CSC (Cardiac Surgery Certification) Exam
Practice Questions 100 Multiple-Choice
Questions with Answers and Rationales
ALREADY GRADED A+
SECTION 1: PROCEDURES (Questions 1–11)
Question 1
A patient is scheduled for coronary artery bypass grafting (CABG) with cardiopulmonary bypass.
Which of the following is a PRIMARY indication for this procedure?
A) Acute myocardial infarction with ST-segment elevation
B) Left main coronary artery stenosis >50%
C) Single-vessel coronary artery disease
D) Mild stable angina
Correct Answer: B
Rationale: Left main coronary artery stenosis >50% is a primary indication for CABG due to the
high risk of mortality with medical management alone. CABG is also indicated for three-vessel
disease and two-vessel disease with proximal LAD involvement. Single-vessel disease is typically
managed with percutaneous coronary intervention (PCI) or medical therapy.
Question 2
A patient is scheduled for a minimally invasive cardiac surgery (MICS) approach for mitral valve
repair. Which of the following is a key advantage of this approach over conventional
sternotomy?
A) Shorter cardiopulmonary bypass time
B) Reduced postoperative pain and faster recovery
C) Better visualization of the mitral valve
D) Lower risk of stroke
1
, Correct Answer: B
Rationale: Minimally invasive cardiac surgery offers reduced postoperative pain, shorter
hospital stays, faster recovery, and improved cosmetic outcomes. However, it often requires
longer cardiopulmonary bypass times and has a steeper learning curve for surgeons.
Question 3
A patient is scheduled for a transcatheter aortic valve replacement (TAVR). Which of the
following patients is the BEST candidate for this procedure?
A) A 65-year-old with severe aortic stenosis and a bicuspid valve
B) A 55-year-old with moderate aortic stenosis and normal ejection fraction
C) An 82-year-old with severe aortic stenosis who is high-risk for surgical valve replacement
D) A 70-year-old with aortic regurgitation
Correct Answer: C
Rationale: TAVR is indicated for patients with severe symptomatic aortic stenosis who are at
high or intermediate surgical risk. It is particularly beneficial for elderly patients and those with
significant comorbidities. TAVR is not indicated for aortic regurgitation or moderate stenosis.
Question 4
During a Cox Maze procedure, which of the following is the PRIMARY goal?
A) Repair of the mitral valve
B) Ablation of abnormal electrical pathways to treat atrial fibrillation
C) Creation of a new bypass graft
D) Repair of a ventricular septal defect
Correct Answer: B
Rationale: The Cox Maze procedure, often performed using radiofrequency or cryoablation,
creates a pattern of scar tissue in the atria to interrupt abnormal electrical pathways and restore
normal sinus rhythm in patients with atrial fibrillation.
Question 5
A patient is undergoing open repair of a thoracic aortic aneurysm. Which of the following is the
MOST critical intraoperative monitoring parameter?
2
, A) Blood glucose levels
B) Core body temperature
C) Spinal cord perfusion and motor-evoked potentials
D) Serum potassium
Correct Answer: C
Rationale: During thoracic aortic aneurysm repair, spinal cord ischemia is a significant risk.
Monitoring motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) helps
detect spinal cord ischemia early, allowing interventions to prevent paralysis.
Question 6
A patient is scheduled for surgical valve replacement with a mechanical valve. Which of the
following is a key postoperative consideration?
A) Lifelong antibiotic prophylaxis
B) Lifelong anticoagulation with warfarin
C) Limited physical activity for 6 months
D) Regular echocardiograms every 6 months
Correct Answer: B
Rationale: Mechanical heart valves require lifelong anticoagulation with warfarin to prevent
thromboembolic complications. The target INR is typically 2.5-3.5 depending on valve position.
Antibiotic prophylaxis is only required for dental procedures, not lifelong.
Question 7
A patient is scheduled for a pericardiectomy. Which of the following is the PRIMARY indication
for this procedure?
A) Acute pericarditis
B) Recurrent pericardial effusion
C) Constrictive pericarditis
D) Cardiac tamponade
Correct Answer: C
Rationale: Pericardiectomy (surgical removal of the pericardium) is primarily indicated for
constrictive pericarditis when medical management fails. It may also be considered for
3
, recurrent pericardial effusions. Acute pericarditis and cardiac tamponade are typically managed
medically or with pericardiocentesis.
Question 8
A patient is undergoing off-pump coronary artery bypass (OPCAB) surgery. Which of the
following is a key difference from on-pump CABG?
A) The heart is stopped and cardiopulmonary bypass is used
B) The procedure is performed on a beating heart without cardiopulmonary bypass
C) The procedure is performed through a small thoracotomy incision
D) The procedure requires deep hypothermia
Correct Answer: B
Rationale: Off-pump coronary artery bypass (OPCAB) is performed on a beating heart without
the use of cardiopulmonary bypass. This may reduce the inflammatory response and
complications associated with bypass, such as stroke and renal dysfunction.
Question 9
A patient is scheduled for endovascular repair of a descending thoracic aortic aneurysm. Which
of the following is the MOST important postoperative assessment?
A) Blood pressure in both upper extremities
B) Distal pulses and spinal cord function
C) Chest tube output
D) Serum creatinine
Correct Answer: B
Rationale: After endovascular aortic repair, distal pulses should be assessed to ensure adequate
perfusion. Spinal cord ischemia is a potential complication, so lower extremity motor and
sensory function should be monitored closely.
Question 10
A patient is scheduled for a pericardial window procedure. Which of the following BEST
describes the purpose of this procedure?
