Surgery 6th Year 2019

Surgery 6th year 2019 GI surgery 1. Hamartomatous polyps... Juetz pegher syndrome 2. Gastroduodenal artery from which artery ?? Hepatic 3. All are part of management of diverticulitis except? -Colonoscopy after 3 weeks** -CT scan -IV abx -Fluids -NPO 4. Male with IBD presents with jaundice? PSC 5. Highest risk for cholangiocarcinoma? -PSC* -Choledochal cyst -Hepatolithiasis -Caroli disease 6. Single most imp step in acute pancreatitis? Rehydration 7. 40 y/o BPR, rectal mass 6 cm from anal verge all part of management except? -FOB test* -family hx -Assess for surgery 8. What is wrong about intestinal obstruction?? -most adhesive SBO are treated conservatively -you shouldn’t give analgesia because it will mask the symptoms 9. True about GI lymphoma: - mucosal biopsy will always diagnose. - treated with surgery or chemotherapy. 10. true about volvulus -cecum is more common than signmoid -higher in females -high fiber diet -Surgery is 1st line ttt -Chronic constipation is the usual presentation 11. Best prognostic factor after CRC: -lymph node involvement -transmural involvement 12. HCC tumor marker : AFP 13. 88 yo, hx of CKD, DM, brain mets, developed an episode of acute cholecystitis, management: - laparoscopic cholecystectomy. - open cholecystectomy. - cholecystostomy. - IV antibiotic and elective surgery. 14. Gallstone ileus: - recurrent cholangitis. - SBO. - acholic stools. - air in biliary tree. - stone on imaging. 15. True about small bowel carcinoma? -more in young -more in terminal ileum -Crohn's is a risk factor * 16. True about the peritoneum: - visceral peritoneum is heavily innervated. - secretes fibrinolytics. -Parietal peritoneum is poorly innervated - It's surface area is double that of skin - It cannot absorb large amounts of fluids (most likely the fibrinolytic activity is correct) 17. Young male developed right loin pain of few hours duration, that radiates to his groin, on physical exam there's right lumbar tenderness, he vomited once, he isn't febrile, what's the most appropriate investigation: - CT with IV contrast. - UA looking for hematuria. - ultrasound for appendicitis. 18. A patient has undergone cholecystectomy. The hepatic artery was injured during the surgery and was repaired. He received 2000 mlL of blood transfusion. After the surgery, the patient BUN continued to rise (10-12 per day). He is well hydrated and his urine output is 2-3 L/day. The most likely dx: - High output renal failure *? - persistent bleeding - postcholecystectomy syndrome (it’s persistent pain after cholecystectomy) 19. The most common indication for surgery in chronic pancreatitis is: - Pain - diarrhea - endocrine insufficiency - malignancy 20. True about gastric bypass surgery: - It’s more of a restrictive procedure rather than malabsorptive (wrong) - It causes protein malnutrition (I don’t know) - It’s not good for obese patients with esophagitis (wrong) - Sleeve gastrectomy was found to be better in treating diabetes compared to it (wrong) - It rarely causes iron deficiency (wrong) Plastic surgery 21. Compartment syndrome... Fasciotomy 22. best way to dx osteomyelitis in pressure ulcer? bone biopsy 23. % in burn affects all except? wound healing time 24. wrong about thermal burn: Smoke inhalation injury best diagnosed with CXR and ABGs 25. 24-48 hrs in wound healing? Neutrophils 26. what triggers re-epithelialization? loss of contact inhibition 27. Order of regain of sensory function: - Temperature, pain, light touch. - light touch, pain, temperature. -pain, light touch temperature. - pain, temperature, light touch. 28. Flaps compare to grafts in all of the following except: - used over joints. - closure of donor area by primary intention. - better vascularity. - better sensation. - more likely to take successfully 29. Wrong about fluids in burns: - UOP in children should be maintained at 1-2 mL/kg/hr - Colloids are given later - High hemoglobin indicates fluid overload * 30. A patient with an abscess in the pulp of his thumb, best next step: - incision * - observation - antibiotics Endocrine surgery 31. Elevated C-peptide... Insulinoma 32. Diagnostic hemithyroidectomy is done for which of the following? - 2 cm nodule with FNA consistent with papillary ca - 2 cm nodule with FNA consistent with follicular ca * - 2 cm nodule with FNA consistent with medullary ca - FNA consistent with degenerative changes - FNA that is inadequate 33. True about salivary glands... Mucoepidermoid m/c malignant Tumor 34. Hyperparathyroidism... Sestemabi 35. Management of bilateral Conn's.. spironolactone?? 