Free Practice Questions for Saudi Board Cardiac Surgery

Exam-style questions and explanations by OpenExamPrep.

✓ No registration✓ No credit card

100+ Questions

100% Free

Loading practice questions...

Same family resources

Explore More Saudi Board Specialty Exams

Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.

Sample Saudi Board Cardiac Surgery Practice Questions

Try these sample questions to review concepts for the Saudi Board Cardiac Surgery exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 66-year-old male who underwent uneventful triple vessel coronary artery bypass grafting 4 hours ago suddenly becomes tachycardic (125 bpm) and hypotensive (75/45 mmHg). Central venous pressure has risen from 9 mmHg to 20 mmHg, and mean arterial pressure fails to respond to volume boluses. The mediastinal chest tube output, which had been 150 mL/h for the first 3 hours, abruptly dropped to zero over the past 30 minutes. What is the most appropriate next step in management?

A.Strip and vigorously milk the chest drainage tubes using high-pressure roller clamps

B.Administer a 500 mL bolus of 5% albumin and double the norepinephrine infusion rate

C.Perform immediate bedside reopening of the sternotomy in the intensive care unit

D.Order a stat portable chest computed tomography angiogram to locate bleeding

Explanation: The clinical presentation of abrupt cessation of chest tube drainage accompanied by acute hypotension, tachycardia, and a dramatic rise in central venous pressure is classic for acute cardiac tamponade due to clotted mediastinal drainage tubes. In an acutely decompensating postoperative cardiac patient, immediate resternotomy in the intensive care unit is life-saving and takes precedence over transport or delayed diagnostic studies. Relieving pericardial tension restores cardiac venous return and ventricular filling.

2A 58-year-old female with end-stage renal disease on hemodialysis undergoes aortic valve replacement for severe infective endocarditis. Following separation from cardiopulmonary bypass, she develops severe vasoplegic syndrome with a systemic vascular resistance index of 600 dynes·s/cm⁵/m² despite high-dose norepinephrine (0.3 mcg/kg/min) and vasopressin (0.04 units/min). Administration of methylene blue is considered. What is the primary cellular mechanism of action of methylene blue in refractory vasoplegia?

A.Direct stimulation of vascular smooth muscle alpha-1 adrenergic receptors

B.Activation of the endothelin-1 receptor complex on vascular smooth muscle

C.Blockade of vascular endothelial prostacyclin (PGI2) synthesis

D.Inhibition of soluble guanylyl cyclase and inducible nitric oxide synthase

Explanation: Vasoplegic syndrome during cardiac surgery is mediated by excessive nitric oxide (NO) generation via inducible nitric oxide synthase (iNOS), leading to activation of soluble guanylyl cyclase (sGC) and increased cyclic GMP (cGMP), which causes profound vascular smooth muscle relaxation. Methylene blue acts as an inhibitor of both soluble guanylyl cyclase and nitric oxide synthase, thereby halting the cGMP pathway and restoring vascular tone.

3On postoperative day 6 following mitral valve replacement, a 62-year-old male develops sudden left calf swelling and pain. His platelet count has dropped from 220,000/mcL at baseline to 85,000/mcL. Venous duplex ultrasonography confirms an occlusive deep vein thrombosis. A diagnosis of Heparin-Induced Thrombocytopenia (HIT) Type II is suspected with a 4T score of 7. Which of the following is the most appropriate immediate anticoagulation strategy?

A.Discontinue all heparin products and initiate therapeutic-dose bivalirudin or argatroban

B.Discontinue unfractionated heparin and initiate low-molecular-weight heparin at therapeutic doses

C.Immediately initiate high-dose warfarin and transfuse one unit of single-donor platelets

D.Continue unfractionated heparin and add therapeutic fondaparinux until platelets recover

Explanation: In confirmed or high-probability HIT Type II (4T score 6–8), all heparin exposures (including flushes, heparin-coated lines, and LMWH) must be immediately ceased. A non-heparin direct thrombin inhibitor (such as bivalirudin or argatroban) must be initiated at therapeutic dosing to prevent catastrophic arterial and venous thromboses.

