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100+ Free FRCS Cardiothoracic Practice Questions

Prepare for the Intercollegiate Specialty Fellowship Examination in Cardiothoracic Surgery (FRCS C-Th) exam with instant access — no signup required.

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Sample FRCS Cardiothoracic Practice Questions

Try these sample questions to test your FRCS Cardiothoracic exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 64-year-old man with stable angina has triple-vessel disease, a SYNTAX score of 35 and diabetes mellitus. According to contemporary ESC/EACTS guidance, which revascularisation strategy is most appropriate?
A.Coronary artery bypass grafting (CABG)
B.Percutaneous coronary intervention (PCI) with drug-eluting stents
C.Optimal medical therapy alone
D.Hybrid coronary revascularisation as first line
Explanation: In patients with complex multivessel disease (high SYNTAX score) and diabetes, CABG provides superior survival and freedom from repeat revascularisation compared with PCI, as shown by the SYNTAX and FREEDOM trials. Guidelines give CABG a Class I recommendation in this group.
2Which conduit is associated with the best long-term patency and survival benefit when grafted to the left anterior descending (LAD) artery during CABG?
A.Saphenous vein graft
B.Right gastroepiploic artery
C.Radial artery
D.Left internal mammary (thoracic) artery
Explanation: The left internal mammary artery (LIMA) to LAD graft has patency exceeding 90% at 10 years and confers a clear survival advantage, making it the gold-standard conduit. Its resistance to atherosclerosis underlies this durability.
3A 70-year-old undergoes off-pump CABG. Compared with on-pump CABG, which outcome is most consistently demonstrated for off-pump surgery in large randomised trials such as ROOBY and CORONARY?
A.Improved 5-year graft patency
B.Reduced perioperative transfusion requirement
C.Lower long-term mortality
D.Higher rate of complete revascularisation
Explanation: Off-pump CABG reduces transfusion needs and short-term blood loss by avoiding cardiopulmonary bypass. However, trials show no survival advantage and a tendency to fewer grafts and lower patency.
4Three days after CABG, a patient develops a new pansystolic murmur, hypotension and pulmonary oedema. Echocardiography shows a ventricular septal rupture. What is the most likely underlying cause?
A.Postpericardiotomy syndrome
B.Prosthetic valve dehiscence
C.Graft occlusion causing acute LAD territory infarction
D.Tamponade from a loculated effusion
Explanation: A post-infarction or perioperative myocardial infarction (often from early graft failure) can cause ventricular septal rupture, producing a new pansystolic murmur and acute cardiogenic shock with a left-to-right shunt. Urgent imaging and surgical/mechanical support planning are required.
5During harvesting of the internal mammary artery, which technique is most strongly associated with reduced risk of deep sternal wound infection, particularly in diabetic patients?
A.Pedicled harvest
B.Skeletonised harvest
C.Bilateral pedicled harvest
D.Harvest with diathermy of the pleura
Explanation: Skeletonised harvesting of the internal mammary artery preserves sternal collateral blood supply, reducing the risk of deep sternal wound infection, which is especially valuable when using bilateral IMA grafts in diabetic patients.
6A patient with an ejection fraction of 28% and viable but akinetic anterior myocardium is being considered for CABG. Which investigation best identifies myocardium that will recover function after revascularisation?
A.Resting transthoracic echocardiography
B.Dobutamine stress echocardiography or cardiac MRI viability imaging
C.Coronary angiography alone
D.Plasma BNP measurement
Explanation: Viability assessment with dobutamine stress echocardiography (contractile reserve) or cardiac MRI with late gadolinium enhancement identifies hibernating myocardium likely to recover after revascularisation, guiding the decision to offer CABG in poor ventricles.
7Which of the following is the most appropriate antiplatelet management for a patient on clopidogrel undergoing elective on-pump CABG?
A.Continue clopidogrel up to and including the day of surgery
B.Add prasugrel the night before surgery
C.Switch to ticagrelor 24 hours before surgery
D.Stop clopidogrel ideally 5 days before surgery
Explanation: Clopidogrel should ideally be stopped 5 days before elective CABG to reduce bleeding and transfusion requirements, balanced against ischaemic risk. Aspirin is generally continued perioperatively.
8A 58-year-old develops refractory cardiogenic shock immediately after weaning from cardiopulmonary bypass following CABG, with poor biventricular function on transoesophageal echocardiography. After optimising inotropes, which is the most appropriate next mechanical support measure?
A.Intra-aortic balloon pump (IABP)
B.Immediate cardiac transplantation
C.Permanent pacemaker insertion
D.Pericardiocentesis
Explanation: An intra-aortic balloon pump augments coronary perfusion and reduces afterload, and is the usual first-line mechanical support for post-cardiotomy low cardiac output when inotropes are insufficient. Escalation to VA-ECMO or a VAD follows if this fails.
9Which statement about the radial artery as a CABG conduit is correct?
A.It should be grafted to vessels with mild (<50%) stenosis to maximise flow
B.It is prone to vasospasm and benefits from calcium channel blocker prophylaxis
C.It has inferior patency to saphenous vein at 5 years
D.It is contraindicated when the Allen test is normal
Explanation: The radial artery is a muscular conduit prone to vasospasm; calcium channel blockers (e.g. diltiazem) are commonly given to reduce spasm. It performs best when grafted to vessels with high-grade (>70%) stenoses.
10A patient who underwent CABG 6 hours ago has chest drain output of 250 mL/h for 3 consecutive hours despite corrected coagulation. The most appropriate management is:
A.Continue observation with hourly bloods
B.Re-exploration of the chest in theatre
C.Administer further protamine
D.Insert a further chest drain
Explanation: Sustained mediastinal drainage of more than about 200 mL/h for several hours, or a sudden large output, with corrected coagulopathy indicates surgical bleeding requiring prompt re-exploration to identify and control the source and prevent tamponade.

