ABSITE:
THE NITTY, GRITTY STUFF
PART 3
The
pre-transplant crossmatch involves
A) recipient lymphocytes & donor plasma
B) recipient plasma & donor lympocytes
C) recipient macrophages & donor globulins
D) recipient globulins & donor macrophages
Adherence
of leukocytes to the
endothelium is due to
A) integrins
B) P-selectin
C) L-selectin
D) E-selectin
The
fluoroquinolones
A) are primarily effective in gram +
bacteremia
B) have low concentrations in bile
C) chronic liver disease dramatically affects
pharmacokinetics
D) are greater than 50% excreted unchanged
in the urine
The
source of free oxygen radicals in
reperfusion injury is
A) superoxide
B) hydrogen peroxide
C) hydroxy radicals
D) xanthine oxidase
Marfan’s
syndrome is associated with all
of the following except
A) aortic valve insufficiencys
B) incomplete collagen formation
C) abnormal bleeding
D) decreased bone mass
The
changes associated with a mucous
producing villous adenoma of the sigmoid
A) metabolic acidosis
B) hypokalemia
C) urine pH 8.0
D) serum HCO3 of 15
Complications
of hypothermia include
A) convulsion
B) tachycardia
C) diuresis
D) hypercoagulation
A
30yo female attempts suicide with the
ingestion of lye. Examination of the mouth
& pharynx demonstrates erythema.
Appropriate management is
A) IVF, antibiotics & observations
B) esophagoscopy to level of the 1st burn
C) esophagoscopy to include the stomach
D) laparotomy, gastrostomy & TPN
A
68yo presents with signs of sepsis,
substernal chest pain & air crepitus in the
left neck. These symptoms & signs
developed 16hr ago after forceful vomiting
of a heavy meal. Treatment should
include
A) chest tube, IVF & antibiotics
B) left thoracotomy & repair
C) right thoracotomy & repair
D) laparotomy & repair
12hr
following esophagoscopy & biopsy of
an obstructing esophageal cancer, the
patient presents with fever & substernal
chest pain. Esophagogram reveals
perforation of the distal esophagus.
Appropriate treatment is
A) esophageal tube suction, IVF & antibiotics
B) chest tube, esophageal suction, IVF &
antibiotics
C) closure of the perforation, chest tube, IVF &
antibiotics
D) esophagectomy & esophagogastrostomy
A
patient is placed on IVF & NPO
following an uneventful laparotomy. 12hr
later the patient develops palor, sweating,
hypotension & abdominal pain. On exam
the upper abdomen is distended &
tympanic with a succussion splash.
Appropriate action is
A) increase IVF & transfuse pRBCs
B) return to the OR
C) insert NGT
D) provide ventilatory support
Splenectomy
may be useful in the
management of
A) hairy cell leukemia
B) malaria
C) chromic myelogenous leukemia
D) sickle cell disease
A
pulmonary function that would prohibit
a successful pneumonectomy is
A) FEV1 of 1000
B) pCO2 47
C) ability to climb 2 flights of stairs
D) previous MI
The
most common complication of a
popliteal aneurysm is
A) thrombosis
B) embolization
C) rupture
D) neurolysis
The
IMV
A) drains the distal rectum
B) passes lateral to the ligament of treitz
C) joins the portal vein
D) is medial to the aorta
The
right renal artery passes
A) anterior to the vena cava
B) anterior to the renal vein
C) anterior to the renal pelvis
D) anterior to the IMV
The
muscle anterior to the femoral artery
in the Hunter’s canal is
A) adductor minimus
B) adductor magnus
C) quadriceps femoris
D) vastus medialis
Which
of the following group of drugs will
provide effective treatment for
hypertrophic subaortic stenosis
A) inotropes
B) Ca channel blockers
C) ACE inhibitors
D) loop diuretics
The
etiology of myasthenia gravis is
A) insufficient Ach
B) motor nerve axonal degeneration
C) decreased number of Ach receptors
D) overproduction of Ach esterase
The
earliest sign of uncal herniation is
A) unilateral pupil dilatation
B) deep coma
C) contralateral decerebrate posturing
D) bilateral decerebrate posturing
A
30yo female with a history of
dysmenorrhea & dyspareunia is found to
have a tender 3cm smooth submucosal
rectal mass. Appropriate treatment is
A) danazol
B) Flagyl
