Content

 Complication of Pulmonary Surgery

 Lung Absces
 Pulmonary Embolism
MCQS
5. Most common cause of lung abscess is ?
A. Aspiration
B. Periodontal disease
C. Alcoholism
D. Immunoglobulin deficiency
6. Most common causative organisms for lung abscess is ?
A. Anaerobic bacteria
B. S. aureus
C. Klebsiella pneumoniae
D. M. tuberculosis
7. Most common causative organisms for lung abscess is ?
A. Anaerobic bacteria
B. S. aureus
C. Klebsiella pneumoniae
D. M. tuberculosis
8. Which of the following in lung abscess indicates anaerobic infection ?
A. Putrid breath
B. Sputum
C. Empyema fluid
D. All of the above
9. Which of the following drugs is now standard therapy for lung abscess ?
A. Penicillin
B. Clindamycin
C. Metronidazole
D. TMP-SMZ
10. Who is at greater risk for pulmonary embolism?
A. Men
B. Women
C. Young women
D. The risk is the same for men and women
11. Signs and symptoms of pulmonary embolism (PE) can include:
A. Redness, warmth, tenderness and swelling
B. Shortness of breath, chest pain, coughing blood
C. Muscle spasms, vertigo, ringing ears
D. All of the above
12. Having a pulmonary embolism includes risk of possible ______________.
A. Sudden death
B. Diabetes
C. High blood pressure
D. Amputation of limbs
13. Pulmonary embolism (PE) can occur without deep vein thrombosis (DVT).
A. True
B. False

14. You are at-risk for developing deep vein thrombosis or pulmonary embolism
if you:
A. Are obese
B. Have had recent surgery
C. Smoke
D. Any of the above
15. A pulmonary embolism is a blood clot that becomes lodged in the lung.
A. True
B. False
16._____is when a blood clot (thrombus) becomes lodged in an artery in the
lung and blocks blood flow to the lung.
1. DVT
2. Embolism
3. COPD
4. Pulmonary embolism
17. The most common pulmonary complication was
1. septic pulmonary embolism
2. Embolism
3. DVT
4.None of these
18. A disease which is a pus-filled cavity in your lung surrounded by inflamed
tissue.
1. Pulmonary Embolism
2. Lung Absces
3. none of these
4. COPD
19. Pulmonary embolism is a blockage in one of the pulmonary arteries in
your ---.
1. Kidney
2. Liver
3. Lungs
4. Heart
20. Pulmonary embolism occurs when a clump of material, most often a blood
clot, gets wedged into an ____in your lungs.
1. Capillary
2. Vein
3. Artery
4. Plasma

Cardiopulmonary resuscitation
Types of operations
Complications of cardiac surgery

When was CPR first developed?

A. 1920
B. 1942
C. 1960 ✅
D. 1971
2. How does CPR help when a person goes into cardiac arrest?
A. It starts the heart beating again
B. It helps the blood flow to the heart
C. It helps blood flow to the brain
D. B and C✅
3. What's the first thing you should do before beginning CPR if you see
an adult collapse and the person is unresponsive?
A. Remove the victim's belt
B. Check the victim's mouth
C. Call 911✅
D. Call the victim's doctor
4. After calling 911, what is the next step in CPR on an unresponsive
adult?
A. Check for a pulse
B. Check for breathing
C. Begin chest compressions✅
D. None of the above
5. When a person has a cardiac arrest, the faster that CPR begins, the
better the chances of a victim's recovery.
A. True✅
B. False
6. How does an automatic external defibrillator (AED) help a person
who is in cardiac arrest?
A. An AED pumps blood
B. An AED shocks the brain
C. An AED restores normal heart rhythm✅
D. An AED helps the victim breathe
7. Who can use an AED?
A. Police officer
B. Emergency medical responder
C. Firefighter
D. Security guard
E. All of the above✅
8. When should you stop doing CPR on a victim?
A. When the person begins to move
B. When emergency help arrives
C. When you are exhausted and unable to continue
D. All of the above✅

