules. B. Demonstrate multiple pulmonary metastases. C. Define the extent of a bronchial carcinoid. D. Rule out mediastinal node involvement by carcinoma.

46. Complication(s) of bronchiectasis include(s):

A. Recurrent pulmonary infections B. Massive hemoptysis C. Empyema D. Brain abscess

47. Which of the following statements regarding acute ascending aortic dissection is/are correct?

A. Aortic valve replacement is required for the majority of patients treated surgically. B. Hospital mortality for immediate surgical treatment is appreciably lower than that for

aggressive medical management. C. The disorder can be readily differentiated from acute myocardial infarction. D. Pericardial tamponade is the most common cause of death.

48. Which of the following statements regarding acute aortic dissection is/are true:

A. It occurs more commonly in women. B. It is fatal within 24 hours in the majority of untreated patients. C. Ascending (type A) and descending (type B) aortic dissections have similar hospital

mortality rates when treated medically D. Surgical treatment of acute type B dissections has a hospital mortality equal to or greater

than that for medical therapy.

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DIRECTIONS: In the following questions, all of the statements are correct one, identify the incorrect statement:

49. In a double blind clinical trial, the following is incorrect:

A. The patients know which treatment they receive. B. Each patient receives a placebo. C. The patients do not know they are in a trial. D. Each patient receives both treatments E. The clinician assessing the patients' condition does not know which treatment the patient has received.

50. Non-parametric tests include the following except

A. ANOVA B. Chi-squared test C. Wilcoxon signed rank test D. Mann-Whitney U test E. All are incorrect

51. The following are true about confidence intervals except:

A. The intervals are larger with smaller sample size. B. They indicate the presence or otherwise of a statistical difference between two groups. C. A 95% confidence interval means that 95% of all observed values fall within that

interval. D. In an odds ratio, if the 95% confidence interval includes unity then no significant

difference may apply. E. The intervals give a range of values within which the true value will lie.

52. Regarding the median estimated from a sample, the following is incorrect

A. It is not always equal to an actual observation. B. It is close to the mean if the distribution is symmetrical. C. It is less than the mean if the distribution is positively skewed. D. It is the most frequently occurring value. E. It is greater than or equal to at least 50% of the observations.

53. Regarding the standard deviation, which statement is incorrect?

A. It is a measure of variability. B. The square root of the variance. C. Twice the standard error. D. In the same units as the observations.

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DIRECTIONS: For the following question, the two lettered headings are followed by a list of numbered items. answer by using the key outlined below: A. If the item is associated with A only B. If the item is associated with B only C. If the item is associated with both A and B D. If the item is associated with neither A nor

A. Heart as a pump B. Heart as a muscle

54. Starling's law 55. Maximal velocity of contraction 56. Ventricular volume 57. Adrenalin

DIRECTIONS: In the following questions, each numbered item is to be matched with one lettered item. Each option may be used once, more than once or not at all. Thoracic anatomy

A. Azygos vein B. Descending thoracic aorta C. Inferior vena cava D. Left main bronchus E. Left superior vena cava F. Ligamentum arteriosum G. Long thoracic nerve of Bell H. Esophagus I. Phrenic nerve J. Phreno-esophageal ligament K. Stellate ganglion L. Supreme intercostals vein M. Thoracic duct N. Thymus O. Vagus nerve

From the list of options above, choose which structure is best described as follows. Each option may be used once, more than once or not at all. 58. It is typically invaded by superior sulcus tumor of the lung. 59. It is at particular risk of damage when applying radio-frequency current during surgery to correct

atrial arrhythmia. 60. It is a common source of major hemorrhage during mediastinoscopy.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper I: Short Accounts

Cairo 07/11/2010 Time allowed: 90 minutes Give A Short Account On The Following Questions: A. The new major changes in the international guidelines for:

1) The right-sided native valve endocarditis and the left-sided prosthetic valve endocarditis.

2) Pulmonary thromboembolism (PTE).

B. The conservation and supporting techniques to avoid and treat

the effects of the extracorporeal circulation on: 1) The blood. 2) The kidneys.

C. The potential complications of:

1) Endovascular stenting of the aorta. 2) Percutaneous valve implantation.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II MCQ

Cairo 08/11/2010 Time allowed: 90 minutes

DIRECTIONS: In the following questions, all of the statements are true except one, identify the incorrect statement:

1. The following statements regarding anticoagulation for atrial fibrillation are correct except:

A. Warfarin therapy for chronic AF reduces the incidence of stroke B. Anticoagulation is not necessary for patients with paroxysmal AF because the risk

thromboembolism is low C. Aspirin therapy reduces the incidence of stroke but is not as effective as coumadin D. For patients younger than 65 years with lone AF, aspirin alone is sufficient to prevent

stroke because the risk of thromboembolism is low 2. Esophageal dilatation for the treatment of achalasia is characterized by except:

A. It is used chiefly in postoperative management B. It is seldom permanently effective C. There is a risk of esophageal rupture D. It cannot be employed if the esophagus is very tortuous E. Relief of dysphagia may occur after a single course of treatment.

