10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free CVTS questions are organized by exam domain, so you can see how each part of the Certificate of Added Qualifications in Cardiovascular and Thoracic Surgery blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Cardiac 38% of exam
Question 1
Four hours after CABG, a patient develops hypotension and a narrowing pulse pressure. Central venous pressure rises from 8 to 19 mm Hg as cardiac index falls from 2.6 to 1.5 L/min/m². Mediastinal drainage, previously 120 mL/h, has nearly stopped. Breath sounds remain bilateral. A technically limited transthoracic echocardiogram shows no large circumferential effusion. Which complication best accounts for this deterioration?
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Correct answer: C - Regional tamponade from retained pericardial blood
Question 2
A 61-year-old man with a flail posterior mitral leaflet reports no exercise limitation. Echocardiography shows an effective regurgitant orifice area of 0.46 cm², a regurgitant volume of 72 mL/beat, an LVEF of 58%, and an LV end-systolic diameter of 43 mm. He has low operative risk, and durable repair is considered highly likely. Which recommendation follows from these findings?
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Correct answer: D - Recommend mitral repair before further LV dysfunction develops
Question 3
At a follow-up visit, a 57-year-old woman with a mechanical mitral valve and persistent atrial fibrillation asks to replace warfarin with a medication that does not require INR testing. Her renal function is normal, INR control has been stable, and she has had no bleeding. Which long-term regimen remains appropriate for her prosthesis?
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Correct answer: C - Warfarin with an INR target of 3.0 and a range of 2.5-3.5
Question 4
A new harsh holosystolic murmur and shock develop 4 days after an inferior myocardial infarction. During right-heart catheterization, oxygen saturation is 62% in the right atrium, 81% in the right ventricle, and 80% in the pulmonary artery. Which structural failure explains the oxygen-saturation pattern?
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Correct answer: B - Postinfarction rupture of the interventricular septum
Domain 2: Thoracic 28% of exam
Question 5
Staging studies for a biopsy-proven 2.6-cm right upper-lobe adenocarcinoma show an FDG-avid, 1.4-cm subcarinal lymph node. PET/CT shows no distant disease, and brain MRI is negative. The patient has adequate cardiopulmonary reserve for resection. What would most directly resolve the nodal uncertainty before a definitive treatment plan is chosen?
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Correct answer: A - EBUS-guided needle sampling of mediastinal nodes
Question 6
Before a proposed right upper lobectomy, a patient has an FEV₁ of 84% predicted and a hemoglobin-corrected DLCO of 38% predicted. All 19 pulmonary segments are functioning, and the planned resection removes 3 segments. Using a segment-based estimate and the 2025 ERS/ESTS risk categories, which interpretation should guide the remaining operative assessment?
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Correct answer: B - Predicted postoperative DLCO is 32%; further exercise-based risk assessment is needed
Domain 3: Vascular 10% of exam
Question 7
An emergency examination of a leg with 4 hours of sudden pain reveals a cool, pale foot, sensory loss extending beyond the toes, and new weakness of ankle dorsiflexion. Arterial Doppler signals are absent, but venous signals remain audible. There is no rigor or fixed mottling. The patient has no contraindication to heparin. How should the limb be classified and managed?
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Correct answer: B - Rutherford IIb: IV heparin; immediate revascularization
Question 8
A vascular laboratory reports a right ankle-brachial index of 1.56 in a man with diabetes and chronic kidney disease. He describes reproducible right calf pain with walking that resolves after several minutes of rest, and his pedal pulses are diminished. He has no rest pain or tissue loss. Which test should clarify whether the apparently elevated ABI is masking arterial occlusive disease?
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Correct answer: A - Toe pressure and toe-brachial index with waveforms
Domain 4: Critical Care 19% of exam
Question 9
The platelet count after on-pump CABG falls from 252 ×10⁹/L preoperatively to 118 ×10⁹/L on day 2, recovers to 226 ×10⁹/L on day 4, and falls again to 82 ×10⁹/L on day 7. Duplex ultrasonography now confirms a proximal leg DVT. The patient is receiving unfractionated heparin prophylaxis, has no active bleeding, and has normal hepatic function. No alternative cause of the second platelet fall is identified. While HIT testing is pending, the anticoagulation orders should be changed to:
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Correct answer: B - Therapeutic argatroban, with all heparin products discontinued
Question 10
An obese woman is intubated for ARDS after aspiration. Her actual weight is 100 kg, but her height-based predicted body weight is 55 kg. On volume-control ventilation, tidal volume is 600 mL, PEEP is 8 cm H₂O, and plateau pressure is 34 cm H₂O. Her pH is 7.33. Which tidal-volume target best follows the ARDS Network low-tidal-volume strategy?
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Correct answer: D - Reduce to 330 mL and reassess plateau pressure