The physiological change most likely to be associated with infrarenal

cross-clamping of the aorta is
A. decreased coronary blood flow
B. decreased renal blood flow✅
C. increased cardiac output
D. increased heart rate
E. reduction in myocardial wall motion abnormalities

A 40-year-old man with Marfan's syndrome has undergone successful

thoracoabdominal aortic
reconstruction for aortic dissection. He has a CSF (cerebrospinal fluid)
drain in situ. 48 hours post-operatively the CSF is noted to be
bloodstained and he becomes obtunded. The most
appropriate urgent investigation is
A. CSF microscopy and culture
B. MRI (magnetic resonance imaging) brain
C. MRI spine
D. non-contrast head CAT scan✅
E. serum electrolytes

A 25-year-old man with Marfan's syndrome is scheduled for aortic arch

reconstruction under circulatory arrest. Cooling to 18 degrees is planned.
The maximum time for circulatory arrest at this temperature after which
the risk of long term neurological injury increases markedly is
A. 15 minutes
B. 25 minutes
C. 35 minutes✅
D. 45 minutes
E. 55 minutes

A 40y.o. man with Marfan's syndrome is to undergo thoraco-abdominal

aortic reconstruction for chronic aortic dissection. An intrathecal
catheter is
inserted. The purpose of this is to
A. allow drainage of CSF✅
B. allow intrathecal admin of metabolic substrates
C. allow intrathecal admin of neuroprotective drugs
D. cool the spinal cord
E. facilitate spinal cord function monitoring

The action of which drug is unchanged in a recipient following cardiac

transplantation
A. Adenosine
B. Adrenaline
C. Atropine
D. Digoxin
E. Isoprenaline✅

In Marfan’s Syndrome which is NOT related:

A. If develop aortic disease most likely to be aortic stenosis✅
B. At risk iliac aneurysm
C. development of mitral valve prolapse is more likely than in general
population
D. Cardiac myopathy due to medial cystic necrosis/atrophy/
degeneration
E. Intracranial aneurysm

Asystolic aortic arch repair. The best method for cerebral protection is:
A. anterograde perfusion via coronary vessel
B. retrograde perfusion via jugular vein
C. thiopentone IV
D. hypothermia to 20 degrees celcius✅
Relative contraindications to mediastinoscopy include
A. Cervical spondylosis
B. Emphysema
C. Mediastinal lymphadenopathy
D. Poor left ventricular function
E. Superior vena cava syndrome✅

Congenital heart diseases

Cardiac transplantation
1. 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.
Answer: A

. The most useful incision in the operating room for patients with
penetrating cardiac injury is:
A. Left anterior thoracotomy.
B. Right anterior thoracotomy.
C. Bilateral anterior thoracotomy.
D. Median sternotomy.
E. Subxyphoid.
Answer: D

In patients who present with a penetrating chest injury, injury to the

heart is most likely when the following physical sign(s) is/are present:
A. Hypotension.
B. Distended neck veins.
C. Decreased heart sound.
D. All of the above.
Answer: D

In an infant with suspected PDA, which of the following would be the

optimal method of confirming the diagnosis?
A. Chest film.
B. Cardiac catheterization.
C. Retrograde aortography via an umbilical artery catheter.
D. Two-dimensional echocardiography with continuous-wave and color-
flow Doppler echocardiography.
Answer: D

Which of the following is/are true of the surgical treatment of VSDs?

A. A right ventricular approach is employed for the repair of most
perimembranous VSDs.
B. Intracardiac repair is advisable for patients with intractable symptoms
and for asymptomatic infants with evidence of increasing pulmonary
vascular resistance.
C. Complete heart block is a common complication.
D. Hospital mortality after repair of VSD in infants approaches 20%.
Answer: B

Which of the following is correct regarding oxygen saturation

measurement in the newborn baby?
(a) Can be used to screen for acyanotic heart disease
(b) Can be used to screen for some duct dependent heart disease
(c) Pre-ductal saturations are best measured in the right arm
(d) Post-ductal saturations should always be higher than pre-ductal
saturations due to shunting across the arterial duct
(e) In a premature baby with a symptomatic PDA there is usually a drop
in saturations between pre and post ductal measurements
Answer B

In cyanotic congenital heart disease, which of the following is true?

