Trial Written Exam April 2023

Section 2: 3 Questions. 30 minutes

A 56-year-old man is brought in by ambulance to ED with angina and shortness of breath whilst exercising in his home gym. He is diagnosed with a NSTEMI and acute pulmonary oedema, which settle with medical therapy. Coronary angiography demonstrates a 70% left main stenosis and severe triple-vessel disease. Echocardiography reveals an LV ejection fraction of 35% with moderate ischaemic mitral regurgitation. RVSP 32mmHg.

He is presented at your hospital’s cardiac cath conference for consideration of surgery.

Background:

Obese 105k/178cm. BMI 33

Current smoker (35 pack year history).

Social drinker

No regular medications prior to admission.

Question 6

Present your opinion as you would at the cath conference. Describe your opinion of the surgical options, whether further investigation is required, and how you would plan the timing of intervention.

Question 7

You are consenting the patient for surgery. What issues specific to his situation would you explain to him? Describe the likely, and possible, operative course and postoperative outcomes as you would to this patient.

Question 8

You have completed the cardiac operative steps and have removed the crossclamp. Describe your management of the weaning phase of this operation, including possible variations in the course of the wean. Once weaned, and closure performed, what would you expect to hand over to intensive care about ongoing management?

Name

First Name

Last Name

Section 1: Questions 1-5

Section 2: Questions 6-8

Section 3: Questions 9-10

Section 4: Question 11

Section 5: Question 12-14

Section 6: Question 15