* On Managing A Patient With A Flail Chest, What Is Your First Step:

- Analgesia.
- Fixation Of The Flail Segment.
- Mechanical Ventilation.
- Ensure Patent Air Way.
* On Managing A Patient With Simple Rib Fracture You Noticed Bruises
Over The Traubs's Area. What Is Your Next Step:
- Ask For Abdominopelvic Sonography (FAST).
- Ask For ABG To Check For Respiratory Failure.
- Open Rib Fixation .
- Analgesia And Bronchial Hygiene.
* After Stabilizing Your Chest Trauma Patient, You Noticed The
Paradoxically Moving Segment Of The Chest Wall. What Is Your Next
Step:
- Mechanical Ventilation.
- ABG.
- CXR.
- Towel Clip Fixation.
* Traumatic Cardiac Tamponade Is Characterized By All Of The
Following EXCEPT:
- Markedly Dilated Pericardial Sac.
- Arterial Hypotension.
- Venous Hypertension.
- Muffled Heart Sounds.
* What Is The Commonest To Be Injured In Chest Trauma?
- Right Ventricle.
- Esophagus.
- Pleura.
IF There's Ribs More Correct.
- Descending Aorta.
CTS Q A.* What Is True Regarding Rib Trauma:
- First Rib Can Be Easily Fractured.
- 11th Rib Fracture May Mandate Abdominal Sonography.
- Simple Rib Fracture Always Needs Fixation.
- Morphia Is Always Needed.
* What Is True Regarding Rib Fracture:
- Commoner In Children.
- Always Treated Conservatively.
- First Rib Fracture Commonly Passes Unnoticed
- Flail Chest Can Halt Blood Circulation.
* What Is True Regarding Traumatic Hemopericardium:
- CXR is Diagnostic.
- Venous Hypertension Is The Earliest Sign.
- Arterial Hypotension Is Always Present.
- Normal Paradoxical Pulse.
* What Is TRUE Regarding Chest Trauma:
- Commonly Blunt.
- Commonly Penetrating.
- Commonly Rapidly Fatal.
- Commonly Involves Airway Injuries.
* If Fracture Bronchus Is Suspected What Is The Main Line For
Diagnosis:
- C.T. Chest.
- Rigid Bronchoscopy.
- Virtual Bronchoscopy.
- Chest MRI.
* All Are True Regarding Chest Trauma EXCEPT:
- Aortic Isthmus Commonly Give Out Anterior Spinal Artery.
- Extra Pleural Hematoma Is Treated Conservatively.
- Hemothorax May Need Urgent Thoracotomy.
- Differential Hypotension Can Occur In Traumatic Aortic Rupture.
* 5 Days Following Admission Of 30 Y.O Male With Traumatic Mild
Hemothorax And Lung Contusion, You Noticed Fever, Tachycardia,
Dyspnea. CXR Shows Moderate Pleural Collection.
What Is Your Next Step:
- Ask For Bronchoscopy.
- Ask For C.T. Chest.
- Needle Aspiration Of The Collection.
- Chest Tube Insertion Then Sends The Collect For Laboratory Work.
* Best Antibiotic To Be Used In Such Case Is:
- Amikacin Iv.
- Quinolones.
- 3rd Generation Cephalosporins.
- Lactamase Sensitive Penicillin.
* After Your Appropriate Initial Steps, New C.T. Shows Thin Pleural
Adhesions With
Minimal Collection. What Is The Best Next Step:
- Streptokinase Adhesiolysis.
- TPA Adhesiolysis.
- VATS Pleurectomy.
- Open Pleural Decortication.
* Now Your Patient Is Admitted For 6 Weeks With Persistent Pleural
Drainage. All
Of The Following May Be a Cause EXCEPT:
- Persistent High Blood Glucose Level.
- Low Blood Hemoglobin Level.
- Daily Patient Mobilization And Walking.
- Improper Antibiotic Therapy.* A 33 Y.O. Male Patient Came To Your
Clinic With Dyspnea And Low - Grade Fever.
Examination Revealed Diminished Air Entry Over The Right Lower Zone.
He Gave
History Of Recurrent Attacks Of Dysentery And Gastric Aches.
