Midterm - DIY CABG Knowt Questions

Which demographic factor is associated with an increased likelihood of coronary atherosclerosis due to cumulative vascular changes over time?
a) Early adulthood
b) Advanced age
c) Childhood exposure to risk factors
d) Adolescence

b) Advanced age

What hormonal influence is thought to partially explain the gender disparity seen in coronary atherosclerosis prevalence?
a) Testosterone accelerating plaque formation
b) Estrogen’s protective effects in females
c) Progesterone causing endothelial damage
d) Lack of hormones in males

b) Estrogen’s protective effects in females

Epidemiologically, which racial group exhibits a disproportionately higher mortality from coronary atherosclerosis, potentially due to socio-economic and genetic factors?
a) Caucasians
b) Non-white populations
c) East Asians
d) Hispanic populations

b) Non-white populations

A family history of coronary atherosclerosis suggests what type of predisposition in an individual?
a) Exclusively environmental
b) Predominantly lifestyle related
c) A multifactorial inheritance pattern involving both genetic and environmental components
d) Viral transmission

c) A multifactorial inheritance pattern involving both genetic and environmental components

Which vascular condition exacerbates the progression of coronary atherosclerosis, especially when present from a young age, by increasing arterial wall stress?
a) Hypotension
b) Hypertension
c) Bradycardia
d) Anemia

b) Hypertension

The cardiovascular toxicity of cigarette smoke arises mainly from which of the following components affecting endothelial function?
a) Carbon dioxide only
b) Nicotine, tar, and carbon monoxide
c) Oxygen
d) Water vapor

b) Nicotine, tar, and carbon monoxide

Dietary patterns high in which of the following contribute most significantly to coronary plaque formation?
a) Unsaturated fatty acids
b) Saturated animal fats
c) Complex carbohydrates
d) Plant-based fibers

b) Saturated animal fats

Individuals with elevated body mass index (BMI) are at increased risk for coronary atherosclerosis primarily due to what?
a) Reduced lipid levels and blood pressure
b) Earlier onset and greater severity of atherosclerotic lesions linked to lipid abnormalities and associated metabolic conditions
c) Increased physical activity
d) Enhanced insulin sensitivity

b) Earlier onset and greater severity of atherosclerotic lesions linked to lipid abnormalities and associated metabolic conditions

Which soluble factors contribute to the pathogenesis of atherosclerotic lesions by promoting thrombosis and vascular inflammation?
a) Anticoagulants
b) Thrombin, fibrin, and platelets
c) Erythrocytes
d) Immunoglobulins

b) Thrombin, fibrin, and platelets

Psychosocial stressors increase coronary atherosclerosis risk by influencing which of the following behavioral and physiological mechanisms?
a) Increased physical activity and improved diet
b) Elevated smoking rates, higher BMI, hypertension, and chronic stress in individuals with type A personality traits
c) Decreased sympathetic nervous system activity
d) Enhanced social support networks

b) Elevated smoking rates, higher BMI, hypertension, and chronic stress in individuals with type A personality traits

Which symptom is most commonly associated with myocardial ischemia and is often described as substernal chest discomfort triggered by exertion?
a) Sharp, localized chest pain unrelated to activity
b) Angina pectoris characterized by pressure or tightness in the chest
c) Persistent cough
d) Epigastric burning relieved by antacids

b) Angina pectoris characterized by pressure or tightness in the chest

What term describes chest pain occurring at rest due to transient coronary artery spasm rather than fixed atherosclerotic obstruction?
a) Stable angina
b) Variant (Prinzmetal’s) angina
c) Silent ischemia
d) Pericarditis

b) Variant (Prinzmetal’s) angina

Which of the following clinical findings is most indicative of a myocardial infarction rather than stable angina?
a) Chest discomfort relieved by rest
b) Prolonged chest pain (>20 minutes) not relieved by nitrates
c) Pain reproducible by palpation
d) Pain only during heavy exercise

b) Prolonged chest pain (>20 minutes) not relieved by nitrates

What is a frequent atypical symptom presentation of CAD, especially in women, diabetics, and the elderly?
a) Classic crushing chest pain
b) Dyspnea, fatigue, or epigastric discomfort without chest pain
c) Sharp chest pain with radiation to back
d) Unilateral leg swelling

