CVP Basic Exam Questions with Detailed Answer
Key For 2026–2027 Examination | A+ Solutions.
DOMAIN 1: ANATOMY OF THE HEART, LUNGS & GREAT VESSELS (15 Questions)
Sub-Topic 1A: Cardiac Chambers, Valves & Flow Pathway (5 Questions)
Question 1 (MC) — A 68-year-old patient is undergoing preoperative evaluation for mitral valve
replacement. During auscultation, the perfusionist notes that the mitral valve closes during
ventricular systole to prevent backflow. Which chamber receives the blood ejected through the
open aortic valve immediately following mitral valve closure?
A) Right atrium
B) Left atrium
C) Ascending aorta
D) Pulmonary trunk
Answer: C) Ascending aorta [CORRECT]
Rationale: During ventricular systole, the mitral valve closes to prevent regurgitation into the
left atrium, while the aortic valve opens simultaneously due to the pressure gradient generated
by left ventricular contraction. Blood is ejected from the left ventricle through the open aortic
valve into the ascending aorta. This represents the completion of the left-sided cardiac cycle and
the beginning of systemic arterial perfusion. The ascending aorta then distributes oxygenated
blood to the coronary arteries (via the right and left coronary ostia) and to the systemic
circulation via the aortic arch and descending aorta.
Question 2 (MC) — During a transesophageal echocardiography (TEE) examination prior to
CABG, the perfusionist observes the tricuspid valve. Which statement correctly describes the
anatomical pathway of deoxygenated blood as it passes through the right side of the heart?
A) Blood flows from the superior vena cava → right ventricle → tricuspid valve → pulmonary
artery
B) Blood flows from the right atrium → tricuspid valve → right ventricle → pulmonary valve →
pulmonary trunk
C) Blood flows from the inferior vena cava → pulmonary valve → right atrium → right ventricle
,→ lungs
D) Blood flows from the coronary sinus → right ventricle → tricuspid valve → pulmonary veins
Answer: B) Blood flows from the right atrium → tricuspid valve → right ventricle →
pulmonary valve → pulmonary trunk [CORRECT]
Rationale: The correct anatomical pathway for deoxygenated blood through the right heart is:
systemic venous return (SVC/IVC/coronary sinus) → right atrium → tricuspid (atrioventricular)
valve → right ventricle → pulmonary (semilunar) valve → pulmonary trunk → right and left
pulmonary arteries → lungs. The tricuspid valve, composed of three leaflets (anterior, posterior,
and septal), prevents backflow into the right atrium during ventricular systole. The pulmonary
valve, with three semilunar cusps (anterior, left, and right), prevents backflow into the right
ventricle during diastole. This pathway is critical for perfusionists to understand when managing
venous cannulation and assessing right heart function during CPB weaning.
Question 3 (SATA) — A perfusion student is reviewing the structural components of the cardiac
valves. Which of the following statements correctly describe the anatomical features of the
atrioventricular (AV) valves? (Select all that apply)
A) The mitral valve has two leaflets (anterior and posterior) and is anchored by chordae
tendineae to papillary muscles in the left ventricle
B) The tricuspid valve has three leaflets and is located between the right atrium and right
ventricle
C) The AV valves open passively during ventricular systole due to pressure generated by atrial
contraction
D) The chordae tendineae prevent the AV valve leaflets from prolapsing into the atria during
ventricular contraction
E) The papillary muscles contract during ventricular systole to tighten the chordae tendineae
and secure the valve leaflets
Answer: A, B, D, E [CORRECT]
Rationale: The mitral (bicuspid) valve consists of two leaflets (anterior and posterior) supported
by chordae tendineae attached to anterolateral and posteromedial papillary muscles in the left
ventricle. The tricuspid valve has three leaflets (anterior, posterior, septal) situated between the
right atrium and right ventricle. The chordae tendineae are fibrous cords that tether the valve
leaflets to papillary muscles, preventing prolapse into the atria during ventricular systole when
intraventricular pressure rises dramatically. The papillary muscles are integral components of
the ventricular myocardium and contract synchronously with ventricular systole, generating
tension in the chordae tendineae to maintain valve competence. Option C is incorrect because
,AV valves open passively during ventricular diastole when ventricular pressure drops below
atrial pressure, not during systole.