(a) The post ductal saturation will always be significantly lower than the
pre-ductal due to right to left shunting across the duct
(b) Cyanosis only develops after the duct closes. Until then the
circulation is normal
(c) Patent ductus arteriosus is the commonest cyanotic heart defect in
babies born before 32 weeks gestation
(d) Prolonged cyanosis can lead to hypoxic brain damage
Answer D

The nurse explains that a ventricular septal defect will allow:

a. blood to shunt left to right, causing increased pulmonary flow and no
cyanosis.
b. blood to shunt right to left, causing decreased pulmonary flow and
cyanosis.
c. no shunting because of high pressure in the left ventricle.
d. increased pressure in the left atrium, impeding circulation of
oxygenated blood in the circulating volume.
ANS: A

The finding the nurse would expect when measuring blood pressure on
all four extremities of a child with coarctation of the aorta is blood
pressure that is:
a. higher on the right side.
b. higher on the left side.
c. lower in the arms than in the legs.
d. lower in the legs than in the arms.
ANS: D
 The assessment that would lead the nurse to suspect that a newborn
infant has a ventricular septal defect is:
a. a loud, harsh murmur with a systolic tremor.
b. cyanosis when crying.
c. blood pressure higher in the arms than in the legs.
d. a machinery-like murmur.
ANS: A

An appropriate doctor action related to the administration of digoxin

(Lanoxin) to an infant would be:
a. counting the apical rate for 30 seconds before administering the
medication.
b. withholding a dose if the apical heart rate is less than 100 beats/min.
c. repeating a dose if the child vomits within 30 minutes of the previous
dose.
d. checking respiratory rate and blood pressure before each dose.
ANS: B

A child develops carditis from rheumatic fever. The areas of the heart
affected by carditis are the:
a. coronary arteries.
b. heart muscle and the mitral valve.
c. aortic and pulmonic valves.
d. contractility of the ventricles.
ANS: B
 The nurse is caring for a child with a diagnosis of Kawasaki disease.
The child's parent asks the nurse, "How does Kawasaki disease affect
my child's heart and blood vessels?" The nurse's response is based on the
understanding that:
a. inflammation weakens blood vessels, leading to aneurysm.
b. increased lipid levels lead to the development of atherosclerosis.
c. untreated disease causes mitral valve stenosis.
d. altered blood flow increases cardiac workload with resulting heart
failure.
ANS: A

A child has an elevated antistreptolysin O (ASO) titer. Which

combination of symptoms, in conjunction with this finding, would
confirm a diagnosis of rheumatic fever?
a. Subcutaneous nodules and fever
b. Painful, tender joints and carditis
c. Erythema marginatum and arthralgia
d. Chorea and elevated sedimentation rate
ANS: B

An infant with congestive heart failure is receiving digoxin (Lanoxin).

The nurse recognizes a sign of digoxin toxicity, which is:
a. restlessness.
b. decreased respiratory rate.
c. increased urinary output.
d. vomiting.
ANS: D

The comment made by a parent of a 1-month-old that would alert the

nurse about the presence of a congenital heart defect is:
a. "He is always hungry."
b. "He tires out during feedings."
c. "He is fussy for several hours every day."
d. "He sleeps all the time."
ANS: B

Gangrene
Aneurysm
Burgers disease

1-Which of the following is the most common cause of abdominal

aortic aneurysms?
A.Postsurgical anastomotic disruption
B.Cystic medial necrosis
C.Atherosclerosis
D.Vasculitis

2-Abdominal ultrasonography or CT is usually the test of choice for

abdominal aortic aneurysm, but which imaging test may be most
appropriate for hemodynamically unstable patients?
A.Abdominal ultrasonography
B.CT
C.Magnetic resonance angiography
D.Plain abdominal x-ray

3-Which of the following is NOT an indication for surgical repair of an

abdominal aortic aneurysm?
A.Chronic abdominal pain
B.Increase in aneurysm size by > 0.5 cm within 6 mo
C.Aneurysms < 5 cm
D.Risk of rupture increases to > 5 to 10%/yr

4-Which of the following blood vessel layers may be damaged in a

client with an aneurysm?