3. Obstruction to pulmonary venous return is associated with which of the following anomalies

except A. Partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava. B. Infracardiac (Type III) total anomalous pulmonary venous connection (TAPVC). C. Pulmonary vein stenosis. D. Cor triatriatum. E. Supracardiac (Type I) TAPVC.

4. The scimitar syndrome is characterized by except:

A. Anomalous drainage of right pulmonary veins B. Involvement of the superior vena cava C. Hypoplasia of the right lung

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D. Anomalous origin of the right pulmonary artery E. Characteristic X ray appearance

5. Which is not true of cardiopulmonary resuscitation (CPR)?

A. Closed chest massage is as effective as open chest massage. B. The success rate for out-of-hospital resuscitation may be as high as 30% to 60%. C. The most common cause of sudden death is ischemic heart disease. D. Standard chest massage generally provides less than 15% of normal coronary and cerebral

blood flow.

6. Which maneuver generally is not performed early before chest compression in basic life support outside the hospital?

A. Call for help. B. Obtain airway. C. Electrical cardioversion. D. Ventilation.

7. The following are surgical options for DORV with subpulmonary VSD (Taussig-Bing Heart) except:

A. Intraventricular tunnel VSD to Aorta B. Close VSD to pulmonary artery plus arterial switch procedure (Jatene) C. Intraventricular tunnel VSD to aorta with pulmonary artery

repositioned anterior to aorta and RVOT patch (Lecompte) D. Complex intraventricular tunnel VSD to aorta with infundibular resection (Kawashima) E. Complex interventricular conduit VSD to aorta with RVOT patch (Doty)

DIRECTIONS: In the following questions, all of the statements are true except one, identify the incorrect statement:

8. Which of the following is incorrect regarding aortic dissections?

A. Men are twice as likely affected as women B. A Stanford A type aortic dissection involves the ascending aorta C. Both Debakey type I&II dissections involve the ascending aorta D. Aortic dissections occur in otherwise healthy women during the first trimester of

pregnancy. E. With successful surgery the 10 year survival is 40-50%.

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9. Regarding cardiac allograft rejection, which statement is false:

A. Depletion of CD4+ cells in cardiac allograft recipients prolongs allograft survival B. CMV infection in cardiac transplant recipients is associated with an increased incidence

of rejection. C. Cardiac allograft vasculopathy is a major cause of morbidity and mortality in the first

year after transplantation. D. Acute cardiac allograft rejection is diagnosed by right ventricular endomyocardial biopsy. E. Cardiac allograft vasculopathy is diagnosed by cardiac catheterization with intravascular

ultrasound

10. Regarding Aortic root enlargement, which statement is incorrect?

A. The Konno Rastan is a posterior enlargement of the aortic root B. The Konno Rastan may damage the first septal artery C. The Nick Procedure involves extending the aortotomy through the posterior commisure

into the interleaflet triangle. D. Posterior aortic root enlargement techniques can be used without an additional risk E. The Manougian’s technique enlarges the root towards the anterior mitral valve leaflet

11. Regarding the Ross procedure, which statement is incorrect?

A. It is replacement of the patient’s diseased aortic valve with his own pulmonary valve B. Longevity of the pulmonary autograft in the aortic position is superior to that of a porcine

bioprosthesis C. The pulmonary valve has the potential to grow with the child D. It requires long term anticoagulation E. It is useful in young patients with Marfan’s Syndrome

12. Considering the results of coronary reoperation in comparison to primary CABG, choose the incorrect statement:

A. Operative morbidity and mortality are increased over those for primary CABG. B. Mortality most often stems from cardiac causes after reoperation. C. Survival of patients after hospital discharge following coronary reoperation is nearly

equivalent to survival after primary CABG. D. Compared to primary CABG, return of anginal symptoms is delayed after reoperative

CABG. E. Myocardial protection and the risk of myocardial infarction in reoperation are complicated by

increased noncoronary collaterals, patent atherosclerotic saphenous vein grafts, and more diffuse coronary atherosclerosis.

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13. Which of the following statements about left atrial myxoma is incorrect? A. This lesion, by site and histology, is the most common primary cardiac tumor. B. It is best diagnosed by Echocardiogram. C. The symptom complex can mimic collagen vascular disease. D. It has an intracavitary growth pattern. E. It has a multicentric origin in the chamber wall.

14. Regarding cerebral protection in aortic surgery, which statement is incorrect?

A. Cerebral metabolism is reduced approximately 5-7% for each degree centigrade

B. Deep hypothermic circulatory arrest at 15 degrees eliminates the metabolic needs of the brain.

C. Moderate levels of hypothermia, in contrast to deep hypothermia, permits a shorter perfusion time.

D. Retrograde cerebral perfusion is used at flow rates that maintain central venous pressure in arrange of 15-25mmHg

E. Antegrade selective cerebral perfusion during moderate hypothermia 25 degrees requires a perfusion volume of 10ml/kg/min.