C) LAR
D) TAH-SBO
Treatment
of a malignant melanoma 2mm
in depth is
A) excision with 1cm margins
B) excision with 2cm margins & sentinel node
biopsy
C) excision with 4cm margins & prophylatic
node dissection
D) excision with 1cm margins & interferon a
Malignant
pheochromocytoma is clearly
identified by which of the following
A) capsular invasion
B) venous invasion
C) invasion of adjacent structures
D) histological examination
The
only certain sign of parathyroid
malignancy is
A) histologic features
B) renal disease
C) bone disease
D) recurrence after resection
Proper
treatment for a 3cm papillary
thyroid cancer with tumor involving 4
lymph nodes is
A) ipsilateral lobectomy with resection of
involved lymph nodes
B) total thyroidectomy
C) total ipsilateral lobectomy, near total
lobectomy on the contralateral side, & resect
involved lymph nodes
D) total thyroidectomy, central compartment
node dissection & modified radical neck
dissection
Appropriate
treatment for family
members (without tumor) having a
heterozygous RET proto-oncogene is
A) observation
B) total parathyroidectomy
C) total thyroidectomy
D) bilateral adrenalectomy
Failure
to identify gamma radiation or
blue dye in a sentinel node biopsy
procedure is due to
A) no evidence of metastatic disease
B) incorrect FNA diagnosis of cancer
C) failure of dye & radiolabeled colloid to
migrate
D) absence of axillary lymph nodes
The
appropriate ultrasound probe for
examination of a breast mass is
A) 1.5-2.5 mHz
B) 3-3.5 mHz
C) 5-5.5 mHz
D) 7.5-10 mHz
Which
of the following is the mediator
that leads to relaxation of the sphincter of
Oddi, is partially mediated by cholinergic
stimuli, & has a diminished effect
following vagotomy
A) somatostatin
B) glucagon
C) cholecystokinin
D) gastrin
E) secretin
The
ilioinguinal nerve
A) is a branch of the femoral nerve
B) has a motor component
C) can be injured easily at the internal
spermatic ring
D) provides sensation for the penis & upper
scrotum
E) runs along the hypogastric vein
The
spleen filters all of the following
particles/cells except
A) malformed erythrocytes
B) T lymphocytes
C) malarial parasites
D) steptococcus pneumoniae
E) platelets
After
undergoing complete axillary node
dissection for sentinel node positive breast
cancer, your patient has difficulty with
forced should adduction. She is having
difficulty pulling herself out of her chair.
There is concern about injury to which
nerve?
A) intercostal brachial nerve
B) thoracodorsal nerve
C) long thoracic nerve
D) lateral pectoral nerve
E) ulnar nerve
Stercoral
perforations are defined as
A) linear tears of the colon without ischemic
changes
B) perforated ulcers caused by an enlarging
colonic carcinoma
C) perforated colonic ulcers with necrotic &
inflammatory edges
D) perforated ischemic ulcers of the terminal
ileum
The
most common cause of intrahepatic
presinusoidal portal hypertension is
A) alcoholic cirrhosis
B) congential hepatic fibrosis
C) schistosomiasis
D) splenic vein thrombosis
E) Budd-Chiari syndrome
Which
of the following statements about
burns is not true
A) in major burns, clinically significant
interstitial edema is seen in distant soft
tissues secondary to a combination of
mediators generated in the wound &
hypoproteinemia
B) using the modified Brooke formula, during
burn resuscitation adults should receive 24mg/kg/%burn/24hr of LR (1/2 in 1st 8 hr)
C) pigment (myoglobin) induced ATN is most
common in patients who have sustained highvoltage electrical injury or deep thermal burns
D) patients who suffer chemical burns as a
result of concentrated hydrofluoric acid may
experience life threatening hypercalemia
Ranson’s
criteria on admission for
prediction of severity of acute non-biliary
pancreatitis include all of the following
except
A) age >55
B) WBC >16,000
C) glucose >200mg/dl
D) serum magnesium >1.5mg/dl
Which
of the following statements about
blunt carotid injury is not true
A) blunt carotid injury is frequently associated
with closed head injury or cervical spine injury