What Is Your Initial Investigation:
- Tuberculin Test.
- Abdominal Sonography.
- C.T. Chest.
- Broncho Alveolar Lavage For Sputum C.&S.
* Chest Imaging Revealed Mild Pleural Collection With Underlying Rt.
Lower Lobe
Collapse. What Is The Best Line Of Management:
- Bronchoscopy For Sputum Drainage.
- Sonar Guided Needle Aspiration.
- Intercostal Tube Insertion.
- Sonar Guided Aspiration And Stool Analysis.
* The Pleural Collect Rapidly Recollects After The Initial Drainage. All
Of The
Following Can Be Done EXCEPT:
- Empiric Cephalosporin Therapy.
- Image-Guided Intercostal Tube Insertion.
- Vats Guided Pleural Space Exploration And Intercostal Tube Insertion.
- Empiric Macrolide Therapy.
* Later On, You Noticed Absence Of Any Pleural Collect With
Persistence Of Rt.
Lower Collapse Despite Clear Air Way. All Can Explain The Condition
EXCEPT:
- Consolidation Collapse.
- Compression Collapse.
- Herniated Liver.
- Ruptured Diaphragm.
* Regarding Chest Trauma All Are Right EXCEPT:
- Right Atrium Is The Commonest To Be Involved In Heart Trauma.
- Esophageal Rupture Can Lead To Mediastinitis And Bilateral
Pyopneumothorax.
- Major Air Injury Is Best Diagnosed By Bronchoscopy.
- Left Atrium Can Be Penetrated By Ingested Fish Bone.* All Are False
Regarding Empyema Thoracic EXCEPT:
- Always Secondary.
- Open Drainage Is Indicated In Fit Patients.
- Open Decortication Is Suitable For Unfit Patients.
- Urokinase Is The Best Chemical Adhesiolysis Agent.
* 5 Days After Initiation Of Proper Antibiotic Therapy And ICT Insertion
In
Empyema Patient. New CXR Revealed Obliteration Of The Costophrenic
Angle With
Acute Relapse Of Fever. What Is Your Next Step:
- Check For Patency Of The Drainage System.
- Ask For C.T. Chest.
- Ask For Rigid Bronchoscopy.
- Check For Anemia.
* Regarding Empyema What Is Wrong:
- Always Secondary.
- Always Needs Drainage.
- Commonly Parapneumonic.
- Commoner On The Right Sided Resections.
* Regarding Posttraumatic Empyema. What Is Wrong:
- Commonly Incidental.
- Commonly Follow High Velocity Penetrating Trauma.
- Commoner Over Right Sides.
- Commonly Treated Surgically.
* Regarding Post Resectional Empyema All Are Eight EXCEPT:
- Commonly On Right Side.
- Commoner With Pneumonectomy.
- Commonly Follow Thoracoplasty.
- May Need Myoplasty.* All Are Life Saving Measures In Trauma
Primary Survey EXCEPT:
- Strangulated Diaphragmatic Hernia Repair.
- Needle Decompression For Tension Pneumothorax.
- Flail Chest Fixation.
- Wide Bore Cannula In The Median Cubital Veins.
* What Is Wrong Regarding Blunt Chest Trauma Management?
- Needle Decompression For Tension Pneumothorax.
- Continous Pericardial Closure After Cardiac Injury Repair.
- Analgesics For Simple Rib Fracture.
- Laparoscopic Repair For Acute Uncomplicated Traumatic
Diaphragmatic Hernia.
* If Fracture Bronchus Is Suspected What Is The Main Line For
Diagnosis:
- C.T. Chest.
- Rigid Bronchoscopy.
- Virtual Bronchoscopy.
- Chest MRI.
* All Are True Regarding Chest Trauma EXCEPT:
- Aortic Isthmus Commonly Give Out Anterior Spinal Artery.
- Extra Pleural Hematoma Is Treated Conservatively.
- Hemothorax May Need Urgent Thoracotomy.
- Differential Hypotension Can Occur In Traumatic Aortic Rupture.
* What Is The Commonest To Cause Empyema:
- Infected Right Lower Lobectomy Stump.
- Blood - Borne Spread From Distant Abscess.
- Spread From Supraclavicular Infection.
