CARDIOVASCULAR AND THORACIC SURGERY

Multiple choice test

1. A large Patent Ductus Arteriosus leads to:
a. Hypervolemia in the pulmonary circuit
b. Hypovolemia in the pulmonary circuit
c. Hypertension in the pulmonary circuit
d. Correct answers A and B
e. All listed

2. A large Patent Ductus Arteriosus is most often complicated by:

a. Bacterial endocarditis
b. Heart rhythm disorders
c. Pulmonary hypertension
d. Circulatory failure
e. Hypertension

3. From the following, which one serves as indication to close the VSD in a child
under 1 year of age?
a. A large left to right shunt
b. Pulmonary hypertension
c. Frequent respiratory infections
d. Hypotrophy
e. The child's age

4. For the complete form of atrioventricular canal it’s characteristic:

a. Atrium level communication
b. Ventricular communication
c. Fibrous rings of the atrioventricular valves are formed correctly
d. The cleavage of the cusps of the tricuspid and mitral valves forms two
ventral and dorsal cusps
e. Common atrioventricular communication

5. For isolated valvular stenosis of the pulmonary artery, on angiography is

possible to find:
a. Poststenotic dilation of the trunk of the pulmonary artery
b. Narrowing of the right ventricular ejection tract during the systole
c. Dilatation of the right ventricular ejection tract during diastole
d. Regurgitation of the contrast substance in the right atrium
e. Narrowing of the ascending aorta

6. Noncyanogenic congenital heart defects are characterized by:

a. Diffuse cyanosis on physical exertion
b. Difficulty in gaining weight
c. Congestive heart failure and pulmonary overcirculation
d. Difficulty in various physical exercises
e. The presence of polycythemia

7. There are the following types of ventricular septal defects (VSD):

a. Perimembranos
b. Infundibular VSD
c. Muscular VSD
d. VSD type ostium secundum
e. Atrioventricular VSD

8. Which of the following is characteristic for the atrioventricular canal:

a. Surgical treatment is always necessary.
b. Banding of the pulmonary artery may be required in premature infants or
infants <5 kg.
c. Surgical correction is done during childhood to avoid irreversible lung
vascular disease.
d. Low mortality in the partial form and high mortality in the complete atrio-
ventricular canal.
e. The patient is not operated on immediately, but stays on the follow up at the
family doctor for as long as possible.

9. From the following, which sentences are true regarding the methods of
treatment of the patent ductus arteriosus:
a. Treatment with Indomethacin, an inhibitor of prostaglandin synthesis, may
be used in premature infants.
b. Medium-sized PDA requires surgical or catheter closure.
c. The ligation of the large canal is usually performed.
d. Continuous infusion treatment of Vasoprostan solution
e. Small CAP does not require treatment, but only dynamic monitoring.

10. Isolated stenosis of the pulmonary artery can be located:

a. at the level of the intrabronchial branches of the pulmonary artery
b. at the level of the pulmonary artery valve
c. supravalvular, on the trunk of the pulmonary artery
d. at the level of the subvalvular RV ejection tract
e. at the level of the pulmonary artery branch

11. Which statements regarding the methods of treatment in pulmonary stenosis

are correct:
a. Mild pulmonary artery stenosis does not require intervention, but only
dynamic follow-up.
b. Balloon percutaneous valvuloplasty - a method of choice in moderate and
severe PA stenosis
c) Isthmoplasty
d. Pericardial patch correction in case of percutaneous balloon valvuloplasty
failure, or associated malformations
e. Infundibulectomy

12. Which of the following are paraclinical investigations specific to the

assessment of CHD hemodynamics?
a. Echocardiography
b. AngioCT
c. Cardiac MRI
d. Chest X-ray
e. Cardiac catheterization

13. Which of the following is specific surgical treatment for supravalvular aortic
stenosis?
a. Aortoplasty with a patch in the non-coronary sinus
b. Inverted Y-spot aortoplasty
c. Aortic section, incisions in all 3 sinuses, accordingly adaptation of the distal
aorta, and reanastomosis.
d. Operation Ross
e. Aortic valve prosthesis with mechanical prosthesis

14. What are the pathogenic theories for aortic coarctation?

a. Ductal tissue theory
b. Hemodynamic theory
c. Turner syndrome
d. Genetic theory
e. The theory of incorrect nutrition

15. Which clinical signs are specific for aortic coarctation:

a. The saturation gradient between the upper and lower limbs
b. Blood pressure gradient between upper and lower limbs
c. The pulse gradient between the upper and lower limbs
d. Hypertrophy of the lower torso and lower limbs
e. Hypotrophy of the lower torso and lower limbs

16. Which of the following are ductal-dependent malformations:

a. Pulmonary artery atresia
b. Interrupted aortic arch
c. Transposition of great vessels
d. Critical aortic coarctation
e. Presence of fetal circulation - persistence of the patent ductus arteriosus and
patent oval foramen.

