Chapter 1

Question 1

24 yr old woman scheduled for an elective cholecystectomy. The best method of identifying a potential bleeder is which of the ff?

Answer 1

A complete history and PE

Question 2

The most common indication for blood transfusion in surgical procedure?

Answer 2

Volume replacement

Question 3

After undergoin transurethral resection of the prostate, a 65 yr old man experiences excessive bleeding attributed to fibrinolysis. It is appropriate to administer?

Answer 3

AMINOCAPROIC ACID

Question 4

Most important management of DIC

Answer 4

Treatment of underlying cause

Question 5

22 yr old man is brought to the ER in profound shock after a fall from the fourth floor of a building. After resuscitation, small bowel resection and hepatic segmentectomy are performed at laparotomy. He receives 15U of packed RBC,M4U of fresh frozen plasma and 8L of Ringers lactate. On closure diffuse oozing of blood is noted. What is the most likely dx?

Answer 5

PLATELET DEFICIENCY

Question 6

Most important management of immediate transfusion reation?

Answer 6

Stop the transfusion: initiate diuresis, alkaline urine

Question 7

64 yr woman undergoing radical hysterectomy under GA is transfused with 2 U of packed RBC. A hemolytic transfusion reaction during anesthesia will characterized by

Answer 7

BLEEDING AND HYPOTENSION

Question 8

Shock that occurs in the setting of adequate intravascular volume?

Answer 8

Cardiogenic shock

Question 9

30 yr old brought to ER following high speed car accident. He was the driver and the windshield of the car was broken. On exam, alert, awake, oriented and no respi distress. Extremities unable to move, warm and pink. Vital signs on admission HR 54bpm and BP 70/40mmHg

Answer 9

NEUROGENIC SHOCK

Question 10

The preferred test in the diagnosis of cardiac tamponade?

Answer 10

ECHOCARDIOGRAPHY

Question 11

Persistentlymelevated base deficit in a trauma patient is usually due to

Answer 11

ONGOING BLEEDING

Question 12

First priority in the the treatment of trauma?

Answer 12

Ensuring an adequate airway

Question 13

Treatment of choice for patients with Von Willebrand’s disease?

Answer 13

Intermediate purity Factor VIII/DDAVP

Question 14

The most direct method to determine the presence of blood within the pericardium

Answer 14

Pericardial window

Question 15

32 yr old female fails from the 10th floor of the building in suicide attempt. Px obvious head and extremity inuries. Primary survey reveals that the patient is totally apneic. By which method is the immediate need for a definitive aiway in the px

Answer 15

OROTRACHEAL INTUBATION

Question 16

The most common indication for intubation

Answer 16

ALTERED MENTAL STATUS

Question 17

Surgical aiway choice in patients with laryngeal fractures?

Answer 17

TRACHEOSTOMY

Question 18

Is the most common method used to establish definitive airway

Answer 18

OROTRACHEAL INTUBATION

Question 19

85 yr old ventilator-dependent male was endotracheallymintubatedn10 days ago. Unresponsive and not candidate for early intubation. ICU attending elects to perform tracheostomy at th bedside.mduring procedure copious dark blood is encountered.

Answer 19

ANTERIOR JUGULAR VEIN

Question 20

Immediate management of px with tension pneumothorax

Answer 20

NEEDLE THORACOSTOMY (2nd ICS MCL)

Question 21

Thoracostomy

Answer 21

4th or 5th ICS (MAL)

The higher or farther from the diaphragm

Question 22

Most important indication for CTT

Answer 22

Absent breath sounds

Question 23

Block Subclavian artery

Answer 23

Trapdoor thoracotomy

Question 24

Lower limit of pleura/lung reflection at the MIDCLAVICULAR LINE

Answer 24

Lung 6th rib

Pleura 8th rib

Question 25

Lower limit of pleur/lung reflection at the lateral border of erector spine

Answer 25

LUNG 10th rib | PLEURA 12th rib

Question 26

Flail chest injuries compromises ventilation because of

Answer 26

UNDERLYING LUNG CONTUSION

Question 27

Trauma px with hypotension have lost approximately how much of blood volume

Answer 27

30-40% (CLASS III SHOCK)

