CHAPTER 21

1. A 75-year-old woman with history of angina is admitted to the hospital for syncope. Examination
of the patient reveals a systolic murmur best heard at the base of the heart that radiates into the carotid
arteries. Electrocardiogram (ECG) is notable for left ventricular hypertrophy with evidence of left
atrial enlargement. ECG reveals an aortic valve area of 0.7 cm. What is the most appropriate next step in
her management?
a. Medical management with a nitrate and an angiotensin-converting enzyme inhibitor
b. Bilateral carotid endarterectomies
c. Percutaneous coronary artery angioplasty and stenting
d. Coronary artery bypass surgery
e. Aortic valve replacement

The answer is e. The patient’s history, physical examination, and

findings on heart studies are classic for aortic stenosis. The only effective therapy with good longterm
results is aortic valve replacement, with most patients achieving symptom relief after surgery.
Percutaneous aortic balloon valvuloplasty is an option for patients who are not candidates for aortic
valve replacement or whose long-term survival is poor. Valvuloplasty involves passing balloon
catheters through the aortic orifice and inflating them in an effort to break the calcium that is
retarding leaflet motion. The results are not as durable as those for valve replacement, with a third of
the patients having recurrent symptoms by 6 months.
Aortic stenosis is most often thought to result from calcification of the aortic valve associated with
advanced age. The process is mostly idiopathic, with only a small percentage associated with
rheumatic fever. Patients may not develop symptoms until the aortic valve area is about 1 cm.
Symptoms may include angina, congestive heart failure, or syncope. The combination of aortic
stenosis and congestive heart failure, which is the presenting symptom in nearly one-third of patients,
has a worse prognosis. Medical management, percutaneous coronary artery angioplasty and stenting,
and coronary artery bypass surgery are options for angina due to coronary artery disease. Carotid
endarterectomy is the treatment of choice for carotid artery stenosis.

2. A 63-year-old man is seen because of facial swelling and cyanosis, especially when he bends
over. There are large, dilated subcutaneous veins on his upper chest. His jugular veins are prominent
even while he is upright. Which of the following conditions is the most likely cause of these findings?
a. Histoplasmosis (sclerosing mediastinitis)
b. Substernal thyroid
c. Thoracic aortic aneurysm
d. Constrictive pericarditis
e. Bronchogenic carcinoma

The answer is e. Superior vena cava obstruction (SVC syndrome) is

almost always due to malignancy (90% of cases) and in 3 out of 4 cases, results from invasion of the
vena cava by bronchogenic carcinoma. Lymphomas are the second most common cause of the SVC
syndrome. Fibrosing mediastinitis as a complication of histoplasmosis or ingestion of methysergide
may occur, but is rare. Rarely, a substernal thyroid or thoracic aortic aneurysm may be responsible for
the obstruction. SVC syndrome can be caused iatrogenically secondary to indwelling catheters.
Although constrictive pericarditis may decrease venous return to the heart, it does not produce
obstruction of the superior vena cava. Whatever the cause of the superior vena cava syndrome, the
resultant increased venous pressure produces edema of the upper body, cyanosis, dilated subcutaneous
collateral vessels in the chest, and headache. Cervical lymphadenopathy may also be present as a
result of either stasis or metastatic involvement. Initial management of superior vena cava syndrome
consists of diuresis, and for malignancies, the treatment consists of radiation and chemotherapy if
applicable. Occasionally, surgical intervention or thrombolysis may be indicated for severe
lifethreatening
complications.

3. A 45-year-old man with poorly controlled hypertension presents with severe chest pain radiating
to his back. An ECG demonstrates no significant abnormalities. A CT scan of the chest and abdomen
is obtained, which demonstrates a descending thoracic aortic dissection extending from distal to the
left subclavian takeoff down to above the iliac bifurcation. A Foley catheter is placed, and urine
output is 30 to 40 cc/h. His feet are warm, with less than 2-second capillary refill. Which of the
following is the most appropriate initial management?
a. Emergent operation for repair of the aortic dissection
b. Angiography to confirm the diagnosis of aortic dissection
c. Echocardiography to rule out cardiac complications
d. Initiation of a β-blocker
e. Initiation of a vasodilator such as nitroprusside

The answer is d. The initial treatment for a descending aortic

dissection is to reduce the rate of change in blood pressure and to reduce shear on the aortic wall,
which is achieved with β-blockade. Nitroprusside may be added after β-blockade has been achieved.
Indications for operative intervention for a descending aortic dissection are end-organ failure (renal
failure, lower extremity ischemia, intestinal ischemia), inadequate pain relief despite optimal medical
therapy, and rupture or signs of impending rupture (increasing diameter or periaortic fluid).

