ABS 2014 Flashcards Preview

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Flashcards in ABS 2014 Deck (155):
1

CRF on plavix - after removal of dilator for R IJ portacath during preporation for placement of tunnled cath pt become hypotensive then asystolic - managment includes

left lat decube
right throacotomy
perc aspiration left vent

2

6 cm MALTOMA tx

"abx"
chemo
chemo xrt
resection

3

adeno esoph confined to muscularis mucosa EUS neg managment should include distal esoph

MRI for to eval medial stinal nodes
5 cm margins

4

32 cm shorten esoph wiht 4 cm distal stricture that has required mult dilations and failed ppis

collis nissen
esophogectomy colon conduit

5

most likely for post splenectomy sepsis

blood cancer lymphoma / leukemia
sickle cell
incidental or en block for Colon CA

6

contrainidcaiton for hepatic met resection in colon cancer

also pulm met
periaortic lymph nodes pos
bilateral hepatic lobes

7

elderly pt most likely to contribute to ileus

PPI
haldol

8

mostly likely to cause enceph

flumazinil
benzos

9

sig diffuse bleeding in elderly pt with sigmoidectomy for tic dz on asa what is tx

platelets
FFP (becasue diffuse realy is factor v lieden def prob)

10

tx for second time spontanous ptx

thoroscopic blebectomy
chest tube and pleurodesis

11

sudden onset lower abdominal pain and right shoulder pain

ruptured ovarian cyst
ovarian torsion
non-ruptured ectopic

12

next test in 24 wk preg with RLQ pain and N/v

us

13

P3 G3; abdoinal pain 28 wk preg MVC neg ct scan O neg blood type and possitve "H-B" test

Ig
plasmophresis
emergency c section

14

temp vasc access in while mature right / left

right IJ / contralat

15

brachio basilic ptfe graft with good thrill at end of case throbosis that night

thrombectomy
look for new site

16

AV graft goes down radio cephalic - next site

brachiocephalic
brachobasilic
ptfe graft
start using other arm

17

most appropriate test for 18 yo tpn for chrons that drops pressure to 70/40 p 130 with pulsus paradoxes

eccho
ekg

18


sudden hypotension / incr CVP


PE
tamponade

19

28 yo chronic renal failure falied medical managment with incr calcium - what is operative treatment

"total parathyroidectomy with autioimplantation"
3-gland parathyroidectomy

20

6 cm right pheo with mibig scan postivive BILAERAL in 18 fem with MEN IIa

left adrenalectomy
bilateral cortical sparing adrenalectom

21

hepatic metastectomy with right suclavian and aline; just before liver parynchimal incision sudden hypotention and

air embo
tenssion ptx

22

most common cuase of long narrowing at desending colon partial obstruction with decompression distal - 3 mo s/p sigmoid ecotmy and liver metastectomy

anstomatic recurrence
diffuse peritoneal spread

23

important work up for mass at angle of mandible on xray consistnet with osteoma and mass also seen on scull in 18 f

colonoscopy
bx the jaw
nasopharyngeal scope

24

most likely retroperitoneal mass in FAP

lipocarcoma
fibrosarcoma
desmoid

25

most common etioloty of 3 cm throid nodue with follicuar cells in 30 yr femal

follicular adenoma
follicular cell carcinoma
papillary carcinoma

26

most important reason to do completion throiectomy in 60 m with follicular variant papillary ca

for effective I131
"cross lobar metastasis"

27

most comon etiology of 3 cm neck mass dx as squam

oropharyng
breast
lung

28

18 yo with ocult gi bleed work up possitve tech 99 what is intial tx

ppi
segmental ileal resection

29

crohs fhx pt take to or for negative appy
appy and cecum normal
inflammed distal ileum and dense inflammation of the mesentary
what is next step

bx ileum
appendectomy

30

32 yo euthroid female
4 weeks of swollen and tender thryoid with pain radiating to the left ear

thyroid lymphoma
subacute thryoiditis
hashiomotos

31

42 yo with TBI with increasing abd distention delveoping over several days now
x ray shows a measure right cecum of 10.4 cm prominate folded loops in the right- x ray is cut off but show part of massive colon in sigmoid

