2008 with explanations (2008_exam_all_reviewed) Flashcards
1
Q
- Which bug is MOST common in surgical infections?
a. S. aureus
b. Coag Neg. Staph
c. E. Coli
d. Some other wrong answer
A
Answer: A.
2
Q
- All of the following are true of Hep C, EXCEPT:
a. It is an RNA flavavirus
b. 75% of infected people become chronic carriers
c. Risk of transmission via needle stick is 2%
d. Some other answer
A
Answer: ? (previous answer C). HCV is an RNA flavavirus. HCV typically leads to chronic infection; 60 to 80 percent of cases develop chronic hepatitis (abnormal liver enzymes). 20 to 30 percent of chronically infected individuals develop cirrhosis over a 20- to 30-year period of time The average incidence of seroconversion to HCV after unintentional needle sticks or sharps exposures from an HCV-positive source is 1.8 percent (range, 0-7 percent). The overall rate of HCV transmission after an exposure ranges from essentially zero to about 10%
Source: Up to date. , JAMA. 2002.
3
Q
- Electrical Voltage is converted to heat (burns) by a person’s body based on what?
a. Directly proportional to voltage and resistance of the body
b. Inversely proportional to voltage and resistance of the body
c. Directly proportional to the current and resistance of the body
d. Inveresely proportional to the current and resistance of the body
A
Answer: C.
4
Q
- 70kg male pt requires how much daily glucose to prevent the catabolism of protein?
a. 10 g
b. 50 g
c. 200 g
d. 500 g
A
Answer: C. 100g of dextrose daily provided enough to spare protein catabolism. You may require about 125 g of glucose.
Source: Nutrition support for the critically ill.
Schwarz says avg person needs 80-120g of protein per day. And every 6 grams of protein = 1g of Nitrogen
5
Q
- What does the Kaplan Meier Curve measure?
a. Survival
b, c, d- Wrong answers
A
Answer: A.
6
Q
- Which of the following is the most common anaerobic bug in post op infections?
a. Actinomyces
b. Bacteroides
c. Clostridium
d. Another bug
A
Answer: B.
7
Q
- While consenting a pt, it appears she isn’t paying attention. At the completion of your disclosure, the patient states, “I don’t want to hear about all the bad things. I trust you, let’s do it.” Should you:
a. Have someone else explain it to her.
b. Tell her this is important and that she needs to pay attention or you won’t operate on her
c. Document in the chart that disclosure has been provided and that the patient wishes to proceed.
d. Some other answer
A
Answer: C. may have an answer to the effect of bringing someone else in the room to help explain
8
Q
- Pt. injured, unable to consent for emergent op, no one else to give consent. You decide to operate, this is an example of :
a. Beneficience
b. Nonmaleficience
c. Something else
d. Something else
A
Answer: A Beneficience - Concept involves the physician making the decisions that are best for the patient, without regard to personal gain or the interests of others. “Do good and avoid evil. Nonmaleficence, which derives from the maxim, is one of the principal precepts that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that “given an existing problem, it may be better to do nothing than to do something that risks causing more harm than good.” It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.
9
Q
- Coherent pt. states pre-op that he does not want blood for religious reasons, pt. undergoes AAA repair and becomes unstable in ICU. Wife tells you to disregard his decision and transfuse him. You should:
a. Abide by wife’s wishes because pt. is no longer competent
b. Give him blood but don’t tell him
c. Continue to resuscitate him, but don’t give blood.
d. Something else
A
Answer: C.
10
Q
- Pt. wants to know highest risk of receiving blood product. You tell him:
a. HIV
b. Bacterial Sepsis
c. HBV
d. Something else
A
Answer: B. ??
Schwartz says that PRBC’s with bacteria is very rare. More common with plt transfusion.
General non-hemolytic fever is more common though (1%), and is secondary to prformed cytokines in donor blood. In the table, this has the highest incidence
Allergic reactions also more common (1%). Often not serious and more frequently associated with plts and FFP
Transfusion related deaths, although rare, do occur and are related primarily to transfusion-related acute lung injury (TRALI) (16%–22%), ABO hemolytic transfusion reactions (12%–15%), and bacterial contamination of platelets (11%–18%).86
11
Q
- Most like bug from receiving blood product:
a. Treponema Pallidum
b. Staph
c. Something else
d. Something else
A
Answer: A.
12
Q
- In obtaining informed consent, you must provide all of the following EXCEPT:
a. Standard accepted rates of success/failure
b. General risks
c. Special & unique risks
d. Alternatives to the procedure
A
Answer: C.
13
Q
- Nerve most at risk in fasciotomy of ant. compartment of lower leg:
a. Superficial Peroneal N.
b. Tibial N.
c. Femoral N.
d. Common Peroneal N.
A
Answer: A.
14
Q
- Guy cuts his forearm with a box knife, unable to feel his thumb and index finger. Cannot flex PIP. Initial management should consist of:
a. I&D in ER, explore and repair damage to deep structures
b. Give Keflex, keep wound open, splint with MCP flexed and refer to hand surgeon the next day.
c. I&D in ER, explore and repair damage to deep structures, suture wound closed and refer to hand surgeon later.
A
Answer: B. (previous A). Cannot feel his thumb index – VOLAR. Median nerve. Flexors are median nerve. I would not explore the wound in the ER. No emergent need to repair lacerated nerves – hand is not ischemic where time is a factor.
Source: M.Bernstein, M.D.
I think I would just irrigate, close skin, dress, splint in safety refer to plastics in the morning
15
Q
- Which of the following will not increase the likelihood of an incision having healing problems?
a. COPD
b. Previous surgery
c. NIDDM
d. Corticosteroids
A
Answer: B. Increases healing.
16
Q
- Keloids have the following characteristics, EXCEPT:
a. Occur more commonly in dark skinned people
b. Are cause of scar overgrowth
c. Intralesional steroid injections are helpful
d. Something else
A
Answer: ? (previous answer C). Certain individuals, most commonly blacks, develop a hyperproliferation of fibroblasts in response to trauma or, less commonly, de novo. Intralesional corticosteroids are first-line therapy for most keloids. A systematic review found that up to 70 percent of patients respond to intralesional corticosteroid injection with flattening of keloids, although the recurrence rate is high in some studies (up to 50 percent at five years
Source: Up to date.
17
Q
- Motorcycle rider crashes and has grossly contaminated open mid tibia (Grade IIIB). Besides I&D, tetanus, etc, you should start:
a. Cefazolin
b. Cefazolin and Gentamicin
c. Cefazolin, Gentamicin, and Penicillin
d. Something else
A
Answer: C. (previous B). The “grossly” suggests that you need to include anaerobic coverage (i.e. PCN).
