Free JCIE Cardiothoracic Surgery Section 1 Practice Questions

Sample Practice Questions

Try these 10 sample questions from the JCIE Cardiothoracic Surgery Section 1 practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1During cardiopulmonary bypass, a centrifugal arterial pump is running at a constant speed when venous return falls. Which pump characteristic explains the associated reduction in delivered flow?

   1. A.Preload dependenceCorrect answer: A
   2. B.Pressure independence
   3. C.Fixed stroke volume
   4. D.Afterload independence

   Explanation: The guideline states: "Centrifugal pumps are non-occlusive and are preload dependent and afterload-sensitive." Reduced venous filling reduces flow through a centrifugal pump. A fixed displacement per revolution cannot be assumed; neither pressure nor afterload independence describes this pump.

   Reference: 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery — Cardiopulmonary bypass—the disposables, Pumps

2. 2A patient is undergoing assessment before potentially curative lung cancer treatment. Which paired lung-function measurements should routinely be obtained?

   1. A.Peak flow and maximal voluntary ventilation
   2. B.Spirometry and carbon monoxide transfer factorCorrect answer: B
   3. C.Closing volume and nitrogen washout capacity
   4. D.Airway resistance and residual volume

   Explanation: The source states: "Perform spirometry and transfer factor (TLCO) in all people being considered for treatment with curative intent." Spirometry and TLCO assess airflow and gas transfer. The other pairs are genuine respiratory measurements but are not the routine pair specified for this assessment.

   Reference: NICE NG122 Lung cancer: diagnosis and management (SCTS copy) — Recommendation 1.4.13, p.12

3. 3A lung transplant recipient develops worsening renal function during maintenance immunosuppression. Which drug class is identified as a nephrotoxic mainstay of this therapy?

   1. A.Antimetabolites
   2. B.Glucocorticoids
   3. C.Calcineurin inhibitorsCorrect answer: C
   4. D.mTOR inhibitors

   Explanation: The source states: "nephrotoxic calcineurin inhibitors remain the mainstay of maintenance immunosuppression." The source specifically highlights calcineurin inhibitor nephrotoxicity. The other classes are real transplant immunosuppressants but are not the class identified by this mechanism and maintenance role.

   Reference: ISHLT Consensus document for selection of lung transplant candidates — Risk factors for poor post-transplant outcomes: Renal function

4. 4An adult has an ASD with Qp:Qs 1.8:1. Pulmonary vascular resistance remains 6 Wood units despite targeted PAH treatment. Under the ESC adult congenital guideline, how should ASD closure be classified?

   1. A.Class I: closure is recommended
   2. B.Class IIa: closure should be considered
   3. C.Class IIb: closure may be considered
   4. D.Class III: closure is not recommendedCorrect answer: D

   Explanation: The source states: "≥5 WU despite targeted treatments for PAH, Class III for ASD closure" Persistently high resistance falls in the Class III group, rather than the lower-resistance groups where closure is recommended or considered.

   Reference: ACC: 2020 ESC Guidelines for Adult Congenital Heart Disease, Key Points — Key point: ASD closure by pulmonary vascular resistance

5. 5A patient with postoperative septic shock remains hypotensive after initial fluid resuscitation. Which vasopressor is recommended first-line?

   1. A.Phenylephrine
   2. B.NorepinephrineCorrect answer: B
   3. C.Vasopressin
   4. D.Epinephrine

   Explanation: The source states: "Use norepinephrine as the first-line vasopressor" Norepinephrine is the initial vasopressor. Vasopressin is added when norepinephrine requirements increase, and epinephrine is a later agent.

   Reference: SCCM/ESICM 2026 Quick Guide for resuscitation and haemodynamic support in adult sepsis — Vasoactive agents: initial resuscitation

6. 6Before bypass, unfractionated heparin is administered. Which plasma protein mediates its principal anticoagulant action?

   1. A.Protein C
   2. B.AntithrombinCorrect answer: B
   3. C.Plasminogen
   4. D.Protein S

   Explanation: The guideline states: "Heparin binds to AT, thereby potentiating the inactivation of thrombin and factor Xa by antithrombin up to 1000-fold." Heparin potentiates antithrombin. Protein C and protein S belong to another anticoagulant pathway, while plasminogen is involved in fibrinolysis.

   Reference: 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery — Anticoagulation, Heparin management

7. 7A patient with normal gastric emptying is preparing for elective lung resection. Under the ERAS/ESTS fasting recommendation, what is the minimum interval between clear fluids and induction of anaesthesia?

   1. A.30 minutes
   2. B.1 hour
   3. C.2 hoursCorrect answer: C
   4. D.6 hours

   Explanation: The source states: "in patients without conditions associated with delayed gastric emptying, the intake of clear fluids up until 2 h before the induction of anaesthesia" Clear fluids are permitted until two hours before induction in this population. The six-hour interval pertains to solid food, while shorter intervals are not this recommendation.

   Reference: ERAS Society/ESTS Guidelines for enhanced recovery after lung surgery — Preoperative fasting and carbohydrate treatment

8. 8A lung transplant candidate has stopped smoking but still uses nicotine patches. Under the ISHLT abstinence requirement, when must nicotine replacement have ceased?

   1. A.Before lung transplantationCorrect answer: A
   2. B.Before post-transplant hospital discharge
   3. C.At the six-month post-transplant review
   4. D.At the first annual post-transplant review

   Explanation: The source states: "Lung transplant candidates must demonstrate abstinence from use of all tobacco and nicotine products (including nicotine replacement therapy) prior to transplant" The abstinence requirement includes replacement nicotine before transplantation. Discharge, six-month review and annual review are genuine later milestones but would defer cessation beyond the required point.

   Reference: ISHLT Consensus document for selection of lung transplant candidates — Psychosocial risk factors: Nicotine

9. 9A patient has a Fontan circulation and a documented atrial thrombus. Which antithrombotic strategy is indicated?

   1. A.Therapeutic anticoagulationCorrect answer: A
   2. B.Aspirin monotherapy
   3. C.Clopidogrel monotherapy
   4. D.Dual antiplatelet therapy

   Explanation: The source states: "Anticoagulation for patients with Fontan circulation is indicated in the presence, or with a history, of atrial thrombus, atrial arrhythmias, or thromboembolic events" The atrial thrombus is an explicit indication for anticoagulation. Antiplatelet strategies do not replace the indicated anticoagulant treatment.

   Reference: ACC: 2020 ESC Guidelines for Adult Congenital Heart Disease, Key Points — Key point: Fontan anticoagulation

10. 10After initial resuscitation for postoperative sepsis, perfusion remains impaired. Which assessment is recommended to decide whether further fluid is likely to increase cardiac output?

    1. A.Change in stroke volume during passive leg raiseCorrect answer: A
    2. B.Single central venous pressure measurement
    3. C.Single inferior vena cava diameter measurement
    4. D.Single pulmonary artery pressure measurement

    Explanation: The source states: "Assess fluid responsiveness using dynamic measures (e.g., change in stroke volume with passive leg raise or fluid bolus)" A reversible preload challenge with measured stroke-volume response tests responsiveness. A single static pressure or diameter cannot establish the dynamic response.

    Reference: SCCM/ESICM 2026 Quick Guide for resuscitation and haemodynamic support in adult sepsis — Persistent hypotension or elevated lactate: fluids