17. Specific for cardiac surgeries is:

a. Use of extracorporeal circulation
b. Use of high doses of heparin
c. Spinal anesthesia
d. Intraoperative patient cooling
e. Stopped heart during surgery

18. From the following, what are the surgical approaches in cardiac surgery:
a. Longitudinal sternotomy
b. McBourney incision
c. Mini sternotomy
d. Left thoracotomy
e. Right thoracotomy

19. Which from the following represent congenital malformations in the heart of
the intrauterine fetus:
a. Presence of ventricular septal defect
b. Presence of patent foramen ovale and ductus arteriosus
c. Aortic obstruction
d. Non-separation of mitral and tricuspid valves
e. Drainage of the pulmonary veins in the right atrium

20. Which of the following are pale congenital heart defects:

a. ASD
b. VSD
c. Aortic coarctation
d. Pulmonary artery atresia
e. PDA
21. Which pathologies represent obstructive lesions of the left side of the heart?
a. Congenital mitral stenosis
b. Congenital aortic stenosis
c. Aortic coarctation
d. Interruption of the aortic arch
e. Congenital pulmonary artery stenosis

22. Which of the following are not absolute contraindications to cardiac surgery
for pale CHD:
a. The presence of Eisenmeiger syndrome
b. Presence of pulmonary hypertension
c. Dilation of the heart cavities
d. Cardiac arrhythmias
e. Ejection fraction between 40% and 50%

23. From the following, surgical treatment for aortic coarctation is:
a. Percutaneous balloon angioplasty
b. Isthmoplasty
c. Coarctation resection with end-to-end anastomosis
d. Coarctation resection with the interposition of a synthetic graft
e. Balloon percutaneous angioplasty of the pulmonary artery valve

24. What do the clinical manifestations in pale CHD depend on?

a. Dimensions of the defects
b. Defect location
c. Pulmonary vascular resistance
d. Amount of blood flow through the defect
e. Systemic vascular resistance

25. What is the indication for surgical treatment of VSD?

a. VSD with no effect on drug treatment and severe, frequent respiratory
infections.
b. VSD with moderate or severe PAH
c.VSD of any size, when associated with the risk of aortic or pulmonary valve
insufficiency.
d. Wide VSD with clinical sign of severe weight loss
e. Restrictive VSD

26. From those listed, for the tetralogy of Fallot is characteristic:

a. Movement of the conal interventricular septum forward and to the left
b. Hypertrophy of right ventricular structures
c. Narrowing of the right ventricular ejection tract
d) Restrictive DSV
e. Aortic dextraposition

27. The hemodynamics of the pulmonary circuit in the Fallot tetralogy is not
characterized by:
a. Normal lung flow
b. Increased pulmonary flow
c. Hypertensive pulmonary flow
d. Poor lung flow
e. Pulmonary flow through collaterals

28. Cardiac catheterization in the tetralogy of Fallot presents the following:

a. Penetration of the catheter from the right ventricle into the aorta
b. Heavy penetration of the catheter into the pulmonary artery
c. Decreased systolic blood pressure in the pulmonary artery
d. Systolic pressure in the right ventricle is lower than in the left ventricle
e. The presence of the systolic gradient between the right ventricle and the
pulmonary artery

29. Hypoxic spells in the Fallot Tetralogy is conditioned by:

a. Decreased pulmonary vascular resistance
b. Decreased systemic vascular resistance
c. Increased pulmonary vascular resistance
d. Increasing systemic vascular resistance
e. Correct answers: a, d

30. Arterial hypoxemia leads to:

a. Pronounced hypoxemia and anaerobic glycolysis
b. Accumulation of acid metabolites and metabolic acidosis
c. Lipid peroxidation and free radical formation
d. Decreased hemoglobin levels in the blood
e. Hyperkalemia

31. On chest X ray in antero-posterior projection, in patients with tetralogy of

Fallot, the pulmonary hilum may be dilated because of the following:
a. The trunk of the pulmonary artery
b. Ascending aorta
c. Superior vena cava
d. Presence of the left vena cava
e. Right ventricular ejection tract

32. The Ebstein abnormality is not characterized by the following anatomical

modification:
a. Positioning the tricuspid valve cusps in the right ventricle
b. Shortening of the cords and hypoplasia of the papillary muscles of the
tricuspid valve
c. ASD type Ostium Secundum, or the presence of FOP
d. Increasing the size of the chambers of the right heart
e. Abnormal drainage of the pulmonary veins

33. In Ebstein's disease, hemodynamics is characterized by:

a. Regurgitation at the level of the tricuspid valve
b. Shunt right to left at the level of the atria
c. Moderate or severe hypoxemia
d. Mitral valve insufficiency
e. Moderate hypovolemia in the pulmonary circuit

34. From the following, which one is not a specific clinical sign for cyanogenic
CHD?
a. Cyanosis
b. Decreased appetite
c. Growth retardation
d. Dyspnea
e. Frequent respiratory infections

35. Which of the following is a cause for cyanosis?

a. Pulmonary diseases
b. Renal disease
c. Cardiac disease
d. Hematological diseases
e. Pathologies of the CNS

36. Which of the following pathologies is not a CHD with differentiated

cyanosis?
a. Atrioventricular canal
b. Fallot tetralogy
c. Truncus arteriosus
d. Interrupted aortic arch
e. Pulmonary artery atresia

37. Which of the following is the cause of death in the evolution of cyanogenic
CHD?
a. Hypoxic spell
b. Progression of cyanosis
c. Heart failure
d. Infectious endocarditis
e. Bilateral pneumonia
38. The most commonly used palliative interventions for cyanotic CHD are:
a. The Rashkind procedure
b. Blalock-Taussing intersystemic anastomosis
c. Blalock-Taussing modified intersystemic anastomosis
d. Pulmonary artery banding
e. Anastomosis Glenn