DIRECTIONS: For each of the following multiple choice questions, select the one most appropriate answer:

15. After repair of a partial anomalous pulmonary venous drainage with 2 anomalous veins draining into the SVC, its noticed that the CVP is 25mmHg and the RA pressure is 6mmHg. TEE reveals no obstruction in pulmonary venous drainage. The most appropriate next step is:

A. Ligation of the azygos vein B. Implantation of the anomalous veins directly into the SVC C. Transection of the SVC and implantation into the RA appendage D. Placing a stent in the SVC E. Enlargement of the intracardiac pericardial patch.

16. Which of the following constitutes a true vascular ring?

A. Pulmonary artery sling. B. Double aortic arch. C. Anomalous origin of right subclavian artery from the descending aorta. D. Cervical aortic arch.

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17. Which one of the following cardiac tumours occurs primarily in the adult age group rather than children?

A. Rhabdomyoma B. Fibroma C. Purkinjie tumours D. Sarcomas E. Hamartoma

18. A 72-year old man underwent a mitral valve repair for ischemic cardiomyopathy and a single saphenous vein graft to the first diagonal for a planned 70% lesion. Operative technique included 2 stage venous cannulation, direct aortic perfusion and LV venting through the right superior PV. Myocardial protection included intermittent cold cardioplegia, topical cooling using a systemic jacket and systemic hypothermia. Which area of the myocardium is likely to be most inadequately cooled?

A. Free right ventricular wall B. Interatrial septum C. Left ventricular subendocardium D. Lateral LV wall E. Diaphragmatic LV surface

19. The predominant determinant of outcome for patients with pulmonary atresia and an intact ventricular septum revolves around:

A. The size of the ASD. B. The baby's age at presentation. C. The size of the right ventricular cavity and tricuspid valve. D. The presence of a tricuspid—as opposed to a bicuspid—pulmonary valve. E. The level of hypoxemia at presentation.

20. After repair of a partial anomalous pulmonary venous drainage with 2 anomalous veins draining into the SVC, its noticed that the CVP is 25mmHg and the RA pressure is 6mmHg. TEE reveals no obstruction in pulmonary venous drainage. The most appropriate next step is:

A. Ligation of the azygos vein. B. Implantation of the anomalous veins directly into the SVC C. Transection of the SVC and implantation into the RA appendage D. Placing a stent in the SVC E. Enlargement of the intracardiac pericardial patch

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21. Which of the following is the strongest contraindication to performing a bidirectional Glenn procedure?

A. Age of 4 month B. Bilateral SVC C. Interrupted IVC D. PV resistance of 6 woods units E. Oxygen sat of 70%.

22. A 2 day old neonate underwent a repair of an obstructed TAPVD with ligation of the vertical vein. After weaning from CPB blood pressure is 50/30 PAP 55/32. LA pressure 12 mmHg. PO2 70mmHg, CO2 32mmHg Ph 7.48. Echo cardiogram reveals no anastmotic obstruction. The most appropriate next step is:

A. Add epinephrine infusion B. Open an atrial fenestration C. Reopen the vertical vein D. Start inhaled nitric oxide E. Decrease the ventilator rate

23. A 50-year old patient who has no history of cardiac disease presents with dyspnea. Echocardiogram reveals the following picture. What is the most common diagnosis?

A. LA thrombus B. Atrial myxoma C. Atrial sarcoma D. Cardiac metastasis E. Primary cardiac lymphoma

24. A 3.5kg has a prenatal diagnosis of congenital aortic stenosis. Echo reveals a stenotic bicuspid valve, aortic annulus of 5mm (Z score -2), mitral annulus 6mm (Z score -4) and non apex forming LV. The best management is:

A. Konno-Ross procedure B. Fontan procedure C. Balloon aortic valvotomy D. Open aortic valvotomy E. Norwood procedure

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25. A newborn underwent repair of type B interrupted aortic arch and a VSD. After hospital discharge which complication is most likely to occur?

A. Subaortic stenosis B. Pulmonary hypertension C. Complete heart block. D. Residual VSD E. Recurrent arch obstruction

DIRECTIONS: In the following questions, all of the statements are false ones; identify the correct or true statement:

26. Which of the following is true regarding surgical ablation of atrial fibrillation?

A. The Maze procedure is a technically challenging cardiac surgical procedure with low success rates

B. Ligation of the left atrial appendage may reduce the incidence of stroke following surgical ablation

C. A successful outcome requires the production of complete and transmural lines of conduction block

D. Newer methods of producing lines of block such as cryoablation have been as effective as the traditional "cut and sew" method

E. The majority of procedures are performed alongside other cardiac surgery, predominantly mitral valve

27. Which of the following is true for isolation of the pulmonary veins by catheter ablation?

A. Pulmonary vein isolation without additional lines of ablation is the usual procedure performed for paroxysmal AF

B. The pulmonary veins can only be isolated with the patient in sinus rhythm C. The pulmonary veins should be ablated proximal to the ostium rather than at distal sites D. Maintenance of sinus rhythm can only be achieved if the pulmonary veins are electrically

isolated from the rest of the left atrium E. Electrical isolation of the pulmonary veins is an electrophysiological end point rather than

an empiric anatomic one 28. Which of the following statements is true regarding operative management of congenital sinus

of valsalva aneurysm?