4A 71-year-old female is in the ICU following complex redo aortic root replacement. She has persistent hypotension and oliguria. A pulmonary artery catheter reveals: Central Venous Pressure (CVP) 18 mmHg, Mean Pulmonary Artery Pressure 22 mmHg, Pulmonary Capillary Wedge Pressure (PCWP) 9 mmHg, Cardiac Index 1.7 L/min/m², and Systemic Vascular Resistance 1400 dynes·s/cm⁵. Echocardiography shows a dilated, hypokinetic right ventricle with severe tricuspid regurgitation and an underfilled left ventricle. Which of the following is the most appropriate hemodynamic intervention?

A.Initiate inhaled epoprostenol and milrinone while avoiding excessive fluid loading

B.Infuse a 1,000 mL bolus of balanced crystalloid to restore left ventricular preload

C.Initiate high-dose phenylephrine to raise systemic afterload above pulmonary pressures

D.Place an intra-aortic balloon pump to directly offload the failing right ventricle

Explanation: The hemodynamic profile demonstrates isolated right ventricular (RV) failure: elevated CVP (18 mmHg) with normal/low PCWP (9 mmHg), depressed cardiac index, and echocardiographic RV dilatation. Inhaled epoprostenol (or inhaled nitric oxide) reduces pulmonary vascular resistance without causing systemic hypotension, and milrinone provides inotropic support to the RV alongside pulmonary vasodilation. Volume loading an already distended RV worsens ventricular interdependence and further compromises LV filling.

5A 64-year-old male with poorly controlled type 2 diabetes mellitus (HbA1c 9.8%) and severe triple vessel disease is evaluated for coronary artery bypass grafting. When planning conduit selection and sternal closure to minimize the risk of deep sternal wound infection (DSWI), which strategy is supported by clinical guidelines?

A.Harvesting bilateral internal thoracic arteries using pedicled technique with standard wire closure

B.Harvesting bilateral internal thoracic arteries combined with routine prolonged 14-day prophylactic vancomycin

C.Harvesting the left internal thoracic artery skeletonized and utilizing rigid plate fixation for sternal closure

D.Avoiding internal thoracic arteries entirely and using only saphenous vein grafts

Explanation: In diabetic patients, skeletonization of the internal thoracic artery preserves collateral blood flow to the chest wall via intercostal branches, significantly reducing sternal ischemia compared to pedicled harvest. Furthermore, rigid plate sternal fixation provides superior biomechanical stability over standard wire cerclage in high-risk patients (e.g., diabetics, obesity), reducing sternal dehiscence and DSWI.

6Following uncomplicated aortic valve replacement, protamine sulfate is administered via a peripheral vein over 3 minutes. Two minutes into the infusion, the patient develops profound systemic hypotension (50/30 mmHg), an acute rise in pulmonary artery systolic pressure from 28 mmHg to 62 mmHg, and severe right ventricular dilatation visible in the surgical field. What type of protamine adverse reaction has occurred, and what is the immediate management?

A.Type I hypotension due to rapid infusion; treat by slowing the infusion rate and giving calcium chloride

B.Type IIb cytotoxic antibody reaction; initiate immediate plasmapheresis in the operating room

C.Type II anaphylactoid reaction; administer high-dose hydrocortisone and continue protamine at half speed

D.Type III pulmonary vasoconstriction; stop protamine and give pulmonary vasodilators

Explanation: Protamine reactions are classified into three types: Type I is mild systemic hypotension from rapid injection causing histamine release; Type II is an IgE- or IgG-mediated anaphylactic/anaphylactoid reaction; and Type III is catastrophic pulmonary vasoconstriction mediated by thromboxane A2 and complement activation, presenting with acute pulmonary hypertension, RV failure, and systemic collapse. Immediate management requires stopping protamine, administering pulmonary vasodilators/inotropes, and re-establishing CPB if the patient does not immediately respond.

7A 69-year-old male develops acute kidney injury on postoperative day 1 after urgent double valve replacement. His baseline serum creatinine was 1.1 mg/dL, and his current creatinine is 2.4 mg/dL with a urine output of 0.3 mL/kg/h for the past 8 hours. Cardiopulmonary bypass (CPB) duration was 165 minutes with a nadir hematocrit of 19% and mean arterial pressure maintained between 50 and 55 mmHg. Which factor is most strongly associated with the development of post-cardiac surgery AKI in this setting?