39. Which of the following are palliative operations:

a. The Rashkind procedure
b. Blalock-Taussing intersystemic anastomosis
c. Arterial switch
d. Pulmonary artery banding
e. Anastomosis Glenn

40. What are the maneuvers to stop a hypoxic spell?

a. Knee-chest position
b. Administration of concentrated oxygen through the face mask
c. Calming the child with sedatives
d. Intravenous administration of bolus fluids
e. Administration of spasmolytic medication
41. Which of the following are steps in the radical correction of the Fallot
Tetralogy?
a. Infundibulectomy
b) Plastia of the VSD
c. Enlargement of the right ventricular ejection tract
d. Anastomosis of the vena cava with the pulmonary artery
e. Application of homographs in pulmonary position if necessary

42. Which of the following is not a feature of the transposition of the great
arteries?
a. The aorta starts from the left ventricle, the pulmonary artery from the right
ventricle
b. The aorta starts from the right ventricle, the pulmonary artery from the left
ventricle
c. The mixing of the blood circuits takes place
d. Both main vessels start from the right ventricle
e. Both main vessels start from the left ventricle

43. The Rashkind procedure is not characterized by:

a. SVC anastomosis to the pulmonary artery
b. Anastomosis between the subclavian artery and the pulmonary artery
c. Endovascular procedure that ends with the "rupture" of the interatrial septum
d. Narrowing of the pulmonary artery
e. Endovascular procedure that ends with the widening of the aortic
coarctation site
44. Which anatomical structures allow the mixing of blood in the transposition
of the great vessels?
a. PDA
b. Patent foramen ovale or atrial septal defect
c. Common atrioventricular valve
d. The common arterial trunk
e. Ventricular septal defect

45. Which of the following is a type of aberrant venous pulmonary drainage?

a. Supracardiac type
b. Intracardiac type
c. Infracardiac type
d. Aortic type
e. Left atrial type

46. Which of the following can serve as a drainage site for aberrant pulmonary
veins?
a. The superior vena cava
b. Inferior vena cava
c. Right atrium
d. Jugular vein
e. Femoral vein

47. Which of the following is not a basic feature for tricuspid valve atresia:
a. Lack of communication between the right atrium and the right ventricle
b. Lack of communication between the left atrium and the left ventricle
c. Higher blood flow from the right atrium to the right ventricle
d. Higher blood flow to the pulmonary artery
e. The systemic and pulmonary blood circuits do not communicate with each
other

48. By what mechanism is the survival of children with tricuspid valve atresia
ensured?
a. Mixing of blood through the common ventricular-arterial valve
b. Mixing of blood through ASD with right-to-left shunting
c. Mixing the blood through the VSD with the left to right shunt
d. Mixing of blood through the PDA with left to right shunt
e. All listed

49. What is characteristic for the Fontan Operation?

a. Anastomosis of the superior vena cava to the pulmonary artery
b. Anastomosis between the subclavian artery and the pulmonary artery
c. Endovascular procedure that ends with the "rupture" of the interatrial septum
d. Narrowing of the pulmonary artery
e. Exclusion of the right parts of the heart from the cardiac cycle by
anastomosis of the vena cava to the pulmonary artery

50. What is characteristic for the operation in cone on the tricuspid valve?
a. SVC anastomosis to the pulmonary artery
b. Reposition on 360º of the tricuspid valve cusps on the native valve ring
c. Endovascular procedure that ends with the "rupture" of the interatrial septum
d. Resection of the misaligned cusps of the tricuspid valve
e. Suturing the atrialized portion of the right ventricle

51. As compensatory mechanisms for cyanogenic heart defects, the most

common are:
a. Polycythemia
b. Anemia
c. Decreased coagulation
d. Decreased blood viscosity
e. Hyperglobulinemia

52. Congenital heart defects are characterized by:

a. Structural, functional, or heart position defect
b. Isolated or complex heart defect
c. Present from birth
d. It can manifest immediately or later in life
e. Represent complications during childbirth

53. For cyanotic congenital heart defects it is characteristic:

a. Incidence of 8-10 per 1000 full-term births
b. The risk increases in children with parents suffering from CHD
c. It is the most common cause of neonatal morbidity and mortality
d. The incidence increases in premature births
e. Cyanosis becomes more pronounced with child's age advance

54. What is the predominant type of heart tumors?

a. Primary more often than secondary
b. Malignant more often than benign
c. The most frequent primary tumors are benign
d. The most frequent primary tumors are malignant
e. All answers are correct

55. Which of the following are symptoms of heart tumors?

a. Systemic symptoms (fever, weight loss, etc.)
b. Embolic symptoms (embolization in the pulmonary artery or cerebral
arteries)
c. Dyspeptic symptoms (nausea, loss of appetite)
d. Cardiac symptoms (occlusion of blood flow, arrhythmias)
e. Symptoms secondary to tumor metastasis (superior vena cava syndrome,
etc.)

