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CSHK Part 1 MCQ study materials
CSHK Part 1 MCQ study resources

CSHK Part 1 MCQ: Cardiothoracic Surgery: Thoracic Trauma, Pleural Disease and Cardiac Principles

CSHK Part 1 MCQ · Work through your exam, one topic at a time.

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Cardiothoracic Surgery: Thoracic Trauma, Pleural Disease and Cardiac Principles

Cardiothoracic Surgery tests thoracic trauma, pleural disease, lung cancer staging, and the principles of cardiac surgery. The MCQ often uses a physiological stem to test whether you prioritise a life-threatening diagnosis over imaging.

Core rules

  • Tension pneumothorax is a clinical diagnosis: respiratory distress, unilateral absent breath sounds, hypotension and distended neck veins. Needle decompression in the adult is performed at the fifth intercostal space in the anterior or mid-axillary line, or by finger thoracostomy, followed by a chest drain.
  • Cardiac tamponade: Beck triad (hypotension, raised JVP, muffled heart sounds) is insensitive; pulsus paradoxus and echocardiography are better. Pericardiocentesis is a bridge; definitive care is thoracotomy or sternotomy.
  • Massive haemothorax: more than 1500 mL drained immediately, or more than 200 mL/hour for 2 to 4 hours, is an indication for thoracotomy.
  • Lung cancer: NSCLC staging uses TNM. N2 is ipsilateral mediastinal nodal disease; N3 is contralateral mediastinal or supraclavicular disease. Stage I to II disease is treated by lobectomy with nodal sampling; SABR is an option for medically unfit stage I patients.
  • Coronary surgery: CABG improves survival in left main disease, three-vessel disease with left ventricular dysfunction, and diabetes with multivessel disease.
  • Aortic stenosis: severe when the valve area is below 1.0 cm², mean gradient exceeds 40 mmHg, or peak velocity exceeds 4 m/s.

Worked example

A 26-year-old man arrives after a stab wound to the left fifth intercostal space. BP is 82/50 mmHg, pulse 135/min, JVP elevated, heart sounds muffled, breath sounds equal bilaterally and the trachea central. FAST shows pericardial fluid.

Reasoning: equal breath sounds and a central trachea argue against tension pneumothorax. Hypotension, raised JVP and muffled heart sounds suggest tamponade. Immediate resuscitation and pericardiocentesis, followed by emergency thoracotomy, are required. Do not wait for a chest X-ray.

Traps

  • Tracheal deviation in tension pneumothorax is a late sign; never wait for it.
  • A small pneumothorax in a stable patient may be observed, but a tension pneumothorax is never managed according to size.
  • Lung cancer with malignant pleural effusion is M1a, not T4.
  • A chest drain is inserted in the safe triangle, not over the nipple or below the costal margin.