Source: M.Bernstein
Orthobullet: penicillin only if you suspect anaerobes (farm or bowel)
18
Q
- 70 kg. guy with burns is being treated with IVF per Parkland formula. Between hours 4-8 his urine output is 45 cc, 75 cc, 50 cc. You should:
a. Observe and wait
b. Bolus with 1000cc RL
c. Increase IVF by one-third
d. Something else
A
Answer: A. (previous C) 70 kg adult should have at least 0.5 cc/kg/hr. that is, > 35 cc/hr. He is meeting this goal, therefore observe and wait.
19
Q
- Older male pt. with hx of smoking presents with painless gross hematuria. Most likely diagnosis:
a. Prostate CA
b. Renal Calculus
c. Bladder CA
d. Something else
A
Answer: C.
20
Q
- Tobacco smoke is a known carcinogenic factor in all of the following types of cancer EXCEPT:
a. Lung
b. Liver
c. Cervical
d. Oral
A
Answer: B.
21
Q
- All of the following require emergent exploratory laparotomy except:
a. Fractured Kidney
b. Gunshot wound that goes through gut
c. Something else
d. Something else
A
Answer: A.
22
Q
- Pt. with Breast CA develops severe headaches. MRI shows large cerebral mass. You should:
a. Palliative care
b. Resect and XRT
c. XRT
d. Something else
A
Answer: B. SURGERY — Surgery is used to provide rapid relief of symptoms resulting from the mass effect of a large tumor, to improve local control of brain metastases, and to establish a histologic diagnosis when a brain metastasis is suspected. Advances in neuroanesthesia and neurosurgery have significantly improved the safety of surgical resection of brain metastases, making this approach applicable to a larger number of patients, including lesions in both eloquent and noneloquent regions of the brain [16,17].
However, complications are not rare. In a series of 400 craniotomies patients with brain tumors (206 with gliomas and 194 with metastasectomy), 13 percent suffered major complications including neurologic worsening (8.5 percent) and meningitis (1 percent) [17]. In another series of 382 patients operated on for brain metastases, there was one death (respiratory, in a patient who had a previous pneumonectomy) and 27 other complications (7 percent). These included three cerebral hemorrhages and three cerebral infarcts [18].
The patient’s performance status and the extent of extracranial disease are the most important factors in determining whether or not surgery is appropriate. Patients with extensive or uncontrolled systemic disease generally have a poor prognosis and only rarely benefit from surgery. Other factors affecting prognosis and hence the appropriateness of surgery include the number and location of brain metastases. A short interval between diagnosis of the primary tumor and the development of a brain metastasis is generally associated with a poor prognosis [16]. In patients treated with surgery, WBRT is often used postoperatively
23
Q
- BEST way to initially assess damage to optic nerve:
a. Fundoscopic Exam
b. Peripheral Vision
c. Visual Acuity
d. Something else
A
Answer: C. repeat. Best exam to alert the physician for eye injury is initial visual acuity exam.
Source: M.Bernstein, M.D.
24
Q
- Pt. unable to be intubated due to stricture and in resp. distress, you should do which of the following?
a. Cricothyrotomy
b. Tracheostomy
c. Nasotracheal intubation
d. Something else
A
Answer: A. Need emergent airway. Cricothyroidostomy is indicated when an urgent surgical airway is needed.
25
26. Guy involved in trauma, non responsive. At the scene, all are signs that someone is receiving adequate ventilation, EXCEPT:
a. Normal chest expansion
b. Good air entry via nose & mouth
c. Good breath sounds
d. Pulse oximetry
Answer: D. In respiratory physiology, ventilation (or ventilation rate) is the rate at which gas enters or leaves the lung. It is categorised under the following definitions:
Source: Wikipedia
26
27. PET scan useful for detecting CA based on what?
a. Increase blood flow to CA
b. Increased glucose at CA
c. Something else
d. Something else
Answer: B (previous A). If the biologically active molecule chosen for PET is FDG, an analogue of glucose, the concentrations of tracer imaged then give tissue metabolic
activity, in terms of regional glucose uptake
Source: Wikipedia.
27
28. First cells to arrive at wound healing:
a. PMNs
b. Macrophage
c. Fibroblasts
d. Lymphocytes
Answer: A. (previous answer B). PMNs are the first infiltrating cells to enter the wound site, peaking at 24 to 48 hours. Macrophages are the dominant cell type in the first phase (inflammatory) but are not the first to appear (macrophages are the second cell to enter)
Source: Schwartz’s Surgery
28
29. Tumors are attacked by:
a. Cell mediated immunity
b. Humoral mediated immunity
c. Cell and Humoral mediated immunity
d. Navy SEALs
Answer: A.
29
30. Which of the following is an example of a heterotopic allograft?
a. Lung
b. Liver
c. Kidney
d. Cornea
Answer: C. Heterotopic suggests that the transplanted organ will be placed in a non-native anatomic location. Lung and cornea can obviously not be heterotopic. Kidney are often transplanted into the pelvis. Conversely, orthotopic transplantation such as that occurs in the liver = in its natural position.
Source: Schwartz
30
```
33. Pt is stabbed in neck at cricoid. Stab wound is in Zone 1. Zone one is between cricoid and which
structure?
a. Angle of mandible
b. Cricothyroid membrane
c. Hyoid bone
d. Clavicle
```
Answer: D.
| Look at an image of zones of the neck
31
34. During thoracotomy, surgeon notices draining thoracic duct. He should:
a. Ligate it
b. Disregard it
c. Something else
d. Something else
Answer: A
32
35. During surgery, pt. has temp of 34°C & oozing of wound. Coag factors are fine. Why is he oozing?
a. Hypothermia
b. Something else
c. Something else
d. Something else
Answer: A.
33
36. Female involved in MVA in snow. Pt. hands appear to have frost bite. Best way to warm them?
a. Rub snow on them
b. Place them in 40° C water
c. Something else
d. Something else
Answer: B.
Schwarz:
Treatment of frostbite includes rapid rewarming to 40 to 42°C, analgesia, debridement of blisters, hydrotherapy,
elevation, topical antimicrobials, topical antithromboxanes (aloe vera), and systemic antiprostaglandins (aspirin).
UTD:
Once the patient has reached the hospital, definitive care consists of rapid rewarming, wound care, efforts to enhance tissue viability, and prevention of complications [31].Rewarming - Rewarming is most effectively accomplished by immersing the affected area in a waterbath heated to 40º to 42ºC. Such water feels warm but not hot to an unaffected hand. Higher temperatures may result in burns. Dry heat is difficult to regulate and not recommended. Thawing is usually complete in 15 to 30 minutes, at which point the tissue is red or purple and soft to the touch. Source: up to date.