4. A 50-year-old salesman is on a yacht with a client when he has a severe vomiting and retching
spell punctuated by a sharp substernal pain. He arrives in your emergency room 4 hours later and has a
chest film in which the left descending aorta is outlined by air density. Which of the following is the
most appropriate next step in his workup?
a. Contrast esophagram
b. Echocardiogram
c. Flexible bronchoscopy
d. Flexible esophagogastroscopy
e. Aortography
The answer is a. The presence of air in the mediastinum after an
episode of vomiting and retching is virtually pathognomonic of spontaneous rupture of the esophagus
(Boerhaave syndrome). A contrast esophagram is the initial test of choice and is indicated with barium
for a suspected thoracic perforation and water-soluble contrast (Gastrografin) for an abdominal
perforation. Barium is inert in the chest but causes peritonitis in the abdomen, whereas aspirated
Gastrografin can cause severe pneumonitis. CT scanning may be useful if a small, contained leak is
suspected. A surgical endoscopy needs to be performed if the imaging studies are negative with a high
degree of suspicion for an esophageal injury. If the leak is contained and the patient does not have any
evidence of sepsis, then the leak can be managed with antibiotics and expectant management. For
leaks associated with systemic signs, patients should undergo prompt surgical therapy. The operation
of choice is dependent on the time to diagnosis. Leaks that are less than 24 hours old in patients
without an underlying esophageal disorder may be managed with thoracotomy, repair, and drainage.
Leaks older than 24 hours typically require more extensive surgery

5. A 26-year-old man is brought to the emergency room after being extricated from the driver ’s seat
of a car involved in a head-on collision. He has a sternal fracture and is complaining of chest pain. He
is hemodynamically stable and his electrocardiogram (ECG) is normal. Which of the following is the
most appropriate management strategy for this patient?
a. Admit to telemetry for 24-hour monitoring
b. Admit to the regular ward with serial ECGs for 24 hours
c. Emergent cardiac catheterization
d. Immediate operative plating of the sternal fracture
e. Discharge to home with nonsteroidal anti-inflammatory agents for the sternal fracture

The answer is a. There are no universally

accepted criteria for the diagnosis of myocardial contusion. Therefore, if there is a significant clinical
suspicion, then the patient should be monitored on telemetry or in the intensive care unit for 24 hours.
An initial ECG may demonstrate ST- or T-wave changes (which are not specific for a myocardial
contusion), arrhythmias, or bundle branch blocks. However, a normal ECG does not rule out a
myocardial contusion. Similarly, cardiac enzymes may be elevated, including the CKMB fraction, but
are neither sensitive nor specific for a myocardial contusion. Echocardiography may demonstrate wall
motion abnormalities, valvular disruption, or a pericardial effusion with or without tamponade.
Antiarrhythmics are not indicated prophylactically in a patient with a myocardial contusion, but
should be used to treat any rhythm disturbances. Supportive therapy for myocardial contusion is
directed at inotropic support of the ventricle; the coronary arteries are usually intact after the injury,
so there is little role for coronary vasodilators and less for coronary artery bypass surgery.

6. A 63-year-old man underwent a 3-vessel coronary artery bypass graft (CABG) 5 hours ago.
Initially, his mediastinal chest tube output was 300 mL blood/h, but an hour ago, there was no further
evidence of bleeding from the tube. His mean arterial pressure has fallen, and several fluid boluses
were administered. His central venous pressure (CVP) is elevated to 20 mm Hg, and he has required
the addition of inotropes. Which of the following is the best management strategy?
a. Addition of vasopressors along with the inotropes
b. Transfusion of packed red blood cells
c. Return to the operating room for exploration of the mediastinum
d. Placement of an intraaortic balloon pump
e. Infusion of streptokinase into the mediastinal chest tube

The answer is c. Cardiac tamponade is a life-threatening

complication that can occur after CABG. If the patient has bleeding postoperatively, the patient’s
coagulopathy should be corrected. Clotting of the mediastinal chest tube followed by hemodynamic
decompensation with decreased mean arterial pressures (MAPs) and cardiac output with increasing
filling pressures is suggestive of tamponade. Equalization of pressures across the 4 chambers on
Swan-Ganz catheter monitoring or collapse of the right atrium on echocardiography is diagnostic of
tamponade. The patient should return to the operating room for exploration and drainage of the
mediastinal hematoma.

