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Absite : the nitty , gritty stuff part 3. The pre-transplant crossmatch involves A) recipient lymphocytes & donor plasma B) recipient plasma & donor lympocytes C) recipient macrophages & donor globulins D) recipient globulins & donor macrophages.

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Absite:the nitty, gritty stuffpart 3


  • The pre-transplant crossmatch involves

    • A) recipient lymphocytes & donor plasma

    • B) recipient plasma & donor lympocytes

    • C) recipient macrophages & donor globulins

    • D) recipient globulins & donor macrophages



  • The fluoroquinolones

    • A) are primarily effective in gram + bacteremia

    • B) have low concentrations in bile

    • C) chronic liver disease dramatically affects pharmacokinetics

    • D) are greater than 50% excreted unchanged in the urine






  • A 30yo female attempts suicide with the ingestion of lye. Examination of the mouth & pharynx demonstrates erythema. Appropriate management is

    • A) IVF, antibiotics & observations

    • B) esophagoscopy to level of the 1st burn

    • C) esophagoscopy to include the stomach

    • D) laparotomy, gastrostomy & TPN


  • A 68yo presents with signs of sepsis, substernal chest pain & air crepitus in the left neck. These symptoms & signs developed 16hr ago after forceful vomiting of a heavy meal. Treatment should include

    • A) chest tube, IVF & antibiotics

    • B) left thoracotomy & repair

    • C) right thoracotomy & repair

    • D) laparotomy & repair


  • 12hr following esophagoscopy & biopsy of an obstructing esophageal cancer, the patient presents with fever & substernal chest pain. Esophagogram reveals perforation of the distal esophagus. Appropriate treatment is

    • A) esophageal tube suction, IVF & antibiotics

    • B) chest tube, esophageal suction, IVF & antibiotics

    • C) closure of the perforation, chest tube, IVF & antibiotics

    • D) esophagectomy & esophagogastrostomy


  • A patient is placed on IVF & NPO following an uneventful laparotomy. 12hr later the patient develops palor, sweating, hypotension & abdominal pain. On exam the upper abdomen is distended & tympanic with a succussion splash. Appropriate action is

    • A) increase IVF & transfuse pRBCs

    • B) return to the OR

    • C) insert NGT

    • D) provide ventilatory support


  • Splenectomy may be useful in the management of laparotomy. 12hr later the patient develops palor, sweating, hypotension & abdominal pain. On exam the upper abdomen is distended & tympanic with a succussion splash. Appropriate action is

    • A) hairy cell leukemia

    • B) malaria

    • C) chromic myelogenous leukemia

    • D) sickle cell disease




  • The IMV pneumonectomy is

    • A) drains the distal rectum

    • B) passes lateral to the ligament of treitz

    • C) joins the portal vein

    • D) is medial to the aorta


  • The right renal artery passes pneumonectomy is

    • A) anterior to the vena cava

    • B) anterior to the renal vein

    • C) anterior to the renal pelvis

    • D) anterior to the IMV




  • The etiology of myasthenia gravis is treatment for hypertrophic subaortic stenosis

    • A) insufficient Ach

    • B) motor nerve axonal degeneration

    • C) decreased number of Ach receptors

    • D) overproduction of Ach esterase


  • The earliest sign of uncal herniation is treatment for hypertrophic subaortic stenosis

    • A) unilateral pupil dilatation

    • B) deep coma

    • C) contralateral decerebrate posturing

    • D) bilateral decerebrate posturing



  • Treatment of a malignant melanoma 2mm in depth is is found to have a tender 3cm smooth submucosal rectal mass. Appropriate treatment is

    • A) excision with 1cm margins

    • B) excision with 2cm margins & sentinel node biopsy

    • C) excision with 4cm margins & prophylatic node dissection

    • D) excision with 1cm margins & interferon a




  • Proper treatment for a 3cm papillary thyroid cancer with tumor involving 4 lymph nodes is

    • A) ipsilateral lobectomy with resection of involved lymph nodes

    • B) total thyroidectomy

    • C) total ipsilateral lobectomy, near total lobectomy on the contralateral side, & resect involved lymph nodes

    • D) total thyroidectomy, central compartment node dissection & modified radical neck dissection






  • The ilioinguinal nerve relaxation of the sphincter of Oddi, is partially mediated by cholinergic stimuli, & has a diminished effect following vagotomy

    • A) is a branch of the femoral nerve

    • B) has a motor component

    • C) can be injured easily at the internal spermatic ring

    • D) provides sensation for the penis & upper scrotum

    • E) runs along the hypogastric vein



  • After undergoing complete axillary node dissection for sentinel node positive breast cancer, your patient has difficulty with forced should adduction. She is having difficulty pulling herself out of her chair. There is concern about injury to which nerve?