A. Asymptomatic patients with small ruptured aneurysms can be followed with serial echocardiography.

B. Direct suture closure of the aneurysm orifice is preferred to patch closure.

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C. VSD repair is best performed through the aorta. D. Reoperation is primarily for progressive aortic insufficiency.

29. Which of the following statements is true regarding operative management of TAPVC?

A. Separate implantation of each pulmonary vein to the left atrium provides the most reliable reconstruction.

B. A secundum ASD can be closed with simple suture in these patients. C. The azygous vein can be mobilized and anastomosed directly to the left atrium in this

type of supracardiac TAPVC. D. The coronary sinus can be unroofed into the left atrium to correct cardiac TAPVC. E. Ligation of the vertical vein during infracardiac TAPVC repair should be done

immediately prior to discontinuing CPB.

30. Which of the following statements is true regarding the diagnosis of thoracic outlet syndrome?

A. The Adson test is positive when the radial pulse is diminished after arm hyperabduction. B. A cervical rib is best identified using cervical CT scanning. C. A nerve conduction velocity above 60 m/sec is normal. D. Decreased velocity across the elbow indicates ulnar nerve entrapment rather than thoracic

outlet syndrome. E. Peripheral angiography should be performed in all cases to exclude subclavian artery

stenosis.

31. Which of the following statements is true regarding operative management of post-infarct LV aneurysm?

A. Concomitant coronary artery bypass is not usually indicated in these patients B. Retaining some of the smooth aneurysm endocardium helps prevent postoperative clot

formation C. Septal aneurysmal tissue should not be resected as part of a Dor repair D. Large asymptomatic aneurysms can be managed non – operatively E. Direct linear closure can be used for small or moderate sized aneurysms.

32. Which of the following statements is true regarding neurogenic tumors of mediastinum?

A. The peak incidence occurs in children. B. Neurosarcomas have been associated with the Doege-Potter syndrome. C. Up to 75% of diffuse ganglioneuroblastomas will have metastasized at initial presentation. D. The posterior compartment is the most common location for neuroblastoma. E. Malignant pheochromocytomas metastasize early in the disease course.

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33. The SYNTAX trial is the first randomized controlled trial to compare DES with CABG. What is the mean number of stents performed in the PTCA arm in the SYNTAX?

A. 1 B. 2 C. 3 D. 4 E. 5

34. A 35 year -old presents to a local cardiology department with breathlessness. He has no previous cardiac history and no previous operation. Further investigation reveals a systolic murmur and echocardiography confirms a ventricular septal defect. Which of the following statements regarding this condition is true?

A. A perimembranous location is most likely B. Endocardial defects often affect the tricuspid valve C. It is likely to be secondary to ischaemic heart disease D. Muscular defects are often associated with other cardiac defects E. Subarterial defects may affect the non coronary aortic cusp

35. How much percent does being a female add on the additive EuroScore as a risk of mortality after cardiac surgery?

A. 0% B. 1% C. 2% D. 3% E. 4%

36. Regarding ventricular remodeling procedure, which statement is correct?

A. The Batisata attempts to specifically restore ventricular contour B. The Batisata is associated with good clinical outcome regarding morbidity and mortality C. The Dor procedure attempts to remove as much muscle tissue as possible. D. The Dor procedure attempts to restore the left ventricular cavity to a circular shape. E. These operations are performed concomitantly with CABG

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37. A 14 month old infant with AVSD underwent cardiac catheterization. Results show balanced ventricles but PAP is 90/40mmHg and Qp/Qs is 1.5:1 which changes to 2:1 with administration of oxygen. Management of this child is

A. Complete repair of AVSD B. PA banding C. Evaluation for pulmonary transplantation D. Evaluation for heart and lung transplant E. Thoracoscopic lung biopsy.

38. A 2-month year old infant was diagnosed with restrictive VSD. 2 months later his congestive heart failure seemed out of proportion to the defect. What associated defect would increase his left to right shunting?

A. Pulmonary hypertension B. Pulmonary stenosis C. Coarctation of the aorta D. Aortic prolapsed E. Double chamber right ventricle

39. A 2-month old 5kg child presents with multiple apical VSDs. A PA band is performed. What is the optimum size of the band.

A. 21mm B. 23mm C. 25mm D. 27mm E. 29mm

40. A 2 year old child presents with cyanosis. An echo is performed and shows the following:

What is the diagnosis?

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A. TGA B. Tetralogy of Fallot C. Tricuspid atresia D. HOCM E. Severe Pulmonary stenosis

41. A 3-year old child is undergoing repair of a low ASD through a mini-sternotomy. After weaning from bypass Blood pressure is 95/55, Aortic oxygen sat 78%, heart rate 90/min and CVP 8mmHg. What is the most common cause of this problem?

A. Diversion of IVC blood to the left atrium B. PAPVD C. Pulmonary hypertension D. Undiagnosed severe PS E. Left SVC to coronary sinus

42. Which of the following are relative indications for mechanical, as opposed to tissue, valve replacement?

A. Patient younger than 30 years. B. Young female patient who desires children. C. An elderly patient. D. Tricuspid valve replacement.

