Cardiothoracic and Vascular - Practice papers

Question 1

@# 1. The following surgical procedures are used in the treatment of the associated conditions:
a) Aorticopulmonary window repair - tetralogy of Fallot
b) Blalock-Taussig shunt - transposition of the great vessels
c) Fontan procedure - tricuspid atresia
d) Mustard procedure - transposition of great vessels
e) Norwood procedure - hypoplastic left heart syndrome

Answer 1

1.
a) True
c) True
d) True
e) True
f) True

Question 2

@# 2. The following decrease signal-to-noise ratio in MRI:
a) 3D imaging
b) Thinner slices
c) Using T2 rather than T1 weighted images
d) Using a shorter echo time
e) Using spin-echo rather than gradient-echo sequences

Answer 2

2.
a) False
b) True
c) True
d) False
e) False

Question 3

3. Plain radiograph findings of a patient with Eisenmenger’s syndrome include:
   a) Constriction of the pulmonary trunk
   b) Dilatation of the peripheral pulmonary arteries
   c) Enlargement of the right ventricle
   d) Dilatation of the pulmonary veins
   e) Left ventricle returning to normal size

Answer 3

3.
a) False - dilatation of the pulmonary trunk
b) False - pruning of peripheral pulmonary arteries
c) True - degree of enlargement is proportionate to volume overload
d) False - condition is characterised by high pulmonary vascular resistance
e) True

Question 4

4. Regarding pulmonary arterial embolisation:
   a) The principal indication is for the occlusion of pulmonary arteriovenous malformations
   b) Pulmonary embolisation is performed with particulate emboli
   c) Pulmonary arteriovenous malformations must be occluded as close to the neck as possible
   d) Pulmonary arteriovenous malformations seen on chest X-ray as opacities remain
   unchanged in size despite successful embolisation
   e) 80-90% of pulmonary arteriovenous malformations are associated with hereditary
   haemorrhagic telangiectasia

Answer 4

4.
a) True
b) False - there is a high risk of particulate emboli passing through into systemic vessels
causing cerebral/myocardial infarcts. Only detachable balloons/coils are used
c) True
d) False - reduction in size with successful embolisation
e) True

Question 5

@# 5. Regarding single photon emission tomography for myocardial perfusion studies:
a) Technetium-99m is the most commonly used radionuclide
b) Infarction can be differentiated from ischaemia
c) Stress and resting images are obtained
d) Imaging begins 30 minutes after injection of radionuclide
e) The half life of technetium-99m is 30 minutes

Answer 5

5.
a) False - 201 Thallium
b) True
c) True
d) False - imaging begins 5-10 minutes after injection and completed by 30 minutes
e) False - 6 hours

Question 6

@# 6. An aberrant left pulmonary artery:
a) Passes below the right main bronchus
b) Passes posterior to the oesophagus on its way to the left lung
c) Is associated with a patent ductus arteriosus
d) Causes deviation of the trachea to the right
e) Is associated with an elevated left hilum

Answer 6

6.
a) False - passes above the right main bronchus
b) False - passes between the oesophagus and the trachea
c) True
d) False - causes deviation of the trachea to the left
e) False - low left hilum

Question 7

7. Regarding Takayasu’s arteritis:
   a) The mean interval between symptom onset and diagnosis is 2-4 months
   b) External carotid artery branches are most commonly affected
   c) It is a recognized cause of fusiform aortic aneurysms
   d) Stenotic lesions are more commonly seen in the thoracic than abdominal aorta
   e) Ultrasound of the proximal common carotid artery shows circumferential thickening of the
   vessel wall

Answer 7

7.
a) False - approximately 8 years
b) False - Takayasu’s arteritis affects main aortic branches and pulmonary arteries. External
carotid artery branches are most commonly affected in temporal arteritis
c) True
d) True
e) True - with increased flow velocity and turbulence seen on US Doppler

Question 8

8. Regarding pericardial disease:
   a) A pericardium of 3 mm thickness is normal
   b) Rheumatoid arthritis is a cause of pericarditis
   c) Elevation of the jugular venous pressure on inspiration is a sign of chronic pericarditis
   d) In chronic pericarditis, CT shows curvature of the interventricular septum to the right
   e) Renal failure is a cause of pericardial effusion

Answer 8

8.
a) True - thickness of the pericardium >4 mm is abnormal
b) True
c) True - Kussmaul’s sign
d) False - curvature of the interventricular septum to the left
e) True