B) neurological deficits associated with blunt
carotid injury are frequently absent on
admission, but do develop within 12hr of
injury
C) more than 50% of patients with
uncomplicated carotid artery dissection as a
result of blunt trauma have a reasonably good
neurologic outcome
D) arterial dissections as a result of blunt
trauma are best managed by anticoagulation
Enterocutaneous
fistula management in a
stable patient should include all of the
following except
A) establishment of controlled drainage & skin
protection
B) immediate corrective surgery
C) provision of adequate nutrition
D) prevention of fluid & electrolyte depletion
A
47yo paraplegic patient is brought to
the ER with abdominal distention. He
has not had a bowel movement in several
days. The abdomen is distended &
minimally tender without evidence of
peritoneal signs. A KUB massive
distention of the colon. The next step in
management should include
A) IV vancomycin
B) IVF & immediate laparotomy
C) colonoscopic decompression
D) CT of the abdomen
E) diagnostic laparoscopy
A
7 yo child undergoes general anesthesia
for repair of an inguinal hernia. 10min
into the operation, the patient is noted to
have a temp of 104, tachycardia, & diffuse
skeletal muscle rigidity. The most
appropriate treatment for this situation is
A) hyperventilation to achieve pCO2
<25mmHg
B) dantrolene sodium
C) SC heparin sodium
D) IM epinephrine
E) none of the above
A
67yo smoker undergoes a chest CT to
evaluate a 1cm lung nodule on chest xray. The CT scan demonstrates
mediastinal adenopathy. The next step in
the workup should be
A) MRI of the chest & abdomen
B) liver-spleen scan to evaluate for metastases
C) chemotherapy consultation
D) radiation consultation
E) bronchoscopy & mediastinoscopy
A
65 yo man presents with moderate
epigastric pain of 2 wks duration
radiating to his back. Evaluation reveals a
3cm tumor in the head of the pancreas.
All the following conditions would
preclude tumor resectability, except
A) presence of extrapancreatic disease
B) evidence of tumor extension to the SMA
C) evidence of tumor extension to the celiac
axis
D) a patent SMV-portal vein confluence
E) involvement of a single lymph node in the
hepatic hilum
An
established indication for coronary
artery bypass grafting remains
A) critical left main disease
B) triple vessel disease with normal
ventricular function
C) 2 vessel disease of the right coronary & left
circumflex arteries
D) distal left anterior descending artery
disease
E) right coronary artery disease with
congestive heart failure
When
performing ERCP, a
sphincterotomy is indicated in
A) acute biliary pancreatitis with common bile
duct stone at ERCP
B) gallstone pancreatitis without CBD stone
present at ERCP when cholecystectomy is not
possible
C) recurrent acute pancreatitis with sludge
present in the biliary tract in the postcholecystectomy patient
D) acute biliary pancreatitis during pregnancy
E) all of the above
Guidelines
for minimizing morbidity
during lap ccy in patients with hepatic
cirrhosis include all of the following except
A) using an open technique with the Hasson
trocar
B) using a right paramedian trocar approach
C) using an argon beam coagulator
D) performing a subtotal cholecystectomy in
cases of severe inflammation
E) using open cholecystectomy more frequently
Which
of the following is true concerning
necrotizing pancreatitis
A) less than 30% of patients develop infected
necrosis
B) infection is the main determinant of
prognosis
C) infected necrosis is an uncommon indication
for surgery in acute necrotizing pancreatitis
D) sterile necrosis is usually treated
operatively
E) surgery is not indicated in acute necrotizing
pancreatitis
A
27yo umpire wearing no protective gear
is inadvertently struck in the chest by a
player’s bat. He lost consciousness for
30sec after impact. During EMS
transport, vital signs are 102/76, 114, 22,
97% on 2L NC. On arrival to the ER, the
patient is awake & alert, c/o chest pain.