Question 28

Saphenous vein cutdown

Answer 28

1cm SUPERIOR AND ANTERIOR MEDIAL MALLEOLUS INTRAOSSEUS INFUSION (

Question 29

The most reliable indicator of organ perfusion during resuscitation

Answer 29

Urine output

Question 30

The most common cause of cardiogenic shock or cardiac failure in trauma patients

Answer 30

TENSION PNEUMOTHORAX

Question 31

Priormto catheterization in stable patients at risk for urethral injury, one should perform

Answer 31

Urethrogram

Question 32

Contraindications to urethral catheterization

Answer 32

Blood at the meatus Scrotal or perineal hematoma High riding prostate Tx: SUPRAPUBIC CYSTOSTOMY

Question 33

Gold standard in the diagnosis of presence of intra-abdominal injuries

Answer 33

DPL

Question 34

Hemobilia is characterized by the triad of

Answer 34

RUQ pain, UGIB, jaundice (QUINCKE's triad) Tx: selective arteriogram + embolization

Question 35

Most commonly injured part of the diaphragm

Answer 35

LEFT Not protected; right covered by liver

Question 36

Duodenal hematoma is best diagnosed by

Answer 36

BARIUM/CONTRAST STUDY (COILED SPRING SIGN)

Question 37

The Pringle maneuver is used to control bleeding coming from

Answer 37

LIVER

Question 38

60 yr old attacked with baseball bat and sustains multiple blows to the abdomen. He presents to the ER in shock and brought to OR. Laparotomy reveals massive hemoperitoneum and a stellate fracture of the right and left lobes of the liver

Answer 38

PACKING THE LIVER

Question 39

Left sided medial visceral rotation

Answer 39

MATTOX MANEUVER

Question 40

Right sided medial visceral rotation

Answer 40

CATELL MANEUVER

Question 41

The most sensitive CXR findinf suggesting tear of the aorta

Answer 41

WIDENED MEDIASTINUM

Question 42

Safest way to lower down ICP

Answer 42

VENTRICULOSTOMY

Question 43

Hard signs of peripheral arterial injuries

Answer 43

Pulsatile hemorrhage Absent pulses Acute ischemia

Question 44

Single most important factor predicting burn related mortality?

