Cardiac Surgery Certification Exam Perioperative Care in Cardiac Surgery 2 — Questions and Answers
Question 1: Which scoring system is most widely used to estimate operative mortality risk before cardiac surgery in the United States?
- Society of Thoracic Surgeons (STS) risk score (Correct answer)
- EuroSCORE II
- APACHE II
- GRACE score
Correct answer: Society of Thoracic Surgeons (STS) risk score
The STS risk score is the standard tool in the US for predicting operative mortality and morbidity before cardiac surgery procedures.
Question 2: Vasoplegic syndrome after cardiac surgery is characterized by:
- Severe hypotension with low systemic vascular resistance and preserved cardiac output (Correct answer)
- Low cardiac output with high SVR
- Hypertension and bradycardia
- Pulmonary hypertension with right heart failure
Correct answer: Severe hypotension with low systemic vascular resistance and preserved cardiac output
Vasoplegic syndrome presents as refractory hypotension with inappropriately low SVR despite normal or high cardiac output, often requiring vasopressin or methylene blue.
Question 3: Sternal wound infection after cardiac surgery is most commonly caused by:
- Staphylococcus aureus (Correct answer)
- Pseudomonas aeruginosa
- Candida albicans
- Enterococcus faecalis
Correct answer: Staphylococcus aureus
Staphylococcus aureus, including MRSA, is the most frequent pathogen in deep sternal wound infections (mediastinitis) after cardiac surgery.
Question 4: Which intraoperative monitoring is considered standard for major cardiac surgery requiring CPB?
- Transesophageal echocardiography (TEE) (Correct answer)
- Pulmonary artery catheter alone
- Intracranial pressure monitoring
- Electroencephalography
Correct answer: Transesophageal echocardiography (TEE)
TEE is standard during cardiac surgery because it provides real-time assessment of cardiac function, valve repair quality, air removal, and filling status.
Question 5: The main purpose of temporary epicardial pacing wires placed at the end of cardiac surgery is:
- To manage postoperative bradyarrhythmias and heart block (Correct answer)
- To measure intracardiac pressures
- To deliver cardioplegia
- To monitor ST-segment changes
Correct answer: To manage postoperative bradyarrhythmias and heart block
Epicardial pacing wires provide immediate access to pacing capability should bradycardia or heart block occur in the early postoperative period.
Question 6: Delayed sternal closure is most often used after cardiac surgery when:
- Significant myocardial edema or hemodynamic instability prevents safe chest closure (Correct answer)
- Bleeding has completely stopped
- The patient is extubated successfully
- Bypass time exceeded 2 hours
Correct answer: Significant myocardial edema or hemodynamic instability prevents safe chest closure
Delayed sternal closure allows the swollen mediastinum to decompress and hemodynamics to stabilize before formal sternal reapproximation.
Cardiac Surgery Certification Exam Perioperative Care in Cardiac Surgery 2
Which scoring system is most widely used to estimate operative mortality risk before cardiac surgery in the United States?