neostigmine
cecetomy

32

75 presents with mental confusion and lung mass sodium is 123

fluid restrict
3%

33

mid esophagus stricture dilation in a male now with servere chest pain xray and ekg negative

gastrigraphen swallow

34

gsw to the mid thigh in obese with ABI of 0.8 no hard signs

explore wound
CT
Angio

35

75 yo 400 lb fem with DM with left leg pain and pallor and bilateral foot pain and rubor - most useful test

angio
abd us

36

3 cm pancreastic mass in the tail - what is the safest lesion to whatch

serous cystadenoma
branch mucinous intraductal papilloma
main duct intraductal papilloma

37

mucin positive CEA positive mass in the tail is most likely
(amylase pos?)

adenocarcinoma
mucinous carcinoma
mucinus intraductal papilloma

38

injury RLN during thryoidectomy in 75 yo no with hoars breathy voice and aspiration of liquids

medialization of cords via thyroplasty or injection
traceostomy with cuff inflation
NGT with speach therapy
gastrec feeding tube
reoperaiton and repair of nerve

39

30 yo f mvc with renal injury moderate abdominal tenderness and stable vitals - gross hematuria - CT shows perinephric hematoma and urine extrav (no blush mentioned)

renal exploration and repair
observation

40

new born with juanice total of 8 (indirect 3?) with cystic dilitaiton of CBD

hepatico J
ERCP

41

new born term baby at the umbuilicus with partially detached umbulicus wiith bowel exposed with out peritoneal covering

gastroschesis
omphalocele
prunebelly

42

most likely complicaiton for crycothyroidotomy

tracheal stenosis
oropharyngeal stenosis

43

massive facial trauma with stridor and bleeding

tracheostomy (cric not an option)
bronch and intubation

44

most common complication from component seperation

UTI
wound infection
pneumonia

45

75 yo about to under go elective sigmoid with
ph 7.40/pco2 40/ pao2 70/. what next

these are normal for patients age

pre operative intermitent positive pressure ventitaiton

46

best test to work up severe COPD pre-op who wishes to under go elective hernia

spirometry with and with out brochodialators

blood gas
pulse ox

47

diffuse upper mucosal bleeding from the body what is best

heater prob
partial gastrectomy

48

best treatment for 1.5 cm lieomyoma at 32 cm in 42 yo man with dysphagia

extramucosal excision
wedge
enodluminal

49

best shunt of polycythemia vera with acites when TIPS does not work

side to side portocaval
distal splenorenal
proximal splenorenal
atrial meso

50

best shunt in patient on transplant list with esophageal varicies and moderate gastric varicies that are not actively bleeding

distal splenorenal
proximal splenorenal

51

treatment of anal canal 3 cm sqaumous cell

chemoradation
wedge
APR

52

best (definitive?) treatment for perforated posterior bleeding duodenal ulcer 32 yo female sclerosis is unsucessfull during EGD

epi and clips
heater probe and clips
band
heater probe and band

53

"previously healthy" 32 yo female found to anterior duodenal perf ulcer 6 mm with minimal solage - found on laparoscopic exploration

repair and omental patch

highly selective vagtomy and repair

pull omentum through with a scope and endoluminally tack in place

54

greatest risk of radiation injury to bowel

size of field
dose
pelvic radiation
thin patient

55

most cost effective initial treatment for anal fissure

nitro paste
botox
calcium channel block topical

56

chronic GS during elective lap chole can not definitve see cystic duct entering GB

(convert to open / cholangiogram not and option)

partial cholecystectomy overshowing the infundibulum

57

cirrhotic during elective lap chole for chronic GS a clear plane can not be established between liver bed and posterior wall

partial cholecystectomy and thermoablate the retained posterior wall

58

post lap chole path comes back GB cancer limited to the mucosa on the peritonealized survase

observe
seg 4b / 5 and node resection
chemo
chemo radiation

59

trauma shattered spleen take taken out pt turn damage control - what to do with 30% of right lobe liver lack

pack

60

4 injuries less than 50% in cercumference over 80 cm of jejunum in 18 yo that requires damage control (16 units blood pressure in the 70s)


staple off each injury without anastamoses

en block resection of jejunum - without anast

repaire injuries in single layer

repair injuries in double layer



61

poly trauma damage control belly left open then 2 wks after small bowel anast and putting in vicryl mesh to close belly - enteric content is seen midline

suction management of stool and tpn
(output rate of fistula not given)

close fistula

62

contraindication for closing the fasica

incr in peak airway pressures by 12

constant abdominal compartment pressure of 10

(cvp of 10)