About the FRCS Cardiothoracic Exam

The FRCS (C-Th) is the UK/Ireland intercollegiate specialty fellowship examination in cardiothoracic surgery administered by the JCIE. Section 1 is a written component of single best answer (and historically extended matching) papers delivered at Pearson VUE, while Section 2 comprises clinical and structured oral examinations. Candidates must hold a GMC- or Irish Medical Council-recognised qualification with at least six years of postgraduate experience.

Assessment

Section 1: two computer-based written papers (SBA, with EMI historically) at Pearson VUE. Section 2: structured clinical examinations and structured oral examinations (vivas) at UK/Ireland host centres.

Time Limit

Section 1: two papers of approximately 2 hours (Paper 1) and 2.5 hours (Paper 2); Section 2 is conducted over a clinical/oral assessment day.

Passing Score

Criterion-referenced; there is no fixed pass percentage. Trained examiners set the standard, including an eligibility-to-proceed mark for Section 1, benchmarked to the day-one consultant level in the generality of cardiothoracic surgery.

Exam Fee

Section 1 GBP 580 and Section 2 GBP 1,420 (total GBP 2,000) for examinations up to 31 December 2026; from 1 January 2027 the fees rise to GBP 600 (Section 1) and GBP 1,470 (Section 2), total GBP 2,070. (Joint Committee on Intercollegiate Examinations (JCIE))

FRCS Cardiothoracic Exam Content Outline

15%

Coronary artery surgery

Revascularisation decisions, conduit choice, on/off-pump CABG, antiplatelet management and post-infarction mechanical complications.

20%

Valvular heart surgery

Aortic and mitral pathology, repair vs replacement, prosthesis selection, TAVI vs SAVR, endocarditis and tricuspid disease.

10%

Aortic surgery

Dissection, aneurysms, root/arch/descending repair, TEVAR, Bentall procedure and cerebral/spinal cord protection.

9%

Congenital cardiac surgery

Transposition, tetralogy of Fallot, hypoplastic left heart, septal defects, coarctation and staged single-ventricle palliation.

20%

Thoracic surgery

Lung cancer resection and staging, oesophageal disease, pleural and mediastinal conditions, chest wall and trauma.

6%

Heart failure, transplantation and mechanical support

Transplant indications and rejection, LVADs, ECMO and destination therapy.

8%

Cardiopulmonary bypass and perioperative critical care

Bypass conduct, heparin/protamine, myocardial protection, low cardiac output and postoperative arrhythmia and bleeding.

12%

Applied basic science

Cardiothoracic anatomy, cardiovascular physiology, ischaemia-reperfusion, pharmacology and pathology.

How to Pass the FRCS Cardiothoracic Exam

What You Need to Know

  • Passing score: Criterion-referenced; there is no fixed pass percentage. Trained examiners set the standard, including an eligibility-to-proceed mark for Section 1, benchmarked to the day-one consultant level in the generality of cardiothoracic surgery.
  • Assessment: Section 1: two computer-based written papers (SBA, with EMI historically) at Pearson VUE. Section 2: structured clinical examinations and structured oral examinations (vivas) at UK/Ireland host centres.
  • Time limit: Section 1: two papers of approximately 2 hours (Paper 1) and 2.5 hours (Paper 2); Section 2 is conducted over a clinical/oral assessment day.
  • Exam fee: Section 1 GBP 580 and Section 2 GBP 1,420 (total GBP 2,000) for examinations up to 31 December 2026; from 1 January 2027 the fees rise to GBP 600 (Section 1) and GBP 1,470 (Section 2), total GBP 2,070.

Keys to Passing

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

FRCS Cardiothoracic Study Tips from Top Performers

1Anchor revision to the JCIE/ISCP cardiothoracic syllabus and weight your effort toward the high-yield valvular, coronary and thoracic surgery domains.
2Practise applied SBA vignettes that test management decisions (revascularisation strategy, valve choice, dissection management) rather than pure recall, because the written papers emphasise clinical reasoning.
3Integrate guideline thresholds (ESC/EACTS valve and aortic criteria) with applied basic science such as bypass physiology, myocardial protection and cardiothoracic anatomy.

Frequently Asked Questions

Who administers the FRCS Cardiothoracic exam?

It is administered by the Joint Committee on Intercollegiate Examinations (JCIE) on behalf of the four UK and Irish surgical royal colleges, leading to the FRCS (C-Th) fellowship.

How is the FRCS Cardiothoracic exam structured?

Section 1 is a written component of computer-based single best answer papers (with extended matching items historically) delivered at Pearson VUE, and Section 2 comprises structured clinical examinations and structured oral examinations (vivas).

How much does the FRCS Cardiothoracic exam cost?

For exam diets up to 31 December 2026 the fee is GBP 580 for Section 1 and GBP 1,420 for Section 2 (GBP 2,000 total). From 1 January 2027 the fees rise to GBP 600 and GBP 1,470 (GBP 2,070 total).

What is the pass standard for Section 1?

There is no fixed pass percentage. Examiners use criterion-referenced standard setting to determine an eligibility-to-proceed mark, benchmarked to the level expected of a day-one consultant in the generality of cardiothoracic surgery.