56. The Corney complex is characterized by:

a. Autosomal dominant pathology
b) Multiple heart myxomas
c. Extracardiac myxomas (skin, breast)
d. Hyperactivity of the endocrine glands
e. Hyperactivity of the exocrine glands

57. Which of the following is not a tumor that usually affects the heart valves?
a. Mixoma
b. Fibroma
c. Fibroelastoma
d. Rhabdomyoma
e. Lipoma

58. Most commonly secondary heart tumors derive from:

a. Melanoma
b. Breast cancer
c. Kidney cancer
d. Lymphoma
e. Lipoma

59. The symptoms of mediastinal tumors are:

a. Hoarse voice
b. Cardiac tamponade
c. Cough
d. Dysphagia
e. Palpitations

60. Prognosis for primary malignant heart tumors:

a. It is negative, caused by the rapid intramural growth of tumors
b. It depends on the reactivity to chemotherapy
c. It is usually up to one year
d. It is aggravated by the rapid production of metastases
e. It is favorable, characterized by rapid regression of tumors

61. Surgical treatment of mediastinal and cardiac tumors:

a. It is indicated for any type of tumor
b. It depends on the location and stage of tumor progression
c. Chemotherapy is recommended as a therapeutic adjunct
d. It is performed by sternotomy in the case of anterior mediastinal tumors
and by thoracotomy in the case of posterior mediastinal tumors.
e. Surgical treatment is indicated depending on the patient's age

62. Hypertension in the pulmonary circuit leads to:

a. Hypertrophy of the middle layer of the small pulmonary vessels
b. Excessive proliferation of the intima of the pulmonary vessels
c. Sclerosis of the inner layer of the small pulmonary vessels
d. At the subsequent thinning of the middle layer of the small pulmonary
vessels
e. Development of the collateral vessels of the lungs

63. The accentuation of the second heart sound in the pulmonary artery point of
auscultation, is a sign of:
a. Large left to right shunt
b. Right to left shunt
c. Pulmonary hypertension
d. Equality of shunt pressures
e. It has nothing to do with any of the above

64. Which of the following is a consequence of pulmonary hypertension:

a. Insufficiency of the right parts of the heart
b. Liver failure
c. Insufficiency of the left side of the heart
d. Respiratory failure
e. Kidney failure

65. From the following, which are relative contraindications to heparin

administration:
a. Recent surgery
b. Association with NSAIDs
c. Intramuscular injections
d. Pericarditis
e. Aortic dissection

66. Which of the following etiologies is listed below as the cause of non-
thrombotic pulmonary embolism:
a. tumor embolism
b. amniotic fluid embolism
c. isolated deep vein thrombosis of the leg
d. fatty embolism
e. gas embolism

67. What are the pathophysiological pathways in the occurrence of tricuspid

valve insufficiency secondary to pre-existing valvular pathology (most commonly
mitral valve disease)?
a. Pulmonary hypertension leads to dilatation of the right ventricular
cavity
b. Dilatation of the tricuspid valve ring
c. The complex of papillary muscles and tendinous cords is shortened
 d. Disaggregation (rupture) of papillary muscles and pathological movement of
the right ventricular wall
e. The position of the tricuspid valve cusps
68. What are the signs on the Chest X-ray in the regurgitation of the tricuspid
valve?
a. Cardiomegaly
b. Proeminent azygous vein
c. Dilatation of the right atrium and ventricle
d. Structural abnormality of the tricuspid valve
e. Displacement of the diaphragm upwards due to ascites

69. What are the surgical techniques in reshaping the tricuspid valve ring?
a. Partial reduction of anterior and posterior valve ring (De Vega
technique)
b. Implantation of the support ring
c. Bicuspidization technique
d. Tricuspid valve prosthesis
e. The technique of shortening the tendinous cords

70. The aortic valve is a morphofunctional unit, which consists of?

a. Functional aortic ring, comprising aorto-ventricular junction and sino-
tubular junction
b. Three leaflets with their attachment
c. Sinuses of Valsalva with coronary artery ostia
d. Right and left coronary arteries
e. Ascending aorta
71. Which are the main functions of the aortic valve?
a. Ensuring unidirectional blood flow from the left ventricle
b. Ensuring bidirectional blood flow from the left ventricle
c. Optimization of coronary blood flow
d. Maintaining myocardial function
e. Obstruction of blood flow from the left ventricle if necessary

72. Which is the most common cause of aortic valve stenosis in people aged 70
and over?
a. Infective endocarditis
b. Bicuspid aortic valve
c. "Senile degeneration" of the valve
d. Rheumatic valve disease
e. Calcification of a normal trileaflet aortic valve

73. Which of the following symptoms is the classic triad of symptoms in aortic
stenosis?
a. Dyspnea
b. Fatigue
c. Syncope
d. Vertigo
e. Angina pectoris

74. The pressure gradient at the aortic valve can be measured by the next
investigations?
a. Eco cardiography
 b. Auscultation
c. Palpation
d. CT angiography
e. Cardiac catheterization

75. Which of the following does the treatment in aortic valve "senile
degeneration" include?
a. Removal of mechanical obstruction
b. Aortic valve replacement
c. Transcatheter aortic valve replacement in patients with increased
surgical risk in the elderly with associated comorbidities
d. Debridement of the aortic valve by surgery
e. Ultrasonic aortic valve debridement
76. What are the indications for aortic valve replacement?
a. Severe aortic valve stenosis
b. Left ventricular dysfunction with aortic valve stenosis (left ventricular
ejection fraction <50%)
c. Severe calcification of the aortic valve
d. Asymptomatic aortic valve stenosis but with lesions on the coronary
arteries requiring revascularization
e. Aortic valve stenosis with asymptomatic 0.9 cm² opening area
77. Acute aortic insufficiency occurs in the case of different morphopathological
conditions of the valve, the most common being?
a. Bacterial endocarditis
b. Acute aortic dissection
c. As an iatrogenic complication of a transcatheter procedure
d. Blunt thoracic trauma
e. Senile degeneration of the aortic valve

