2011 exam

Question 1

Dog bites a child on the hand, what is the treatment?

Answer 1

amox-clav

if face then you need to do closure in layers, if its just on hands you can let it close on its own

Question 2

patient with renal transplant, presents with fever, back pain and bilateral leg pain. What imaging should you get?

Answer 2

CT, always

Question 3

what is the MOST specific sign of a aortic dissection on imaging?

Answer 3

widened mediastium

Question 4

what are 5 signs of ruptured AAA on imagig?

Answer 4

1) widened mediastium over 6 cm
2) apical cap ( blood is where it shouldn’t be in the lung)
3) tracheal deviation to the right ( its usually on the left side of the body)
4) loss of the aortopulmonic window
5) depression of left mainstem bronchus ( because there is blood in the left apical lung cap so everything shifts down)

Question 5

A domestic cat bites a child on the hand, what abx do you give?

Answer 5

amox clav

Question 6

How do you treat an extraperitoneal bladder rupture?

Answer 6

foley always, as they are essentially asking about a urethral tear
-there are five types of bladder rupture the most common being extraperitoneal ruptuer ( aka concomitant with a pelvic fracture). Here you place a foley. If there is an intraperitoneal bladder rupture ( eg a full bladder is struck with force) then you need OR repair because the urine leaks into the abdomen.

Question 7

chronic renal transplant rejection is mediated by?

Answer 7

host lymphocytes

Question 8

A man has a laceration with gravel and grass in it. What is the most important first step?

Answer 8

irrigation

Question 9

cyclosporine and tacrolimus mechanism of action is?

Answer 9

suppression of IL2
what this means is that the drug goes into the T cell cytoplasm and blocks the calcineurin pathway, which blocks IL2, which is needed for T cell proliferation

Question 10

all facts about banked blood are true except

Answer 10

stored blood is ept at pH 6.98
this is false, the blood is stored at about 7.20 on day one and then from there it undergoes glycolysis and lactate acid builds up causing decreased in pH aka it gets acidic

Question 11

pregnant patient gets a DVT- what SHOULDNT you do?

Answer 11

give her warfarin it causes fetal defects

Question 12

a postoperative diabetic patient is solmnolent with pH 7.2, Na 145, C02 34.what is the diagnosis?

Answer 12

HHS coma
they are acidotic
Na is high because they are peeing out all their water/ dieuresis
C02

Question 13

Patient is postoperative from ileal conduit, returns to ED with serosang discharge from upper part of the wound - what should you do?

Answer 13

i cant tell if this is ileum or a urinary coduit. either way, sending some labs seems reasonable, so send the fluid for Cr and Amylase

Question 14

all true about PE except:
Raised CVP
raised Pc02
raised PCWP

Answer 14

raised PCWP

this is is a false statemetn

Question 15

Congested pale flap, how do you treat?

Answer 15

leeches

Question 16

In regards to smoking 8 weeks prior to surgery, all are true EXCEPT?

Answer 16

there seeems to be two answers here, iether decreased pulmonary complications
vs
decreased reactivity of airways

Question 17

When do you consider thrombectomy for PE

Answer 17

patient has shock/ cardioresp compromise
so the answer is
a)patient with lobar PE and shock

Question 18

patient has blood at the urethral meatus, what test do you do?

Answer 18

do a retrograde urethrogram by inserting a foley and put in some contrast

Question 19

child has 25% second and third degree burns what do you do for nutrition?

Answer 19

people are between two answers here, either feeding tube with enteral feeds or central line and TPN right away. I would lean towards the former

Question 20

What is the treatment for a patient with unstable afib, hr 180, BP soft 70/40

Answer 20

cardioversion

Question 21

coagulopathy of acute trauma - all true EXCEPT

Answer 21

does not oocur before they reach the trauma bay

OF course they are coagulopathic before hitting the stretcher, we just dont see it in their labs until then

Question 22

contraindication to TPN is all EXCEPT

Answer 22

starvaton over 7 days

this is actually an indications for TPN

Question 23

breast cancer patient isnt feeling well, has bone, pain, mets, hypercalcemia. What is the intial treatment?

Answer 23

fluid and lasix

Question 24

brain death patient is initially stable but suddenly becomes hypotensive, serum sodium is increasing and the urinary outputs at over 500 cc/hr. what is happening and what is the treatment?