7. A 56-year-old woman presents for evaluation of a murmur suggestive of mitral stenosis and is
noted on echocardiography to have a lesion attached to the fossa ovalis of the left atrial septum. The
mass is causing obstruction of the mitral valve. Which of the following is the most likely diagnosis?
a. Endocarditis
b. Lymphoma
c. Cardiac sarcoma
d. Cardiac myxoma
e. Metastatic cancer to the heart

The answer is d. The most common benign cardiac tumor is a

myxoma. Symptoms can include valvular obstruction (mitral or tricuspid valve) or embolization
systemically. Histologic examination of a peripheral embolus can confirm the diagnosis. In the heart,
they are often attached by a pedicle to the fossa ovalis of the left atrial septum. Treatment is resection

8. A 59-year-old man is found to have a 6-cm thoracoabdominal aortic aneurysm which extends to
above the renal arteries for which he desires repair, but he is concerned about the risk of paralysis
postoperatively. Which of the following maneuvers should be employed to decrease the risk of
paraplegia after repair?
a. Infusion of a bolus of steroids immediately postoperatively with a continuous infusion for 24 hours
b. Maintenance of intraoperative normothermia
c. Clamping of the aorta proximal to the left subclavian artery
d. Cerebrospinal fluid (CSF) drainage
e. Extracorporeal membrane oxygenation

The answer is a. Operative intervention is usually recommended for

thoracic aortic aneurysms greater than 5 or 6 cm in diameter or those that are increasing in size.
Spinal cord ischemia can result in paraplegia with a risk of 5% to 15%, depending on the extent of the
repair. Various strategies that have been employed to prevent spinal cord ischemia include aggressive
reattachment of segmental intercostal and lumbar arteries, minimizing cross-clamp time (moving the
clamp sequentially more and more distally as branches are reattached), hypothermia, moderate
systemic heparinization, left heart bypass, and cerebrospinal fluid drainage (using a lumbar drain).
The rationale for cerebrospinal fluid drainage is that it decreases the pressure on the blood supply to
the spinal cord and therefore improves perfusion. Postoperative steroids do not reduce the risk of
paraplegia.

9. A 70-year-old woman undergoes a cardiac catheterization for exertional chest pain. Her pain
continues to worsen and she is interested in having either surgery or percutaneous coronary
intervention (PCI). Which of the following would be an indication for her to undergo either coronary
artery bypass grafting or PCI?
a. Two-vessel coronary disease with proximal left anterior descending artery stenosis and depressed
left ventricular ejection fraction
b. Isolated left main stenosis, no diabetes, and normal left ventricular ejection fraction
c. Isolated left main stenosis and diabetes
d. Left main stenosis and additional coronary artery disease with depressed left ventricular ejection
fraction.
e. Three-vessel coronary artery disease and diabetes

The answer is a. Coronary artery bypass

grafting (CABG) is indicated in patients with angina (chronic, unstable, or postinfarction) and in
asymptomatic patients with ischemia on cardiac stress tests. CABG offers a long-term survival benefit
in patients with multivessel disease, left main coronary artery disease, and 1-vessel and 2-vessel
disease with proximal left anterior descending (LAD) coronary artery obstruction. CABG is the
treatment of choice in diabetic patients. CABG and percutaneous coronary intervention (PCI) are both
appropriate in patients with 2-vessel disease and proximal LAD obstruction. For all of the other
choices, it is either uncertain or inappropriate to choose PCI over CABG.