    • A) intercostal brachial nerve

    • B) thoracodorsal nerve

    • C) long thoracic nerve

    • D) lateral pectoral nerve

    • E) ulnar nerve


  • Stercoral perforations are defined as sentinel node positive breast cancer, your patient has difficulty with forced should adduction. She is having difficulty pulling herself out of her chair. There is concern about injury to which nerve?

    • A) linear tears of the colon without ischemic changes

    • B) perforated ulcers caused by an enlarging colonic carcinoma

    • C) perforated colonic ulcers with necrotic & inflammatory edges

    • D) perforated ischemic ulcers of the terminal ileum



  • Which of the following statements about burns is not true hypertension is

    • A) in major burns, clinically significant interstitial edema is seen in distant soft tissues secondary to a combination of mediators generated in the wound & hypoproteinemia

    • B) using the modified Brooke formula, during burn resuscitation adults should receive 2-4mg/kg/%burn/24hr of LR (1/2 in 1st 8 hr)

    • C) pigment (myoglobin) induced ATN is most common in patients who have sustained high-voltage electrical injury or deep thermal burns

    • D) patients who suffer chemical burns as a result of concentrated hydrofluoric acid may experience life threatening hypercalemia



  • Which of the following statements about blunt carotid injury is not true

    • A) blunt carotid injury is frequently associated with closed head injury or cervical spine injury

    • B) neurological deficits associated with blunt carotid injury are frequently absent on admission, but do develop within 12hr of injury

    • C) more than 50% of patients with uncomplicated carotid artery dissection as a result of blunt trauma have a reasonably good neurologic outcome

    • D) arterial dissections as a result of blunt trauma are best managed by anticoagulation


  • Enterocutaneous fistula management in a stable patient should include all of the following except

    • A) establishment of controlled drainage & skin protection

    • B) immediate corrective surgery

    • C) provision of adequate nutrition

    • D) prevention of fluid & electrolyte depletion


  • A 47yo paraplegic patient is brought to the ER with abdominal distention. He has not had a bowel movement in several days. The abdomen is distended & minimally tender without evidence of peritoneal signs. A KUB massive distention of the colon. The next step in management should include

    • A) IV vancomycin

    • B) IVF & immediate laparotomy

    • C) colonoscopic decompression

    • D) CT of the abdomen

    • E) diagnostic laparoscopy


  • A 7 yo child undergoes general anesthesia for repair of an inguinal hernia. 10min into the operation, the patient is noted to have a temp of 104, tachycardia, & diffuse skeletal muscle rigidity. The most appropriate treatment for this situation is

    • A) hyperventilation to achieve pCO2 <25mmHg

    • B) dantrolene sodium

    • C) SC heparin sodium

    • D) IM epinephrine

    • E) none of the above


  • A 67yo smoker undergoes a chest CT to evaluate a 1cm lung nodule on chest x-ray. The CT scan demonstrates mediastinal adenopathy. The next step in the workup should be

    • A) MRI of the chest & abdomen

    • B) liver-spleen scan to evaluate for metastases

    • C) chemotherapy consultation

    • D) radiation consultation

    • E) bronchoscopy & mediastinoscopy


  • A 65 yo man presents with moderate epigastric pain of 2 wks duration radiating to his back. Evaluation reveals a 3cm tumor in the head of the pancreas. All the following conditions would preclude tumor resectability, except

    • A) presence of extrapancreatic disease

    • B) evidence of tumor extension to the SMA

    • C) evidence of tumor extension to the celiac axis

    • D) a patent SMV-portal vein confluence

    • E) involvement of a single lymph node in the hepatic hilum


  • An established indication for coronary artery bypass grafting remains

    • A) critical left main disease

    • B) triple vessel disease with normal ventricular function

    • C) 2 vessel disease of the right coronary & left circumflex arteries

    • D) distal left anterior descending artery disease

    • E) right coronary artery disease with congestive heart failure


  • When performing ERCP, a sphincterotomy is indicated in grafting remains

    • A) acute biliary pancreatitis with common bile duct stone at ERCP

    • B) gallstone pancreatitis without CBD stone present at ERCP when cholecystectomy is not possible