He has ecchymosis & tenderness over his
sternum. Lungs are clear, heart sounds
tachycardic with no murmurs. His
physical exam is otherwise normal.
Which
of the following is the best
screening tool for assessing blunt cardiac
injury?
A) CK, CK-MB
B) EKG
C) transesophageal echo
D) transthoracic echo
E) troponin
A
65 yo woman presents to the ER with a
swollen right calf. She has a hx of lung ca
& is receiving chemotherapy. DVT is
suspected, & a D-dimer test is ordered,
the result of which is highly positive.
Records of previous blood tests show that
this patient’s D-dimer levels were always
higher than normal.
What
is the next step in the management
of this patient?
A) order a BNP to rule out heart failure caused
by chemotherapy
B) order compression ultrasonography
C) order a venogram
D) no further evaluation
The
patient is found to have DVT of the
calf with extension to the right proximal
vein. Anticoagulation therapy should be
initiated. Which of the following is a
relative contraindication to
anticoagulation?
A) brain metastasis
B) GI bleeding in the past 6 months
C) platelet count < 60,000
D) severe hypotension
The
patient is prescribed unfractionated
heparin. All the following are adverse
effects associated with unfractionated
heparin except
A) elevated PTT
B) osteoporosis
C) thrombocytopenia
D) worsening renal failure
EMBRYOLOGY
Ileal
atresia
Vascular insult
Duodenal
atresia
Lack of revacuolization from solid cord
Name
2 pancreatic enzymes that are
secreted in their active forms
Amylase
Lipase
True
or False
Glucagon increases myocardial contractility &
HR
TRUE
Most
common cause of pneumaturia
Diverticulitis
Sigmoid cancer
Others: crohn’s disease, radiation colitis
Where
Junction of SVC & RA
Where
is the SA node
is the AV node
Junction of coronary sinus & RA
Most
likely reason for inguinal hernia
recurrence after laparoscopic repair
Migration of mesh
Treatment
for urokinase overdose
Amicar (e-aminocaproic acid)
Inhibits fibrinolysis blocks the conversion
of plasminogen to plasmin
What
Eyes, face
What
is the last muscle to be paralyzed
diaphragm
True
is the first muscle to be paralyzed
or False
Last to go….first to come back
TRUE!!!!
HEAD & NECK TUMORS
0.5cm
squamous cell cancer of vocal cord
which is mobile
Radiation
T1 lesion
1cm
lesion extending to supraglotic larynx
with impaired mobility, clinically negative
node
Radiation
T2 lesion
HEAD & NECK
Squamous
cell cancer of vocal cord that is
fixed & extends to contralateral cord
Resection & radiation
T3 lesion
HEAD & NECK
True
or False
Adenoid cystic carcinoma of parotid gland
invades into the facial nerve
TRUE
Malignant cancer total parotidectomy,
resection facial nerve, ipsilateral MRND,
radiation
4
malignancies that are decided on clinical
basis (can’t depend on histology)
Cystosarcoma phylloides
Pheochromocytoma
Malignant thymic tumor
Parathyroid cancer
CROHN’S OR ULCERATIVE COLITIS
Crypt
abscesses
Ulcerative colitis
Granulomas
Crohn’s
Cobblestoning
Crohn’s
CROHN’S OR ULCERATIVE COLITIS
Serpiginous
ulcers
Crohn’s
Pseudopolyps
Ulcerative colitis
ORDER OF TREATMENT
MEN
1
Total parathyroidectomy with autotransplantation
Pancreatic tumor
Pituitary tumor
MEN2a
Adrenalectomy
Thyroidectomy
Pituitary
ORDER OF TREATMENT
MEN2b
Adrenalectomy
Thyroidectomy
Most
common pancreatic endocrine tumor
Insulinoma
Most
common pancreatic endocrine tumor
in MEN syndromes
Gastrinoma