Question 9

9. Features of cardiac myxoma include:
   a) Commonest location is the right atrium
   b) Association with Carney complex
   c) Reduced signal on T2 weighted spin-echo MRI images
   d) Commonest site of metastases is the liver
   e) The majority show homogenous contrast enhancement on CT

Answer 9

9.
a) False - left atrium
b) True - majority are sporadic
c) False - markedly hyperintense on T2, iso-hypointense on T1 weighted images
d) False - most common benign primary tumour
e) False - majority show heterogenous contrast enhancement on CT due to necrosis, cyst
formation and haemorrhage

Question 10

@# 10. The following are signs of an aortic graft infection:
a) Perigraft haematoma seen at 2-3 weeks post-surgery
b) Ectopic gas seen at 5-6 weeks post-surgery
c) >5 mm soft tissue between graft and surrounding wrap after 7 weeks postoperative
d) Focal bowel wall thickening adjacent to graft
e) Focal discontinuity of calcified aneurysmal wrap

Answer 10

10.
a) False - complete resolution of haematoma by 2-3 months
b) True - disappears by 3-4 weeks
c) True
d) True - suggests a fistula
e) True

Question 11

@# 11. Regarding polysplenia syndrome:
a) It is more commonly associated with congenital heart disease than asplenia syndrome
b) Dextrocardia is seen in 30-40%
c) A large azygous vein which mimics the aortic arch is a specific feature
d) Bilateral minor fissures are seen
e) Bilateral superior vena cavas are seen in 40-50%

Answer 11

11.
a) False - 50% congenital heart disease incidence in asplenia syndrome
b) True
c) True
d) False - this is a feature of asplenia syndrome
e) True

Question 12

@# 12. Regarding metastases to the heart and pericardium:
a) Primary cardiac tumours are more common than metastases to the heart and pericardium
b) Lymphoma is the commonest primary tumour to metastasise to the heart
c) Melanoma metastases spread via the lymphatics
d) Melanoma metastases appear as low signal intensity lesions on T1 weighted MRI images
e) More than 50% of cases of mesothelioma invade the pericardium

Answer 12

12.
a) False
b) False - bronchogenic carcinoma in 30%, breast in 7%
c) False - haematogenous spread
d) False - high signal intensity lesions on T1 weighted MRI images
e) True

Question 13

@# 13. Regarding popliteal artery disease:
a) The popliteal artery is located between the two heads of the gastrocnemius muscle
b) The popliteal artery is considered aneurysmal if its diameter exceeds 7 mm
c) Popliteal artery aneurysms are bilateral in 10-15%
d) In popliteal artery entrapment syndrome, patients are usually elderly females
e) Primary treatment for popliteal artery entrapment syndrome is vascular stenting

Answer 13

13.
a) True - deep to the vein
b) True - true aneurysms of the popliteal artery are the commonest peripheral artery
aneurysms
c) False - bilateral in 50-70%. Abdominal aortic aneurysm is present in 30-50% of patients
with popliteal artery aneurysm
d) False - young men
e) False - there is no role for angioplasty or stenting. Surgical release of muscles/tendons
causing entrapment is the treatment. Artery bypass is performed if there is
thrombus/fibrosis due to chronic entrapment

Question 14

14. Features of polyarteritis nodosa include:
    a) Necrotising vasculitis involving the small and medium-sized arteries
    b) Involvement of kidneys in 70-80%
    c) Multiple aneurysms
    d) Luminal irregularities
    e) Involvement of small veins

Answer 14

14.
a) True
b) True
c) True
d) True
e) True - rare

Question 15

@# 15. Regarding positron emission tomography (PET):
a) 18F fluorodeoxyglucose is the radioisotope most commonly used
b) Two times more events are detected with PET per decay than single photon imaging
c) Image noise is decreased by increasing the scan time
d) Benign and malignant pleural effusions can be differentiated on PET
e) Tuberculosis is a recognized cause of a false positive

Answer 15

15.
a) True
b) False - 100 times more events are detected
c) True
d) True - with an accuracy of 92%
e) True

Question 16

16. The following statements about endovascular repair of thoracic/abdominal aortic aneuryms
    are true:
    a) The commonest complication after stent graft implantation is graft thrombosis
    b) Type 2 endoleak arises due to defects of the graft
    c) Type 3 endoleak is the commonest type
    d) Shower embolism occurs less frequently after endovascular than open aneurysm repair
    e) Aortic dissection is a complication arising due to retrograde injury from introduction of
    stent delivery systems