    • C) recurrent acute pancreatitis with sludge present in the biliary tract in the post-cholecystectomy patient

    • D) acute biliary pancreatitis during pregnancy

    • E) all of the above


  • Guidelines for minimizing morbidity during lap ccy in patients with hepatic cirrhosis include all of the following except

    • A) using an open technique with the Hasson trocar

    • B) using a right paramedian trocar approach

    • C) using an argon beam coagulator

    • D) performing a subtotal cholecystectomy in cases of severe inflammation

    • E) using open cholecystectomy more frequently


  • Which of the following is true concerning necrotizing pancreatitis

    • A) less than 30% of patients develop infected necrosis

    • B) infection is the main determinant of prognosis

    • C) infected necrosis is an uncommon indication for surgery in acute necrotizing pancreatitis

    • D) sterile necrosis is usually treated operatively

    • E) surgery is not indicated in acute necrotizing pancreatitis


  • A 27yo umpire wearing no protective gear is inadvertently struck in the chest by a player’s bat. He lost consciousness for 30sec after impact. During EMS transport, vital signs are 102/76, 114, 22, 97% on 2L NC. On arrival to the ER, the patient is awake & alert, c/o chest pain. He has ecchymosis & tenderness over his sternum. Lungs are clear, heart sounds tachycardic with no murmurs. His physical exam is otherwise normal.



  • A 65 yo woman presents to the ER with a swollen right calf. She has a hx of lung ca & is receiving chemotherapy. DVT is suspected, & a D-dimer test is ordered, the result of which is highly positive. Records of previous blood tests show that this patient’s D-dimer levels were always higher than normal.


  • What is the next step in the management of this patient? She has a hx of lung ca & is receiving chemotherapy. DVT is suspected, & a D-dimer test is ordered, the result of which is highly positive. Records of previous blood tests show that this patient’s D-dimer levels were always higher than normal.

    • A) order a BNP to rule out heart failure caused by chemotherapy

    • B) order compression ultrasonography

    • C) order a venogram

    • D) no further evaluation


  • The patient is found to have DVT of the calf with extension to the right proximal vein. Anticoagulation therapy should be initiated. Which of the following is a relative contraindication to anticoagulation?

    • A) brain metastasis

    • B) GI bleeding in the past 6 months

    • C) platelet count < 60,000

    • D) severe hypotension



Embryology
embryology following are adverse effects associated with unfractionated heparin except

  • Ileal atresia

    • Vascular insult

  • Duodenal atresia

    • Lack of revacuolization from solid cord




  • Where is the SA node forms

    • Junction of SVC & RA

  • Where is the AV node

    • Junction of coronary sinus & RA




Head neck tumors
Head & neck tumors laparoscopic repair

  • 0.5cm squamous cell cancer of vocal cord which is mobile

    • Radiation

    • T1 lesion

  • 1cm lesion extending to supraglotic larynx with impaired mobility, clinically negative node

    • Radiation

    • T2 lesion


Head neck
Head & neck laparoscopic repair

  • Squamous cell cancer of vocal cord that is fixed & extends to contralateral cord

    • Resection & radiation

    • T3 lesion


Head neck1
Head & neck laparoscopic repair

  • True or False

    • Adenoid cystic carcinoma of parotid gland invades into the facial nerve

      • TRUE

      • Malignant cancer  total parotidectomy, resection facial nerve, ipsilateral MRND, radiation



Crohn s or ulcerative colitis
Crohn’s depend on histology) or ulcerative colitis

  • Crypt abscesses

    • Ulcerative colitis

  • Granulomas

    • Crohn’s

  • Cobblestoning

    • Crohn’s


Crohn s or ulcerative colitis1
Crohn’s depend on histology) or ulcerative colitis

  • Serpiginous ulcers

    • Crohn’s

  • Pseudopolyps

    • Ulcerative colitis


Order of treatment
Order of treatment depend on histology)

  • MEN 1

    • Total parathyroidectomy with auto-transplantation

    • Pancreatic tumor

    • Pituitary tumor

  • MEN2a

    • Adrenalectomy

    • Thyroidectomy

    • Pituitary


Order of treatment1
Order of treatment depend on histology)

  • MEN2b

    • Adrenalectomy

    • Thyroidectomy

  • Most common pancreatic endocrine tumor

    • Insulinoma

  • Most common pancreatic endocrine tumor in MEN syndromes

    • Gastrinoma


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