43. The most common location of accessory pathways in patients with the Wolff-Parkinson-White syndrome is the:

A. Left free wall. B. Right free wall. C. Posterior septum. D. Anterior septum.

44. According to the Euroscore, what is highest risk in patients undergoing cardiac surgery?

A. Preoperative Cardiogenic Shock B. Poor Ejection Fraction C. Preoperative renal failure D. Severe peripheral vascular disease E. Ischemic VSD.

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45. A 10 month child complains of dyspnea. The following X-ray was done. What is the diagnosis:

A. Unroofed coronary sinus

B. Coarctation of the Aorta

C. Scimatar syndrome

D. SVC Syndrome

E. Anomalous systemic venous drainage.

DIRECTIONS: More than one answer. For the next question , determine whether each choice is true ( T ) or false ( F ): 46. Optimal myocardial protection afforded by hypothermic potassium cardioplegia is achieved

when: A. The myocardial temperature is kept to less than 20C. B. The potassium concentration of the cardioplegic solution is greater than 46 mEq per liter. C. There is absence of electrocardiographic activity throughout the aortic cross-clamp

period. D. Steroids are added as adjuvants for membrane stabilization.

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DIRECTIONS: There are four-choices for the answer to each of the following questions; one or more may be correct. Use this code to select the most appropriate response: A B C D E (1-3) (I & 3) (2 & 4) (4) (1-4) 47. Carcinoid tumors of the airways:

A. Do not produce carcinoid syndrome. B. Occur in the trachea in about 25% of patients. C. Are uniformly visible by flexible bronchoscopy. D. May metastasize to lymph nodes.

48. Indication(s) for pulmonary resection in patients with aspergillosis include(s):

A. Recurrent major hemoptysis. B. To rule out the possibility of carcinoma. C. Development of a tension cavity. D. Frequent allergic bronchitis attack.

DIRECTIONS: For the following question, answer by using the key outlined below: A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

49. Pain associated with ingestion of food during childhood is commonly associated with the

presence of:

A. Achalasia of the esophagus B. Congenital esophageal diverticulum

50. Leiomyosarcomas of the esophagus:

A. Tend to ulcerate B. Are submucosal

51. Presence of aberrant gastric type columnar cells:

A. Barrett's ulcer B. Schatzki's ring

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DIRECTIONS: There are four-choices for the answer to each of the following questions; determine whether each choice is true or false. any combination of answers may occur.

A B C D E

1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

52. Paraplegia following operation on descending thoracic aorta is :

A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

53. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome?

A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

54. Complication(s) attributed to the use of bilateral internal thoracic artery grafts for CABG

include(s):

A. Chest wall dysesthesias. B. Respiratory insufficiency. C. Increased incidence of mediastinits in diabetic patients. D. Paresis or paresthesias of the arm.

DIRECTIONS: In the following questions, each numbered item is to be matched with one lettered item. Each option may be used once.

Match the four surgical procedures that have been developed for the treatment of atrial fibrillation with the major detrimental sequela(e) of atrial fibrillation that each corrects.

A. His bundle ablation. B. Left atrial isolation procedure. C. Corridor procedure. D. Maze procedure.

55. Patient's sensation of irregular heart rhythm. 56. Hemodynamic compromise because of loss of AV synchrony. 57. Increased vulnerability to thromboembolism.

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Answer: A-1. B-1,2. C-1. D1,2,3

DIRECTIONS: In the following questions, each numbered item is to be matched with one lettered item. Each option may be used once, more than once or not at all.

Indications for valve surgery

A. Aortic annular abscess B. Aortic valve vegetation >2mm C. Asymptomatic patient with AR and aortic root diameter of 40 mm D. Asymptomatic patient with AR and decline in EF from 0.60 to 0.40 during stress echo E. Asymptomatic patient with AR and EDD of 55 mm F. Asymptomatic patient with AR, EF 0.60 and ESD of 40 mm G. Asymptomatic patient with aortic valve area of 1.2 cm2 H. Asymptomatic patient with aortic valve area of 1.6 cm2 and TIAs I. Dyspnic patient with aortic valve area of 0.8 cm2 but no hypotension on exercise J. Dyspnic patient with aortic valve area of 2.5 cm2 K. P-R interval of 0.20 sec L. Persistent pyrexia and leucocytosis after three days of antibiotics M. Planned CABG with an aortic valve gradient of 10 mmHg N. Proteinuria and microscopic hematuria O. Symptomatic patient with AR and EF 0.45

From the list of options above, choose which would be an indication for valve surgery in the following situations. Each option may be used once, more than once or not at all. 58. Chronic severe aortic regurgitation. 59. Aortic stenosis. 60. Native aortic valve endocarditis without hemodynamic compromise.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper II: Short Accounts

Cairo 08/11/2010 Time allowed: 90 minutes Give A Short Account On The Following Questions: A. The new major changes in the international guidelines for

1) Myocardial revascularization in ST-segment elevation myocardial infarction.