A Externa
B.Interna
C.Media
D.Interna and Media

5-When assessing a client for an abdominal aortic aneurysm, which

area of the abdomen is most commonly palpated?
A.Right upper quadrant
B.Directly over the umbilicus
C.Middle lower abdomen to the left of the midline
D.lower abdomen to the right of the midline

6-Which of the following conditions is linked to more than 50% of

clients with abdominal aortic aneurysms?
A.DM
B.HPN
C.PVD
D.Syphilis

7-Which of the following signs and symptoms usually signifies rapid

expansion and impending rupture of an abdominal aortic aneurysm?
A. Abdominal pain.

B. Absent pedal pulses.

C. Chest pain.
D. Lower back pain.
8-With which of the following disorders is jugular vein distention most
prominent?
A. Abdominal aortic aneurysm
B. Heart failure
C. Myocardial infarction
D. Pneumothorax

9-In which of the following areas is an abdominal aortic aneurysm most

commonly located?
A. Distal to the iliac arteries
B. Distal to the renal arteries
C. Adjacent to the aortic branch
D. Proximal to the renal arteries

10-What is the most common symptom in a client with abdominal

aortic aneurysm?
A. Abdominal pain
B. Diaphoresis
C. Headache
D. Upper back pain
11-Which of the following symptoms usually signifies rapid expansion
and impending rupture of an abdominal aortic aneurysm?
A. Abdominal pain
B. Absent pedal pulses
C. Angina
D. Lower back pain

12-What is the definitive test used to diagnose an abdominal aortic

aneurysm?
A. Abdominal X-ray
B. Arteriogram
C. CT scan
D. Ultrasound

13-Which of the following complications is of greatest concern when

caring for a preoperative abdominal aneurysm client?
A. HPN
B. Aneurysm rupture
C. Cardiac arrythmias
D. Diminished pedal pulses

14-when assessing a client for an abdominal aortic aneurysm, which

area of the abdomen is most commonly palpated?
A. Right upper quadrant
B. Directly over the umbilicus
C. Middle lower abdomen to the left of the midline
D. Midline lower abdomen to the right of the midline

15.Which of the following conditions is linked to more than 50% of

clients with abdominal aortic aneurysms?
A. DM
B. HPN
C. PVD
D. Syphilis

16-Which of the following sounds is distinctly heard on auscultation

over the abdominal region of an abdominal aortic aneurysm client?
A. Bruit
B. Crackles
C. Dullness
D. Friction rubs

17-Which of the following complications of an abdominal aortic repair

is indicated by detection of a hematoma in the perineal area?
A. Hernia
B. Stage 1 pressure ulcer
C. Retroperitoneal rupture at the repair site
D. Rapid expansion of the aneurysm

18.A pulsating abdominal mass usually indicates which of the following

conditions?
A. Abdominal aortic aneurysm
B. Enlarged spleen
C. Gastric distention
D. Gastritis

19-The most frequently encountered clostridial species in gas gangrene

is?
A.Clostridium botulinum
B.Clostridium welchii
C.Clostridium tetani
D.Clostridium difficile

20.Gas gangrene is a infection ?

A.Viral
B.Bacterial
C.infectious
D.All
21-Gas gangrene is most often caused by bacteria called Clostridium
perfringens ?
A.Clostridium botulinum
B.Clostridium Perfringens
C.Clostridium tetani
D.Clostridium difficile

22.IgA nephropathy, also known as

A.Berger's Disease
B.Bowler's Disease
C.None
D.Both A and B

23.lga nephropathy is disease of ?