34
37. Surgeon is legally responsible for which of the following:
a. Anesthetist
b. OR room nurses
c. Student observers
d. His office staff
Answer: C. repeat.
35
38. A woman with breast CA can sue her surgeon for all of the following, EXCEPT:
a. Delay in diagnosis
b. Failure to treat properly
c. Something else
d. Recurrence of CA while participating in a clinical trial.
Answer: D.
36
39. Pt. with hypothermia is receiving warmed IV fluids, is placed in warm room with blankets. What else should you do?
a. Peritoneal lavage with warm fluid
b. Pleural lavage with warm fluid
c. Observe and keep pt. warm
d. Something else
Answer: C.
37
40. Fluid rate for 4 kg kid with vomiting, etc. secondary to pyloric stenois:
a. Something else
b. Something else
c. D5 ½ NS with 20-30 meq KCL at 25 cc/hr
d. Something else
Answer: C. 4 kg child. Use 4:2:1: rule. First 10kg, multiply weight by 4. I.e. 4 kg, 4 x 4 is 16 cc/hr. Infants presenting with normal electrolyte values and mild dehydration, as is the case with more than 60 percent of patients, should receive maintenance intravenous fluids such as 5 percent dextrose with 0.25 percent NaCl and 2 meq KCl per 100 mL. Infants with moderate or severe dehydration require more involved fluid management with higher NaCl concentrations (0.5 percent to normal saline) and higher rates of administration (1.5 to 2 times maintenance), perhaps combined with bolus administration initially. The correction of alkalosis prior to surgery is imperative because alkalosis has been associated with an increased risk of post-operative apnea
Source: up to date.
38
41. Pt with splenomegaly. Which of the following are TRUE?
a. Decrease platelet life
b. Increased total body platelet mass
c. Thrombocytosis
d. Spherocytosis
Answer: C.
Previous answer was C, but I don't think splenomegaly causes increased plts. Its sequesters them and thus causes thrombocytopenia...
From Schwarz:
Thrombocytopenia may result from excessive sequestration of platelets as well as accelerated
platelet destruction in the spleen. Splenomegaly may result in sequestration of up to 80% of the platelet pool. The spleen may also contribute to the immunologic alteration of platelets, which leads to thrombocytopenia in the absence of splenomegaly (e.g., idiopathic thrombocytopenic purpura [ITP]).
39
42. Guy with hemophilia. His wife’s family has no hx of disease. The guy has 4 kids- 2 girls and 2 boys. Which of the following is true:
a. All of the kids will have the disease.
b. All of his kids will be carriers of the disease
c. Half of the girls will be carriers of the disease and the boys will have the disease
d. All of the girls will be carriers of the disease and the boys will not have the disease
Answer: D Hemophilia A and B are X-linked recessive disorders, which explains who is likely to bleed and the modes of genetic transmission [2]. These hemophilias occur almost exclusively in a male having one defective copy of the relevant gene on his X chromosome (ie, he is hemizygous for the defect). Because the affected male will transmit a normal Y chromosome to all his sons and an abnormal X chromosome to all his daughters, his sons will not be affected and all of his daughters will be carriers (ie, they are heterozygous for the defect).
Source: Up to date.
40
43. You wish to compare data between 3 groups. You should use:
a. ANOVA
b. A calculator
c. Your fingers
d. Toothpicks
Answer: A
41
44. Besides Double Blinded Randomized control study, which is least likely to include selection bias:
a. Case Control
b. Cohort
c. Something else
d. Meta analysis
Answer: D.
42
45. In order to use a t-test, which of the following must be true:
a. Data must be normally distributed
b. Something else
c. Something else
d. Something else
Answer: A. A t-test is any statistical hypothesis test in which the test statistic has a Student's t distribution if the null hypothesis is true. It is applied when the population is assumed to be normally distributed but the sample sizes are small enough that the statistic on which inference is based is not normally distributed because it relies on an uncertain estimate of standard deviation rather than on a precisely known value.
Source: Up to date.
43
46. All of the following increase the sickling phenomenon, EXCEPT:
a. Presence of HgbF
b. Acidosis
c. Hypotension
d. Decrease in cell water concentration
Answer: A. HbF is protective.
| Source: up to date.
44
47. Pt. s/p elbow ORIF, now c/o decreasing ROM. XR shows heterotopic ossification. All are true, EXCEPT:
a. Can be prevented with NSAIDs
b. XR evidence shows before limitation of ROM
c. Common with head injury
d. Immobilization can cause it
Answer: B
45
48. Why is morphine preferred over meperidine in post-op pain?
a. Meperidine has agonist/antagonist properties
b. Mep has no specificity for opioid receptors
c. Meperedine has a higher ceiling effect
d. Worry about buildup of meperidine metabolites.
Answer: D
Metabolites are shown to have serotonergic effect so can cause serotonin syndrome
46
49. Pt. very pregnant, best position for surgery?
a. R Lateral decubitus
b. Supine
c. Reverse Trendelenburg
d. Something else
Answer: B (previous answer A.) L lateral decubitus position would offload her IVC. R lateral would be bad. It depends on the surgery.
47
50. At what level of training is resident most likely to suffer accidental needle stick?
a. I
b. II
c. III
d. V
Answer: D vs A. According to the study by the NEJM in 2007, 99% of PGY-5 trainees had suffered a needlestick injury. 99% of residents had a needlestick injury before their training ended.
Source: Makary et al. NEJM. 2007. Needlestick injuries among surgeons in training.
48
51. Question comparing and contrasting Apoptosis and Necrosis, which is true?
a. They can occur simultaneously after ischemia/reperfusion injury.
a
49
52. Norepinephrine mainly acts on which of the following receptors:
a. α1
b. α2
c. β1
d. β2
Answer: A. (previous C) Norepi has little beta-2 agonist activity. It acts on both alpha1 and beta1 receptors. Alpha1 having slight higher affinity.
Source: Eric, Pharmacist at MGH
50
54. Proto-oncogenes can become oncogenes by all of the following, EXCEPT:
a. Loss of both alleles
b. Frameshift mutation
c. Translocation
d. Something else
Answer: A.
Schwarz:
Proto-oncogenes can be activated (show increased activity) or overexpressed (expressed at increased protein levels) by translocation (e.g., abl), promoter insertion (e.g., c-myc), mutation (e.g., ras), or amplification (e.g., HER2/neu).