78. From a pathophysiological point of view, what does the regurgitating

volume in chronic aortic insufficiency depend on?
a. The surface of the regurgitation orifice
b. Diastolic pressure difference between aorta and left ventricle
c. The systolic pressure difference between the aorta and the left ventricle
d. Duration of diastole
e. The duration of systole

79. Does the functional unit of the tricuspid valve consist of the following?
a. Myocardium of the right atrium and fibrous ring
b. Three leaflets and tendinous cords
c. Myocardium of the right ventricle and papillary muscles
d. Todaro's tendon and Eustachian's valve
e. The Koch`s triangle and the atrioventricular node

80. Which are the main cusps/leaflets of the tricuspid valve?

a. Anterior cusp
b. The posterior cusp
c. Septal cusp
d. Antero-septal cusp
e. Postero-lateral cusp

81. The mitral stenosis is classified in three categories – which are they?
a. Very mild mitral stenosis - has an area of the mitral orifice> 2 cm2
 b. Mild mitral stenosis - has an area of the mitral orifice> 1.5 cm2
c. Moderate form mitral stenosis - mitral orifice is 1.5 - 1 cm2
d. Severe form mitral stenosis - has mitral orifice <1 cm2
e. Mitral stenosis critical form - mitral orifice area <0.5 cm2

82. The etiological factors of the nonsuppurative pleural effusion are:

a. Thoracic Duct Injuries (chylothorax)

b. Chest injuries with damage to the pleura, intercostal arteries, lung

parenchyma (hemothorax)

c. Pancreatogenic pleural effusion

d. Rupture of the lung abscess in the pleural cavity

e. Malignant pleural effusion (metastatic)

83. Which of the following are methods of choice of investigation for

establishing the appearance of pleural effusion:

a. Thoracentesis

b. Fluid sampling by pleural puncture for cytological study

c. Fluid sampling by pleural puncture for biochemical study

d. Radionuclide investigations

e. Ultrasound

84. Which of the following statements refers to primary spontaneous

pneumothorax (idiopathic):

a. It's a medical-surgical emergency

 b. Occurs on pre-existing lesions

c. It appears suddenly

d. As a rule, without a previously known cause

e. It is found mainly in children

85. What are the main conditions for the occurrence of spontaneous

pneumothorax?

a. The existence of a place of minimum resistance

b. Age

c. Intervention of a trigger (physical exertion, cough)

d. Existence of associated diseases

e. It depends on the patient's gender

86. The degree of ischemia caused by the obstacle is variable, depending on

several factors:

a. The location and extent of the obstacle

b. Obstacle formation speed

c. Destruction of collateral

d. The patient's age

e. Extensive thrombosis

87. Non-invasive vascular bed explorations include:

a. Doppler examination
b. Computed tomography angiography

c. Magnetic resonance angiography

d. The Seldinger technique for angiography

e. Triplex examination of blood vessels

88. Local complications in Seldinger technique for arteriography are as

follows:

a. Hematoma

b. Arteriovenous fistulas

c. Dissection, vascular occlusion and peripheral arterial embolism

d. Acute renal failure

e. Pseudoaneurysms

89. Under the conditions of a normal arterial bed, arteriography provides the

following information:

a. The accurate location of the lesions

b. Presence of single or multiple lesions

c. Existence of collateral circulation

d. May establish the embolic or thrombotic origin of acute ischemia

e. The condition of the distal vascular bed

90. The vascular injuries with the best prognosis are the following:

a. Simple vascular wounds

b. Stabbed wounds

c. Blood Vessel Rupture

d. Arterial contusions

e. Iatrogenic vascular injury

91. As general principles of treatment in vascular trauma the following are

true:

a. All patients with vascular trauma should be evaluated for further

lesions in order to prioritize treatment.

b. Hemorrhagic shock is frequently present in patients with vascular

trauma to the limbs

c. Jaws should be used to ensure hemostasis

d. Hemodynamic balancing should be started immediately and as soon as

possible preoperatively

e. First and foremost, life-threatening injuries must be excluded or treated

92. Patients who have manifestations due to damage to important vessels need

immediate surgical treatment. Which of the following statements is true?

a. The first measure in surgery is proximal and distal control of the lesion

b. At the level of the damaged vessel, the presence of thrombosis should be

sought, in case of its existence, the thrombosis should be removed with the

help of the Fogarty probe.

c. Once the arterial control is obtained, the damaged vessel will be excised

to the healthy area.

d. The arterial and venous repair is usually done by interposing a graft,

preferably synthetic (it's PTFE)

e. Arterial and venous repair is usually done by interposing an autologous

graft.

93. Which of the following statements about vascular trauma is true:

a. Extremity without sensitivity and motor skills usually requires

amputation if there is significant nerve destruction

b. Traumatized extremities are likely to develop acute compartment

syndrome

c. The precise and correct evaluation of the compartment syndrome is

done by directly measuring the pressure in the compartment

d. The presence of shock or associated multiple lesions are absolute indications

for amputation

e. Vascular injury itself is not the deadly factor for amputation.