Question 4 (MC) — During a teaching session on cardiac anatomy, a perfusionist explains that
the pulmonary valve is classified as a semilunar valve. What is the primary structural and
functional distinction between semilunar valves and atrioventricular valves?
A) Semilunar valves have three leaflets, while atrioventricular valves have only two
B) Semilunar valves lack chordae tendineae and papillary muscle attachments, opening and
closing passively in response to pressure gradients
C) Semilunar valves are located between atria and ventricles, while atrioventricular valves are
located at the ventricular outflow tracts
D) Semilunar valves open during ventricular diastole, while atrioventricular valves open during
ventricular systole
Answer: B) Semilunar valves lack chordae tendineae and papillary muscle attachments,
opening and closing passively in response to pressure gradients [CORRECT]
Rationale: The semilunar valves (aortic and pulmonary) are structurally distinct from the
atrioventricular valves because they lack the chordae tendineae and papillary muscle apparatus.
Instead, they consist of three pocket-like cusps (right, left, and posterior in the aortic valve;
anterior, left, and right in the pulmonary valve) that open passively when ventricular pressure
exceeds arterial pressure during systole, and close passively when arterial pressure exceeds
ventricular pressure during diastole. This pressure-responsive mechanism is critical during CPB,
as the aortic valve must remain competent to prevent regurgitation into the left ventricle when
the heart is arrested and the aorta is cross-clamped. The absence of chordae tendineae means
semilunar valve competence depends entirely on the structural integrity of the cusps and the
supporting fibrous annulus.
Question 5 (Calc) — A patient has an end-diastolic volume (EDV) of 140 mL and an end-systolic
volume (ESV) of 60 mL. The perfusionist needs to calculate the ejection fraction (EF) to assess
preoperative cardiac function. What is the patient's ejection fraction?
A) 43%
B) 57%
C) 80%
D) 33%
Answer: B) 57% [CORRECT]
, Rationale:
Formula: Ejection Fraction (EF) = (Stroke Volume / End-Diastolic Volume) × 100
Step 1: Calculate Stroke Volume (SV)
SV = EDV − ESV
SV = 140 mL − 60 mL = 80 mL
Step 2: Calculate Ejection Fraction
EF = (80 mL / 140 mL) × 100
EF = 0.5714 × 100 = 57.14%
Clinical Significance: An ejection fraction of 57% falls within the normal range (55–70%). This
calculation is fundamental for perfusionists when assessing preoperative cardiac reserve and
predicting the patient's ability to tolerate CPB. Patients with reduced EF (<40%) require
modified perfusion strategies, including higher pump flows, meticulous myocardial protection,
and consideration of ventricular assist devices.
Sub-Topic 1B: Great Vessels — Three-Dimensional Mapping (4 Questions)
Question 6 (MC) — During aortic cannulation for CPB, the surgeon must identify the correct
anatomical position of the ascending aorta. Which statement accurately describes the three-
dimensional orientation and branching pattern of the aortic arch?
A) The aortic arch gives rise to the brachiocephalic trunk, left common carotid artery, and left
subclavian artery in that order from proximal to distal
B) The ascending aorta terminates at the level of the sternal angle and immediately bifurcates
into the right and left common carotid arteries
C) The descending aorta passes anterior to the esophagus and posterior to the trachea
throughout its thoracic course
D) The aortic arch is located entirely within the mediastinum at the level of the T8 vertebra
Answer: A) The aortic arch gives rise to the brachiocephalic trunk, left common carotid artery,
and left subclavian artery in that order from proximal to distal [CORRECT]
Rationale: The aortic arch is the curved portion of the aorta that begins at the right second
sternocostal joint and arches posteriorly and to the left, passing anterior to the right pulmonary
artery and left main bronchus. From proximal to distal, it gives rise to three major branches: (1)
the brachiocephalic trunk (innominate artery), which bifurcates into the right subclavian and
right common carotid arteries; (2) the left common carotid artery; and (3) the left subclavian
Key For 2026–2027 Examination | A+ Solutions.