A.Severe haemodilution (nadir Hct <21%) with low perfusion pressure

B.Use of tranexamic acid during cardiopulmonary bypass

C.Preoperative administration of oral aspirin within 24 hours of surgery

D.Maintenance of systemic normothermia during the entire bypass run

Explanation: Renal oxygen delivery during cardiopulmonary bypass is the product of pump flow rate and arterial oxygen content (governed primarily by hematocrit). Severe hemodilution (nadir hematocrit <21-22%) combined with low perfusion pressure (<60 mmHg) results in renal medullary dysoxia and acute tubular necrosis, representing a major modifiable risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI).

8A 74-year-old male who underwent urgent repair of an acute Stanford Type A aortic dissection has persistent microvascular bleeding (400 mL/h) from chest tubes despite normal activated clotting time (ACT 115 seconds). A bedside Thromboelastography (TEG) is performed with the following results: Reaction time (R) = 14 minutes (reference 5–10 min), K time = 4.2 minutes (reference 1–3 min), Alpha angle = 41 degrees (reference 53–72°), Maximum Amplitude (MA) = 59 mm (reference 50–70 mm), and Ly30 = 1.2% (reference <3%). Which blood product should be administered first based on this TEG profile?

A.Fresh Frozen Plasma (FFP)

B.Single-donor apheresis platelets

C.Cryoprecipitate

D.Intravenous tranexamic acid bolus

Explanation: On TEG, the reaction time (R) reflects the latency from test initiation to the initial formation of measurable fibrin and is primarily dependent on soluble coagulation factors. A prolonged R time (>10 minutes) with normal activated clotting time indicates deficiency or dilution of clotting factors and is corrected by administering Fresh Frozen Plasma (or prothrombin complex concentrates).

9Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery. Which statement accurately describes its epidemiology and evidence-based prevention according to current clinical guidelines?

A.Peak incidence occurs within the first 6 hours following intensive care unit admission

B.Routine preoperative initiation of amiodarone is mandatory for all patients undergoing coronary surgery

C.Continuation or early reinstitution of beta-blockers is the most effective pharmacologic prophylaxis

D.Digoxin is the primary recommended prophylactic agent to maintain sinus rhythm postoperatively

Explanation: Postoperative atrial fibrillation occurs in 20–40% of adult cardiac surgical patients, with peak incidence typically between postoperative days 2 and 3. Guidelines from the STS and EACTS strongly endorse the continuation or prompt restart of oral beta-blockers as first-line prophylaxis to prevent POAF in all patients without contraindications.

10An intra-aortic balloon pump (IABP) is inserted in a patient with post-cardiotomy low cardiac output syndrome. To achieve optimal hemodynamic benefit and avoid adverse cardiac loading, what is the precise mechanical timing of balloon deflation?

A.Immediately at the dicrotic notch of the central aortic pressure waveform

B.Simultaneously with the onset of the P wave on the surface electrocardiogram

C.At mid-systole when peak left ventricular ejection velocity is reached

D.Immediately prior to opening of the aortic valve during isovolumetric contraction

Explanation: Optimal IABP deflation occurs immediately before the onset of left ventricular ejection (at the end of isovolumetric contraction, corresponding to the physiological opening of the aortic valve or the nadir of aortic end-diastolic pressure). This creates a vacuum effect in the ascending aorta, drastically reducing afterload, LV myocardial wall stress, and myocardial oxygen consumption.

About the Saudi Board Cardiac Surgery Exam

Independent English-language MCQ study adaptation by OpenExamPrep. Independent practice resource by OpenExamPrep for the Saudi Board Final Written Examination in Cardiac Surgery. Covers principles of cardiac surgical care, coronary artery disease revascularization, valvular heart disease, thoracic aortic surgery, surgical management of heart failure, pacemaker/ICD/EP surgery, tumors and pericardial disease, congenital cardiac surgery, and cardiopulmonary bypass and cardioplegia. Note: This question bank is an independent study aid for the final written examination and does not simulate the separate clinical OSCE and structured oral examination required for final board certification. OpenExamPrep is not affiliated with or endorsed by the Saudi Commission for Health Specialties (SCFHS).

