Free CHS Practice Questions

Question 1

A term newborn with d-transposition of the great arteries and an intact ventricular septum remains profoundly hypoxemic during alprostadil infusion. Echocardiography shows a widely patent ductus, a 1-mm interatrial communication with a high-velocity jet, and preserved ventricular function. Blood pressure and peripheral perfusion remain satisfactory. The catheterization team is available while arterial switch surgery is being arranged. Which intervention addresses the immediate physiological bottleneck?

Accepted Answer

Perform balloon atrial septostomy.

Answer

Increase alprostadil to augment mixing through the arterial duct.

Answer

Add inhaled nitric oxide to lower pulmonary vascular resistance.

Answer

Establish venoarterial ECMO before attempting atrial intervention.

Question 2

Serial echocardiograms in a 6-year-old show that a doubly committed juxtaarterial ventricular septal defect appears smaller than it did two years earlier. The right coronary cusp now protrudes into the defect, and previously trivial aortic regurgitation has become moderate. Qp:Qs is only 1.2:1, and the child has no heart-failure symptoms. How should the apparently smaller shunt influence management?

Accepted Answer

It should not delay surgical assessment of progressive cusp prolapse and regurgitation.

Answer

It supports continued observation until the left-to-right shunt reaches 1.5:1.

Answer

It makes isolated aortic valve repair preferable to closing the ventricular defect.

Answer

It supports transcatheter defect closure without addressing the prolapsing aortic cusp.

Question 3

After a Warden repair, new facial edema and distended neck veins prompt catheterization. Mean pressure is 21 mmHg in the upper SVC but only 6 mmHg in the right atrium. There is no pulmonary edema, and ventricular function is normal. Where is the most likely repair-related problem?

Accepted Answer

Stenosis of the SVC-to-right-atrial-appendage anastomosis

Answer

Obstruction of the pulmonary venous baffle entering the left atrium

Answer

A substantial residual left-to-right communication across the atrial septum

Answer

Severe tricuspid regurgitation caused by distortion of the right atrium

Question 4

For a neonate with pulmonary atresia and an intact ventricular septum, imaging shows membranous valvar atresia, a usable tripartite right ventricle, and an adequately sized tricuspid valve. Ventriculocoronary communications are present. Selective angiography demonstrates patent coronary ostia and proximal arteries, with aortic perfusion of every major myocardial territory and no proximal coronary stenosis. At the operative conference, which conclusion is justified?

Accepted Answer

The coronary communications do not, by themselves, preclude right ventricular decompression.

Answer

A shunt-only strategy is required to preserve coronary perfusion from the pressurized right ventricle.

Answer

A biventricular pathway requires surgical closure of the coronary communications before right ventricular decompression.

Answer

The tripartite ventricular morphology establishes decompression safety independently of the coronary findings.

Question 5

After a Norwood operation with a systemic-to-pulmonary artery shunt, an infant has falling diastolic blood pressure, oliguria, and a rising lactate. During a steady-state hemodynamic assessment, systemic arterial and pulmonary arterial saturations are both 84%, representative mixed systemic venous saturation is 48%, and pulmonary venous saturation is 96%. Hemoglobin concentration is uniform, dissolved oxygen is negligible, and ventricular mixing is complete. Which Qp:Qs estimate and interpretation fit these findings?

Accepted Answer

3:1; excessive pulmonary blood flow is compromising systemic perfusion.

Answer

1:3; inadequate pulmonary blood flow is the main cause of the impaired systemic perfusion.

Answer

4:1; the systemic arteriovenous oxygen difference should use pulmonary venous saturation as its arterial value.

Answer

3:1; the arterial saturation above 80% indicates that systemic oxygen delivery is satisfactory.

Question 6

A 10-week-old infant cries abruptly during feeds, becomes pale and diaphoretic, and then stops feeding. Echocardiography shows a dilated, poorly contracting left ventricle, moderate mitral regurgitation without leaflet dysplasia, and an unusually echogenic anterolateral papillary muscle. The ECG has deep, broad Q waves in leads I, aVL, V5, and V6. The left coronary origin was not confidently visualized. Which diagnosis best unifies this pattern?

Accepted Answer

Anomalous origin of the left coronary artery from the pulmonary artery

Answer

Acute myocarditis with secondary functional mitral regurgitation

Answer

Primary dilated cardiomyopathy with secondary functional mitral regurgitation

Answer

Congenital mitral valve dysplasia with secondary left ventricular volume overload

Question 7

In severe neonatal Ebstein anomaly, the ductus carries aortic blood into the pulmonary artery. Severe pulmonary and tricuspid regurgitation return much of this blood to the right atrium, then across an unrestricted atrial communication to the left heart. Name the resulting hemodynamic lesion.

Accepted Answer

Circular shunting through the incompetent pulmonary and tricuspid valves

Answer

Isolated ductal pulmonary overcirculation with increased pulmonary venous return

Answer

Right-to-left ductal shunting that bypasses the pulmonary capillary bed

Answer

Restricted atrial egress that traps systemic venous blood in the right atrium

Question 8

Which reconstruction replaces an irreparable aortic valve with a pulmonary autograft while also enlarging a markedly hypoplastic annulus and a long, narrow subannular tunnel? Assume adequate ventricles and a normal pulmonary valve.

Accepted Answer

Pulmonary autograft root replacement with Konno enlargement

Answer

Isolated pulmonary autograft replacement of the aortic root

Answer

Surgical aortic valvotomy with limited resection of subaortic fibrous tissue

Answer

Mechanical aortic valve replacement without enlargement of the annulus

Question 9

A 26-year-old who underwent tetralogy of Fallot repair with a transannular patch reports progressive exertional fatigue. Serial cardiopulmonary exercise tests confirm declining capacity. CMR shows severe pulmonary regurgitation, RV end-diastolic volume index 150 mL/m², RV end-systolic volume index 90 mL/m², and RV ejection fraction 40%. Rhythm monitoring shows no sustained tachyarrhythmia, and there is no important residual RV outflow obstruction. What is the appropriate direction of treatment?

Accepted Answer

Plan pulmonary valve replacement using the combined symptoms, exercise findings, and ventricular measurements.

Answer

Continue surveillance until the RV end-diastolic volume index exceeds 160 mL/m².

Answer

Prioritize a primary-prevention defibrillator over valve intervention because the RV ejection fraction is 40%.

Answer

Defer valve intervention in favor of medical therapy until the RV ejection fraction falls below 35%.

Question 10

On postoperative day 3 after complete atrioventricular septal defect repair, an infant remains in complete AV block. Temporary epicardial AV-sequential pacing provides reliable capture and good perfusion. During supervised checks, the ventricular escape rate is 48/min. There is no residual structural lesion or evidence of extensive conduction-system destruction. Choose the pacing plan for this stage of recovery.

Accepted Answer

Continue temporary AV-sequential pacing with repeated assessment for recovery of AV conduction.

Answer

Implant a permanent epicardial pacemaker now because complete block has lasted longer than 48 hours.

Answer

Plan four weeks of temporary pacing before evaluating the need for permanent pacemaker implantation.

Answer

Wean ventricular pacing because the appearance of an escape rhythm demonstrates recovery of AV conduction.

Free CHS Practice Questions

Domain 1: Basics of the Supervisor Role

Question 1

Domain 2: Leadership

Question 2

Domain 3: Time Management

Question 3

Domain 4: Effective Communication

Question 4

Domain 5: Handling Problems and Conflict

Question 5

Domain 6: Conducting Orientation and Training

Question 6

Domain 7: Motivation and Team Building

Question 7

Question 8

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