DOMAIN 1: ANATOMY OF THE HEART, LUNGS & GREAT VESSELS (15 Questions)
Sub-Topic 1A: Cardiac Chambers, Valves & Flow Pathway (5 Questions)
Question 1 (MC) — A 68-year-old patient is undergoing preoperative evaluation for mitral valve
replacement. During auscultation, the perfusionist notes that the mitral valve closes during
ventricular systole to prevent backflow. Which chamber receives the blood ejected through the
open aortic valve immediately following mitral valve closure?
A) Right atrium
B) Left atrium
C) Ascending aorta
D) Pulmonary trunk
Answer: C) Ascending aorta [CORRECT]
Rationale: During ventricular systole, the mitral valve closes to prevent regurgitation into the
left atrium, while the aortic valve opens simultaneously due to the pressure gradient generated
by left ventricular contraction. Blood is ejected from the left ventricle through the open aortic
valve into the ascending aorta. This represents the completion of the left-sided cardiac cycle and
the beginning of systemic arterial perfusion. The ascending aorta then distributes oxygenated
blood to the coronary arteries (via the right and left coronary ostia) and to the systemic
circulation via the aortic arch and descending aorta.
Question 2 (MC) — During a transesophageal echocardiography (TEE) examination prior to
CABG, the perfusionist observes the tricuspid valve. Which statement correctly describes the
anatomical pathway of deoxygenated blood as it passes through the right side of the heart?
A) Blood flows from the superior vena cava → right ventricle → tricuspid valve → pulmonary
artery
B) Blood flows from the right atrium → tricuspid valve → right ventricle → pulmonary valve →
pulmonary trunk
C) Blood flows from the inferior vena cava → pulmonary valve → right atrium → right ventricle
,→ lungs
D) Blood flows from the coronary sinus → right ventricle → tricuspid valve → pulmonary veins
Answer: B) Blood flows from the right atrium → tricuspid valve → right ventricle →
pulmonary valve → pulmonary trunk [CORRECT]
Rationale: The correct anatomical pathway for deoxygenated blood through the right heart is:
systemic venous return (SVC/IVC/coronary sinus) → right atrium → tricuspid (atrioventricular)
valve → right ventricle → pulmonary (semilunar) valve → pulmonary trunk → right and left
pulmonary arteries → lungs. The tricuspid valve, composed of three leaflets (anterior, posterior,
and septal), prevents backflow into the right atrium during ventricular systole. The pulmonary
valve, with three semilunar cusps (anterior, left, and right), prevents backflow into the right
ventricle during diastole. This pathway is critical for perfusionists to understand when managing
venous cannulation and assessing right heart function during CPB weaning.
Question 3 (SATA) — A perfusion student is reviewing the structural components of the cardiac
valves. Which of the following statements correctly describe the anatomical features of the
atrioventricular (AV) valves? (Select all that apply)
A) The mitral valve has two leaflets (anterior and posterior) and is anchored by chordae
tendineae to papillary muscles in the left ventricle
B) The tricuspid valve has three leaflets and is located between the right atrium and right
ventricle
C) The AV valves open passively during ventricular systole due to pressure generated by atrial
contraction
D) The chordae tendineae prevent the AV valve leaflets from prolapsing into the atria during
ventricular contraction
E) The papillary muscles contract during ventricular systole to tighten the chordae tendineae
and secure the valve leaflets
Answer: A, B, D, E [CORRECT]
Rationale: The mitral (bicuspid) valve consists of two leaflets (anterior and posterior) supported
by chordae tendineae attached to anterolateral and posteromedial papillary muscles in the left
ventricle. The tricuspid valve has three leaflets (anterior, posterior, septal) situated between the
right atrium and right ventricle. The chordae tendineae are fibrous cords that tether the valve
leaflets to papillary muscles, preventing prolapse into the atria during ventricular systole when
intraventricular pressure rises dramatically. The papillary muscles are integral components of
the ventricular myocardium and contract synchronously with ventricular systole, generating
tension in the chordae tendineae to maintain valve competence. Option C is incorrect because
,AV valves open passively during ventricular diastole when ventricular pressure drops below
atrial pressure, not during systole.