10. A 27-year-old woman seeks your advice regarding pain and numbness in the right arm and hand.
She reports that it is exacerbated by raising her arm over her head. On examination, the right radial
pulse disappears when the patient takes a deep breath and turns her head to the left. A provisional
diagnosis is made. Which of the following is the most appropriate initial treatment for this patient?
a. Physical rehabilitation
b. Gabapentin to treat neuropathic pain
c. Right first rib resection
d. Thoracoscopic sympathectomy
e. Upper thoracic discectomy

The answer is a. The patient has thoracic outlet syndrome. The

initial treatment should be conservative management with an exercise program to strengthen shoulder
girdle muscles and decrease shoulder droop. Operative treatment includes division of the scalenus
anticus and medius muscles, first rib resection, cervical rib resection, or a combination of all three.
Gabapentin may be prescribed to treat neuropathic pain, but is not the primary treatment of thoracic
outlet syndrome. Thoracoscopic sympathectomy is a surgical treatment for hyperhidrosis. Carpal
tunnel syndrome and cervical disk disease can be commonly confused with thoracic outlet syndrome.
Since the innervation of the brachial plexus is derived from the nerve roots C5-T1, upper thoracic
discectomy is unlikely to be helpful.

11. An elderly man with abnormal pupillary responses (Argyll Robertson pupil).
a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

12. A 24-year-old drug addict with jugular venous distention and exophthalmos.
a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

13. A 20-year-old drug addict with exophthalmos.

a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

14. A patient with flushing and paling of the nail beds (Quincke pulse) and a bounding radial pulse.
a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

15. A patient with Quincke pulse

a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

16. A patient with conjunctivitis, urethral discharge, and arthralgia

a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

17. A patient with conjunctivitis and arthralgia

a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

18. A patient with short stature, webbed neck, low-set ears, and epicanthal folds
a. Massive tricuspid regurgitation
b. Aortic regurgitation
c. Coarctation of the aorta
d. Thoracic aortic aneurysm
e. Myocarditis

The answers are d, d, a, a, b, b, e, c.

The Argyll Robertson pupil (a pupil that constricts with accommodation but not in
response to light) is characteristic of central nervous system syphilis and is associated with vascular
system manifestations of that disease. Treponema pallidum invades the vasa vasorum and causes an
obliterative endarteritis and necrosis. The resulting aortitis gradually weakens the aortic wall and
predisposes it to aneurysm formation. Once an aneurysm has formed, the prognosis is grave. Massive
isolated tricuspid regurgitation produces a markedly elevated venous pressure, usually manifested by
a severely engorged (often pulsating) liver. If the venous pressure is sufficiently elevated,
exophthalmos may result. Tricuspid regurgitation of rheumatic origin is almost never an isolated
lesion, and the major symptoms of patients who have rheumatic heart disease are usually attributable
to concurrent left heart lesions. Bacterial endocarditis from intravenous drug abuse is becoming an
increasingly important cause of isolated tricuspid regurgitation. A Quincke pulse, which consists of
alternate flushing and paling of the skin or nail beds, is associated with aortic regurgitation. Other
characteristic features of the peripheral pulse in aortic regurgitation include the waterhammer pulse
(Corrigan pulse, caused by a rapid systolic upstroke) and pulsus bisferiens, which describes a double
systolic hump in the pulse contour. The finding of a wide pulse pressure provides an additional
diagnostic clue to aortic regurgitation. Myocarditis, aortitis, and pericarditis have all been described
in association with Reiter syndrome; the original description included conjunctivitis, urethritis, and
arthralgias. Although its cause is unknown, Reiter syndrome is associated with HLA-B27 antigen, as
are aortic regurgitation, pericarditis, and ankylosing spondylitis. Short stature, webbed neck, lowset
ears, and epicanthal folds are the classic features of patients who have Turner syndrome. Persons
affected by the syndrome, which is commonly linked with aortic coarctation, are genotypically XO.
However, females and males have been described with normal sex chromosome constitutions (XX,
XY) but with the phenotypic abnormalities of Turner syndrome. Additional cardiac lesions associated
with Turner syndrome include septal defects, valvular stenosis, and anomalies of the great vessels.