A proto-oncogene is a normal gene that can become an oncogene due to mutations or increased expression. Upon activation, a proto-oncogene (or its product) becomes a tumor-inducing agent, an oncogene.[7] Examples of proto-oncogenes include RAS, WNT, MYC, ERK and TRK. Activation: The proto-oncogene can become an oncogene by a relatively small modification of its original function. There are three basic activation types: 1. A mutation within a proto-oncogene can cause a change in the protein structure, causing an increase in protein (enzyme) activity a loss of regulation 2. An increase in protein concentration, caused by an increase of protein expression (through misregulation) an increase of protein stability, prolonging its existence(chunky time) and thus its activity in the cell a gene duplication (one type of chromosome abnormality), resulting in an increased amount of protein in the cell. 3. A chromosomal translocation (another type of chromosome abnormality), causing an increased gene expression in the wrong cell type or at wrong times the expression of a constitutively active hybrid protein. This type of aberration in a dividing stem cell in the bone marrow leads to adult leukemia. Mutations in microRNAs can lead to activation of oncogenes.[8] New research indicates that small RNAs 21-25 nucleotides in length called microRNAs (miRNAs) can control expression of these genes by downregulating them.[9]Antisense messenger RNAs could theoretically be used to block the effects of oncogenes.
51
55. Vitamin K levels can be decreased by all of the following except
a. Coumadin
b. Vit B12
c. Something else
d. Something else
Answer: B.
52
56. Pt. comes in, requires urgent OR, on coumadin with INR 3.6. What should you do?
a. Give 10 mg Vit K and wait 12 hours
b. Stop coumadin and wait for INR to normalize
c. Give 10 mg Vit K and FFP and go to OR
d. Something else
Answer: C.
53
57. Pt. post op after some random surgery, develops renal failure on POD #2, next day develops heart and liver failure. His mortality rate is approximately:
a. Doubles with each new organ failure
b. 50%
c. 90%
d. Something else
Answer: C. The mortality rate for isolated renal failure is about 10%; however when greater it is multi-organ failure, as the case here, the mortality rate is great than 90%. Although Morrell notes says 50-60% when 3 organs involved.
Source: Internal Medicine, Jay Stein. P2263
54
58. All of the following are signs of anticholinergics, EXCEPT:
a. Fever
b. Cramping
c. Hallucinations
d. Sweating
Answer: D. Red as a beet" - Cutaneous vasodilation occurs as a means to dissipate heat by shunting blood to the skin, in order to compensate for the loss of sweat production.
"Dry as a bone" (anhidrosis) - Sweat glands are innervated by muscarinic receptors, so anticholinergic medications produce dry skin.
"Hot as a hare" (anhydrotic hyperthermia) - Interference with normal heat dissipation mechanisms (ie, sweating) frequently leads to hyperthermia.
"Blind as a bat" (nonreactive mydriasis) - Muscarinic input contributes to both pupillary constriction and effective accommodation. Anticholinergic medications generally produce pupillary dilation and ineffective accommodation that frequently manifests as blurry vision.
"Mad as a hatter" (delirium; hallucinations) - Blockade of muscarinic receptors in the central nervous system (CNS) accounts for these findings. Manifestations may include: anxiety, agitation, dysarthria, confusion, disorientation, visual hallucinations, bizarre behavior, delirium, psychosis (usually paranoia), coma, and seizures. Hallucinations are often described as "Alice in Wonderland-like" or "Lilliputian type," where people appear to become larger and smaller. Patients with altered mental status often present with agitation and may appear to grab invisible objects from the air [11]. Although central and peripheral anticholinergic effects are commonly seen together, in some cases, central effects may persist after resolution of peripheral symptoms.
"Full as a flask" - The detrusor muscle of the bladder and the urethral sphincter are both under muscarinic control; anticholinergic substances reduce detrusor contraction (thereby reducing or eliminating the desire to urinate) and prevent normal opening of the urethral sphincter (contributing to urinary retention).
Source: Up to date.
55
59. Signs of Hypercalcemia, EXCEPT:
a. Proximal muscle weakness
b. Carpopedal spasm
c. Something else
d. Coma
Answer: B. Fatigue, abdominal pain, anorexia, weakness, depression, vomiting, and constipation. Severe hypercalcemia may cause acute pancreatitis, and peptic ulcer disease secondary to prolonged hypercalcemia is also common. With ionized calcium concentrations above 3.0 mmol/L, cognitive dysfunction becomes more prominent, and above 4.0 mmol/L psychosis, stupor, and coma are expected. Although a shortened QTc interval may be seen on EKG, hemodynamically significant arrhythmias are rare.
Source: Morris, Emergency Medicine.
56
60. Trauma pt. with blood from meatus. You should:
a. Cystogram
b. Retrograde Cysto
c. Something else
d. Something else
Answer: B.
57
61. Least sensitive indicator of compartment syndrome:
a. Parasthesia
b. Pain out of proportion
c. Decreased pulses
d. Pain with passive stretch
Answer: C. earliest sign is pain on passive stretch.
| Source: M.Bernstein, M.D.
58
62. Trauma pt. with pelvic and femur fx. Pt becomes hypotensive with dropping HCT. You should do which FIRST:
a. Stabilize the fractures
b. Give pRBCs
c. Give fluids
d. Something else
Answer: C. (previous answer A) ABCs. C = circulation, first fluid administration is IV bolus of fluid and determine if responsive.
Source: M.Bernstein, M.D.
59
63. Most common cause of Carpal Tunnel Syndrome:
a. Volar ganglion cyst
b. Trauma
c. Tenosynovitis
d. Masturbation
Answer: B An entrapment neuropathy from compression of the median nerve in the carpal tunnel, particularly from synovitis of the tendon sheaths or carpal joints and recent or poorly healed fracture
60
64. Which oncogene is associated with MEN II?
a. k-ras
b. p53
c. p diddy
d. ret
Answer: D.
61
65. Epstein-Barr virus is associated with which of the following:
a. Liver cancer
b. Nasopharyngeal cancer
c. Kaposi’s Sarcoma
d. Something else
Answer: B. Kaposi’s is associated with HTLV.
62
67 The median is the best measure of central tendency in which of the following cases?
a. skewed population sample
b. small sample size
Answer: A.
63
68 To better write prescriptions a couple of changes were discussed, all would be useful EXCEPT?
a. Add zero to left of dose (e.g. 0.12 mg )
b. Add zero to right of dose (e.g. 12.0 mg)
c. Not to write international unit as “IU”
d. Not write QD, OS and OD
Answer: B.
