CSC Cardiac Surgery Sample 3

Question 1

A patient undergoing cardiac surgery develops diffuse microvascular bleeding refractory to FFP and platelets. Thromboelastography (TEG) shows a long clot formation time and low maximum amplitude. What agent should be administered?

Accepted Answer

Cryoprecipitate

Answer

Low maximum amplitude on TEG indicates platelet dysfunction or fibrinogen deficiency; cryoprecipitate provides concentrated fibrinogen and factor VIII to address this specific coagulopathy.

Question 2

During a Bentall procedure, what are the three components that are replaced?

Accepted Answer

Aortic valve, ascending aorta, and coronary ostia reimplantation

Answer

The Bentall procedure replaces the aortic root and ascending aorta with a composite graft containing a prosthetic valve, with reimplantation of the coronary ostia as buttons.

Question 3

What is the target activated clotting time (ACT) during full cardiopulmonary bypass?

Accepted Answer

>400 seconds

Answer

An ACT greater than 400–480 seconds is required during full CPB to prevent clotting within the bypass circuit and ensure adequate anticoagulation.

Question 4

Which repair technique for hypertrophic obstructive cardiomyopathy (HOCM) involves resecting basal septal muscle?

Accepted Answer

Morrow myectomy

Answer

The Morrow (septal) myectomy involves surgical resection of hypertrophied basal septal muscle through the aortic valve to relieve left ventricular outflow tract obstruction.

Question 5

Following coronary artery bypass surgery, a patient develops low cardiac output with a pulmonary artery wedge pressure of 22 mmHg and SVR of 1,800 dyn·s·cm⁻⁵. What is the most appropriate initial management?

Accepted Answer

Intra-aortic balloon pump insertion

Answer

An IABP reduces afterload and augments diastolic coronary perfusion pressure, making it the preferred mechanical support for post-bypass low cardiac output with elevated filling pressures and SVR.

Cardiac Surgery Certification Exam Practice Test

Cardiac Surgery Certification Exam Practice Test

CSC Cardiac Surgery Sample 3