b) Dyspnea, fatigue, or epigastric discomfort without chest pain

Which diagnostic marker is most specific for myocardial cell injury in suspected acute coronary syndrome?
a) Creatine kinase (CK) total
b) Troponin I or T
c) Lactate dehydrogenase (LDH)
d) Myoglobin

b) Troponin I or T

In the context of CAD, what does “silent ischemia” refer to?
a) Ischemia without pain or symptoms
b) Severe chest pain unrelieved by medication
c) Ischemia caused by infection
d) Rapid onset heart failure

a) Ischemia without pain or symptoms

Which physical examination finding can be associated with chronic ischemic heart disease?
a) Loud third heart sound (S3)
b) Elevated jugular venous pressure
c) Carotid bruits indicating atherosclerosis
d) Peripheral edema unrelated to heart function

c) Carotid bruits indicating atherosclerosis

Which of the following ECG changes is commonly seen during an episode of myocardial ischemia?
a) Tall peaked T waves
b) ST segment depression or T wave inversion
c) Sinus bradycardia
d) Complete heart block

b) ST segment depression or T wave inversion

What symptom often signifies progression from stable angina to unstable angina or acute coronary syndrome?
a) Decreasing frequency of chest pain episodes
b) Chest pain at rest or increasing severity and duration of pain
c) Pain only during strenuous activity
d) Absence of symptoms

b) Chest pain at rest or increasing severity and duration of pain

Which lifestyle modification has been shown to significantly reduce the risk of coronary events in patients with established CAD?
a) Increasing saturated fat intake
b) Smoking cessation
c) Avoiding exercise
d) Reducing water intake

b) Smoking cessation

What is the initial pathological event in the formation of an atheroma within medium and large arteries?
a) Deposition of cholesterol crystals in the arterial lumen
b) Injury to the endothelial lining of the arterial wall
c) Formation of thrombus on the arterial surface
d) Calcification of the arterial intima

b) Injury to the endothelial lining of the arterial wall

Following endothelial injury, what cellular components are first deposited as part of the arterial repair mechanism?
a) Neutrophils and fibroblasts
b) Blood platelets and lipoproteins
c) Erythrocytes and collagen fibers
d) Macrophages and smooth muscle cells

b) Blood platelets and lipoproteins

How do growth factors released from platelets contribute to the progression of an atheroma?
a) They cause degradation of the arterial wall
b) They stimulate the proliferation of smooth muscle cells within the arterial wall
c) They induce apoptosis of endothelial cells
d) They reduce lipid accumulation

b) They stimulate the proliferation of smooth muscle cells within the arterial wall

What metabolic alteration occurs in smooth muscle cells during atheroma development?
a) Increased fatty acid oxidation leading to energy depletion
b) Accumulation of cholesterol and other lipids within their cytoplasm
c) Loss of contractility and fibrosis
d) Transformation into endothelial cells

b) Accumulation of cholesterol and other lipids within their cytoplasm

What is the role of scavenger macrophages in the atheroma formation process?
a) They phagocytize lipids and secrete substances that exacerbate arterial wall injury
b) They repair the endothelial lining
c) They synthesize collagen to stabilize the plaque
d) They induce vasodilation of the artery

a) They phagocytize lipids and secrete substances that exacerbate arterial wall injury

What pathological change leads to narrowing of the arterial lumen in advanced atherosclerosis?
a) Vasospasm induced by sympathetic stimulation
b) Collagen deposition and scar tissue formation within the lesion
c) Expansion of the arterial media layer
d) Sudden rupture of the arterial wall

b) Collagen deposition and scar tissue formation within the lesion

Why does lipid leakage from smooth muscle cells into the interstitial spaces accelerate atheroma progression?
a) Lipid accumulation inhibits macrophage activity
b) Lipids attract scavenger macrophages that release damaging biologically active substances
c) Lipid leakage enhances endothelial cell regeneration
d) Lipids prevent platelet aggregation

b) Lipids attract scavenger macrophages that release damaging biologically active substances

What is the main cause of progressive chronic myocardial ischemia in coronary atherosclerosis?
a) Vasospasm of the coronary arteries
b) Progressive narrowing of the coronary artery lumen due to atheroma formation
c) Acute infection of the myocardium
d) Congenital coronary artery malformation

b) Progressive narrowing of the coronary artery lumen due to atheroma formation

Angina pectoris occurs when:
a) Myocardial oxygen demand is less than supply
b) Myocardial oxygen demand exceeds supply
c) There is no blood flow in coronary arteries
d) Blood pressure is elevated

b) Myocardial oxygen demand exceeds supply

Which of the following best describes the typical pain of angina pectoris?
a) Sharp, stabbing pain localized to the right arm
b) Substernal or retrosternal “crushing” pain often radiating to throat, back, or left arm
c) Dull abdominal pain relieved by eating
d) Constant headache

b) Substernal or retrosternal “crushing” pain often radiating to throat, back, or left arm

