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SU26.{1,3-4} | Cardiothoracic Surgery — Graded Quiz
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A 70-year-old man with significant left main coronary artery stenosis and triple-vessel disease, refractory to optimal medical therapy, is referred for surgery. Which conduit, anastomosed to the left anterior descending artery, offers the best long-term graft patency in coronary artery bypass grafting?
Correct. The left internal mammary artery to the LAD is the conduit of choice in CABG because of its superior long-term patency; vein and radial artery grafts supplement it.
CABG uses arterial and venous conduits; the LIMA-to-LAD anastomosis is the gold-standard graft for durability.
The LIMA-to-LAD graft gives the best long-term patency in CABG. Prosthetic tubes, homografts and patches are not used to bypass coronary arteries.
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Two patients each receive a prosthetic heart valve: Patient X gets a MECHANICAL valve, Patient Y a BIOPROSTHETIC valve. Which pairing of long-term consequences is correct?
Correct. Mechanical valves are durable but thrombogenic (lifelong warfarin); bioprosthetic valves avoid lifelong anticoagulation but are less durable and degenerate over time — the central valve trade-off.
The mechanical-vs-bioprosthetic decision balances durability against the burden and risk of lifelong anticoagulation.
Mechanical = durable + lifelong warfarin; bioprosthetic = no lifelong warfarin but limited durability. Option B states this correctly.
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A paediatric cardiologist groups congenital heart lesions by whether they cause central cyanosis. Which option correctly classifies the lesions?
Correct. ASD, VSD and PDA are left-to-right shunts and therefore acyanotic; Tetralogy of Fallot is the classic right-to-left, cyanotic lesion.
Direction of shunt determines cyanosis: left-to-right (ASD/VSD/PDA) = acyanotic; right-to-left (TOF) = cyanotic.
Left-to-right shunts (ASD, VSD, PDA) are acyanotic; right-to-left lesions like TOF are cyanotic.
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A 45-year-old woman has a chest X-ray showing a widened mediastinum; CT confirms an ANTERIOR mediastinal mass. Which list correctly enumerates the classic differential ('four T's') for an anterior mediastinal mass?
Correct. The anterior mediastinal 'four T's' are Thymoma, Teratoma (germ-cell), Thyroid (retrosternal) and Terrible lymphoma — derived from the structures in that compartment.
Compartment predicts pathology: anterior = the four T's; middle = nodes/cysts; posterior = neurogenic tumours.
Neurogenic tumours are posterior; cysts and nodes are middle. The anterior 'four T's' are thymoma, teratoma, thyroid and lymphoma.
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A 66-year-old smoker has a peripheral, well-circumscribed lung mass. Biopsy confirms non-small-cell lung cancer (NSCLC); staging shows early-stage, resectable disease with no nodal or distant spread, and his lung function is adequate. What is the most appropriate principle of management?
Correct. Early-stage, resectable NSCLC in a fit patient is treated by surgical resection (lobectomy) with curative intent — the branch point being histology (NSCLC, not SCLC) and an early stage.
NSCLC, early/resectable stage, fit patient → curative surgical resection. SCLC → chemotherapy. Histology + stage drive the plan.
Surgery helps in NSCLC when the disease is resectable and the patient fit. SCLC, by contrast, is treated with chemotherapy. The decision turns on histology AND stage.
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A 65-year-old smoker presents with a changed cough, haemoptysis and weight loss; a central mass is suspected to be lung cancer. Which sequence correctly reflects the staging work-up that decides treatment?
Correct. The work-up answers three questions in turn — is there a tumour, what cell type, and how far has it spread — because only histology and stage together decide whether surgery, chemotherapy or radiotherapy applies.
Lung-cancer pathway: confirm tumour → histology (SCLC vs NSCLC) → stage (TNM) → treatment decision.
Investigation moves from confirming the tumour, to histology, to staging. Treatment is never decided before both histology and stage are known.
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