Answer 16

16.
a) False - the commonest complication is leak of blood into the aneurysm sac (endoleak)
a) False - Type 3 endoleak arises due to defects of the graft such as a hole/laceration of graft.
Type 2 endoleak involves retograde flow into the aneurysm sac via patent arteries
b) False - Type 1 endoleak is the commonest type. This involves proximal/distal leakage of
blood due to incomplete graft fixation
c) False - more frequently
d) True

Question 17

@# 17. Thymoma:
a) Is associated with myasthenia gravis
b) Is associated with hypogammaglobulinaemia
c) Commonly presents with SVC obstruction
d) Commonly presents in children
e) Is isointense to skeletal muscle on T1 weighted MRI images

Answer 17

17.
a) True - 15-25% of patients with myasthenia gravis have thymoma
b) True - 5% of patients with hypogammaglobulinaemia have thymoma
c) False - rare. 50% are asymptomatic
d) False - adults. 70% present in the 5-6th decade
e) True

Question 18

@# 18. Causes of cardiac calcification include:
a) Endocardial fibroelastosis
b) Endomyocardial fibrosis
c) Chronic renal failure
d) Mediastinal radiotherapy
e) Left ventricular aneurysm

Answer 18

18.
a) True
b) True - though very rare
c) True
d) True
e) True

Question 19

@# 19. Regarding superior mesenteric angiography:
a) Cobra catheters have 1 end hole and 4-6 side holes
b) Gastrointestinal ischaemia is an indication
c) When carried out for gastrointestinal bleeding, blood loss of 0.5 ml per minute can be
identified if the patient is bleeding at the time
d) Examination is performed with the patient in a prone position
e) When examined with the inferior mesenteric artery, the superior mesenteric artery should
be examined first

Answer 19

19.
a) False - 1 end hole and 0 side holes
b) True
c) True
d) False - supine
e) False - the inferior mesenteric artery should be examined first so that contrast medium
accumulation in the bladder doesn’t obscure the terminal branches

Question 20

@# 20. Regarding cardiomyopathies:
a) Alcoholism is a recognized cause of restrictive cardiomyopathy
b) Amyloidosis is a recognized cause of dilated cardiomyopathy
c) Hypertrophic cardiomyopathy is inherited in an autosomal recessive manner
d) Mitral stenosis is a feature of hypertrophic cardiomyopathy
e) In dilated cardiomyopathy the left ventricle is usually spared

Answer 20

20.
a) False - cause of dilated cardiomyopathy
b) False - cause of restrictive cardiomyopathy
c) False - autosomal dominant inheritence
d) False - mitral regurgitation
e) False - global 4 chamber enlargement

Question 21

@# 21. Regarding thoracic anatomy:
a) The superior accessory fissure separates the apical segment of the right lower lobe from the
other segments
b) The left transverse fissure is seen in 15-20% of post mortem specimens
c) The right major fissure is more vertically orientated than the left
d) The minor fissure is absent in 25-30%
e) The minor fissure meets the right major fissure at the level of the 6th rib in the midclavicular
line

Answer 21

21.
a) True
b) True
c) False
d) False - the minor fissure is absent in 10%
e) False - the mid-axillary line

Question 22

@# 22. Loss of clarity of the right heart border silhouette can be due to:
a) Pneumothorax on a supine radiograph
b) Pectus excavatum
c) Middle lobe collapse
d) Right lower lobe collapse
e) Asbestosis

Answer 22

22.
a) False
b) True
c) True
d) False
e) True

Question 23

23. The following are anterior relations of the trachea:
    a) Inferior thyroid veins
    b) Left recurrent laryngeal nerve
    c) Left brachiocephalic vein
    d) Sternohyoid muscle
    e) Arch of the azygous vein

Answer 23

23.
a) True
b) False - posterior
c) True
d) True
e) False - right lateral relationship

Question 24

@# 24. Regarding endovascular management of disorders of the thoracic aorta:
a) Zenith endograft is a self-expanding stent graft suitable for treating thoracic aortic
aneurysms
b) Imaging criteria for stent grafting are upper and lower zones of relatively normal calibre
aorta of at least 5 mm
c) Brachial artery access is used
d) Endovascular treatment is suitable for ascending but not descending thoracic aortic
aneurysms
e) The diameter of the stent device should be oversized by 10-20% of the diameter of normal
aorta

Answer 24

24.
a) True
b) False - upper and lower zones of relatively normal calibre aorta of at least 15 mm is
required though 20 mm is preferable
c) True
d) False - it is suitable for descending but not ascending thoracic aortic aneurysms
e) True - this reduces the risk of the stent slipping

