CSC (Cardiac Surgery Certification) Exam / CSC
Cardiac Surgery Exam 2026 | Comprehensive Test
Bank Exam Ultimate Practice Exam 200 Real
Scenario-Based Questions with Answers and
Rationales Instant Pdf.
SECTION 1: CARDIOTHORACIC SURGERY PROCEDURES
1. A 68-year-old male with triple-vessel coronary artery disease is scheduled for
coronary artery bypass grafting. Which conduit is considered the gold standard for
grafting the left anterior descending artery due to its superior long-term patency?
A) Saphenous vein graft
B) Left internal mammary artery (LIMA)
C) Radial artery
D) Right internal mammary artery (RIMA)
Answer: B
The LIMA is the preferred conduit for CABG due to its superior long-term patency rates of
90-95% at 10 years. It is typically anastomosed to the LAD artery. Saphenous vein grafts
have lower patency rates of 50-60% at 10 years and are used for secondary targets.
2. A patient with symptomatic atrial fibrillation refractory to medical therapy is
scheduled for a surgical procedure. Which procedure creates a "maze" of scar
tissue in the atria to block abnormal electrical pathways?
,A) Coronary artery bypass grafting
B) Cox-Maze procedure
C) Valve replacement
D) Pericardial window
Answer: B
The Cox-Maze procedure creates scar tissue in the atria to redirect electrical impulses. It is
indicated for patients with symptomatic atrial fibrillation refractory to medical therapy or
catheter ablation and is often performed concurrently with other cardiac surgeries.
3. A 78-year-old female with severe aortic stenosis is deemed high-risk for surgical
valve replacement. She is scheduled for a transcatheter procedure. Which imaging
modality provides the most accurate measurement of annular dimensions for
valve sizing?
A) Transthoracic echocardiography (TTE)
B) Transesophageal echocardiography (TEE)
C) Multidetector computed tomography (MDCT)
D) Cardiac magnetic resonance imaging (CMR)
Answer: C
MDCT offers high-resolution, three-dimensional reconstruction of the aortic annulus,
essential for accurately sizing the transcatheter valve. TEE provides valuable
intraprocedural guidance but MDCT is superior for pre-procedural annular measurement.
4. A patient is undergoing off-pump coronary artery bypass (OPCAB). What is the
primary advantage of this approach compared with conventional CABG on
cardiopulmonary bypass?
A) Reduced operative time
B) Lower risk of stroke
C) Decreased blood loss
D) Improved graft patency
Answer: B
OPCAB avoids the use of cardiopulmonary bypass, thereby reducing the risk of embolic
,phenomena that can cause postoperative stroke. It also reduces the systemic inflammatory
response associated with CPB.
5. During aortic root replacement, which graft material is most commonly used to
recreate the sinuses of Valsalva?
A) Dacron tube graft
B) Homograft (cryopreserved aortic root)
C) Bovine pericardial patch
D) Polytetrafluoroethylene (PTFE) patch
Answer: B
Homografts preserve native aortic root anatomy, including the sinuses of Valsalva, making
them the preferred choice for root replacement when available. They also have excellent
hemodynamic properties and lower risk of infection.
6. A 60-year-old male presents with acute type A aortic dissection. He has severe
aortic regurgitation, pericardial effusion, and a tear in the ascending aorta just
above the sinotubular junction. Which of the following is the most appropriate
surgical procedure?
A) Bentall procedure
B) Ascending aortic replacement with aortic valve resuspension
C) Wheat procedure
D) David procedure
Answer: B
For an acute type A aortic dissection with a tear in the ascending aorta and associated
aortic regurgitation, the recommended surgical approach is often ascending aortic
replacement with resuspension of the aortic valve if the valve leaflets are structurally
normal. Resuspension can effectively restore aortic valve function.
, 7. A 45-year-old female undergoes mitral valve repair for severe mitral
regurgitation due to myxomatous degeneration. Post-bypass transesophageal
echocardiography reveals a residual mild central mitral regurgitation with a stable
mean gradient of 4 mmHg. What is the appropriate next step in management?
A) Return to cardiopulmonary bypass for immediate re-repair
B) Accept the result and close the chest
C) Perform a mitral valve replacement
D) Administer intravenous nitroglycerin to reduce afterload
Answer: B
A residual mild (1+) central mitral regurgitation after mitral valve repair with an
acceptable mean gradient is generally considered an acceptable result. The goal of mitral
valve repair is to achieve a competent valve without significant stenosis. Mild residual
regurgitation is often well-tolerated and may improve with postoperative left ventricular
remodeling.
8. A 72-year-old male with severe aortic stenosis undergoes TAVR via transfemoral
approach. During balloon valvuloplasty, the patient develops acute hypotension
and bradycardia. TEE shows a new moderate pericardial effusion with right
ventricular collapse. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pericardial tamponade due to ventricular perforation
D) Anaphylactic reaction to contrast media
Answer: C
Acute pericardial tamponade is a known complication of TAVR, particularly during balloon
valvuloplasty or valve deployment. The wire or balloon can perforate the right ventricle,
leading to pericardial effusion and subsequent tamponade. The clinical presentation of
hypotension, bradycardia, and right ventricular collapse on TEE is classic for tamponade.
