module 1

Question 1

A 22-year-old male involved in a motorcycle accident presents to A&E with a fractured femur
and, following fixation, is noted to have become disorientated with several areas of petechial
haemorrhage.

Answer 1

Fat Embolism

Question 2

A 75-year-old female presents with a sudden episode of acute pain in the right leg. On
examination she has an irregular tachycardia of 120 beats/min and a white, paraesthetic right
lower leg. She has no palpable pulses below the groin but her left leg pulses are present and
normal.

Answer 2

Popliteal arterial embolism

Question 3

3 A 59-year-old male presents to A&E with paralysis and paraesthesia of his lower limbs.
On examination there are no femoral pulses and he has mottling of the skin of the lower
abdomen.

Answer 3

Acute Aortic thrombosis

Question 4

65-year-old woman presents to her GP with several recent episodes of temporary left eye
blindness which resolved on each occasion after about 5 min. Retinoscopy shows several areas
of poor filling in the retinal arteries.

Answer 4

Cholesterol embolism

Question 5

A 40-year-old IV drug abuser presents with fevers, breathlessness and pain in his right buttock.
His temperature is 38oC and examination reveals marked mottling over the right gluteal area
and thigh. He has a grade V aortic murmur.

Answer 5

Mycotic Embolism

Question 6

Acute arterial occlusion may not be
caused by:

Answer 6

Intra abdominal swelling

Question 7

Which of the following are not indications for major amputation?

Answer 7

Neurofibroma

Question 8

Gangrene
11. Which of the following is not a cause
of gangrene?

Answer 8

Deep vein thrombosis insufficiency

Question 9

Which of the following regarding
amputations are true?

Answer 9

Toe amputations usually heal well in
diabetics. + Below-knee amputations are not ‘end-
weight-bearing’ amputations.

Question 10

Which of the following statements are false?

Answer 10

Primary Raynaud’s phenomenon often
results in digital gangrene. + Sympathectomy is an effective
treatment of Raynaud’s phenomenon.

Question 11

Ruptured abdominal aortic
aneurysms True statement

Answer 11

Most patients die following ruptured
AAA. + Ruptures are rarely seen in aneurysms
of less than 5 cm.

Question 12

Which of the following statements
regarding complications of AAA
surgery are false?

Answer 12

Most elective deaths are from
respiratory failure. + Endovascular aneurysm repair has a
perioperative mortality equivalent to open repair.

Question 13

Which of the following statements are true?

Answer 13

B Older chronological age is not a bar to surgery.
+
C Ultrasound has a high degree of
sensitivity and specificity for AAAs.

Question 14

Which of the following drugs have
been shown to improve claudication?

Answer 14

Oxpentifylline

Question 15

Which of the following statements
regarding angiography are false?

Answer 15

B Compared with conventional
angiography, the digital subtraction
angiograms require an increased
contrast load for reliable images.

Question 16

Which of the following are false in aorto-iliac disease?

Answer 16

C It is very unlikely in the presence of
femoral pulse.
+
D Surgical intervention has the poorest
results in aorto-iliac disease when
compared with infra-inguinal disease.

Question 17

Which of the following statements are
true?

Answer 17

Intermittent claudication is most
commonly felt in the calf.

Question 18

Which of the following statements are false?

Answer 18

A Rest pain is commonly found in the calf
in critical limb ischaemia. + D Absence of foot pulses implies critical
ischaemia.

Question 19

Which of the following statements are false?

Answer 19

B ABPI means ‘ankle brachial pulsatility
index’.

Question 20

A middle-aged male patient presents with spontaneous recurrent haemoptysis, and clinical
examination reveals no abnormal findings. Her chest radiograph is normal. What is the
procedure of choice?

Answer 20

Bronchosocpy

Question 21

After reading the information booklet about his proposed procedure, an anxious 45-year-old
female patient being consented for a procedure is worried about the post-procedural
complications of pain and possible rib fractures. What procedure is this patient planned to
have?