- Infected Left Upper Lobectomy Stump.* Regarding Cardiac Trauma.
Which Is Wrong:
- Traumatic Aneurysm Commonly Affects RV.
- Blunt Trauma Commonly Affects RV.
- Traumatic Septal Defects Commonly Significant At The Ventricular
Level.
- Left Atrium Is Commonly Protected.
* On Managing Your Chest Trauma Patient, You Noticed A Scaphoid
Abdomen,
Diminished Air Entry On The Left Side Of The Chest With A Gurgling
Sound.
What Is Your Next Step:
- Consult Specialized Thoracic Surgeon.
- Prepare For Laparoscopy.
- Ensure Neck Collar Fixator.
- Nasogastric Tube Insertion.
* Regarding Pleural Space What Is Wrong:
- Always Negatively Pressurized.
- Always Secondary Site For Infection.
- Devoid Of Any Exudative Fluids.
- Always Inflamed By Infection.
* All Of The Following Are Indications For Flail Chest Internal Fixation
EXCEPT:
- Extra Dural Hematoma.
- Carbon Dioxide Retention.
- Tension Pneumothorax.
- Worsening Acidosis.
* What Is WRONG Regarding Chest Trauma:
- First Rib Fracture Can Cause Tension Hemopneumothorax.
- Eleventh Rib Fracture Can Cause Hemoperitoneum.
- Sternal Fracture Usually Needs External Fixation.
- Thoracic Esophageal Traumas Are Rarely Accidental.* Regarding ERT,
Choose The Correct Answer:
- Includes Pectoralis Major Cutting.
- Done Through The 6th Intercostal Space.
- Extends To The Midaxillary Line Anteriorly.
- Done Over The Upper Border Of The Sixth Rib.
25 Male Patient FALLING FROM HEIGHT Oxygen Saturation By Pulse
Oximetry Is
92% With Oxygen Mask Slightly Dyspneic.
* What Is Most Probable Diagnosis:
- Tension Pneumothorax.
- Open Pneumothorax.
- Mild Pneumothorax.
- Stove - In Chest.
* What Is Your Next Step:
- Needle Decompression In The First Space.
- Tube Thoracostomy Over 6th Rib Upper Border.
- Tube Thoracotomy In The 5th Space Midclavicular Line.
- Needle Decompression Through The 5th Space.* All Are Life Saving
Measures In Trauma Primary Survey EXCEPT:
Strangulated Diaphragmatic Hernia Repair. -
- Needle Decompression For Tension Pneumothorax.
- Flail Chest Fixation.
- Wide Bore Cannula In The Median Cubital Veins.
* What Is Wrong Regarding Blunt Chest Trauma Management:
- Needle Decompression For Tension Pneumothorax.
- Continous Pericardial Closure After Cardiac Injury Repair.
- Analgesics For Simple Rib Fracture.
- Laparoscopic Repair For Acute Uncomplicated Traumatic
Diaphragmatic Hernia.
* Least To Be Involved In Chest Trauma Is:
- Eleventh Rib.
- Apical Pleura.
- Left Atrium.
- Right Ventricle.
* Popcorn Calcification In Mammography Seen In:
- Fibroadenoma.
- Cancer Breast.
- Cystosarcoma Phylloid.
- Fat Necrosis.
* Regarding Chest Trauma What Is True:
- Commonly Fatal.
- Commonly Visceral.
- May Need CPB For Management.
- Diaphragmatic Rupture Is Issued On The Primary Survey. * Regarding
Heart Trauma What Is WRONG:
- Mitral Valve Is The Commonest Valve To Be Injured.
- The Left Atrium Can Be Injured By Invasive Esophageal Maneuvers.
- Pericardial Tamponade Rarely Manifests With All Signs Of Cushing’s
Triad.
- Coronary Artery Trauma Is Commoner In Atherosclerotic Vessels.
* All Of The Following Regarding Tracheobronchial Trauma Is True
EXCEPT:
- May Manifest With Pneumomediastinum.
- Should Be Issued On Primary ATLS Survey.
- Bronchoscopy Is The Mainstay Diagnostic Procedure.
- Urgent Tracheostomy May Be Life Saving In Right Bronchial Fracture.