Answer 44

BURN SIZE

Question 45

Recommended fluid resuscitation solution for burns

Answer 45

PLR parkland's formula

Question 46

Management of patients with significant intra oral/pharyngeal burns

Answer 46

IMMEDIATE ET INTUBATION antibiotics and steroid are contraindicated

Question 47

How is smoke inhalation injury diagnosed

Answer 47

History and PE

Question 48

The definitive diagnosis of burn wound sepsis can be made by

Answer 48

WOUND CULTURE

Question 49

Predominant organism causing fatal burn wound infection

Answer 49

PSEUDOMONAS SP

Question 50

Antidote for chemical burns caused by HYDROFLUORIC ACID

Answer 50

CALCIUM GLUCONATE

Question 51

Malignancy most commonly developing from MARJOLIN'S ULCER

Answer 51

SQUAMOUS CELL CA

Question 52

Impaired healing due to ZINC DEFICIENCY

Answer 52

ACRODERMATITIS ENTEROHEPATICA

Question 53

Major cell responsible for wound contraction

Answer 53

MYOFIBROBLAST

Question 54

The first cells to enter the wound site during wound repair

Answer 54

NEUTROPHILS

Question 55

Extend from the xiphoid from the pubic

Answer 55

Midline

Question 56

Obliquely McBurneys incision extending to the flank of the px

Answer 56

Muscle splitting loin

Question 57

Non absorbable

Answer 57

Nylon Prolene Stainless steel Silk

Question 58

Natural suture

Answer 58

Catgut Silk Chromic catgut

Question 59

Synthetic

Answer 59

``` Nylon Vicryl Monocryl PDS Prolene ``` Face: nylon, prolene

Question 60

Single strand of suture material

Answer 60

Monofilament Nylon Monocryl Proleme PDS

Question 61

Fibers are braided or twisted together

Answer 61

Microfilament

Question 62

Suture characteristics

Answer 62

Nonabsorbable suture has better tensile strength but can persist and become a focus of infection or a draining sinus tract

Question 63

Suture removal

Answer 63

7-10 days

Question 64

The layer of the GIT that imparts the greatest tensile strength and greatest suture holding capacity

Answer 64

SUBMUCOSA

Question 65

Pressure ulcer stage when there is partial thickness skin loss

Answer 65

STAGE II

Question 66

Non blanchable erythema of intact skin

Answer 66

Stage I

Question 67

Earliest known genetic alteration in colorectal cancer

Answer 67

APC gene

Question 68

Microsatellite instability is the hallmark of what hereditary cancer syndrome

Answer 68

LYNCH SYNDROME (HNPCC)

Question 69

Virus implicated in th development of Burkitt's Lymphoma

Answer 69

EBV

Question 70

The most common arrythmia seen during laparoscopy procedures

Answer 70

Bradycardia

Question 71

Tumor marker elevated in primary liver cancer and geem cell tumors

Answer 71

AFP

Question 72

Most important factor determining the exten of DNA damage ff radiation

Answer 72

CELLULAR LEVEL OF OXYGEN

Question 73

Most sensitive phase of cell cycle radiation

Answer 73

G2 and M phase

Question 74

Taxanes blocks tumor growth at mitosis through

Answer 74

Formation of excess microtubule

Question 75

A lethal and rapidlyrogressive soft tissue caused by microaerophilic streptococcus

Answer 75

Meleney's synergicpstic

Question 76

Right iliac fossa

Answer 76

Kidney transplant place

Question 77

Most common complication after placing a central venous line

Answer 77

ARRHYTHMIA

Question 78

Most dreaded complications of placing a swan gans

Answer 78

Pulmonary artery

Question 79

Mainstay of treatment of severe soft tissue infections

Answer 79

Wide debridgement

Question 80

Most common skin malignancy

Answer 80

Basal cell CA

Question 81

Waxy, cream colored, rolled, pearly borders, pallisading arrangement

Answer 81

Basal cell CA

Question 82

Tx of melanoma

Answer 82

Surgical

Question 83

Standard staging procedure to evaluate tue regional nodes for patients with clinically node-negative melanoma

Answer 83

SLNB

Question 84

Tumors arising from areas of previous radiation/lymphedema

Answer 84

ANGIOSARCOMA (Stewart-Treves Syndrome)

Question 85

Kaposi sarcoma tx

Answer 85

Radiation

Question 86

Epidemic peurperal mastitis transmitted via

Answer 86

Suckling neonate

Question 87

Chronic inflammatory condition of nipple areola complex that originates from areolar glands

Answer 87

HIDRADENITIS SUPPURATIVA

Question 88

Types of mastectomies

Answer 88

``` Radical mastectomy (Halsted/Meyer) MRM: Patey and Dyson, Scanlon,mMadden and Auchincloss ```

Question 89

The level of axillary lymph nodes are based on structure

Answer 89

PECTORALIS MINOR

Question 90

Most frequent site of metastasis for breat cancer

Answer 90

BONE

Question 91

True anatomic precursor of invasive ductal CA

Answer 91

DCIS

Question 92

Paget ds may be confused with type of melanoma

Answer 92

SUPERFICIAL SPREADING MELANOMA

Question 93

Breast cancer type confirmed by the presence of intra-cytoplasmic mucin

Answer 93

LOBULAR CA | "Indian file configuration"

Question 94

Breast cancer treatment during pregnancy

Answer 94

1st and 2nd trimester MRM | 3rd trimester BCS