Answer 24

diabetes insipidus, likely central

give DDAVP/vasopressin infusion to tell the kidneys to keep water

Question 25

fat embolism is associated with which? liposuction sickle cell DM

Answer 25

sickle cell - there is a bone marrow ischemia crisis | - however a quick google search also showed embolism after liposuction procedure. I would go with sickle cell tho

Question 26

woman with worsening peripheral vascular disease, what is the basis of Pouiselles law in determining the resistance in the vessel?

Answer 26

pouseille law says the resistance is inversely proportional to the radius(to the 4th degree) and directly proportional to the length of stenosis So just remember resistance is inversely proportional to the radius to the 4, directly to length

Question 27

How does fat appear on the T1 and T2 versions of an MRI?

Answer 27

it is Bright on T2 dark on T1 think of it, the first pass thru, T1 is dark before we hit the light

Question 28

the definition of the incidence of disease is

Answer 28

the rate of new disease | vs pervalance which is the overall rate of existing disease or absolute amt of disease

Question 29

C02 in laparoscopic surgery causes all of the following except

Answer 29

increased preload actually the c02 inflates the diaphragm, pushes on the IVC and casues decreased preload. There is also hypercarbia that occurs, so you need to ventilate the patient well. Lastly the trendelenberg

Question 30

least reactive suture is

Answer 30

polypropolene ( prolene)

Question 31

what is the most prominent type of collagen in the proliferative phase of wound healing?

Answer 31

collagen III is first placed down starting at 10hrs -24 hrs. | this is then converted to type 1 collagen later in materation

Question 32

44 year old man 8 yrs post renal transplant, what cancer is he most likely to get? BCC testicular Prostate

Answer 32

non-melanoma skin cancer- BCC!! Apparently this is very common post solid organ transplant because you are on immunosupressants for so long. makes sense, the skin is a huge organ..

Question 33

what is the biggest risk for SSI? Obesity? Anemia? thrombocytopenia?

Answer 33

i really dont know | I think anemia since oxygen is so vital and DM patients have such issues with wound healing due to poor oxygenation

Question 34

patient is in a multitrauma, what are their TPN requirements in terms of kcal/day grams of protein/day % diet that should be lipids

Answer 34

you should give them 30-35kcal/day/kg 1.5-2g prot/day/kg 20-30% lipids

Question 35

in wound healing what is the correct sequence of events?

Answer 35

``` injury vasoconstriction vasodilation PMNs/neutrophil invasion re-epithelialize the injury collagen type III deposition contraction of the wound ```

Question 36

male on TPN gets septic, and has a non-anion gap metabolic acidosis. What is it from? the lactic acidosis or the TPN?

Answer 36

TPN - it causes a NAGMA when its wrong | recall that lactic acidosis is a cause of anion gap metabolic acidosis (mUDPILES!)

Question 37

male on TPN gets septic, and has a non-anion gap metabolic acidosis. What is it from? the lactic acidosis or the TPN?

Answer 37

TPN - it causes a NAGMA when its wrong | recall that lactic acidosis is a cause of anion gap metabolic acidosis (mUDPILES!)

Question 38

treat MRSA osteomyelitis with?

Answer 38

vanco

Question 39

Example of a clean contaminated wound is:

Answer 39

appy on a non-perforated appendix

Question 40

In a dirty operation, antibiotics are given, what is the chance of infection?

Answer 40

a book said 5% but thats not an option... so go with `5?? who know

Question 41

in rhabdo, what happens to phasphate and calcium?

Answer 41

``` you get hypocalcemia and hyperphosphatemia ( it leaks out of cells) ```

Question 42

in pelvic fracture the bleeding comes from

Answer 42

pelvic venous plexus/ posterior plexus

Question 43

Best was to distinguish between ATN and prerenal cause of low UO is

Answer 43

Fractional excretion of sodium. in prerenal, the excretion of sodium will be low in ATN it is high

Question 44

what are the guidelines for giving peri-op stress steroids?

Answer 44

they need to have been on 20mg IV for 2 weeks prior to surgery..plus there are alot of other rules about this...maybe youll get around to reading them maybe not

Question 45

``` in which pathology do you not retain sodium? CHF cirrhosis hypercortisolism hypoaldosteronism ```

Answer 45

hypoaldo - recall aldo helps you retain NA. without it you pee out your NA, your BP becomes soft and unstable and people collapse. You

Question 46

Patient post AAA repair, now has lost motor function. What happened?

Answer 46

anterior cord syndrome