General

Question 1

Management of acute cholangitis

Answer 1

1. Fluids
2. Abx
3. ERCP

Question 1

Most common causes of acute cholangitis

Answer 1

1. Gallstones
2. Malignancy
3. Inflammatory strictures

Question 2

Significant bleeding can occur during a distal pancreatectomy due to injuries to tributaries of the

Answer 2

Splenic vein

Question 3

Treatment of choice for gastric trichobezoars

Answer 3

Gastrotomy with bezoar extraction (laparoscopic or open)

Question 4

Ureteral injuries with < 50% transection can be repaired with

Answer 4

Stent and drainage, regardless of location.

Question 5

Management for ureteral injuries > 50% transection distal to the iliac vessels (distal third)

Answer 5

Reimplantation into the bladder
Psoas hitch procedure or Boari flap

Question 6

Management for ureteral injuries > 50% proximal to the iliac vessels (middle third)

Answer 6

Debridement, spatulation of ureteral ends, and primary anastomosis

Question 7

Most common cause of primary adrenal insufficiency

Answer 7

Autoimmune atrophy of adrenals

Question 8

Most commonly injured nerves during laparoscopic inguinal hernia repairs

Answer 8

Genitofemoral and lateral femoral cutaneous nerves.

Question 9

Femoral nerve palsy (leg weakness with knee buckling / inability to extend the knee) is a known complication of

Answer 9

Ilioinguinal nerve blocks
- between external and internal oblique muscles at ~1-2 cm medial / inferior to ASIS.

Question 10

Techniques to improve difficult colonoscopy

Answer 10

• Limiting air insufflation.
• Changing patient positioning.
• Withdraw scope to reduce looping.
• Apply counter abdominal pressure
• Use pediatric colonoscope

Question 11

Nicotinic acetylcholine receptor agonist used in paralysis in intubation

Answer 11

Succinylcholine

Question 12

Spinal cord injuries can lead to severe hyperkalemia from succinylcholine due to

Answer 12

Upregulation of acetylcholine receptors.
(others include severe burns and neuromuscular disorders)

Question 13

Mutations in SMAD4, BMPR1A that leads to numerous polyps in colon/rectum, gastric polyps, and AVMs

Answer 13

Juvenile polyposis (autosomal dominant)

Question 14

Mutation in STK11/LKB1 that leads to small intestine colon and gastric polyps, increase risk of malignancy, pigmentation of lips / buccal membranes, hamartomas.

Answer 14

Puetz-Jeghers syndrome

Question 15

Mutation in APC that lead to thousands of colonic / duodenal adenomas, desmoid tumors, osteomas, fibromas, lipomas, and thyroid/adrenal tumors

Answer 15

Gardner syndrome

Question 16

Mutation in APC, DNA mismatch repair that leads to colonic adenomas, medulloblastoma, and gliobastloma multiforme

Answer 16

Turcot syndrome

Question 17

Mutation in hMLH1/hMSH2 that leads to sebaceous adenoma/adenocarcinomas, BCC, CRC, and GU malignancies

Answer 17

Muir-Torre syndrome

Question 18

PRSS1 gene mutation (autosomal dominant) is most commonly associated with

Answer 18

Hereditary pancreatitis (no specific treatment)

Question 19

Patients with hereditary pancreatitis can develop chronic pancreatitis and should be advised about what risk factor for pancreatic adenocarcinoma?

Answer 19

Smoking cessation

Question 20

Stretch marks (striae atrophicae) are caused by

Answer 20

Disruption of dermis, collagen fibers, and atrophy of epidermis.

Question 21

Most common cause of acute liver failure in the United States

Answer 21

Acetaminophen overdose.
- 2nd most common is idiopathic liver failure

Question 22

First line diagnostic tool for nonocclusive mesenteric ischemia in critically ill patients

Answer 22

CT angiogram
- no contrast enhancement of bowel wall
- pneumatosis intestinalis
- portal venous gas
- distended bowel

Question 23

What is needed to ensure a complete resection of a colonic polyp during cold snare polypectomy?

Answer 23

Margin of healthy tissue
- 6 o’clock positioning of polyp and downward pressure.

Question 24

EGD findings that indicate re-bleeding risk in peptic ulcer disease (from high to low)

Answer 24

1. Active pulsatile bleeding 2. Active oozing 3. Visible vessel in ulcer 4. Adherent clot to base 5. Ulcer with black spot 6. Visible clean ulcer

Question 25

What is an organ space wound infection?

Answer 25

< 30 days without implant or < 1 year after surgery with an implants. - deep organ spaces that have been manipulated.

Question 26

What is the most common complication of hepatic trauma?

Answer 26

Bile leak. Abd pain, distension, feeding intolerance, elevated LFTs.

Question 27

What are the two states in which patients can have falsely lowered anion gap measurements in metabolic acidosis?

Answer 27

Hypoalbuminemia Hyperkalemia

Question 28

What are characteristics of third-degree frostbite?

Answer 28

Full thickness injury, hemorrhagic blisters, nonviable skin can form black eschar. Takes 1-3 months to heal.

Question 29

Management of hypothermia

Answer 29

Remove all jewelry Rapid rewarming of tissue in heated water (98.6 F - 102.2 F) Needle aspiration for blisters that are NOT hemorrhagic

Question 30

Heavy smokers are at risk for develop peripheral artery disease where?

Answer 30

Superficial femoral artery

Question 31

Intra-aortic balloon pump is indicated for

Answer 31

1. Cardiogenic shock following MI 2. Mitral regurgitation with HD instability w or w/o MI 3. VSD following MI

Question 32

Most common complication after a Whipple procedure

Answer 32

Delayed gastric emptying. Leak / abscess should be ruled out prior to initiating Reglan / erythromycin.

Question 33

Popcorn-like calcifications on CXR or chest CT are

Answer 33

Pulmonary hamartoma

Question 34

Management of hypercalcemia

Answer 34

Normal saline and loop diuretics - LR and potassium sparing diuretics are contraindicated

Question 35

How does ASA affect platelet aggregation and clotting?

Answer 35

Irreversible inhibition of PGE synthesis in platelets by acetylating COX. Leads to permanent dysfunction of platelets.