64
69 Patient fell from horse on head had seizure then was brought to ER with stable vitals and normal CT and clinical exam what would you do to prevent seizures?
a. Iv fluids
b. Trendelenburg position
c. Loading dose of phenytoin “dilantin"
d. Observe
Answer: C
65
70 Mutation found in MEN II?
a. K-Ras oncogene
b. Ret oncogene
c. P53
d. CEA
Answer: B
66
71 Patient head injury, what is most likely prognostic facture of having seizures?
a. Occipital lesion
b. Use of illicit drugs
c. Age
d. GCS
Answer: D
67
72 Which of the following tissues has been shown to be the most immunogenic?
a. Skin
b. Liver
c. Heart
d. Kidney
Answer: A
68
73 Patients with Hepatitis C are more liable to have all the following EXCEPT:
a. Cryoglobulinemia
b. Lymphoma
c. Chronic infection
d. Hepatocellular carcinoma
Answer: D
B: 20-30% increase chance of non-hodgkin lymphoma
A: true
C: I think they mean chronic Hep C - common
D: HCV does not directly increase risk of HCC but it increases the chance of having cirrhosis, which is a risk factor for HCC. So having HCV will indirectly increase your chance of HCC
69
74 In 59 year old diabetic women with claudication. Angiogram reveals atherosclerosis of the superior femoral artery. According to Poiseuille’s law, an artery with a segment of atherosclerotic narrowing would have a decrease in blood flow:
a. directly proportional to the radius and inversely proportional to the length
b. indirectly proportional to the radius to the fourth and directly proportional to the length
c. indirectly proportional to the radius and directly proportional to the length
d. directly proportional to the radius to the fourth and directly proportional to the length
Answer: B
70
75 Which kind of HLA not responsible for kidney HLA matching
a) HLA A
b) HLA B
c) HLA C
d) HLA DR
Answer: C
71
76 Patient had total thyroidectomy for papillary carcinoma, which marker will indicate recurrence:
a. Calcitonin
b. CT
c. MRI
d. Thyroglobulin
Answer: D
72
77 What doesn’t happen after massive transfusion?
a. Coagulopathy
b. Hypothermia
c. metabolic acidosis
d. Hypocalcaemia
Answer: C
73
78 If you were planning a clinical trial to test the efficacy and the morbidity of a new drug compared to the standard chemotherapeutic agent, what type of clinical trial would that be?
a. Phase I trial
b. Phase II trial
c. Phase III trial
d. Cohort study
Answer: C
74
79 A 23 year old male is stabbed in the neck and sustains a carotid artery injury. He has been in a coma for two hours. What is the best intervention to prevent permanent damage?
a. Ligate the carotid artery
b. Repair the carotid artery
c. Observe
d. Heparinize
Answer: B?? I thought guy in coma we should observe.
75
80 Which NSAID has the least chance of causing a GI Bleed:
a. ASA
b. Ibuprofen
c. Celecoxib
d. Naproxen
Answer: C
76
81 A 60 year old woman with past history of breast cancer and was treated, presented with ataxia and gait, found to have single large cerebellum mass pressing against ventricle causing distention. Rest of metastatic workup was negative. What is the best management?
a. Radiotherapy alone
b. Surgical excision and radiotherapy
c. Chemo alone
d. VP shunt and dexamethasone
Answer: B
77
82 Best analgesia for post thoracic surgery is?
a. Oral analgesia
b. SC analgesia
c. Epidural
d. PCA
Answer: C
78
83 Fetal wound healing is characterized by all EXCEPT:
a. No TGF-B
b. Less neutrophils and macrophages
c. No scarring
d. More hyaluronic acid in the wound
Answer: A.
79
84 All of these are proper in completing an informed consent EXCEPT:
a. General risks of the procedure
b. reasonable alternatives to the proposed intervention
c. specific risks of the procedure
d. the exact percentages of success and failure
Answer: D
80
85 In obtaining a consent you should not:
a. Explain the risks
b. What are the available alternatives
c. Make sure the patient understands the procedure
d. Withhold recommendations from the patient
Answer: D
81
86 You are explaining a breast cancer treatment to your patient for consent, while you are explaining the patient takes out her iphone and is playing bubble buster, she has obviously lost interest. When you ask her if she understood she says that she doesn’t want to listen to these bad things. What should you do?
a. Tell her either she listens to you or no surgery
b. Tell her to go to another surgeon
c. Bring in a someone from the patients side “an advocate” and explain the risks and procedure in detail
d. Go ahead with the surgery just document clearly in the chart that everything was explained
Answer: C
82
87 Epithelialization in wound healing:
a. Only starts from margins
b. Doesn’t occur over necrotized and infected areas
Answer: B.
83
88 Which of these cells is not necessary for wound healing:
a. Neutrophils
b. Macrophages
c. Epithelial basal cells
d. Fibroblast
Answer: A
84
89 What would help in wound healing
a. Tobacco
b. Steroids
c. Vitamin A
d. Something else that’s idiotic, Clorox or spit
Answer: C
85
90 Fibroblasts stimulated by:
a. TNF
b. TGF a
c. TGF b
d. One of the IL’s
Answer: C
86
91 Dominant cell in proliferative phase
a. Neutrophil
b. Fibroblast
c. Myloblast
d. Macrophages
Answer: B
87
92 A 45 year old male had a free muscle flap for coverage of a defect. Three hours later the nurse notices that the flap is cold, clammy and dusky. When pricked with a needle, the flap oozes dark blue blood. The appropriate treatment is:
a. Observation
b. Application of leeches
c. Local injection of heparin
d. Re-exploration
Answer: B
88
93 What is not a proper method to asses a musculocutaneus flap vascular supply “pedicle”:
a. Doppler
b. Temperature
c. Transcutaneus oxygen something
d. Inject flurosomething into flap
p. s we have no Idea,, but were darn sure were not injecting anything with fluro in its name in to our new flap
Answer: D
89
94 Sickle-cell patient would have less sickling with:
a. Increase pH
b. Increase fetohemoglobin in their blood
c. Low PaO2
Answer: B
90
95 Spleen is not enlarged in:
a. Idiopathic Thrombocytopenic Purpura
b. Liver failure
c. Leukemia
d. Hyperspleenisim
Answer: A.
91
96 In hyperspleenisim:
a. Lower life expectancy of platelets
b. Platelets are non functioning
c. The amount of bleeding you would expect is disproportionate to how much platelets you give
Answer: A.
92
97 Patient found to have renal Ca in the upper lobe of left kidney, pressing the spleen upwards, in preparation for surgery and a possible splenectomy you would:
a. Give nothing
b. Give preoperative vaccination for influenza and pnemoccocus
c. Give postoperative vaccination for influenza
d. Give life long prophylactic antibiotics
Answer: C.
I think it's B. This is an elective surgery so should be given two weeks in advance. If this was a Trauma setting, then yes, give after 2 weeks, or before discharge.
From Schwarz
In the setting of elective splenectomy, patients should be
vaccinated 2 weeks prior to surgery to optimize antigen recognition and processing. If splenectomy is performed emergently, vaccinations can be administered postoperatively and consideration should be given to delaying administration for 2 weeks to avoid the transient immunosuppression associated with surgery.