9. A 68-year-old male with a history of hypertension and diabetes presents with
progressive dyspnea on exertion and angina. Echocardiography reveals severe
Cardiac Surgery Exam 2026 | Comprehensive Test
Bank Exam Ultimate Practice Exam 200 Real
Scenario-Based Questions with Answers and
Rationales Instant Pdf.
SECTION 1: CARDIOTHORACIC SURGERY PROCEDURES
1. A 68-year-old male with triple-vessel coronary artery disease is scheduled for
coronary artery bypass grafting. Which conduit is considered the gold standard for
grafting the left anterior descending artery due to its superior long-term patency?
A) Saphenous vein graft
B) Left internal mammary artery (LIMA)
C) Radial artery
D) Right internal mammary artery (RIMA)
Answer: B
The LIMA is the preferred conduit for CABG due to its superior long-term patency rates of
90-95% at 10 years. It is typically anastomosed to the LAD artery. Saphenous vein grafts
have lower patency rates of 50-60% at 10 years and are used for secondary targets.
2. A patient with symptomatic atrial fibrillation refractory to medical therapy is
scheduled for a surgical procedure. Which procedure creates a "maze" of scar
tissue in the atria to block abnormal electrical pathways?
,A) Coronary artery bypass grafting
B) Cox-Maze procedure
C) Valve replacement
D) Pericardial window
Answer: B
The Cox-Maze procedure creates scar tissue in the atria to redirect electrical impulses. It is
indicated for patients with symptomatic atrial fibrillation refractory to medical therapy or
catheter ablation and is often performed concurrently with other cardiac surgeries.
3. A 78-year-old female with severe aortic stenosis is deemed high-risk for surgical
valve replacement. She is scheduled for a transcatheter procedure. Which imaging
modality provides the most accurate measurement of annular dimensions for
valve sizing?
A) Transthoracic echocardiography (TTE)
B) Transesophageal echocardiography (TEE)
C) Multidetector computed tomography (MDCT)
D) Cardiac magnetic resonance imaging (CMR)
Answer: C
MDCT offers high-resolution, three-dimensional reconstruction of the aortic annulus,
essential for accurately sizing the transcatheter valve. TEE provides valuable
intraprocedural guidance but MDCT is superior for pre-procedural annular measurement.
4. A patient is undergoing off-pump coronary artery bypass (OPCAB). What is the
primary advantage of this approach compared with conventional CABG on
cardiopulmonary bypass?
A) Reduced operative time
B) Lower risk of stroke
C) Decreased blood loss
D) Improved graft patency
Answer: B
OPCAB avoids the use of cardiopulmonary bypass, thereby reducing the risk of embolic
,phenomena that can cause postoperative stroke. It also reduces the systemic inflammatory
response associated with CPB.
5. During aortic root replacement, which graft material is most commonly used to
recreate the sinuses of Valsalva?
A) Dacron tube graft
B) Homograft (cryopreserved aortic root)
C) Bovine pericardial patch
D) Polytetrafluoroethylene (PTFE) patch
Answer: B
Homografts preserve native aortic root anatomy, including the sinuses of Valsalva, making
them the preferred choice for root replacement when available. They also have excellent
hemodynamic properties and lower risk of infection.
6. A 60-year-old male presents with acute type A aortic dissection. He has severe
aortic regurgitation, pericardial effusion, and a tear in the ascending aorta just
above the sinotubular junction. Which of the following is the most appropriate
surgical procedure?
A) Bentall procedure
B) Ascending aortic replacement with aortic valve resuspension
C) Wheat procedure
D) David procedure
Answer: B
For an acute type A aortic dissection with a tear in the ascending aorta and associated
aortic regurgitation, the recommended surgical approach is often ascending aortic
replacement with resuspension of the aortic valve if the valve leaflets are structurally
normal. Resuspension can effectively restore aortic valve function.
, 7. A 45-year-old female undergoes mitral valve repair for severe mitral
regurgitation due to myxomatous degeneration. Post-bypass transesophageal
echocardiography reveals a residual mild central mitral regurgitation with a stable
mean gradient of 4 mmHg. What is the appropriate next step in management?
A) Return to cardiopulmonary bypass for immediate re-repair
B) Accept the result and close the chest
C) Perform a mitral valve replacement
D) Administer intravenous nitroglycerin to reduce afterload
Answer: B
A residual mild (1+) central mitral regurgitation after mitral valve repair with an
acceptable mean gradient is generally considered an acceptable result. The goal of mitral
valve repair is to achieve a competent valve without significant stenosis. Mild residual
regurgitation is often well-tolerated and may improve with postoperative left ventricular
remodeling.
8. A 72-year-old male with severe aortic stenosis undergoes TAVR via transfemoral
approach. During balloon valvuloplasty, the patient develops acute hypotension
and bradycardia. TEE shows a new moderate pericardial effusion with right
ventricular collapse. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pericardial tamponade due to ventricular perforation
D) Anaphylactic reaction to contrast media
Answer: C
Acute pericardial tamponade is a known complication of TAVR, particularly during balloon
valvuloplasty or valve deployment. The wire or balloon can perforate the right ventricle,
leading to pericardial effusion and subsequent tamponade. The clinical presentation of
hypotension, bradycardia, and right ventricular collapse on TEE is classic for tamponade.
9. A 68-year-old male with a history of hypertension and diabetes presents with
progressive dyspnea on exertion and angina. Echocardiography reveals severe