Question 25

25. Regarding extralobular bronchopulmonary sequestration:
    a) 75-85% of bronchopulmonary sequestrations are of extralobular type
    b) Usually presents within the first 6 months of life
    c) 40-50% are associated with congenital anomalies
    d) It is commoner in the lower lobes
    e) It usually communicates with the bronchial tree

Answer 25

25.
a) False - 75% are intralobular
b) True
c) True
d) True
e) False - no communication with the bronchial tree

Question 26

@# 26. The following statements regarding malignant mesothelioma are true:
a) Crocidolite asbestos fibres are of greater carcinogenic potential than chrysotile fibres
b) 5-10% of asbestos workers develop malignant mesothelioma in their lifetime
c) Pleural effusions are rarely associated
d) Metastases to the ipsilateral lung are seen in 50-60%
e) It predominantly involves the visceral pleura

Answer 26

26.
a) True
b) True - there is a latent period of 20-40 years
c) False - 70-80% have pleural effusions
d) True
e) False - parietal pleura

Question 27

@# 27. Concerning mycetomas;
a) Mycetomas are fungus balls of Aspergillus hyphae
b) They are commonly found in the lower lobes
c) Calcification of the mycetoma occurs in over 80% of cases
d) Haemoptysis is the most important complication
e) Appearance of a crescent of air between the wall of the cavity and fungus ball is specific
for mycetoma

Answer 27

27.
a) True
b) False - upper lobes and the superior segments of the lower lobes. Most commonly found in
TB cavities
c) False - rare
d) True - sometimes haemorrhage is so severe that surgical resection is required
e) False - similar appearance can be seen with a hydatid and cavitatory neoplasm

Question 28

@# 28. The following statements regarding Mycoplasma pneumoniae are true:
a) It has an incubation period of 10-20 days
b) Pleural effusions are seen in 70-80%
c) Bronchiectasis is a recognized pulmonary complication
d) Mediastinal lymphadenopathy is more commonly seen in adults than children
e) The radiographic pattern is unilateral upper lobe consolidation

Answer 28

28.
a) True
b) False - rare
c) True
d) False - commoner in children
e) False - lower lobes are involved. Multilobar and bilateral disease are also observed

Question 29

@# 29. Regarding pulmonary metastases:
a) On CT imaging, haematogenous metastases are usually seen centrally in the lungs rather
than peripherally
b) Cavitation is more often seen in adenocarcinoma metastases
c) Calcification is seen in chondrosarcoma metastases
d) Osteosarcoma is a recognized primary for metastases which double in size in less than 30
days
e) Thyroid carcinoma is a recognized cause of miliary metastases

Answer 29

29.
a) False - haematogenous metastases are peripheral
b) False - cavitation is more often seen in squamous cell carcinoma metastases
c) True
d) True - also observed with choriocarcinoma metastases
e) True - causes of miliary metastases include renal cell carcinoma, bone sarcomas and
choriocarcinoma

Question 30

@# 30. The following statements regarding radiation pneumonitis are true:
a) Radiographic changes are seen following a radiation dose of 15 Gray
b) Adriamycin has a protective effect on the lung in reducing the reaction to radiation
c) In the acute phase, radiation pneumonitis can present with cough and pyrexia at 6-12 weeks
d) Initial radiographic changes are of localised interstitial oedema
e) Pleural effusions are a feature

Answer 30

30.
a) False - clinical and radiological changes are not seen with doses of <20 Gray. Most have
changes following a dose of 40 Gray.
b) False - chemotherapeutic agents, e.g. Adriamycin, Bleomycin and Cyclophosphamide
potentiate the effect. Pneumonitis presents earlier and is more severe
c) True
d) True - can progress to airspace consolidation and atelectasis
e) True - but not common

Question 31

@# 31. Causes of unilateral pulmonary oedema on the side of the underlying pathology include:
a) Pulmonary contusion
b) Rapid thoracocentesis
c) Lobectomy
d) Pulmonary embolism
e) Congenital hypoplasia of the pulmonary artery

Answer 31

31.
a) True
b) True
c) False - contralateral side
d) False - contralateral side
e) False - contralateral side

Question 32

32. The following statements regarding bronchiectasis are true:
    a) A ‘tram line’ appearance due to bronchial wall thickening and dilatation is a plain
    radiograph sign
    b) Allergic bronchopulmonary aspergillosis is a recognized cause
    c) Varicose bronchiectasis is the commonest subtype
    d) Cystic bronchiectasis is associated with severe bronchial infections
    e) The upper lobes are predominantly affected