19. A 56-year-old man presents with a blood pressure of 220/110 mm Hg, chest pain, and ST
elevations on an ECG.
a. Epinephrine
b. Norepinephrine
e. Dobutamine
f. Nitroprusside
g. Nitroglycerin

20. A 65-year-old man presents with cardiogenic shock following a myocardial infarction.
a. Epinephrine
b. Norepinephrine
e. Dobutamine
f. Nitroprusside
g. Nitroglycerin

21. A 30-year-old man presents with perforated appendicitis and heart rate of 120 beats per minute,
blood pressure of 80/40 mm Hg, and central venous pressure of 17 mm Hg. The patient remains
hypotensive after a continuous infusion of dopamine
a. Epinephrine
b. Norepinephrine
e. Dobutamine
f. Nitroprusside
g. Nitroglycerin

22. A 21-year-old man undergoes major abdominal surgery after a motor vehicle collision. He has a
cardiac arrest in the intensive care unit shortly after returning from surgery.
a. Epinephrine
b. Norepinephrine
e. Dobutamine
f. Nitroprusside
g. Nitroglycerin

23. A 45-year-old woman presents with a blood pressure of 220/130 mm Hg and a headache. After
several hours of an intravenous drip of medication to control her hypertension, she becomes acidotic.
a. Epinephrine
b. Norepinephrine
e. Dobutamine
f. Nitroprusside
g. Nitroglycerin

The answers are g, e, b, a, f.

Norepinephrine and dopamine are the first-line agents used for septic shock. Phenylephrine is often
used as a first-line agent in the treatment of neurogenic shock (where there is a loss of sympathetic
tone) or as a secondary agent for refractory hypotension in the setting of tachycardia which limits
increases in other medications such as dopamine. Dobutamine is primarily used in patients with
cardiogenic shock. Epinephrine is used as a short-term agent given in intravenous boluses during
cardiac arrests and in patients with cardiac dysfunction refractory to other agents such as dobutamine.
Nitroprusside can be used in severe cardiogenic shock to reduce afterload or to treat severe
hypertension. Nitroglycerin is used to treat acute myocardial ischemia.

Epinephrine is a circulating endogenous catecholamine, released mainly from the adrenal medulla,
whose effects are mediated by binding of free circulating hormone to β
1
and β
receptors, with lesser
effects on α adrenoreceptors. At low infusion rates the β
1
2
-adrenergic effects predominate causing
increased heart rate, stroke volume, and contractility. At higher infusion rates, α-adrenergic receptors
are stimulated, resulting in an increase in blood pressure and systemic vascular resistance. Prolonged
use of high-dose epinephrine is limited by renal and splanchnic vasoconstriction, cardiac
dysrhythmias, and increased myocardial oxygen demand. Norepinephrine is also endogenously
produced, but acts locally through release at nerve synapses. It acts on α-adrenergic and β-adrenergic
receptors, resulting in an increase in afterload and glomerular perfusion pressure with preservation of
cardiac output. Norepinephrine is associated with increase in urine output in hypotensive, septic
patients. Dopamine is an endogenous catecholamine that is released into the circulation and acts by
binding to α
receptors as well as to specific dopamine receptors in the renal, mesenteric, coronary,
and intracerebral vascular beds, causing vasodilation. It has effects that change with increasing doses
1
by binding to different receptors. At low serum concentrations, dopamine binds to dopaminergic
receptors in the renal and splanchnic beds leading to increased urine output and natriuresis. At modest
concentrations, dopamine binds to cardiac β
-adrenergic receptors leading to increased myocardial
contractility and increased heart rate. At high doses, dopamine binds to α-adrenergic receptors and
1
causes an increase in blood pressure and peripheral vascular resistance. Dopamine is an effective
agent in increasing blood pressure in hypotensive patients with adequate fluid resuscitation.
Dobutamine is a synthetic catecholamine that predominately binds to β-adrenergic receptors and
enhances myocardial contractility with minimal changes in heart rate. It is often used in treatment of
cardiogenic shock following myocardial infarction to support myocardial contractility while reducing
peripheral resistance. Phenylephrine is a pure α-agonist and its use results in increased peripheral
vascular resistance and blood pressure. The increase in afterload increases left ventricular work and
oxygen demand, and may cause a decrease in stroke volume and cardiac output. Nitroprusside is an
arterial and venous smooth muscle vasodilator. Continuous infusions of nitroprusside require
monitoring of serum thiocyanate levels and arterial pH for cyanide toxicity. Nitroglycerin is primarily
a venous smooth muscle vasodilator. It is an effective treatment for myocardial ischemia because it
diminishes myocardial oxygen demand by reducing excessive preload and ventricular end-diastolic
pressure.