63

ureter trapped in L1-3 harware - discovered when patient symptomatic a week later

transureteroureterostomy
perc nephrostomy
primary repair

64

5mm stone at ureterocystic junction with patient with 54 hyrdronephrosis and constant pain

shockwave lythotripsy
percnephrostomy

65

30 yo female MVC Abd CT right peritoneal hematoma - lower urinary tract ok with hematuria; stable; mild abd pain

retrograde urethrogram and cysOSCOPY (not cystogram)

renal angio

explore kidney and repair

66

young female mvc pt in OR for splenectomy - stable - non expanding right perinephric hematoma (bad grade of injury) - intra op urogram right does not light up - left contralteral does

right nephrectomy
observe
renal artery repair of right kidney

67

48 yo f at the time of simple mastectomy with path of DCIS HIGH grade comedo necrosis - and micro (microfocus of invasion) most appropriate next step

XRT and SLB
XRT and tamoxafin

68

shattered right kidney no blush, with gross hematuria stable patient

observe
nephrectomy

69

65 ref for new micro calcs seen by radiology s/p stereotactic bx with path of NON-proliferative dysplasia and sclerosing adenitis - marker left behind

excision

observe and repeat mammo in 1 yr

tamoxofen

70

30 obese female with halo surrounding lesion - heterogenous - calcified rim

fat necrosis

adenoma

...

71

45 60% TBSA inhilation injury torso and upper extremities intubated and carboxyhemoglobin level of 20

tx with 100% O2
hyperbarric O2

72

24 hr of ressuss 16 yo femal 40% TBSA burn vitals normal urine output ok - base def and lactic acid still up

continue fluids

test for..
(pe?, ).. rhabdo??

73

60 yo male massonry worker 6mm wide by 0.4 mm deep melanoma excised from cheek with closest margin 1.2 cm

superfical parotidectomy
observe
SLNB
neck dissection

74

nasty oozing purple papules leg of patient post chemo for lymphoma

kaposies

75

incidentally "simple" focus of small bowel low grade lymphoma (without spread)

observe
chemo

76

400 lb female with 4 cm medial leg venous stasis ulcer - best INITIAL treatment

INelastic compression
(is that a una boot)
superficial throbectomy
saphenous vein ligation

77

findings most consistent with hepatorenal syndrome rather than tubular necrosis

renal sodium less than 10
FENA less than 1
BUN / CR 20
fractional excretion of sodium

78

most common complicaiton from lazer ablation for vicose veins

thermal
recanulation

79

16 hot nodule 3 cm hyperthyroid 1 mo depsite antithyroid - tachy improves with bisphos - best treatment

continue bisphos
hemilobectomy

80

18 yo male with ASX testicle lesion that transilluminates. It bothers him and he wants taken care of.

inguinal excision
obs 3 mo re-eval / (us?)
aspirate
inject sclerosant

81

45 yo female with chronic esophageal reflux and dysphgia 1 year of PPI 4 cm stricture of mid esophagus that has required multiple dilations for relief of dysphagia - path shoes intestinal metaplasia (no mention of dysplasia)

nissen
duble dose PPI
collis
esophagectomy

82

durring nissen the GE junction is found 1 cm below the hiatus after disseciton of the funds - what is next step

mobilation of distal thoracic esophagus

take down short gastrics

collis

83

18 yo sallow dive complete parlysis no other observed injury. mentating BP 70/40 (pulse not given) after crystaloid.