Answer 32

32.
a) True
b) True
c) False - varicose bronchiectasis is rare. Associated with Swyer- James syndrome.
Cylindrical bronchiectasis is the commonest subtype
d) True
e) False - posterobasal segments of the lower lobes

Question 33

33. The following statements regarding sarcoidosis are true:
    a) Lymph node enlargement is seen in 80-90% of cases
    b) Predominant appearance is of a mid-zone reticulonodular pattern
    c) Pleural effusion is seen in 70-80%
    d) Mycetoma is a common complication of advanced sarcoidosis
    e) A radionuclide gallium scan can be used to assess disease activity

Answer 33

33.
a) True
b) True
c) False - pleural effusion is seen in 2-3%
d) True - chronic advanced disease can cause progressive fibrosis, lung retraction and bullae
formation
e) True - uptake in salivary glands, lymph nodes and lung parenchyma is correlated with
disease activity

Question 34

@# 34. The following statements regarding alveolar cell carcinoma are true:
a) it is usually located subpleurally
b) Growth is rapid
c) It is associated with underlying pre-existing lung fibrosis
d) The diffuse pneumonic form is commoner than the local mass form
e) Air bronchograms are a feature of both forms

Answer 34

34.
a) True
b) False - doubling time is longer than 18 months
c) True - associated with pre-existing pulmonary scarring and scleroderma
d) False - diffuse pneumonic form accounts for 10-40%
e) True

Question 35

35. The following chest X-ray signs are associated with the following collapsed lobes:
    a) Depressed horizontal fissure - right upper lobe collapse
    b) Indistinct left heart border - lingular collapse
    c) Horizontal orientation of the right main bronchus - right upper lobe collapse
    d) Indistinct right hemidiaphragm - right lower lobe collapse
    e) Right hilar elevation - right upper lobe collapse

Answer 35

35.
a) False - middle lobe collapse
b) True
d) True
e) True
f) True

Question 36

@# 36. Concerning traumatic aortic rupture:
a) 80-90% occur just proximal to the origin of the left subclavian artery
b) Chest X-ray features include filling in of the aortopulmonary window
c) Pseudoaneurysm is a direct sign of aortic rupture on CT
d) Widening of the right paratracheal stripe is a recognized sign
e) A normal chest X-ray is highly sensitive in excluding aortic rupture

Answer 36

36.
a) False - 80-90% occur just distal to the origin of the left subclavian artery
b) True - this is a sign of mediastinal haematoma
c) True
d) True
e) True - a normal chest radiograph has a negative predictive value of 96-98%

Question 37

37. The following features are more associated with Streptococcus pneumoniae infection rather
    than Staphylococcus aureus:
    a) Cavitation
    b) Empyema
    c) Incidence in patients with infective endocarditis
    d) Pneumatocoeles
    e) Air bronchograms

Answer 37

37.
a) False
b) False
c) False
d) False
e) True

Question 38

@# 38. The following statements regarding lymphangitis carcinomatosis are true:
a) It is associated with gastric cancer
b) Chest X-ray appearances are of multiple reticulonodular opacities
c) Kerley A and B lines are seen
d) Radiological changes usually precede symptom onset
e) Hilar adenopathy is seen in 80-90%

Answer 38

38.
a) True - associated with cancer of the cervix, colon, stomach, breast, pancreas, thyroid and
larynx
b) True
c) True - sign of lymphatic obstruction
d) False - shortness of breath precedes chest X-ray changes
e) False - hilar adenopathy is seen in 20-50%

Question 39

@# 39. Regarding extrinsic allergic alveolitis:
a) It occurs in highly atopic patients
b) Acute presentation on chest X-ray is of diffuse air space consolidation
c) Is a cause of lower lobe fibrosis
d) Pleural effusions are rare in chronic extrinsic allergic alveolitis
e) Septal lines are seen in acute extrinsic allergic alv

Answer 39

39.
a) False - occurs in non-atopic patients as a response to organic dusts
b) True
c) False - upper lobe fibrosis
d) True
e) True

Question 40

@# 40. Features of alveolar proteinosis include:
a) ‘Bat wing’ air space shadowing
b) Pleural effusion
c) Lymphadenopathy
d) Cardiomegaly
e) interstitial shadowing with Kerley B lines

Answer 40

40.
a) True
b) False
c) False
d) False
e) True - chronic stage