A.Kidney
B.Liver
C.Brain
D.None

24.IgA nephropathy (Berger's Disease) is a condition in which a protein

causes damage to the kidneys.
A. immunoglobulin A
B. immunoglobulin B
C. immunoglobulin C
D. immunoglobulin D

 Prolapsed intervertebral disc

 Tumors of vertebral column
 Intracranial Tumors
 Renauda phenomenon disease/syndrome

1. Raynaud’s syndrome primarily affects ______________.

A. Joints
B. Muscles
C.Finger and toes
D. Men

2. In the United States, __________ of the population is affected by

Raynaud’s.
A.20 to 25 percent
B. 13 to 15 percent
C. 5 to 10 percent
D. Less than 5 percent

3. All of the following true about Raynaud’s disease except:

A. More common in females
B. Positive Antinuclear Antibodies
C. Most common cause of raynaud’s phenomenon
D. Has good prognosis

4. People with Raynaud’s experience an exaggerated response to stress

and _________.
A. Cold temperatures
B. Hot temperatures
C. Water
D.All of the above
1:A 29-year-old woman presents with tinnitus and a sensori-neural hearing
loss on the left. The excised mass was seen near the cerebellopontine
angle, arising from the left VIIIth nerve. Histology showed a tumor
comprising of benign spindle shaped cells with Antoni A and Antoni B type
of patterns. What is your diagnosis?
 a)Ependymoma
 b)Astrocytoma
 c)Schwannoma
 d)Medullaoblastoma

2:Classic astrocytoma has which of following microscopic features?

 Widespread concentric calcifications

 Fibrillary astrocytes in the background of loosely structured
microcysts.
 Cells with rounded vesicular nuclei with small distinct nucleoli,
perinuclear halos, chicken wire vessels
 Microvascular proliferation and geographic necrosis
Answer: B
3. Most IDH- mutant diffuse astrocytomas have which of the following
mutations?
 R132G
 R132L
 R132H
 R132S
Answer: C
4. Which of the following statements are true regarding astrocytomas?
 Diffuse astrocytomas do not progress to IDH-mutant glioblastoma
 IDH-mutant diffuse astrocytoma’s and IDH-wildtype glioblastomas
develop from the same precursor population
  IDH-mutant astrocyomas have a better prognosis compared to IDH-
wildtype
 Among IDH wildtype tumours, a genotype of 7q gain and 10q loss
have a favourable outcome
Answer: C
5:For a diagnosis of gemistocytes what is The cut-off percentage of
gemistocytes required?
 50%
 30%
 20%
 10%
Answer: C
6: Which one of the following is described among one of the Secondary
structures of scherer?
 Geographic necrosis
 Perineural satellitosis
 Microvascular proliferation
 Scattered dense eosinophilic structures
Answer: B
The most common intracranial tumor is -
 Astrocytoma
 Medulloblastoma
 Meningioma
 Secondaries

Which of the following is the CORRECT order for the regions of the human
spine going from the neck to the lower back?
 cervical, umbilical, lumbar, sacrum, coccyx
 cervical, thoracic, lumbar, sacrum, coccyx
 cervical, lumbar, thoracic, coccyx, sacrum
 thoracic, cervical, lumbar, sacrum, coccyx
The bulge is very prominent and the soft jelly center has spilled out to the
inner edge of the outer fibers, barely held in by the remaining disc fibers
 Bulging
 Protrusion
 Extrusion
 Sequestration

In the case of a herniated spinal disc, the soft jelly has completely spilled
out of the disc and now protruding out of the disc fibers.
 Bulging
 Protrusion
 Extrusion
 Sequestration

Here some of the jelly material is breaking off away from the disc into the
surrounding area.
 Bulging
 Protrusion
 Extrusion
 Sequestration

The intervertebral discs are made of _____

 hyaline cartilage
 elastic cartilage
 fibrocartilage
 ligaments

The disc is stretched and doesn’t completely return to its normal shape
when pressure is relieved. It retains a slight bulge at one side of the disc.
 Bulging
 Protrusion
  Extrusion
 Sequestration

The ventral root of the spinal cord contains axons of

 sensory neuron
 motor neuron
 mixed neuron
 spinal neurons

The spinal cord is a link between body parts and

 skull
 brain
 vertebral column
 Midbrain

A rupture in a blood vessel of brain or spinal cord is called

 clotting
 swelling
 stroke
 high blood pressure

 The number of spinal nerves along the spinal cord is

 30
 38
 32
 31

The white matter of the spinal cord is made of

 myelinated dendrite
 non myelinated dendrite
 myelinated axon
 non myelinated axon