A) To remove the entire pericardium
B) To create a drainage pathway for recurrent pericardial effusions
4
Practice Questions 100 Multiple-Choice
Questions with Answers and Rationales
ALREADY GRADED A+
SECTION 1: PROCEDURES (Questions 1–11)
Question 1
A patient is scheduled for coronary artery bypass grafting (CABG) with cardiopulmonary bypass.
Which of the following is a PRIMARY indication for this procedure?
A) Acute myocardial infarction with ST-segment elevation
B) Left main coronary artery stenosis >50%
C) Single-vessel coronary artery disease
D) Mild stable angina
Correct Answer: B
Rationale: Left main coronary artery stenosis >50% is a primary indication for CABG due to the
high risk of mortality with medical management alone. CABG is also indicated for three-vessel
disease and two-vessel disease with proximal LAD involvement. Single-vessel disease is typically
managed with percutaneous coronary intervention (PCI) or medical therapy.
Question 2
A patient is scheduled for a minimally invasive cardiac surgery (MICS) approach for mitral valve
repair. Which of the following is a key advantage of this approach over conventional
sternotomy?
A) Shorter cardiopulmonary bypass time
B) Reduced postoperative pain and faster recovery
C) Better visualization of the mitral valve
D) Lower risk of stroke
1
, Correct Answer: B
Rationale: Minimally invasive cardiac surgery offers reduced postoperative pain, shorter
hospital stays, faster recovery, and improved cosmetic outcomes. However, it often requires
longer cardiopulmonary bypass times and has a steeper learning curve for surgeons.
Question 3
A patient is scheduled for a transcatheter aortic valve replacement (TAVR). Which of the
following patients is the BEST candidate for this procedure?
A) A 65-year-old with severe aortic stenosis and a bicuspid valve
B) A 55-year-old with moderate aortic stenosis and normal ejection fraction
C) An 82-year-old with severe aortic stenosis who is high-risk for surgical valve replacement
D) A 70-year-old with aortic regurgitation
Correct Answer: C
Rationale: TAVR is indicated for patients with severe symptomatic aortic stenosis who are at
high or intermediate surgical risk. It is particularly beneficial for elderly patients and those with
significant comorbidities. TAVR is not indicated for aortic regurgitation or moderate stenosis.
Question 4
During a Cox Maze procedure, which of the following is the PRIMARY goal?
A) Repair of the mitral valve
B) Ablation of abnormal electrical pathways to treat atrial fibrillation
C) Creation of a new bypass graft
D) Repair of a ventricular septal defect
Correct Answer: B
Rationale: The Cox Maze procedure, often performed using radiofrequency or cryoablation,
creates a pattern of scar tissue in the atria to interrupt abnormal electrical pathways and restore
normal sinus rhythm in patients with atrial fibrillation.
Question 5
A patient is undergoing open repair of a thoracic aortic aneurysm. Which of the following is the
MOST critical intraoperative monitoring parameter?
2
, A) Blood glucose levels
B) Core body temperature
C) Spinal cord perfusion and motor-evoked potentials
D) Serum potassium
Correct Answer: C
Rationale: During thoracic aortic aneurysm repair, spinal cord ischemia is a significant risk.
Monitoring motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) helps
detect spinal cord ischemia early, allowing interventions to prevent paralysis.
Question 6
A patient is scheduled for surgical valve replacement with a mechanical valve. Which of the
following is a key postoperative consideration?
A) Lifelong antibiotic prophylaxis
B) Lifelong anticoagulation with warfarin
C) Limited physical activity for 6 months
D) Regular echocardiograms every 6 months
Correct Answer: B
Rationale: Mechanical heart valves require lifelong anticoagulation with warfarin to prevent
thromboembolic complications. The target INR is typically 2.5-3.5 depending on valve position.
Antibiotic prophylaxis is only required for dental procedures, not lifelong.
Question 7
A patient is scheduled for a pericardiectomy. Which of the following is the PRIMARY indication
for this procedure?
A) Acute pericarditis
B) Recurrent pericardial effusion
C) Constrictive pericarditis
D) Cardiac tamponade
Correct Answer: C
Rationale: Pericardiectomy (surgical removal of the pericardium) is primarily indicated for
constrictive pericarditis when medical management fails. It may also be considered for
3
, recurrent pericardial effusions. Acute pericarditis and cardiac tamponade are typically managed
medically or with pericardiocentesis.
Question 8
A patient is undergoing off-pump coronary artery bypass (OPCAB) surgery. Which of the
following is a key difference from on-pump CABG?
A) The heart is stopped and cardiopulmonary bypass is used
B) The procedure is performed on a beating heart without cardiopulmonary bypass
C) The procedure is performed through a small thoracotomy incision
D) The procedure requires deep hypothermia
Correct Answer: B
Rationale: Off-pump coronary artery bypass (OPCAB) is performed on a beating heart without
the use of cardiopulmonary bypass. This may reduce the inflammatory response and
complications associated with bypass, such as stroke and renal dysfunction.
Question 9
A patient is scheduled for endovascular repair of a descending thoracic aortic aneurysm. Which
of the following is the MOST important postoperative assessment?
A) Blood pressure in both upper extremities
B) Distal pulses and spinal cord function
C) Chest tube output
D) Serum creatinine
Correct Answer: B
Rationale: After endovascular aortic repair, distal pulses should be assessed to ensure adequate
perfusion. Spinal cord ischemia is a potential complication, so lower extremity motor and
sensory function should be monitored closely.
Question 10
A patient is scheduled for a pericardial window procedure. Which of the following BEST
describes the purpose of this procedure?
A) To remove the entire pericardium
B) To create a drainage pathway for recurrent pericardial effusions
4