24. What is the most commonly used device for mechanical circulatory support, and it may be easily
deployed in the catheterization laboratory, in the operating room or at the bedside?
A. Intra-Aortic Balloon Pump
B. Total Artificial Heart
C. Right Ventricular Assist Devices
D. Biventricular Assist Devices

ANSWER: A

Intra-Aortic Balloon Pump is the most commonly used device for mechanical circulatory support, and it
may be easily deployed in the catheterization laboratory, in the operating room or at the bedside. The
device is inserted percutaneously through the femoral artery into the thoracic aorta.

25. Which of the following is characterized by infiltration of the cellular and fibrous pericardium by
inflammatory cells. It is found in approximately 1% of autopsies and accounts for up to 5% of
presentations of nonischemic chest pain.
A. Myocardial Infarction
B. Acute Pericarditis
C. Myocarditis
D. Rheumatic heart disease

ANSWER: B
Acute pericarditis is characterized by infiltration of the cellular and fibrous pericardium by inflammatory
cells. It is found in approximately 1% of autopsies and accounts for up to 5% of presentations of
nonischemic chest pain. It requires the identification of at least two of four cardinal features:
Pleuritic and positional, retrosternal chest pain
Pericardial friction rub
EKG changes: diffuse ST elevation and PR depression
Pericardial effusion

26. Heart Rhythm Society state that surgical ablation for atrial fibrillation is indicated for the following
EXCEPT:
A. All symptomatic AF patients undergoing other cardiac surgery
B. Selected asymptomatic AF patients undergoing cardiac surgery in which the ablation can be
performed with minimal additional risk
C. Symptomatic patients with lone AF who have failed medical therapy and prefer a surgical approach,
have failed one or more attempts at catheter ablation, or are poor candidates for catheter ablation
D. None of the above

ANSWER: D
27. True of Cox-Maze IV Procedure
A. First successful operation for supraventricular tachycardia
B. Clinically introduced in 1987 by James Fox
C. Procedure involved the completion of a zigzag-like pattern of surgical incisions across both the right
and left atrial that were designed to interrupt the multiple macroreentrant circuits that were thought to
be responsible for AF
D. It is performed on cardiopulmonary bypass through either a median sternotomy, often in
combination with other cardiac surgery, or a right minithoracotomy

ANSWER: D
It is the first successful operation for atrial fibrillation and was clinically introduced in 1987 by James
Cox. Procedure involved the completion of a maze-like pattern of surgical incisions across both the right
and left atrial that were designed to interrupt the multiple macroreentrant circuits that were thought to
be responsible for AF. It is performed on cardiopulmonary bypass through either a median sternotomy,
often in combination with other cardiac surgery, or a right minithoracotomy.

28. It is the mainstay imaging technique for the detection of cardiac tumors
A. Transesophageal echocardiography
B. Cardiac MRI
C. Transthoracic echocardiography
D. CT scans

ANSWER: C
Transthoracic echocardiography is the mainstay imaging technique for the detection of cardiac tumors
Transesophageal echocardiography is generally only beneficial for small localized tumors due to its
limited field of view
Cardiac MRI is therefore the current standard for delineating the anatomical extent of the tumor and
assessing the paracardiac space and great vessels
CT scans include better soft-tissue evaluation without the need for iodinated contrast and no exposure
to ionizing radiation

29. The basic CPB circuit consists of, except:

A. PUMP
B. ARTERIAL RESERVIOR
C. OXYGENATOR
D. VENOUS CANNULAE

ANSWER: B
The basic CPB circuit consists of:
- venous cannulae
- venous reservoir
- pump
- oxygenator
- filter
- arterial cannula

30. The 1st saphenous vein CABG was performed by

A. Favalaro
B. Sening
C. Green
D. Sabiston

ANSWER: D
The 1st saphenous vein CABG was performed by Sabiston in 1962, popularized by Favalaro in 1967
1968 Bypass conduit by Green
Sening described the use of vein patches to repair arteriostomy sites in 1961