94. Acute arterial insufficiency is in most cases the result of intrinsic

obstruction through a thrombus. The following statements are true:

a. The most common source of embolism is the heart

b. Atheroma plaque embolism or blue finger syndrome may occur

c. The clinical manifestations of acute arterial occlusion by thrombosis are

more severe than in other etiologies.

d. Deep vein thrombosis can cause a paradoxical arterial embolism.

e. The major cause of acute peripheral ischemia is embolism

95. Cardinal clinical signs in acute ischemia:

a. Pain

b. Paresthesia

c. Pallor

d. The presence of the distal pulse at the level of the occlusion

e. Skin cold

96. The following statements are true:

a. In cases of severe acute ischemia, where the diagnosis is obvious and

suspicion of a strong etiology is not required, no further paraclinical

investigations are required to establish the therapeutic indication.

b. Since the heart is the main source of embolism, examination of cardio-

pulmonary function is essential.

c. Ultrasound examination (especially Duplex examination) is especially

useful for establishing the existence of associated venous thrombosis.

d. Long-term success does not depend on controlling the sources of embolism

e. Changing the consistency of muscle mass means a poor prognosis.

 97. The following statements about acute peripheral ischemia are true:

a. Administration of heparin prevents distal thrombus spreading

b. Ischemic extremities should be protected not only from the cold, but

also from the heat or pressure exerted on them.

c. Retrograde flow (the flow of blood flowing from the distal end of the artery

after removal of the obstruction) means an efficient distal vascular bed.

d. In the case of venous thrombosis, venous thrombosis should be removed

after restoring arterial flow.

e. Protecting the vascular bed located distal to the obstruction is the first

stage of treatment in acute ischemia

98. Which of the following statements is not false?

a. To be effective, embolectomy must be indicated and performed early, in

the first 6 hours.

b. Decompression fasciotomies are indicated preventively in all acute ischemia.

c. Embolectomy is usually performed under local anesthesia, especially

since most patients are elderly and in poor general condition.

d. Heparin minimizes thrombosis spread and stimulates natural thrombus

lysis as well as the development of collateral circulation.

e. Efficient arterial revascularization is ruled out in the absence of

adequate distal flow.

 99. The following statements are true about acute aortic dissection:

a. High blood pressure is the most commonly used contributing factor in

the production of acute aortic dissection.

b. The incidence of Marfan syndrome in aortic dissections is between 4-

15%

c. Media necrosis (cystic degeneration of the media) is found in 20% of

cases of aortic dissection.

d. Most often the aortic dissection is asymptomatic and can go unobserved

e. Abnormality of aortic root may be the pre-existing anatomical condition

of an aortic dissection.

100. The following statements are true:

a. The bicuspid aortic valve is frequently associated with acute aortic

dissection

b. Chest trauma can cause aortic dissection

c. Half of the dissections that occur in young women (under the age of 40)

are of interest to pregnant women.

d. Low blood pressure is a rule in patients with aortic dissection.

e. Iatrogenic trauma during cardiac surgery can lead to aortic dissection.

101. The following are valid in acute aortic dissection:

a. Rupture of the external (adventitial) wall of the false lumen most

commonly occurs in the pericardium or left pleural cavity.

b. Patients with type A dissection are generally younger and include

patients with Marfan syndrome and annuloaortic ectasia.

c. Type B dissection is usually found in middle-aged or elderly men.

d. Aorctic insufficiency is rare in the case of dissection of the proximal aorta.

e. Dissection in pregnant women usually occurs in the second trimester or

even during labor.

102. A number of factors influence preoperative mortality in acute aortic

dissection:

a. The time interval between diagnosis and surgery.

b. Existence of cardiac tamponade

c. Existence of acute renal failure.

d. Existence of preoperative aortic insufficiency

e. Acute myocardial infarction.

103. In the case of traumatic rupture of the thoracic aorta, surgery is

postponed in four categories of patients:

a. Patients with severe brain damage.

b. Septic patients

c. Patients with extensive burns

d. Patients with severe left lung trauma

e. Patients with severe trauma to the right lung.

104. The non-invasive methods of vascular exploration are as follows:

a. Measuring the ankle-arm index

b. plethysmography

c. Doppler examination

d. Angiography

e. Digital blood pressure measurement

105. Therapeutic thrombolysis is mainly used in the following situations:

a. In the treatment of acute myocardial infarction

b. In the treatment of pulmonary embolism

c. In deep vein thrombosis with onset of more than 14 days

d. In deep vein thrombosis with onset less than 14 days

e. In acute arterial thrombosis

106. The main contraindications of thrombolysis are:

a. Medical history of brain and spinal cord injuries: injure, aneurysms,

surgery, neoplasms

b. Stroke.

c. Uncontrolled bleeding

d. Arterial hypotension.
 e. Arterial hypertension

107. The following statements about aorto-iliac disease are true:

a. intermittent claudication is located in the b uttocks, hips, thighs and legs

b. distal claudication (at the level of the foot) excludes aortoiliac occlusive

disease.

c. type I aorto-iliac disease involves limiting the pathological process to

bifurcation of the aorta and iliac arteries

d. Type III aortic-iliac disease involves in addition to affecting the aorta

and iliac and infrahinal arteries

e. In addition to intermittent claudication, men with aorto-iliac disease

may also experience impotence

108. Patients with aorto-iliac disease manifested by moderate or mild

intermittent claudication will benefit from the following conservative

therapeutic measures:

a. smoking cessation

b. daily exercise

c. weight loss

d. ” D’emblée” surgery

e. Daily water consumption

109. The age and strengths associated with patients with aorto-iliac

disease may indicate a specific alternative revascularization technique:

a. Axillary-femoral bypass

b. Atherectomy

c. Endoluminal angioplasty

d. Aorto-femoral bypass

e. Femoro-femoral bypass

110. The following statements about obstructive atherosclerotic disease

are true:

a. The natural course of chronic obstructive pulmonary disease is invariably

toward amputation

b. It is more frequently characterized by stable intermittent

claudication.