Answer 21

Thoracotomy

Question 22

Following a right pneumonectomy, the postoperative recovery of a 52-year-old male patient
is complicated by bronchopleural fistula, which presents with pyrexia, expectoration of large
amounts of purulent sputum and a high fluid level on chest radiograph. In addition to
positioning the patient to lie on the operated side, what procedure is urgently required?

Answer 22

Chest drain insertion

Question 23

A mediastinal mass is found incidentally on the chest radiograph of a 65-year-old female
non-smoker who is otherwise healthy, with no significant past medical history. Which option
would you recommend to this patient at this time?

Answer 23

CT scan

Question 24

Which procedure is required to assess the fitness for lung resection of a 73-year-old male with
left upper lobe lung cancer and emphysema?

Answer 24

Pulmonary function test

Question 25

3. Which one of these statements is false?

Answer 25

Diaphragmatic hernia through the
foramen of Morgagni is usually posterior, while herniation through the foramen of Bochdalek lies more anteriorly.

Question 26

3. Which one of these statements is false?

Answer 26

Finger clubbing and hypertrophic
pulmonary osteoarthropathy, sometimes
described as clinical features of lung
cancer, are usually incidental findings
and not due to primary lung cancer.

Question 27

4. Which one of these statements is true?

Answer 27

A Chest radiograph yields very useful
information about primary lung cancer.

Question 28

Which of the following statements are false?

Answer 28

B The left lung has more lobes and
segments than the right lung.

Question 29

Which of the following statements are false?

Answer 29

E Chest drains are no longer critical to the
management of chest disease.

Question 30

A 72-year-old female with chronic stable angina presents with new-onset dyspnoea on
mild exertion, bilateral basal crepitations and a new loud apical pansystolic murmur. Chest
radiograph shows cardiomegaly and pulmonary congestion, and electrocardiography confirms
recent myocardial infarction. What is the likely diagnosis?

Answer 30

Mitral Regurgitation

Question 31

Clinical examination of a 35-year-old man who has Marfan’s syndrome with aneurysmal
dilatation of the ascending aorta reveals wide pulse pressure, water-hammer pulse and a
mid-diastolic murmur. What procedure is appropriate at this stage in the management of this
patient?

Answer 31

echocardiography

Question 32

A 66-year-old male is informed during consent for a procedure for a cardiac disease that, in
addition to a procedure-related mortality of about 2%, there is a risk of neurological dysfunction of less than 2%, cardiac arrhythmia up to 30% and significant
bleeding up to 5%. what condition is this procedure for?

Answer 32

Ischaemic heart disease

Question 33

On routine chest radiography, a 78-year-old male is suspected of having an aneurysm of the
descending thoracic aorta. What is the appropriate investigation?

Answer 33

CT Scan

Question 34

Which one of these statements is false?

Answer 34

D Stanford types A and B aortic dissection
require emergency repair.

Question 35

Which of these are not acyanotic heart
diseases?

Answer 35

B Total anomalous pulmonary venous
drainage
C Transposition of the great vessels (tip: if they start with T they are cyanotic)

Question 36

Which of the following statements is false?

Answer 36

Four types of atrial septal defects
are perimembranous, muscular,
atrioventricular and subarterial.

Question 37

6. Which of these statements are true?

Answer 37

A Biological valves are obtained from
animals (xenograft or heterograft), dead
humans (allograft or homograft) and the
patient (autograft).
+
B Mechanical valves are more durable than
biological valves.

Question 38

Which of the following statements is false?

Answer 38

C Cardiopulmonary bypass is not used outside cardiac surgery.

Question 39

Which of these is not a risk factor for ischaemic heart disease?

Answer 39

E Female gender.

Question 40

Which of the following statements are false?

Answer 40

B Myocardial infarction is an indication
for emergency coronary artery bypass
surgery.

Question 41

Which of the following statements are false?

Answer 41

A The indication for surgery in mitral valve
disease (regurgitation and stenosis) is
severe symptoms, as assessed by the
New York Heart Association (NYHA)
functional classification.
+
B Acute and chronic mitral regurgitation
have similar pathophysiology and clinical
presentation.

Question 42

Which of the following statements are false?

Answer 42

C Distinguishing between aortic stenosis
and chronic aortic regurgitation is usually
difficult on clinical grounds alone.