phenylephrin

blood

84

inhibits wound contracture the most

deep dermis graft
topical steroids
split thickness

85

60 yo DM 3 wks s/p nec soft tissue debride of thigh 8x 15 cm good granulation tissue no signs of infection best way to get fastive definitive healing

STSG

tissue plasma activator topical

colligenase debride

86

lidocaine minor procedure 30 yo f syncopy brady 60/40 p 43 most effective single treatment

atropine
entubate

87

translate immaging findings to birads

then rec f/u

88

massive trauma transfusion with 18 units blood 4 of FFP now normal vitals in ICU with platelet count of 18 - most likely cause

hemodilution

DIC

89

most important agent to stop for before patient on chemo undergoes elective sigmoidectomy and transition to serolomus

tacrolumis

cyclophosphomide
mmf

90

NEC kid with necrotic bowel

resect with out anastamosis
resect and bring out throug abdomin
resect with anastamosis

91

most likely nerve to injure while taking the IJ for a MRND

hypoglossal

vagus
recurrent laryngeal

92

most likely site of ectopic inferiro parthyroid

thymus

93

most likely site of missed parathyroid adenoma (inf or sup not specified)

in normal anatomic location

94

18 yo with persistant hyper ca with normal renal fxn most common cause

parathyroid adenoma
parathyroid hyperplasia
secondary hyperparthyoridism

95

adult with colon intussusception

resection

96

biggest risk factor for mediastinitis (medialstinal infection?)

urosepsis
redo CABG
harvest LIMA

97

no stone seen xray imaging for history of multiple relapse UTI for renal colic (renal calculi?) despite correct abx - with hydronephrosis

perc nephrostomy
lithotripsy

98

52 yo f vomiting and diarrea - hypo na, hyop ch, bcarb down, marked alcalosis

0.9
hydrochoic acid
lactated ringers

99

4 days post pucture to P1 now with pain on extention

pyogenic flexor tenosynovitis

100

late second term / early third preg - breast cancer

chemo

xrt

101

preg female intervention performed for PE recs now

IVC fliter

low molecular weight heparin
comadin

102

female body builder vein thrombus

thrombolysis
thrombectomy
first rib

103

best way determin PERIPHERAL oxygen utilization in patient in shock

mixed venous sat
transcutaneous dopler
pulse ox
mucus oxygen tension?

104

best determinate of addequate ressus in shock trauma

correcting base def
uop

105

80 kg COPD ARDs patient already on PEEP of 18-20 best vent setting

pressure relase vent p high 35
pressure support pressure 30
volume control vol 460cc

106

18 yo female with 2 paternal aunts with cancer after the age of 50. maternal grandmother with breast cancer at age 70 reck screening for BRCA

no

107

most important to rule out in new born with bili emesis and few scatered air in bowel distal

malro

108

low grade phyloids tumor comes back on path after enucleation of the 4 cm mass

observation
chemo
xrt
tamoxafin

re excision with 3 cm margin

109

rectus hematoma on anticoagulation - not expanding

observe

excise

110

peritoneal cath fungal infection

remove cath and antifungal

antifungal and keep cath

111

post spleen preservation distal panc for mass (cancer?) pt is seen to have a 4 cm (6cm) inferior pole irregular hypodensity - concering for abscess

drainage
splenorraphy
splenectomy

112

what is released in component separation

external oblique aponearosis

transversus aponerosis

lateral rectus

113

trauma CBD injury lateral D2 injury through and through 1-2 cm

primary repair of D ; hepatico J

primary repair of d, drains and pyloric exclusion

primary repair of d and primary repair of CBD

whipple

114

8 cm pancreatic cyst communicating with main duct in chronic panc

tranampulary stent

endoscopic cyst gastro

per drain

115

new born baby with dilated CBD and jandice demonstrtatee on US - what is management

ERCP

hepatico J

116

45 with chronic gs admitted to hopital with panc
sick
vent
ICU
CT 80% necrosis - no air

MRI
FNA of panc

117

ilius at 8 days after whipple in 65 yo with DM still requires NGT drainage and TPN

PPI
erythromycin
revise enteroanast

118

patient has dysphasia after scope of esophagus most likely incision that will be needed

left cervicle

right throcotomy

119

best position for patient with suspected air embo

left lat decube / trend
right lat decube / trend
left lat decube rev trend
right lat decube rev trend