More information on infection rates from Schwarz
Patients undergoing splenectomy for hematologic or
malignant indications have the greatest risk, whereas patients who undergo splenectomy for trauma or iatrogenic injury have the lowest risk. OPSS is more common in the pediatric population, with 4.4% of children less than 16 years of age versus 0.9% of adults developing this life-threatening condition. The risk has been observed to be the greatest in the first 2 years
after splenectomy; however, asplenic patients remain at lifelong risk.108,109,110 Considering that the spleen is the site for special adaptation of macrophages that target encapsulated organisms, asplenic patients are at higher risk of infection caused by Streptococcus pneumoniae (responsible for >50% of OPSS), H. influenzae type b, Neisseria meningitidis, and Capnocytophaga
canimorsus (transmitted by dog bites).111
need to give post-operative. Ideally 10-14 days otherwise, give prior to discharge.
93
98 Patient had MVA and was found to have pelvic and femur fracture, abdominal exam was benign, patient was stable with pulse 100 BP 120/70 but confused and Hb 79, your initial step would be:
a. Give blood
b. Give 2 liters of RL
c. Reduction of fractured femur
d. Give hot chocolate
Answer: B.
94
99 A researcher performs a retrospective study in which 40 patients who had pouch reconstruction and 70 patients, who had ileostomy, are sent a questionnaire about satisfaction with results. A total of 60 patients respond. Using chi-square analysis of the proportion of patients satisfied in each group, she finds a significant difference in the level of satisfaction between groups (p=0.03). This work could be criticized for which of the following:
a. Inappropriate statistical test
b. Selection bias
c. Sample size too small for statistical analysis
d. The p value was too high to be significant
Answer: B
95
100 Patient presented post nephrectomy with wound oozing found to have high amylase in the fluid and ct scan showed pancreatic collection:
a. NPO and TPN
b. Drain then NPO & TPN
c. Open wound
d. Observe
Answer: B
96
101 During an excisional cervical lymph node biopsy, the thoracic duct is transected. The best action at this time is:
a. ligation of the duct
b. re-anastamosis of the duct to the subclavian vein
c. primary repair of the duct
d. closed suction drain
Answer: C – because we could identify the lesion, if not you ligate it, always try primary repair first.
Debatable … we think if u can see the duct infront of you try and anastamos it… if you cant then ligate it… most books would say ligate it
97
102 In a polyuric patient with an increased urine specific gravity, which is the most appropriate diagnosis?
a. Diabetes insipidus
b. Diabetes mellitus
c. Diuretic use
d. SIADH
Answer: B
98
103 Findings in tension pneumothorax all except:
a. Increase CO2
b. Increase CVP
c. Increase SVR
d. Increase HR
Answer: C.
99
104 All these factors are made in the liver except:
a. VI
b. VIII
c. IX
d. V
Answer: B
100
105 Supine position effects all except:
a. Decrese HR
b. Decrese venous return
c. Decrease SVR
Answer: C
101
106 Transfusion related acute lung injury “TRALI” is due to transfusion of:
a. PRBC
b. Platelets
c. Crio
d. Plasma
Answer: A.
102
107 Regarding radiotherapy , it works by all except:
a. Rendering the ability of the cell to reproduce
b. Directly ionizing DNA molecule
c. Indirectly ionizing DNA with free radicals from ionized H2O
d. Oxygen renders the effect of radiation and makes tumors more resisitant.
Answer: D.
It works directly .indirectly and oxygen actually helps by making damage more permanent.
103
108 Vitamin D plays a role in:
a. Increase GI Ca absorption
b. Increase PTH
c. Decrease reabsorption Ca in the kidneys
d. Decrease GI Phos absorption
Answer: A.
104
109 Cause of chronic rejection in liver transplant:
a. Cell mediated immunity “non-nucleated cells”
b. Humoral mediated immunity “abx”
c. both
d. Schwartzman phenomenon
Answer: C
105
110 Patient with a mass on the superior pole of the kidney pressing on the spleen. Will undergo elective nephrectomy and spleenectomy. What is the best method of minimizing post op splenectomy complications?
a. Implant portions of spleen into omentum
b. Immunize against pneumococcus and H flu
c. Immunize against influenza
d. Immunize against pneumococcus
Answer: B
Should be all three; Pneumococcus pneumoniae SC, Neisseria meningitidis IM and Haemophilus influenza IM. 14 days prior in elective or 14 days post in emergencies
106
111 Patient received silver nitrate, blood became dark brown w cyanosis and SOB most likely cause:
a. Cardiac failure
b. Respiratory failure
c. Methemoglobinemia
d. Cyanide poisoning
Answer: C. known hematologic side effect of silver nitrate is methemoglobinemia
107
112 Patient post hernia repair under spinal anesthesia, developed respiratory distress after morphine, failed intubation and difficult bagging, what’s next:
a) Nasotrachial
b) Tracheostomy
c) Cricothyroidotomy
d) Laryngeal mask
Answer: D. !!!
108
113 Heterotopic Ossification all true except:
a. seen on XR before clinically significant
b. preventable by NSAIDs
c. linked to head and spine injuries
d. Didronel should be before xray changes
Answer: A. Didronel = etidronate = is a type of bisphosphonate
109
114 Patient with burn who is receiving adequate amount of hydration,,, the amount is given with weight and %, but 2nd hour pt has border line low urine output was normal first hour:
a. Observe with follow up urine output
b. Increase fluid rate
c. Give bolus
Answer: A.
110
115 Most common anaerobic bacteria found in post op wound infection:
a. Clostridia
b. Peptostreptococcus
c. Bacteroides fragilis
d. Campylobacter
Answer: C
111
116 Most common bacteria found in post op wound infection is:
a. Streptococcus
b. Staph aureus
c. Coag –ve staph
d. Enterococci
Answer: B
112
117 Aspirin is not used for anti-thrombosis prophylaxis because:
a) No way to monitor effectiveness
b) The high incidence of fatal pulmonary embolism
c) Increased incidence of deep venous thrombosis
d) Increased side effects
From a European study
Answer: B
113
118 Intubated patient found to have fat embolism. best management?
a. Increase PEEP is the best management
114
119 On 2nd post operative day a patient is oozing from his wound and has crepitation on the edges of it , this is most likely:
a. Wound dehiscence
b. Simple wound infection
c. Fistula
d. Necrotizing fasciitis
Answer: D
115
120 Patient was injured with beer bottle to forearm, continues to bleed with strong compression, most likely cause is?
a. Coagulopathy
b. Remnant glass practical
c. Complete tear of radial artery
Answer: B
Not sure I said b as particle doesn’t permit complete compression?