c. Symptoms may improve as collateral circulation develops.

d. Resting pain and critical limb ischemia are absolute surgical

indications.

e. Distal trophic lesions are classified in stage IV Leriche-Fontaine

111. Among the postoperative complications that may occur after a

femoral-popliteal bypass are the following complications:

a. thrombosis of the graft

b. Bleeding

c. Infection

d. Sexual impotence

e. Lymphoma

112. Which of the following statements is true?

a. Transient stroke is a strong indication for carotid endarterectomy if

associated with more than 70% carotid stenosis

b. Age does not in itself contain a contraindication for intervention

c. Most transient ischemic strokes last more than 24 hours

d. Most transient ischemic strokes last less than 24 hours

e. Loss of vision on the same side as the lesion (amaurosis fugax) is a

characteristic symptom of carotid stenosis.

113. The characteristic symptoms of carotid stenosis are:

a. Weakness, numbness and clumsiness in the contralateral limbs

b. Loss of vision in the same part as the lesion (amaurozis fugax)

c. Dysphasia in case of damage to the dominant hemisphere

d. Tinnitus

e. Vision loss is characteristic, with the patient describing blindness as a dark

curtain drawn from top to bottom.

114. Complications of carotid endarterectomy can be:

 a. Stroke

b. Paralysis of the hypoglossal nerve, glossopharyngeal, facial or recurrent

larynx

c. Hematoma

d. Amnesia

e. Acute myocardial infarction

115. Rupture of the infrarenal aortic aneurysm occurs more often

posteriorly in the retroperitoneum. The clinical signs are:

a. Shock

b. The presence of a pulsatile abdominal mass

c. Abdominal or lumbar pain

d. Digestive hemorrhage

e. Hypotension

116. Among the complications that can occur in elective surgery of

infrarenal aortic aneurysms are:

a. Intraoperative bleeding

b. Declamping shock in operations on the abdominal aorta

c. Embolization in the carotid territory

d. Damage to the ureter

e. Embolization in the distal arterial bed

 117. The main complication of peripheral aneurysms are:

a. Thrombosis

b. Distal embolism

c. Rupture

d. Digestive hemorrhage

e. Compression of adjacent veins

118. Klippel-Trenaunay syndrome is characterized by:

a. Hypertrophic elongation of a limb

b. Painful flat angiomas

c. Congenital varicose veins

d. Macroscopic arteriovenous fistulas

e. Microscopic arteriovenous fistulas

119. Parks-Weber syndrome is manifested by:

a. Hypertrophic elongation of a limb

b. Angioma

c. Vascular nevi

d. Congenital arterial-venous fistulas

e. Varicose veins

120. The following statements about thrombangitis are true:

a. Lumbar sympathectomy is still widely indicated.

b. Distal touch and the absence of a distal vascular bed do not allow

surgery to revascularize the seams.

c. Smoking cessation is the essential etiopathogenetic treatment.

d. Surgical revascularization is possible in the vast majority of cases.

e. Quitting smoking reduces the rate and incidence of amputations.

121. The clinical manifestations characteristic of chronic venous

insufficiency are:

a. Edema

b. Pachyderm

c. Trophic ulcer

d. Erythrosis of declivity

e. Other dermatitis

122. Non-invasive paraclinical investigations in vein diseases are:

a. Photoplethysmography

b. Venous Doppler test

c. Phlebography

d. Venous Doppler ultrasound

e. Radioactive labeled fibrinogen scintigraphy

123. A multitude of signs and symptoms have been described as part of

the clinical picture of deep vein thrombosis:

a. Absent of fever

b. The climbing pulse-Mahler's sign

c. Spontaneous pain, located in the knuckle, which is accentuated by

palpation and dorsiflexion of the foot-sign of Homans

d. Dilation of the pretibial skin veins -sighn of Pratt.

e. sensitivity to palpation on the deep venous trajectory of the leg from the

internal retromaleolar groove to the popliteal region.

124. The indications for placing an inferior vena cava filter are:

a. Recurrent pulmonary embolism despite adequate anticoagulation

b. Certain pulmonary embolism in patients in whom anticoagulant

treatment is contraindicated.

c. Complications of the anticoagulant treatment that forces you to stop

treatment

d. Before pulmonary embolectomy

e. Following pulmonary embolectomy.

125. Contraindications to closing of perforating veins are:

a. Occlusive arterial disease of that limb

b. Venous ulcer infection

c. morbid obesity

d. Class 4-6 CEAP clasiffication of venous insufficiency

e. associated severe pathology

126. The treatment of superficial thrombophlebitis consists of:

a. Nonsteroidal anti-inflammatory treatment

b. Maintenance with elastic band

c. Antibiotics

d. Anticoagulant treatment when the thrombotic process is extended to the

deep vein system.

e. Surgical treatment in cases of ascending extension to the thigh.