36. thyroid known for multifocality? -papillary? -medullary 37. An old diabetic lady presenting after suffering an injury to her foot. On exam, she was found to have erythema at the site of injury. There was also crepitus and calf tenderness. What is the best next step? Surgical debridement * Pediatric surgery 38. 3 year old, BPR, Hb=8, no abd pain or vomitng.. next setp?? -Technetium* (Meckel's diverticulum?) -Colonoscopy 39. 2 week old, was breastfed & previously healthy, presented with bilious vomiting (this is a case of volvulus)... what is the test with highest diagnostic yield? -Contrast enema -upper GI contrast study* -CT scan 40. Not a risk for inguinal hernia -Female* -CF -Prematurity 41. VACTREL? TEF 42. new born with respiratory distress on ventilator was found to have reducible inguinal hernia.. management? - repair while the new born on ventilator. - repair after extubation and before discharge* 43. most common finding in FB aspiration? -hyperinflation** -pneumonia -pleural effusion -foreignbody 44. CDH : Persistence of pleuroperitoneal canal 45. True about testicular torsion -Testicular torsion is most common before 3yrs and after puberty* -Testicular salvage is very high regardless duration -extravaginal is also called bellclapper deformity -intravaginal is more common in perinatal 46. wrong about neurofibromatosis? Autosomal recessive 47. Normal testis that is pulled up with cremastric muscle contraction: retractile testis Cardiothoracic surgery 48. True about Dominant Right coronary artery: means that it gives PDA branch and supplies AV node 49. requires immediate intervention? transposition of great vessels 50. Fatal condition? left coronary from pulmonary 51. PDA dependent heart defect? PGE1 52. Which of the following is the most appropriate statement regarding chest trauma: - 25% of trauma mortalities are related to the chest. - most patients with chest trauma will end up needing a thoracotomy. - tracheal and bronchial trauma are repaired via a median sternotomy. - continuous bleeding of 50 ml/hr requires a thoracotomy. 53. A patient undergoes left pneumonectomy for lung ca. 5 days after the surgery, he has fever and cough with copious amount of sputum. CXR showed air fluid level in the postpneumonectomy space. What is the best next step? - Pleural fluid analysis and culture - Chest drainage - Thoracotomy - Sputum cultures and start antibiotics 54. All are causes of persistent decrease in CO after cardiac surgery except: - poor myocardial function - cardiac tamponade - Hypovolemia - Bleeding - Alkalosis (most likely) Oncology 55. All indcate local invasion except :arm edema 56. Not viral etiology... Testicular ca 57. most common site of rhabdomyosarcoma in children? Head and neck 58. wrong? chronic ulcer ---> BCC 59. A patient with 2.5 cm grade 3 invasive ductal ca in the right breast, what to do next? - wide local excision with sentinel LN biopsy*? - Mastectomy with sentinel LN biopsy 60. A patient with stage 2 non-small cell lung ca that was resected, which of the following is the most important prognostic factor? - number of N1 LNs involved - T stage - neoadjuvant chemo and radio - postoperative radiotherapy - invasion of visceral pleura 61. A 35-year-old woman, who is currently breast-feeding her firstborn child, develops an erythematous and inflamed fluctuant area on breast examination. Which of the following statements is wrong concerning her diagnosis and management? a. The most common organism which would expect to be cultured is Staphylococcus aureus b. Open surgical drainage is likely indicated c. Breast-feeding absolutely should be discontinued d. If the inflammatory process does not completely respond, a biopsy may be indicated e. The organism has gained access through a macerated nipple Answer: c 62. Which of the following statements is wrong concerning the histologic variants of invasive breast carcinoma? a. The presence of an in situ component with invasive ductal carcinoma does not adversely affects prognosis b. Medullary carcinomas, although often of large size, are associated with a better overall prognosis than common invasive ductal cancers c. Mucinous or colloid carcinoma is one of the more common variants of invasive ductal cancer d. Invasive lobular carcinoma is associated with a higher incidence of bilateral breast cancer e. When mixed histologies are encountered, the clinical behavior parallels that of the invasive ductal carcinoma. Answer: c general 63. 