Sudden occlusion of which artery would most likely cause an anterior ventricular wall infarction?
a) Right coronary artery
b) Left anterior descending artery (LAD)
c) Circumflex artery
d) Pulmonary artery

b) Left anterior descending artery (LAD)

Which coronary artery accounts for about 50% of all atherosclerotic lesions?
a) Circumflex artery
b) Right coronary artery
c) Left anterior descending artery (LAD)
d) Left main coronary artery

c) Left anterior descending artery (LAD)

What are typical early signs within 24 hours following a myocardial infarction (MI)?
a) Hypothermia and decreased white blood cell count
b) Elevated temperature and increased white blood cell count
c) Decreased heart rate and platelet count
d) Increased urine output

b) Elevated temperature and increased white blood cell count

Sudden cardiac death (SCD) after MI usually results from:
a) Myocarditis
b) Ventricular fibrillation, heart block, or asystole
c) Stable angina
d) Hypertension

b) Ventricular fibrillation, heart block, or asystole

Which methods are commonly used to confirm diagnosis of myocardial infarction?
a) Physical exam, electrocardiography, and serum enzyme levels
b) Chest X-ray only
c) Pulmonary function test
d) Complete blood count alone

a) Physical exam, electrocardiography, and serum enzyme levels

What causes myocardial rupture after a myocardial infarction (MI)?
a) Hardening of the ventricular wall
b) Softening of the necrotic ventricular myocardium combined with increased ventricular pressure
c) Infection of the pericardium
d) Decreased ventricular pressure

b) Softening of the necrotic ventricular myocardium combined with increased ventricular pressure

What life-threatening condition results from blood escaping into the pericardial sac after myocardial rupture?
a) Pulmonary embolism
b) Cardiac tamponade
c) Stroke
d) Peripheral edema

b) Cardiac tamponade

What is the common treatment for cardiac tamponade following myocardial rupture?
a) Coronary artery bypass graft
b) Pericardiocentesis
c) Diuretics
d) Pacemaker insertion

b) Pericardiocentesis

What is a cardiac aneurysm in the context of MI complications?
a) A narrowing of the ventricular wall
b) Ballooning of the ventricular wall due to increased pressure and scar tissue formation
c) Infection of the heart valves
d) Thinning of the pericardium

b) Ballooning of the ventricular wall due to increased pressure and scar tissue formation

Heart failure and cardiogenic shock after MI primarily result from:
a) Excessive fluid volume
b) Inadequate tissue perfusion by a failing heart
c) High blood pressure
d) Lung infection

b) Inadequate tissue perfusion by a failing heart

Which organ is most often damaged due to inadequate perfusion in cardiogenic shock after MI?
a) Liver
b) Kidneys
c) Brain
d) Lungs

b) Kidneys

Which symptoms are common signs of renal failure in patients with cardiogenic shock?
a) Increased urine output and thirst
b) Oliguria and anuria
c) Fever and chills
d) Cough and chest pain

b) Oliguria and anuria

Which complication of MI can cause multisystem organ failure, including cerebral ischemia and potential irreversible brain damage?
a) Cardiac aneurysm
b) Cardiogenic shock
c) Pulmonary embolism
d) Myocarditis

b) Cardiogenic shock

What is the typical patient position for a coronary artery bypass graft (CABG) procedure?
a) Prone with legs extended
b) Supine with legs externally rotated
c) Lateral decubitus
d) Trendelenburg position

b) Supine with legs externally rotated

Which invasive monitoring device is used to measure right atrial, right ventricular, and pulmonary artery wedge pressures during cardiac surgery?
a) Central venous catheter
b) Swan-Ganz pulmonary artery catheter
c) Arterial line in the radial artery
d) Pulmonary vein catheter

b) Swan-Ganz pulmonary artery catheter

Why is a urinary catheter with a temperature sensor used intraoperatively during cardiac surgery?
a) To measure urinary output and core body temperature
b) To administer fluids and medications
c) To detect arrhythmias
d) To monitor lung function

a) To measure urinary output and core body temperature

Which of the following is a noninvasive intraoperative monitoring technique during CABG?
a) Swan-Ganz catheter
b) Pulse oximeter
c) Arterial line
d) Central venous pressure monitor

b) Pulse oximeter

During skin preparation for cardiac surgery, which area is included for prepping?
a) From lower mandible to toes of both legs bilaterally, and circumferentially on both legs
b) Only the chest and abdomen
c) From the neck to the umbilicus only
d) Just the legs

a) From lower mandible to toes of both legs bilaterally, and circumferentially on both legs