116
121 Incisional hernia post op, all are risks except:
a. Previous surgery
b. Steroids
c. Wound infection
d. Chronic lung disease
Answer: A.
Nice table: http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=DSU20003
117
123 Father has hemophila, no history in his wife’s family. What can be said about his kids:
A all sons will have hemophila
B all daughters will have hemophilia
C no sons, and all daughters
D no sons, and all daughters will be carriers
Answer: D. Hemophilia is an X-linked recessive disorder. Affected fathers will transmit normal Y to all sons (sons not-affected) and diseases X to all daughters (carriers, because normal X from mother)
118
124 78 year old man found awake oriented at scene, now four hours post 35% burn is in shock most likely due to:
a. Sepsis from his open dirty wounds
b. Cardiogenic from an imposing MI
c. Hypovolemic from inadequate resuscitation
d. Unsuspected internal bleed
Answer: C.
119
125 Cholestatic jaundice while on TPN most likely results from:
a) Carbohydrates
b) Lipids
c) Proteins
d) billiary sludge
Answer: A. I cant remember how we found this but I think it was from an article about how carbs in TPN bypass the port-hepatic system and the liver recognizes it as hyperglycemia and stores it as apposed to GI source which it would take store a bit and release the rest
120
126 In trauma you would expect:
a. Increase in insulin.
b. Decrease in catecholamines
c. Decrease in GH
d. Increase in glucagon
Answer: D.
121
127 Which of the following is used in von Willebrand’s Disease to restore vWf to above 80%:
a. platelet transfusion
b. Warfarin
c. desmopressin acetate (ddAVP)
d. fresh frozen plasma
Answer: C. A three- to five-fold increase in baseline levels of VWF and factor VIII levels is expected at approximately 30 to 60 minutes after the infusion, with the response persisting for 6 to 12 hours [12]. The half-life of the released VWF will correspond to the particular half-life of the patient's own VWF
122
128 What is the most common tumor in HIV-infected patients:
a. B-cell lymphoma
b. Kaposi sarcoma
c. Cervical cancer in females
d. Anal squamous cell carcinoma
Answer: B.
123
129 Degree of burn is not related to:
a. Duration of burn
b. Thickness of skin
c. If covered with clothing
d. Skin color
Answer: D.
124
130 Pyloric stenosis the findings would be:
a. Hyperchloremic, hypokalemic, metabolic acidosis
b. Hyperchloremic, hypokalemic, metabolic alkalosis
c. Hypochloremic, hypokalemic, metabolic acidosis
d. Hypochloremic, hypokalemic, metabolic alkalosis
Answer: D. hypochloremic, hypokalemic, met alkalosis.
125
131 Which of the factors below stimulate renin release by the kidney?
a) catecholamines
b) Angiotensin II
c) Leukotrienes
d) Thromboxane A2
Answer: A.
126
132 A patient with multiple myeloma is found to have a sodium of 127. The other blood results are shown (given lytes, total protein elevated). The cause of hyponatremia is:
a. Meningitis
b. SIADH
c. Pseudohyponatremia
Answer: C.
Pseudohyponatremia: normal [Na] but reported low due to elevated lipids or proteins
127
133 Which is an irreversible platlet COX inhibitor:
a. Heparin
b. Clopidogrel
c. ASA
d. Enoxaparin
Answer: C.
128
136 All are true about keloids except:
a. more common on face ,turnk and arms
b. confined to boundaries of scar
c. May respond to intralesion injection of triamcinolone
d. Common in black people
Answer: B. keloids behave like true neoplasms and grow beyond borders of the scar.
129
mechanism of epidermal inclusion cyst?
result from the proliferation of epidermal cells within the dermis
130
138 Viruses that relates to cancer include all except:
a. HepB
b. HepC
c. EBV
d. CMV
Answer: D. HBV, HCV cause hepatocellular carcinoma. EBW causes Burkitt’s lymphoma. CMV - >?
131
139 Commonest virus transmitted by blood transfusion in immunosuppressed patients:
a. CMV
b. HIV
c. HBV
d. HCV
Answer: A.
Severe anaphylactic reactions have a reported incidence of 1:20,000 to 50,000 [30,31], but are believed to be more common."
Up to Date also says the following for the risk of viral infection with blood transfusion:
RISK OF INFECTION FROM A TRANSFUSION — Safety measures, such as improved screening tests, have dramatically reduced the risk of acquiring a viral infection from a blood transfusion. Recent estimates suggest the following risks of developing certain infections after receiving a unit of blood:
One in 58,000 to 269,000 for hepatitis B
One in 2 million for hepatitis C
One in 2 million for human immunodeficiency virus (HIV)
One in 2 million for human T-cell lymphoma/leukemia virus (HTLV)
132
140 Kaplan-Meyer method is used for:
a. Calculating the curve of durability
b. estimating probability of surviving a unit of time
c. sample size determination
d. nonparametric stats
Answer: B.
133
141 The most common cause of death after blood transfusion is:
a. HCV
b. HBV
c. HIV
d. Acute transfusion reaction
Answer: D?
134
142 Zone one in the neck is from cricoid cartilage to:
a. Angle of mandible
b. Base of skull
c. Clavicles “thoracic outlet”
d. Hyoid bone
Answer: C. Zone I = clavicles – cricoid cartilage. Zone II – cricoid cartilage to base of mandible. Zone III – base of mandible of TMJ
135
144 High pressure injection of workers finger with greese:
a. Abx and observe
b. Observe
c. Debride injection site
Answer: C
136
145 Patient with CO poisoning on 100% Oxygen , half life of carboxyhemoglobin is:
a. 40-60mins
b. 2-3 hours
c. 6-8 hours
d. 15-30 mins
Answer: A The half-life of CO while a patient is breathing room air is approximately 300 minutes, while breathing high-flow oxygen via a nonrebreathing face mask is about 90 minutes, and with 100 percent hyperbaric oxygen is approximately 30 minutes..
137
146 Which factor would cross link fibrin to form a clot:
a. VII
b. VIII
c. IX
d. XIII
Answer: D.
138
147 Commonly found in labs post spleenectomy:
a. Leukocytosis
b. Thrombocytosis
c. Spherocytosis
d. Erythrocytosis
Answer: B.
139
148 Sepsis following a blood transfusion is most likely from what organism?
a. Syphilis
b. Yersina
c. E. coli
d. Pseudomonas
Answer: B.