1st in hemostasis... Vasoconstruction 64. Vit. C... Hydroxyaltion 65. True about abx: carabapenems have good coverage for gram +ve and anaerobes 66. True about gas gangrene?? -pain, crepitus and toxemia* -rarely cause gas in muscles -Gram negative 67. Wrong about Inguinal hernia? -femoral is the most common hernia in females* -females are more likely to have femoral -males are more likely to have inguinal -Inguinal hernia is superior & medial to pubic tubercle -Femoral hernia is inferior & lateral to pubic tubercle 68. True? -Canal of nuck opens in labia majora* -Indrect is medial to epigastric vessels -Processus Vaginalis is superior to spermatic cord -External inguinal ring is a defect is transversalis -Internal inguinal ring corresponds to mid-inguinal point 69. True about hemorrhoids? Pain is unusual unless complicated* Hemorrhoids are palpable Permanent prolapse is grade 3 Age 20-40 70. True about anal fissures: -m.c is hypertoinic internal sphincter* -in females m.c is anterior -Glyceryl nitrate as effective as LIS 71. true about hypovolemic shock? Increased SVR*? 72. m.c in septic shock? staph/ pseudomonas/ Ecoli*? 73. true about septic shock: persisting hypotension requiring vasopressors to maintain a MAP of 65 74. Who should receive blood transfusion? - A patient with with Hb 8 with tachycardia and SOB * - A patient with with HB 10 and CAD - A patient on hemodialysis and Hb 7 - A patient with 1 g\dL drop in Hb after bleeding 75. Which of the following is an indication for FFP? - volume repletion - reversal of bleeding due to clopidogrel - A patient who received 1 PRBC - A patient who is on warfarin with a high INR * 76. Not a complication of blood tx? -hyperkalemia -hypercalcemia* 77. not commonly seen with diarrhea? alkalosis hypercalcemia 78. Management of gastric outlet obstruction with hyperchloremic hypokalemic metabolic alkalosis?? 0.9 NS infusion with KCl 79. All of the following can present in an acute trauma patient except: - hypoglycemia*? - lipolysis. - hypercatabolism. - gluconeogenesis. 80. A patient presenting to the ER after an RTA. He is conscious and communicative. He was found to be hypotensive and is complaining of abdominal pain. What is the best next step? - Jaw thrust - chin lift - intubation - IV line * - emergent laparotomy 81. A patient was being treated for lower leg ulcer with a cephalosporin. He developed diarrhea and tested positive for C.diff with the stool toxin test. Best next step? - Switch to oral vancomycin * - start metronidazole therapy 82. Which of the following is associated with the highest perioperative mortality? - MI 4 months ago - Aortic stenosis - CHF with Hb 7 - Frequent PVCs - Age more than 70 83. A patient had epidural anesthesia for a lower abdominal surgery, she has headache after the procedure, which of the following is not done to decrease the headache? - bed rest - analgesics - decrease caffeine intake * - epidural blood patch - oral hydration Vascular surgery 84. acute lower limb ischemia (The embolus was in the common femoral artery and the patient presented with weak sensation of 5 hour-duration.) best management: -IV heparin -Embolectomy -Aorto-femoral bypass - femero-femoral bypass 85. PVD ?? -most have intermittent claudication -asx have same survival rate as general population -rest pain and intermittent claudication have different natural hx -Normal ABI excludes significant disease 86. Wrong about DVT -pt needs dmission before starting the treatment -pt may have PE without any symptoms -It's important to assess whether it was provoked or unprovoked -Level of DVT affects your management -You should not delay treatment till you do the u/s 87. What is true about fetal circulation? - Functional closure of foramen ovale occurs within 24 hrs - Ductus arteriosus continues to shunt blood from Rt to Lt after birth - Umbilical artery is a branch of common iliac artery (it’s a branch of internal iliac) - the pulmonary artery resistance decreases after closure of the ductus arteriosus (maybe) - Low O2 tension is associated with closure of PDA 88. A patient presenting with signs and sx mostly consistent with acute mesenteric ischemia. ABGs: pH 7.32, HCO3 14, pCO2 31. What is the acid-base disorder? - Metabolic acidosis with respiratory compensation 89. There was a question about lower limb amputation but I can’t remember the details. I guess the right answer was to start rehabilitation as soon as possible