* All Are True EXCEPT:
- Post Traumatic Empyema Is Commonly Right Sided.
- Posttraumatic Diaphragmatic Hernia Is Commonly Left Sided.
- Post Esophageal Perforation Can Lead To Mediastinitis And Bilateral
Pyopneumothorax.
- Tracheobronchial Injuries Commonly Approached Through Left
Thoracotomy.
* Regarding TRAUMATIC Pyothorax What Is Wrong:
- May Complicate Clotted Hemothorax.
- Commonly Nosocomial.
- Commonly Respond To Cephalosporin.
- Commonly Treated Conservatively.
* Regarding LIMA What Is True:
- Bifurcates Into Superior Epigastric And Pericardiophrenic Arteries.
- Arises From Cephalic Surface Of Subclavian Artery.
- Commonly Used As Skeletonized Graft.
- Does Not Need Proximal Anastomosis.* What Is Missed ?
- INR For Follow Up In Patients With Biological Valve Prosthesis.
- Interrupted Suture Closure Of Pericardium After Cardiac Injury
Control.
- External Flail Fixation For Polytrauma Patients With Increasing
Pelvic Collection.
- Laparoscopy For Acute Diaphragmatic Hernia.
* All Are True Regarding CABG EXCEPT:
- Can Be Done Through Sternotomy.
- Can Be Done Without CPB.
- Can Be Done Using Tube Grafts 8mm.
- Can Be Done Through Right Anterolateral Thoracotomy.
* All Are True Regarding CPB. EXCEPT:
- Aorta Atrial Approach Is Used In On-Pump CABG.
- Left Partial Bypass Is Used On Operating The Ascending Aorta.
- The Most Common Buffer For Cardioplegia Is Warm Blood.
- CPB Main Problem Is The Non - Pulsatile Flow.1. During The Staff
Round, Your Senior Noticed That EF Is Below 30% In A 35-Year
Old Male Patient With Aortic Stenosis. He Decided To Postpone The
Operation.
What Did You Miss?
A. Abdominal Ultrasonography.
B. Coronary Angiography.
C. Assess LV Contractile Reserve (Dobutamine Stress ECHO).
D. Check Patient Medications.
2. All Of The Following Are Solid Indications For CABG In Ischemic Heart
Disease EXCEPT:
A. Right Coronary Artery 40% Occlusion.
B. LAD 60% Occlusion With Rheumatic Severe Mitral Regurgitation.
C. LAD 50% & LCX 70% Occlusions In A Patient With Aneurysm.
D. Left Main 70% Occlusion.
3. Which Of The Following Will Not Favor Complications Of Empyema?
A. Old Age .
B. Lung Malignancy .
C. Female Sex.
D. Lung Entrapment.
4. What Is The Most Common Intervention Required For Patients With
Thoracic Trauma ?
A. Chest Tube Insertion.
B. Thoracotomy.
C. VATS (Video - Assisted Thoracoscopic Surgery) .
D. Pericardiocentesis.
Final CTS A.5. Comparing SVG And LIMA As Conduits For CABG
Operation, Which Of The
Following Statements Is TRUE?
A. LIMA Has Faster Atherosclerosis .
B. LIMA Is The Best Conduit.
C. LIMA Thrombosis Is More Common .
D. None Of The Above .
6. All Of The Following Can Be Used As Conduits For CABG Operation.
EXCEPT:
A. Saphenous Vein .
B. Internal Mammary Artery .
C. Radial Artery .
D. Anterior Tibial Vein.
7. All Of The Following Are Options Of Intervention In Severely
Symptomatic Mitral
Regurgitation EXCEPT :
A. Mitral Valve Repair .
B. Mitral Valve Replacement .
C. Trans - Catheter Mitral Clipping .
D. Trans - Catheter Mitral Balloon Valvotomy.
8. Which Of The Following Is The Commonest To Cause Empyema ?
A. Infected Lobectomy Stump.
B. Blood - Borne Spread.
C. Contaminated Stab Injury . Neck .
D. Descending Infection From.
9. Empyema Necessities Describe:
A. Empyema Resistant To Medical Treatment.
B. Empyema Eroding Through The Chest Wall.
D. Empyema Necessitates Surgical Intervention .
C. Empyema With Mediastinal Extension .10. Pericardial Tamponade Is
Characterized By All Of The Following EXCEPT:
A. Jugular Vein Distension .
B. Muffled Heart Sounds
C. Arterial Hypotension .
D. Venous Hypotension.
11. Which Injuries Are Considered Life - Threatening Requiring
Immediate
Intervention ?