2) Surgical and endovascular treatment of thoracic aortic diseases by location of disease.

B. The risk factor calculation in:

1) The mesothelioma and radical surgery (MARS) trial. 2) Long-term results of arterial switch and atrial switch operations.

C. The management strategies of:

1) Hypertrophic obstructive cardiomyopathy (HCOM, IHSS). 2) Pulmonary hypertensive crisis.

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery

Faculty of Medicine Paper III Commentary

Cairo 09/11/2010 Time allowed: 90 minutes

COMMENTARY For each of the following three cases answer the multiple-choice questions, select the one most appropriate answer, based on the history given below, justify and comment on the choice:

1. Case # 1 A 36-week pregnant lady with a mechanical mitral valve prosthesis in place who had discontinued coumadin therapy the last month with the institution of subcutaneous heparin as her OB advised. She arrived in the ER severely dyspenic with muffled clicks of the prosthesis and the fetal sounds are diminished. ECHO proved thrombosed valve. There was a dispute between the obstetrician (OB) and the cardiac surgeon in timing and place of the interventions; mitral valve re-replacement (MVRR) and the Caesarean Section (CS).

. 1. Which of the following procedures is the best management for her?

A. MVRR and then CS. B. CS first and then MVRR. C. Both MVRR and CS are done simultaneously. D. MVRR and termination of pregnancy

2. On selection of a new prosthesis, which valve prosthesis (es) is/are appropriate for her?

A. Mechanical valve B. Bioprosthetic porcine valve C. Bioprosthetic pericardial valve D. Homograft E. Pulmonary autograft

2. Case #2:

After repair of a partial anomalous pulmonary venous drainage with 2 anomalous veins draining into the SVC, it is noticed that the CVP is 25mmHg and the RA pressure is 6mmHg. TEE reveals no obstruction in pulmonary venous drainage. The most appropriate next step is:

A. Ligation of the azygos vein. B. Implantation of the anomalous veins directly into the SVC C. Transection of the SVC and implantation into the RA appendage D. Placing a stent in the SVC E. Enlargement of the intracardiac pericardial patch

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3. Case # 3:

A 32-year old male suffers a road traffic accident and sustains multiple injuries. What is the best management for his thoracic injury?

A. Conservative management B. Intercostal drain C. Ascending Aorta replacement D. Repair with end to end anastomosis E. Endovascular stenting

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery

Faculty of Medicine Paper IV MCQ (ANA. & PATH.)

Cairo 10/11/2010 Time allowed: 90 minutes

ANATOMY & EMBRYOLOGY DIRECTIONS: For each of the following multiple choice questions, select the one most appropriate answer: 1. Which of the following statements about diaphragmatic anatomy is true?

A. The azygos vein pass through the aortic hiatus B. The foramen of Morgagni is a posterior diaphragmatic defect C. Innervation is by the phrenic nerve which arise from the lower trunk of the cervical plexus D. The thoracic duct passes through the esophageal hiatus E. The vena caval foramen is located between the diaphragmatic crurae that arise from the lumbar

vertebrae

2. Which of the following is true regarding the diaphragmatic development? A. As an outgrowth of the septum transversum B. During the eighth week of fetal life C. Partly from pleuropritaneal folds D. With the left dome closing later than the right E. All of the above

3. Which of the following statements is true regarding anatomy of the thoracic outlet?

A. The distal section of the cervicoaxillary canal is the more critical for compression syndromes B. The brachial plexus and subclavian artery are located in the anteromedial compartment of the

costoclavicular space C. The borders of the scalene triangle are scalenus anticus, scalenus medius, and first rib D. Inspiration tilts the coracoid process inferiorly, placing tension on the neurovascular bundle E. Bony abnormalities are present in the majority of patients

4. Which of the following is true regarding the lung?

A. Is the only organ with a dual blood supply B. Will function satisfactorily after complete denervation C. Is inferior to the kidney in adjusting acid-base balance D. Does not possess a lymphatic system E. All of the above

5. Which of the following is true regarding the usual drainage of persistent left superior vena

cava? A. Coronary sinus B. Left atrium C. Right atrium

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D. Inferior vena cava E. Right superior vena cava

6. Which of the following is true regarding the level of the narrowest part of the esophagus?

A. A point adjacent to the carina B. The cricopharyngeal ring C. The cardia D. The second thoracic vertebra E. The aortic knob

7. Which of the following is true regarding the azygos vein?

A. Receives venous blood from the middle one-third of the esophagus B. Passes through the aortic opening of the diaphragm C. Receives the left bronchial veins D. Enters the right brachiocephalic vein at the level of T4 E. Is joined by the hemiazygos vein

8. Which of the following statements is true regarding the inferior vena cava?

A. Has a longer intra-abdominal course than the aorta B. Pierces the central tendon of the diaphragm C. Is formed posterior to the right common iliac artery D. Receives as tributaries the first and second lumbar veins E. Has more valves than the external iliac veins

9. Regarding pericardium:

A. visceral part supplied by phrenic nerve B. Fibrous pericardium consist of visceral & parietal parts C. Serous pericardium down represent the attachment of central tendon of diaphragm D. Located laterally to the esophagus E. The oblique sinus is bounded anteriorly by the visceral layer of serous pericardium.