Why is the surgeon’s hands wetted with saline when tying polypropylene sutures?
a) To improve knot security
b) To prevent breaking the suture
c) To sterilize the hands
d) To reduce bleeding

b) To prevent breaking the suture

What is an important consideration regarding cannulation sutures during CABG?
a) The arterial cannulation suture is placed after the atrial suture in all cases
b) The atrial cannulation suture is for the right atrium, and the arterial cannulation suture is for the aorta; they must not be confused
c) Only one cannulation suture is used for both sites
d) Sutures are placed only after CPB is established

b) The atrial cannulation suture is for the right atrium, and the arterial cannulation suture is for the aorta; they must not be confused

How many Mayo stands are typically used during a CABG procedure involving saphenous vein harvesting?
a) One
b) Two
c) Three
d) Four

c) Three

Why should the surgical technologist not break scrub until the patient leaves the OR after cardiac surgery?
a) To avoid contaminating instruments
b) To assist in patient transfer
c) To keep back table and Mayo stand sterile in case of emergency re-initiation of cardiopulmonary bypass
d) To monitor anesthesia equipment

c) To keep back table and Mayo stand sterile in case of emergency re-initiation of cardiopulmonary bypass

During a CABG procedure, the initial incision typically extends from:
a) The xiphoid process to the umbilicus
b) The sternal notch to the xiphoid process
c) The clavicle to the nipple line
d) The mid-axillary line to the sternum

b) The sternal notch to the xiphoid process

Which instrument is preferred for opening the sternum during a repeat sternotomy to avoid injury to the heart?
a) Standard sternal saw
b) Oscillating saw
c) Gigli saw
d) Bone chisel

b) Oscillating saw

If the internal mammary artery (IMA) is being used for coronary artery anastomosis, which retractor is used instead of the sternal retractor?
a) Thoracic retractor
b) Mammary retractor
c) Rib spreader
d) Finochietto retractor

b) Mammary retractor

Why is papaverine-soaked gauze wrapped around the internal mammary artery during harvesting?
a) To prevent vasospasm
b) To increase bleeding
c) To sterilize the graft
d) To promote adhesion

a) To prevent vasospasm

During saphenous vein harvesting, how are vein tributaries typically managed?
a) Left open to drain naturally
b) Ligated with hemoclips and 4-0 silk ties
c) Tied with 2-0 nylon sutures only
d) Sealed with cautery exclusively

b) Ligated with hemoclips and 4-0 silk ties

How is the saphenous vein prepared after harvesting before grafting?
a) Flushed with normal saline and stored dry
b) Flushed with heparinized saline and stored in heparin-saline solution
c) Immediately anastomosed without flushing
d) Frozen for later use

b) Flushed with heparinized saline and stored in heparin-saline solution

What is the purpose of a Satinsky partial-occlusion clamp during CABG?
a) To clamp the pulmonary artery
b) To partially occlude the ascending aorta for proximal anastomosis
c) To clamp the vena cava
d) To occlude the coronary artery distally

b) To partially occlude the ascending aorta for proximal anastomosis

How is the proximal saphenous vein graft connected to the aorta during CABG?
a) End-to-end anastomosis
b) Side-to-side anastomosis
c) End-to-side anastomosis using 6-0 polypropylene sutures
d) Only clipped and ligated

c) End-to-side anastomosis using 6-0 polypropylene sutures

Why is needle aspiration of the graft performed after removal of the Satinsky clamp?
a) To check for leaks
b) To remove air bubbles from the graft
c) To deliver medication to the graft
d) To flush the graft with saline

b) To remove air bubbles from the graft

What is the primary concern when closing the sternum with wire sutures?
a) Ensuring the wire is as tight as possible
b) Avoiding glove punctures and controlling wire recoil to prevent contamination
c) Using absorbable sutures instead of wire
d) Leaving sutures loose for swelling