A. Tension Pneumothorax And Pericardial Tamponade.
B. Cardiac Contusion And Rib Fractures .
C. Clavicle Fracture And Pulmonary Contusion.
D. Pneumomediastinum And Subcutaneous Emphysema.
12. How Can You Define Flail Chest ? A. Floating Ribs At The Bottom Of
The
Rib Cage:
B. Broken Ribs On Both Sides Of The Chest .
C. Three Or More Broken Ribs Broke On The Same Side .
D. Three Or More Ribs Broke In Two Or More Points.
13. Empyema Thoracis Can Be Complicated By All Of The Following,
EXCEPT :
A. Rib Osteomyelitis .
B. Mediastinitis .
C. Bronchopulmonary Fistula .
D. Pulmonary Embolism.
14. All Of The Following Are Class I Indications For EMERGENCY CABG
Operation EXCEPT:
A. Rupture Mitral Papillary Muscle With Acute Regurgitation.
B. Post-Infarction VSD .
C. Persistent Anginal Pain With Preserved Hemodynamics.
D. Cardiogenic Shock .15. What Is The Agent Of Choice To Reverse
Heparin?
A. Warfarin. B. Protamine.
C. Albumin. D. Cryoprecipitate .
16. Which Of The Following Findings Is Not Associated With Severe
Mitral Stenosis ?
A. Pulmonary Vascular Congestion.
B. Atrial Fibrillation .
C. Valve Area > 2 Cm²
D. Left Atrial Thrombus .
17. The Radiographic Findings Indicating A Torn Thoracic Aorta Include:
A. Widened Mediastinum .
B. Presence Of An Apical Opacity (Pleural Cap) .
C. First Rib Fractures .
D. All Of The Above.
18 .What Is Most Important In The INITIAL Management Of Traumatic
Hemorrhagic Shock ?
A. Place A Central Venous Pressure Line Early For Fluid Resuscitation
And
Monitoring.
B. Blood Type And Crossmatching .
C. Secure The Airway And Ventilate Adequately.
D. Rapidly Infuse Colloids.
19. Dullness On Percussion Of The Chest Occurs With:
A. Acute Bronchitis. B. Empyema.
C. Pneumothorax. D. Healthy Lung.
20. Fluid Aspirated From Pleural Space Contains The Causative
Organism In Which
Phase Of Empyema :
A. Exudative Phase .
B. Fibrinopurulent Phase .
C. Organizing Phase .
D. B And C. 21. All Of The Following Can Be Used For Residual Space
Obliteration Complicating
Chronic Empyema EXCEPT:
A. Pleural Decortication For Entrapped Lung .
B. Muscle Transplant, Mobilization .
C. Lung Resection.
D. Multiple Rib Resection.
22. During Echocardiographic Stress Testing, It Was Concluded That The
Patient
Has An Underlying Area Of Ischemia, Because Of Reduced Insert To
Response To :
A. Epinephrine. B. Dobutamine.
C. Adenosine. D. Dipyridamole.
23. All Of The Following About Chest Trauma Are True EXCEPT:
A. Scapular Fracture Denotes Minor Trauma.
B. Lung Contusion Is Commonly Treated Conservatively.
C. Flail Chest Should Be Managed As A Part Of The Primary Survey.
D. Diaphragmatic Hernia May Be Missed .
24. Which Of The Following Is A Relative Indication For Mitral Valve
Replacement
And Not Mitral Valve Repair ?
A. Extensive Leaflet Calcification.
B. Mitral Regurgitation .
C. Chordal Rupture Of The Anterior Mitral Leaflet
D. Significant Annular Dilatation .
25. Aortic Regurgitation Could Be Caused By Which Of The Following ?
A. Endocarditis. B. Aortic Dissection.
C. Aortic Aneurysm. D. All Of The Above.