120

75 yo female sig GI bleed procto negative requires 6 unit of blood with hypotension

upper scope

ex lap and colen resection

121

55 yo male
on going persistant hematemessis patient with normal vital in no distress

angio

protective bronchio blocing intubation

122

most likely fat solb vitamin def barriatric procedure

Panc bilio bypass

gastric band
gastric sleeve

123

23 you f DM failed prokinetics for gastroperesis

neck vagal intervention
(is this gastric pacemaker)

gastro J

124

75 f with constant moaning - non focal abd tenderness - plain film demonstrates pneumotsis dx

angio

CT scan



125

hiccups and bloat with something else fishy in patient hx of bariatric bypass - manage

revise J-J

CT scan

126

78 yo male with high rectal cancer (maybe even sigmoid) cancer and intermitent inconinance tx

APR

LAR
trans anal

127

preg female with intermit bloody bm moderate external hemorrhoids and internal hemorroids tx

stool soft and water

band

128

paget of skin dx best indication for breast conservation therapy

2 cm sub nipple mass
MRI negative

129

painful breast eyrthema 2 wks post partum breast feeding s/p 10 day of ancef - no improvement. what is management

change abx to MRSA coverage

skin bx

130

breast way to eval nodes in breast cancer

SLNB
MRI
ax dissection

131

best workup for asx adrenal mass in 40 yo f with neg serum pheo test - no htn, no lyte abormalities, no endocrine disterb, normal vitals - most important test

none needed

24 h urine, metaneph, cortisol, ...

...

132

tx of sub ungual melanoma

amputation to next phalanx

MLE of nail bed

133

chronic decube now with pearly raised lesion

squma

134

what throws off pulse ox

lymphsurian (methalene blue not an option)

anemia below 15

fetal hemogolobin

135

most common injury with L1 fx hyperflexion injury

"small bowel"
spleen
liver
pancreas not listed

136

pt returns with fever urin incont parylysis lower extrem 10 day after epidural for flail

epidural absess

137

epidural with narcotic and lidiocaion after simoid resection that night pressure 90/60 p 100 uop 0.4 cc/kg/h

500 ml fluid
turn down narcotic
turn down lido

138

palliative care pt with obstrucitn small bowel mass with servere pain states 6/10 associated with eating - best tx

fenatnyl patch
spinal stim
oral morphine

139

how to you place probe when looking at spleen site for FAST

transvere LUQ
vert LUQ
btw 8-9 ribs
btw 11-12 ribs
parralle to 12 rib

140

2 wks with empyemia tx still there with ct in place

thorscopic
add ct

141

best indication the BKA will heal

palp pedal puse

transcutanous oxygen tention 10

142

coverage for dorsal hand exposed tendons

radial forearm graft

143

18 yo f with varicose venin port wine stain on thigh and leg 2 inches longer than the other side - what is biggest with doing venous stripping

risk of bleeding

Consumptive of platelets

PE

144

most common presentaiton of TOS

ulnar

145

fingers numb hand cool and pulses only by dopler 2 weeks after brachial av fistula

ARTERIAL steal

median nerve injury

146

best confirmation of brain death after clinical critera met

nuc med no flow

corneal reflex gone

single EEG

147

best chance of have doner family sign up based on who asks

ICU doc

tranplant coordinator

148

best confirmation that that is chylothrozx

trgl 40
milky

149

what is seen on thryoglossal duct cyst exam that is different from base of thryoid

move with swallow
protrossion of tongue

150

thryogolossal duct cyst path

"THROUGH" hyoid bone
foramen cecum

151

Prosthetic Mesh Infections - Management

Prosthetic Mesh Infections - Management

152

Esophageal Perforation - Spontaneous

Esophageal Perforation - Spontaneous

153

kid with short gut 12 hold on tpn - excema behind the knees what is def

zinc

copper
selenium
chromium

154

glucose absorption gut vs IV


but incr via hepatic independent path

155

up in trauama glucocon vs insulin


both up but gluocone more