b) Avoiding glove punctures and controlling wire recoil to prevent contamination

Postoperatively, what complication can arise from systemic heparinization and cardiopulmonary bypass affecting clotting?
a) Deep vein thrombosis
b) Excessive bleeding and platelet damage
c) Pulmonary embolism
d) Hypertension

b) Excessive bleeding and platelet damage

What postoperative complication is indicated by excessive chest tube drainage after CABG?
a) Cardiac tamponade due to hemorrhage
b) Pulmonary edema
c) Pneumonia
d) Renal failure

a) Cardiac tamponade due to hemorrhage

If a patient requires urgent reoperation for hemorrhage after CABG, this is commonly referred to as:
a) Emergent sternotomy
b) Bring-back heart
c) Repeat sternotomy
d) Emergency thoracotomy

b) Bring-back heart

How is the wound classified for CABG and saphenous vein harvesting?
a) Class II: Clean-contaminated
b) Class I: Clean
c) Class III: Contaminated
d) Class IV: Dirty/infected

b) Class I: Clean

In an emergency cardiac procedure requiring immediate chest access and cannulation, which of the following items should be prepared first?
a) Surgical counts and wound closure materials
b) Scalpel, electrosurgical pencil, sternal saw, sternal retractor, cell saver suction, pump lines, and cannulation sutures
c) All instruments including staplers and drains
d) Only the sternal saw and retractors

b) Scalpel, electrosurgical pencil, sternal saw, sternal retractor, cell saver suction, pump lines, and cannulation sutures

During emergency preparation for chest opening, which of these steps can be delayed until after cannulation is complete?
a) Opening the sternal saw
b) Preparing pump lines
c) Performing surgical counts
d) Setting up electrosurgical pencil

c) Performing surgical counts

Why is it critical to have the sternal retractor ready immediately in emergency cardiac surgery?
a) To retract lung tissue
b) To provide exposure of the sternum after saw incision for quick access to the heart
c) To clamp blood vessels
d) To hold sutures during closure

b) To provide exposure of the sternum after saw incision for quick access to the heart

Which device is used during emergency cardiac procedures to minimize blood loss and recycle the patient’s blood?
a) Electrocautery
b) Cell saver suction
c) Pulse oximeter
d) Tourniquet

b) Cell saver suction

In emergency cardiac surgery, why should surgical counts be delayed until after chest cannulation?
a) To reduce infection risk
b) To prioritize rapid chest entry and heart access over counting instruments
c) Because no instruments are used initially
d) Counts are not necessary in emergencies

b) To prioritize rapid chest entry and heart access over counting instruments

What is the primary difference between conventional CABG and off-pump coronary artery bypass (OPCAB) surgery?
a) OPCAB uses a longer incision than conventional CABG
b) OPCAB is performed on a beating heart without the use of the cardiopulmonary bypass (CPB) machine
c) Conventional CABG is performed without anesthesia
d) OPCAB requires a heart-lung machine

b) OPCAB is performed on a beating heart without the use of the cardiopulmonary bypass (CPB) machine

Which of the following is an advantage of OPCAB compared to conventional CABG?
a) OPCAB requires more time in surgery
b) OPCAB generally requires a blood transfusion
c) OPCAB leads to decreased recovery time and less postoperative pain
d) OPCAB allows grafting of more than four arteries

c) OPCAB leads to decreased recovery time and less postoperative pain

What is a limitation of OPCAB surgery compared to conventional CABG?
a) Incision size is larger in OPCAB
b) OPCAB allows unlimited number of arterial grafts
c) Maximum of four arteries can be grafted due to smaller incision and technical difficulty
d) OPCAB completely eliminates the risk of ischemia

c) Maximum of four arteries can be grafted due to smaller incision and technical difficulty

Why must the surgical team be prepared to convert OPCAB to conventional CABG?
a) Because the heart stops beating during OPCAB
b) Due to possible ischemia or bleeding that obscures the surgical field during beating-heart surgery
c) Because OPCAB is performed without suturing
d) Conversion is never necessary

b) Due to possible ischemia or bleeding that obscures the surgical field during beating-heart surgery

Compared to conventional CABG, the incision length for OPCAB is approximately:
a) 10 cm longer
b) 30 cm
c) 20 cm
d) 40 cm

c) 20 cm