140
149 Patient post central line insertion had air embolisim :
a. Place in trendelenberg, Lt decubitus and aspirate from central line
b. Place in trendelenberge, Rt decubitus and aspirate from central line
c. Place in reverse trendelenberg
d. Remove the line and hepranize
Answer: A. Lt side down = Rt ventricle up = best way to keep air in rt ventricle…
141
150 Released from muscles in stress for fuel:
a. Alanine
b. Lysine
c. Glutamine
d. Glucose
Answer: C. Although considered a nonessential amino acid, glutamine is a conditionally essential amino acid during periods of stress [26]. It is not usually included in TPN formulations due to stability issues.
142
151 A 45 y old man is rushed to the OR after identification of a leaking aortic aneurysm on CT scan in the trauma evaluation following a high speed MVC. The patient declares that he is a Jehovah’s witness and therefore consented to the surgery but not to the administration of any blood or blood products.During the surgery the patient’s blood pressure falls and it becomes clear the patient will likely not survive without blood transfusions.The nurse then comes into the OR stating that the wife is outside and threatens to sue you unless you do everything you can to save her husband,emphasizing that you should administer blood if that’s“what he needs”.The most appropriate action at this time is:
a. listen to the wife because she is the POA while the patient is incapable of making this decision on his own under the general anesthesia
b. administer blood and disregard the evidence
c. do not administer any blood products and continue to resuscitate the patient to the best of your ability
d. don’t give blood or any other IV fluid
Answer: C.
143
152 A pregnant women in OR with decrease in BP best action:
a. give IV fluid as patient is dehydrated
b. place patient on right side
c. place patient on left side
d. awake patient IVC
Answer: B.
I think it's actually C. Look it up
144
153 Which of these studies would have the least bias error:
a. RCT
b. Meta-analysis
c. Case control
d. Cohort
Answer: B.
145
154 Osmotic pressure is determined by:
a. Intracellular Na
b. Extracellular Na
c. Intracellular protein
d. Extracellular protein
Answer: B
Previous answer was D, but I think that is wrong.
Na: (most abundant ECF ion) is responsible for the majority of extracellular osmolality
K: most abundant ICF ion, responsible for majority of ICF osmolality
The difference in osmolalities over a membrane is the osmotic pressure
146
155 All are complications of Lasix therapy EXCEPT:
a. Hyperuricemea
b. Hyponatremia
c. Hypercalcemia
d. Metabolic alkalosis
Answer: C. Lasix is used to treat hypercalcemia.
147
156 Patient for repair of hernia has INR 3.6 will need for surgery after 6 h:
a. Vit K 10mg
b. FFP + Vit K 10 mg
c. Vit K 5mg
d. Observe
Answer: B.
148
157 Semi-occlusive dressing “keeps moisture in”
a. Decrease bacteria colonization
b. Keeps wound dry
c. Decreases scab formation
d. Least infection rate
Answer: C.
149
158 What is the source of the enzymes that degrade tissue in an abcess
a. Neutrophils
b. Macrophages
c. Eosinophils
d. Mast cells
Answer: A. We thought of macs then found Abscess = dead neutophils
150
159 Most common cause of post operative infection:
a. UTI
b. Wound infection
c. Pneumonia
d. Line sepsis
Answer: A.
151
160 To be eligible for weight loss surgery “bariatric surgery” patient must have a BMI of:
a. BMI > 30
b. BMI > 35
c. BMI > 40
d. BMI > 45
Answer: C.
152
161 HLA matching is routinely performed prior to transplants of the following organs:
a. lung
b. heart
c. kidney
d. liver
Answer: C.
153
163 Patient with close angle glaucoma can give what induction agent?
propofol
154
164 epinephrine’s role in asystole is for it’s:
a. inotropic effect
b. increase BP
c. chornotropic effect
d. vasodilation
Answer: A.
155
165 steroid cause all ecept:
a. suppress IL-2 production
b. suppress INF production
c. suppress upgrade lymphocyte “proliferation”
d. decrease expression of MHC
Answer: D. inhibits uptake and processing of MHC but not presentation
156
167 Cautery most common hazard would be:
a. Skin burn
b. Electric shock to surgeon
c. Visceral perf
d. Arrhythmias
Answer: A.
157
168 All except decrease infection rate:
a. No hypotension in OR
b. Less persons in the room
c. Well control of glucose
d. Shaving pt the day before
Answer: D. Clipping on table is the best, shaving increase infct rate
158
169 Factor that activates thrombin formation:
a. XI
b. VII
c. IX
d. X
Answer: D.
159
170 Minimal daily requirement of glucose for metabolism is:
a. 50g/day
b. 100g/day
c. 500g/d
d. 10g/day
Answer: B. 1.5g/kg/d is the minimum requirement for basic metabolisim
160
171 Dirty, open fracture grade III of tibia , abx of choice:
a. Ancef
b. Ancef genta
c. Ancef genta penicillin
d. Clinda cipro
Answer: B Grade3 open tibia require 3rd gen + aminoglyco if risk of clostridia from barn infection swap genta for high dose penicillin
161
173 PIP injury in hand “tendon” commonalty hospital hours from a plastic surgeon, you would: “cant remember details”
a. Take to OR try to fix and send to plastic surgeon
b. Just wrap and send to plastic surgeon
c. Observe and f/u in clinic
d. Fix and f/u in clinic
Answer: A.
162
174 Consented Breast cancer patient on trial drug ends up with recurrence. Can they successfully sue the surgeon?
No.
| ?
163
175 All the following drug when administered will cause hypokalemia except?
a. Insulin
b. Vitamin B12 “by promoting erythropoises”
c. Salbutamol
d. Digoxin
Answer: D.
“hypokalemia causes dig toxicity, but dig itself doesn’t cause hypokalemia”
Vitamin B12 “by promoting erythropoises”
164
176 Patient with fractured pelvis, stable with HB 76, pulse 160, BP 120 … initaly you would:
a. Give blood
b. Fix pelvis in OR
c. Send for Angio
d. Give IVF
Answer: D. ABCs
165
177 Patient with pancreatic fistula and acidosis most likely due to:
a. Loss of bicarb
b. Sepsis
c. Renal failure
d. Diarrhea
Answer: A.
Pancreatic fluid is rich in bicarb. If you los a lot you can get hyperchloremic non-anion gap metabolic acidosis
166
178 In comparison to full thickness graft, split thickness grafts:
a) have better take on contamination surface
b) have less pigmentation
c) have less primary contraction
d) develop better sensation
Answer: C. Previous answer was correct, but explanation was wrong.
primary contracture is that in OR when taking the graft and before planting it (How much it shrinks immediately). This is based on the quantity of elastin in the graft (thickness of the dermis). Therefore, full thickness skin grafts have MORE primary contracture than STSG.
2ndry contraction is that occurs later on in the scar… Less in full-thickness skin grafts
Think thick cosmetic, thin practical