Exam sponsor: Saudi Commission for Health Specialties (SCFHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

Time Limit

Not published by SCFHS

Passing Score

70% (lowered to minimum 65% if pass rate under 70%)

Exam / Certification Fees

Not published by SCFHS

Exam sponsor website

Reported exam pass rate: Not published by SCFHS. SCFHS publishes no candidate pass rate. The blueprint instead sets the passing score at 70% and, if fewer than 70% of candidates pass before final approval, lowers that score one mark at a time until a 70% pass rate is reached or the score reaches 65%, whichever comes first; it is never lowered below 65%. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

16%

Principles of Cardiac Surgical Care

Preoperative evaluation, intensive care management, hemodynamics, surgical complications, and pharmacology.

16%

Adult Cardiac Surgery - Coronary

Coronary artery disease, CABG indications, conduit selection, off-pump surgery, and mechanical complications of MI.

16%

Adult Cardiac Surgery - Valvular

Aortic, mitral, tricuspid, and pulmonary valve disease pathology, repair techniques, and prosthetic replacement.

Adult Cardiac Surgery - Aorta

Thoracic aortic aneurysms, acute aortic syndromes, dissection classifications, root reconstruction, and endovascular repair.

11%

Surgery for Heart Failure

Advanced heart failure, mechanical circulatory support, durable LVADs, ECMO, and orthotopic heart transplantation.

Pacemaker/ICD/EP Surgery

Cardiac pacing, implantable cardioverter-defibrillators, lead extraction, and surgical ablation for atrial fibrillation.

Tumors and Pericardial Disease

Primary cardiac tumors, myxomas, fibroelastomas, acute pericarditis, tamponade, and constrictive pericarditis.

15%

Congenital Cardiac Surgery

Acyanotic and cyanotic congenital defects, shunts, outflow tract obstructions, and single ventricle palliation.

CPB and Cardioplegia

Extracorporeal circuit components, cannulation strategies, systemic heparinization, hypothermia, and myocardial protection.

Preparing for the Saudi Board Cardiac Surgery Exam

What You Need to Know

Passing score: 70% (lowered to minimum 65% if pass rate under 70%)
Assessment: Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.
Time limit: Not published by SCFHS
Exam / certification fees: Not published by SCFHS Official sources

Using Our Practice Resources

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Saudi Board Cardiac Surgery: Suggested Study Strategy

1Review hemodynamic profiles in post-cardiotomy low cardiac output syndrome, differentiating right versus left ventricular failure and vasoplegia.

2Master coronary revascularization guidelines and anatomy, including arterial conduit selection (LIMA, BIMA, radial) and contraindications.

3Understand the timing and operative thresholds for valve repair and replacement in severe aortic and mitral regurgitation or stenosis.

4Familiarize yourself with Stanford Type A versus Type B dissection emergency algorithms and surgical cerebral protection strategies during aortic arch repair.

5Study congenital heart lesion anatomy, physiology of mixing and shunting, and staged single-ventricle palliation steps.

Frequently Asked Questions

What is the format of the Saudi Board Cardiac Surgery Final Written Examination?

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

What is the passing score for the Saudi Board Cardiac Surgery Final Written Examination?

The passing standard is set at 70%. If the overall pass rate among candidates falls below 70%, the passing score is adjusted downward one mark at a time until reaching a 70% candidate pass rate, with an absolute floor of 65%.

Does this question bank simulate the clinical OSCE component?

This bank is an independent English-language MCQ study adaptation for the written examination. It does not simulate or replace the separate mandatory final clinical/practical assessment. Consult the specialty clinical blueprint for its station formats and any structured oral or OSCE components.

Who administers the Saudi Board Cardiac Surgery certification?

The examination and specialty certification are administered by the Saudi Commission for Health Specialties (SCFHS). OpenExamPrep is an independent educational platform and is not affiliated with or endorsed by SCFHS.

Free Practice Questions for Saudi Board Cardiac Surgery

Explore More Saudi Board Specialty Exams

Saudi Board Anesthesia Final Written Exam (SCFHS)

Saudi Board Emergency Medicine Final Written Exam (SCFHS)

Saudi Board Dermatology Final Written Exam (SCFHS)

Saudi Board Orthopedic Surgery Final Written Exam (SCFHS)

Saudi Board Diagnostic Radiology Final Written Exam (SCFHS)

Saudi Board Family Medicine Final Written Exam (SCFHS)