127. The following complications may appear as a result of injury to the

arterial wall:

a. Arterial spasm

b. Thrombosis

c. Embolism

d. Increase in collagenase activity

e. Acute pain

128. The clinical signs of arterial injury are:

a. External bleeding

b. Lymphedema

c. Expansive hematoma

d. Acute ischemia
e. Perceptible trill

129. These are options for surgical revascularization in open vascular

injury:

a. Lateral arterial or lateral venoraphysis

b. Venous patch angioplasty.

c. Resection without interposition of a venous patch

d. Bypass with venous graft.

e. Resection with the interposition of a venous conduits.

130. Which of the following is a cause of acute ischemia?

a. Embolism

b. Arterial injury

c. Spontaneous or iatrogenic arterial dissection

d. Vasodilatation

e. Vasospasm

131. These are embolic sources in acute ischemia:

a. Heart's cavities

b. Myocardial aneurysm

c. Paradoxical emboli (deep vein system)

d. Superficial thrombophlebitis

e. Abdominal aneurysm
 132. The most commonly used thrombolytics are:

a. Recombinant tissue-plasminogen activator (rt-PA)

b. Urokinase

c. Streptokinase

d. Warfarin

e. Reteplase

133. The following are characteristic of obliterating arteriopathy:

a. Pain with sudden onset

b. Stenosis followed by occlusion

c. Multilevel disease

d. Development of collateral circulation

e. Claudication

134. Possible complications in the surgical treatment of aorto-iliac

disease are:

a. Thrombosis

b. Intraoperative atheroembolism

c. Popliteal artery rupture

d. Damage to the adjacent duodenum

e. Injury to the inferior vena cava and iliac vein

135. The following clinical signs are due to chronic venous insufficiency:
a. Varicose veins

b. Telangiectasia

c. Absence of pulse

d. Edema

e. Reticular veins

136. In the fetal circulation: The vast majority of deoxygenated blood in

the superior vena cava enters primarily into?

a. Right atrium

b. Foramen oval patent

c. Left atrium

d. Tricuspid valve

e. Right ventricle

137. In the fetal circulation: The vast majority of deoxygenated blood in

the right ventricle is directed into?

a. Pulmonary artery valve

b. Branch as the pulmonary artery

c. The left branch of the pulmonary artery

d. Arterial duct

e. Descending thoracic aorta

138. Fetal circulation is characterized by:

a. High pulmonary vascular resistance secondary to filling the lungs with

fluid and a hypoxic environment

b. Low systemic vascular resistance secondary to large area of utero-

placental bed with low resistance

c. The most oxygenated blood in the umbilical vein infuses the brain and

heart, preferably by shunting the liver through the venous duct and bypassing

the intracardiac by the oval foramen.

d. Less oxygenated blood infuses the lower body through the arterial duct

into the descending thoracic aorta

e. The most oxygenated blood infuses the lower body through the arterial duct

into the descending thoracic aorta

139. Are the pathological factors that determine the return to fetal

circulation after the birth of the child?

a. Hypothermia

b. Hypercarbia

c. Acidosis

d. Hypoxia

e. Sepsis

140. Does the functional unit of the mitral valve consist of the following?

a. Mitral valve ring and two cusps

b. Myocardium of the left atrium and myocardium of the left ventricle

c. Papillary muscles and chordae tendineae

d. Todaro's tendon

e. Atrioventricular node

141. What are the main mitral valve leaflets?

a. Anterior or aortic

b. Posterior or mural

c. Septal

d. anterolateral

e. posterior medial

142. The area of the mitral valve ring is larger in?

a. Left ventricular systole

b. Left ventricular diastole

c. Left atrium systole

d. Left atrium diastole

e. It does not depend on the function of the left ventricle and left atrium

143. The most common etiological factors in acquired mitral valve stenosis

are?

a. Rheumatic fever caused by β-hemolytic Streptococcus A

b. Degenerative disease of the mitral valve with ring calcification

c. Autoimmune diseases such as systemic lupus erythematosus, rheumatoid

disease

d. Carcionoid heart disease and drug-induced valvular heart disease

e. Infectious endocarditis of the mitral valve

144. Mitral valve stenosis leads to?

a. Obstruction of blood flow in the left ventricular diastole

b. Obstruction of blood flow in the left ventricular systole

c. Obstruction of blood flow in the left atrial systole

d. Obstruction of blood flow in the left atrial diastole

e. Increased pressure in the left atrium

145. Pathophysiologically, does chronic mitral valve stenosis lead to the

following morphological changes?

a. Pathological changes in the left ventricle

b. Pathological changes in the left atrium

c. Pathological changes in the pulmonary vascular bed

d. Pathological changes in the tricuspid valve

e. Pathological changes in Thebesius valve

146. Does the physiological closure of the mitral valve depend on the

interaction of the following components of the valvular apparatus?

a. Left atrium and valvular ring

b. Valve leaflets and chordae tendineae

c. Papillary muscles and left ventricle

d. Tendon of Todaro and interatrial septum

e. Right fibrous trigone and left fibrous trigone

147. The most common etiological factors in mitral valve insufficiency are?

a. Coronary artery disease

b. Dilated cardiomyopathy

c. Mitral valve prolapse

d. Myxomatous degeneration of the mitral valve

e. Calcification of the mitral valve ring

148. Pathophysiologically, mitral valve failure leads to the following

changes, except?

a. Pathological changes in the left ventricle

b. Pathological changes in the left atrium (dilation)

c. Pathological changes in the pulmonary vascular bed (secondary

pulmonary hypertension)

d. Pathological changes in the right ventricle

e. Dramatic increase in pressure in the left atrium