10. Which of the following statements is true regarding in the root of the neck?

A. Scalenus anterior arises from the anterior tubercles of the typical cervical vertebrae B. The supreme intercostals vein lies lateral to the first thoracic nerve on the neck of the first rib C. The scalene tubercle lies posterior to the subclavian artery D. The phrenic nerve passes anterior to the subclavian vein E. The vagus nerve passes anterior to the thoracic duct

11. Which of the following statements is true regarding the subclavian artery?

A. Begins at the lateral border of the first rib B. The costocervical trunk arises from the first part C. Blood supply to the first two intercostal spaces posteriorly arises from branches of the

thyrocervical trunk D. The subclavian artery and vein are enclosed in a connective tissue sheath derived from the

prevertebral fascia E. Becomes the axillary artery at the upper border of teres major

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DIRECTIONS: In the following question, all of the statements are true except one, identify the incorrect statement:

12. During embryologic development of the heart, the following occur except: A. The septum secundum originates to the left of the septum primum B. A spiral septum arises to divide the truncus arteriosus C. The interventricular foramen closes during the second month D. The septum primum develops perforations E. The endocardial cushions divide the atrioventricular canal

DIRECTIONS: For the following question, answer by using the key outlined below: A. If only A is correct B. If only B is correct C. If both A and B are correct D. If neither A nor B is correct

13. The parietal pleura:

A. Is very sensitive to pain B. Absorbs the pleural fluid

14. A moderator band is usually found in the:

A. Left ventricle . B. Right ventricle

15. Eustachian valve:

A. Is a single fold attached to the orifice of inferior vena cava B. Is more prominent in the fetus and directs the blood to the foramen ovale

16. The bundle of his passes closer to:

A. The right side of the interatrial septum B. The left side of the interatrial septum

17. The sinus venosus forms:

A. The superior and inferior vena cava B. The right atrium

DIRECTIONS: There are four-choices for the answer to each of the following questions; one or more may be correct. Use this code to select the most appropriate response: A B C D E (1-3) (I & 3) (2 & 4) (4) (1-4)

18. The thoracic duct: A. Enters the thorax through the esophageal hiatus B. Crosses anterior to the subclavian artery in the neck C. Crosses posterior to the thyrocervical trunk D. Passes in front of the vertebral artery

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19. In pulmonary sequestration: A. The lung tissue is primitive B. New-born infants may be involved C. The blood supply is always systemic D. Only one pulmonary segment is involved

20. The bulbus cordis:

A. Is a part of the primitive heart tube B. Lies entirely above the sernilunar valves C. Gives rise to the aorta and pulmonary artery D. Persists into adult life

21. The atrioventricular (AV) node:

A. Receives nerves from the right vagus B. Its arterial supply is from the right coronary artery C. Is located near the entrance of the superior vena cava D. Is located near the coronary sinus

22. The left vagus nerve:

A. Descends anterior to the aorta B. Descends posterior to the aorta C. Contains preganglionic parasympathetic fibers D. Contains postganglionic parasympathetic fibers

DIRECTIONS: In the following two questions, each numbered item is to be matched with one lettered item. Each option may be used once.

A. Anterior mediastinum B. Posterior mediastinum C. Middle mediastinum D. Superior mediastinum

23. Carina 24. Thymic remnants 25. Trachea 26. Sympathetic ganglia

A. Right pulmonary artery B. Left pulmonary artery C. Main pulmonary artery D. Aorta

27. Lies superior to bronchus. 28. Drains left ventricle in corrected transposition. 29. Lies anterior to upper lobe bronchus. 30. Lies adjacent to fold of Marshall

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PATHOLOGY DIRECTIONS: For each of the following multiple choice questions, select the one most appropriate answer:

31. Which of the following statements is true regarding the anatomy and pathophysiology of post-infarct left ventricular aneurysm? A. The inner wall of the aneurysm retains its trabeculations. B. Mural thrombus is uncommon. C. Calcification may occur in the adherent pericardium. D. Most posterior aneurysms are true aneurysms. E. Most patients with left ventricular aneurysms have single vessel LAD disease.