Question 4 (MC) — During a teaching session on cardiac anatomy, a perfusionist explains that
the pulmonary valve is classified as a semilunar valve. What is the primary structural and
functional distinction between semilunar valves and atrioventricular valves?
A) Semilunar valves have three leaflets, while atrioventricular valves have only two
B) Semilunar valves lack chordae tendineae and papillary muscle attachments, opening and
closing passively in response to pressure gradients
C) Semilunar valves are located between atria and ventricles, while atrioventricular valves are
located at the ventricular outflow tracts
D) Semilunar valves open during ventricular diastole, while atrioventricular valves open during
ventricular systole
Answer: B) Semilunar valves lack chordae tendineae and papillary muscle attachments,
opening and closing passively in response to pressure gradients [CORRECT]
Rationale: The semilunar valves (aortic and pulmonary) are structurally distinct from the
atrioventricular valves because they lack the chordae tendineae and papillary muscle apparatus.
Instead, they consist of three pocket-like cusps (right, left, and posterior in the aortic valve;
anterior, left, and right in the pulmonary valve) that open passively when ventricular pressure
exceeds arterial pressure during systole, and close passively when arterial pressure exceeds
ventricular pressure during diastole. This pressure-responsive mechanism is critical during CPB,
as the aortic valve must remain competent to prevent regurgitation into the left ventricle when
the heart is arrested and the aorta is cross-clamped. The absence of chordae tendineae means
semilunar valve competence depends entirely on the structural integrity of the cusps and the
supporting fibrous annulus.
Question 5 (Calc) — A patient has an end-diastolic volume (EDV) of 140 mL and an end-systolic
volume (ESV) of 60 mL. The perfusionist needs to calculate the ejection fraction (EF) to assess
preoperative cardiac function. What is the patient's ejection fraction?
A) 43%
B) 57%
C) 80%
D) 33%
Answer: B) 57% [CORRECT]
, Rationale:
Formula: Ejection Fraction (EF) = (Stroke Volume / End-Diastolic Volume) × 100
Step 1: Calculate Stroke Volume (SV)
SV = EDV − ESV
SV = 140 mL − 60 mL = 80 mL
Step 2: Calculate Ejection Fraction
EF = (80 mL / 140 mL) × 100
EF = 0.5714 × 100 = 57.14%
Clinical Significance: An ejection fraction of 57% falls within the normal range (55–70%). This
calculation is fundamental for perfusionists when assessing preoperative cardiac reserve and
predicting the patient's ability to tolerate CPB. Patients with reduced EF (<40%) require
modified perfusion strategies, including higher pump flows, meticulous myocardial protection,
and consideration of ventricular assist devices.
Sub-Topic 1B: Great Vessels — Three-Dimensional Mapping (4 Questions)
Question 6 (MC) — During aortic cannulation for CPB, the surgeon must identify the correct
anatomical position of the ascending aorta. Which statement accurately describes the three-
dimensional orientation and branching pattern of the aortic arch?
A) The aortic arch gives rise to the brachiocephalic trunk, left common carotid artery, and left
subclavian artery in that order from proximal to distal
B) The ascending aorta terminates at the level of the sternal angle and immediately bifurcates
into the right and left common carotid arteries
C) The descending aorta passes anterior to the esophagus and posterior to the trachea
throughout its thoracic course
D) The aortic arch is located entirely within the mediastinum at the level of the T8 vertebra
Answer: A) The aortic arch gives rise to the brachiocephalic trunk, left common carotid artery,
and left subclavian artery in that order from proximal to distal [CORRECT]
Rationale: The aortic arch is the curved portion of the aorta that begins at the right second
sternocostal joint and arches posteriorly and to the left, passing anterior to the right pulmonary
artery and left main bronchus. From proximal to distal, it gives rise to three major branches: (1)
the brachiocephalic trunk (innominate artery), which bifurcates into the right subclavian and
right common carotid arteries; (2) the left common carotid artery; and (3) the left subclavian