32. Which of the following statements is true regarding cervical rib? A. Is bilateral in approximately 40% of cases B. Neurological complications are more common than vascular C. Treatment includes trapezius strengthening exercises D. Horner's syndrome is a complication of surgery E. The C8 never root is mainly affected

33. Which of the following statements is true regarding gastro-esophageal reflux? A. Endoscopy is normal in 30% of cases B. Hiatus hernias in patients over 50 are more likely to be asymptomatic than symptomatic C. Dysphagia is a complication of Nissen's fundoplication D. Anti-reflux surgery may reduce the risk of cancer developing in Barrett's esophagus E. Initial management may include increasing the number of meals eaten per day

34. Which of the following statements is true regarding carotid artery disease?

A. Strokes are more likely to be due to extracranial than intracranial disease B. Carotid duplex scanning is a good way of assessing the type of carotid plaque that is present C. A bruit may be absent in a severe stenosis D. Initial investigation of a patient with a transient ischemic attack commonly includes CT scan of

the brain E. Surgery has been shown to be better than medical therapy in the management of asymptomatic

patients with stenoses greater than 70%. DIRECTIONS: In the following questions, all of the statements are true except one, identify the incorrect statement:

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35. Esophageal hiatus hernia in infants:

A. May be an important cause of vomiting B. Is often associated with constipation C. Can be demonstrated during the first week of life D. May be associated with pyloric stenosis E. Is frequently accompanied by gastrointestinal bleeding

36. In primary seminoma of the mediastinum, all of the following are true except: A. It occurs in both men and women. B. Optimum therapy includes operation. C. Radiation therapy should be limited to the mediastinum. D. The overall 5-year survival is 50 to 60%. E. The tumor is known to be extremely radio- sensitive.

37. Bronchogenic cysts:

A. Are lined by pseudostratified columnar epithelium B. Usually appear as air-filled cavities C. Do not cause hemoptysis D. Frequently become infected E. Mostly occur close to the hilum

DIRECTIONS: There are four-choices for the answer to each of the following questions; one or more may be correct. Use this code to select the most appropriate response:

A B C D E

(1-3) (I & 3) (2 & 4) (4) (1-4)

38. In cases in which there is no bronchial obstruction, the area(s) most frequently involved in

bronchiectasis are: A. Basal segments of lower lobe. B. Superior segments of lower lobe. C. Lingula and right middle lobe. D. Anterior segments of upper lobes.

39. Complication(s) of bronchiectasis include(s): A. Recurrent pulmonary infections B. Massive hemoptysis C. Empyema D. Brain abscess

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DIRECTIONS: There are four-choices for the answer to each of the following questions; determine whether each choice is true or false. any combination of answers may occur.

A B C D E

1, 2 &3 1 & 3 2 &4 4 ONLY all are correct

40. Paraplegia following operation on descending thoracic aorta is : A. Increased by preoperative shock. B. Increased by emergency surgery. C. Affected by the duration of cross-clamp time. D. Prevented by evoked somatosensory potential monitoring.

41. Which of the following congenital anomalies is/are frequently associated with Wolf-Parkinson-White syndrome? A. Coarctation of the aorta. B. Bicuspid aortic valve. C. Patent ducts arteriosus. D. Ebstein’s anomaly.

DIRECTIONS: For the following question, answer by using the key outlined below: If both statement and reason are true but not related cause and effect

A. If the statement is true and the reason is false B. If the statement is false and the reason is true C. If both statement and reason are false

42. Underdevelopment of the main pulmonary artery is usually associated with narrowing or stenosis

of the outflow tract of the right ventricle BECAUSE both are derived from the conus. 43. The presence of a cervical rib does not produce symptoms in childhood BECAUSE the rib is

rudimentary at this age. 44. Bronchial foreign bodies more frequently occur in children BECAUSE the right main stem

bronchus is relatively straighter than the left. 45. Tumourlets are epithelial proliferations which are usually associated with bronchiectatic lobes

BECAUSE these microscopic lesions are never found in the absence of damage to the lungs.  

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DIRECTIONS: For the following question, answer by using the key outlined below: A. If A is of greater magnitude or frequency than B B. If B is of greater magnitude or frequency than A C. If A and B are approximately equal

46. Blood supply of tuberculous lesions

A. Pulmonary arteries B. Bronchial arteries

47. Benign pulmonary tumors: A. Tumorlets B. Hamartomas

48. Development of lung abscess in:

A. Alveolar cysts B. Bronchogenic cysts

DIRECTIONS: In the following questions, each numbered item is to be matched with one lettered item. Each option may be used once, more than once or not at all.

A. Azygos lobe B. Congenital bronchial atreria C. Pulmonary sequestration

49. May lie below diaphragm 50. Obstructive emphysema 51. Incomplete fissure 52. Mediastinal shift 53. Anomalous artery 54. Lower lobes not involved

A. Heterotaxia B. Arrested development C. Persistence of fetal structures

55. Left superior vena cava 56. . Situs inversus 57. Ostium primum defect 58. Right aortic arch 59. Isolated dextrocardia 60. Patent ductus arteriosus

GOOD LUCK

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AIN SHAMS UNIVERSITY M.D. Cardiothoracic Surgery Faculty of Medicine Paper IV (ANA. & PATH.)

Cairo 10/11/2010 Time allowed: 90 minutes

ANATOMY Give A Short Account On The Following Questions:

1. The developmental anatomy of the lung. 2. The embryology of the vena cavae. 3. The dynamic anatomy of the aortic valve complex.

PATHOLOGY Give A Short Account On The Following Questions:

1. The molecular staging of lung cancer, the new classification of adenocarcinoma, and the neuro-endocrine histology in NSCLC

2. The pathology of the chest wall tumors. 3. The trunco-conal septation.

GOOD LUCK