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Absite : the nitty , gritty stuff part 3 PowerPoint PPT Presentation


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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 stuff part 3

Absite:the nitty, gritty stuffpart 3


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


Absite the nitty gritty stuff part 3

  • Adherence of leukocytes to the endothelium is due to

    • A) integrins

    • B) P-selectin

    • C) L-selectin

    • D) E-selectin


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • The source of free oxygen radicals in reperfusion injury is

    • A) superoxide

    • B) hydrogen peroxide

    • C) hydroxy radicals

    • D) xanthine oxidase


Absite the nitty gritty stuff part 3

  • Marfan’s syndrome is associated with all of the following except

    • A) aortic valve insufficiencys

    • B) incomplete collagen formation

    • C) abnormal bleeding

    • D) decreased bone mass


Absite the nitty gritty stuff part 3

  • The changes associated with a mucous producing villous adenoma of the sigmoid

    • A) metabolic acidosis

    • B) hypokalemia

    • C) urine pH 8.0

    • D) serum HCO3 of 15


Absite the nitty gritty stuff part 3

  • Complications of hypothermia include

    • A) convulsion

    • B) tachycardia

    • C) diuresis

    • D) hypercoagulation


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • Splenectomy may be useful in the management of

    • A) hairy cell leukemia

    • B) malaria

    • C) chromic myelogenous leukemia

    • D) sickle cell disease


Absite the nitty gritty stuff part 3

  • A pulmonary function that would prohibit a successful pneumonectomy is

    • A) FEV1 of 1000

    • B) pCO2 47

    • C) ability to climb 2 flights of stairs

    • D) previous MI


Absite the nitty gritty stuff part 3

  • The most common complication of a popliteal aneurysm is

    • A) thrombosis

    • B) embolization

    • C) rupture

    • D) neurolysis


Absite the nitty gritty stuff part 3

  • The IMV

    • A) drains the distal rectum

    • B) passes lateral to the ligament of treitz

    • C) joins the portal vein

    • D) is medial to the aorta


Absite the nitty gritty stuff part 3

  • The right renal artery passes

    • A) anterior to the vena cava

    • B) anterior to the renal vein

    • C) anterior to the renal pelvis

    • D) anterior to the IMV


Absite the nitty gritty stuff part 3

  • The muscle anterior to the femoral artery in the Hunter’s canal is

    • A) adductor minimus

    • B) adductor magnus

    • C) quadriceps femoris

    • D) vastus medialis


Absite the nitty gritty stuff part 3

  • Which of the following group of drugs will provide effective treatment for hypertrophic subaortic stenosis

    • A) inotropes

    • B) Ca channel blockers

    • C) ACE inhibitors

    • D) loop diuretics


Absite the nitty gritty stuff part 3

  • The etiology of myasthenia gravis is

    • A) insufficient Ach

    • B) motor nerve axonal degeneration

    • C) decreased number of Ach receptors

    • D) overproduction of Ach esterase


Absite the nitty gritty stuff part 3

  • The earliest sign of uncal herniation is

    • A) unilateral pupil dilatation

    • B) deep coma

    • C) contralateral decerebrate posturing

    • D) bilateral decerebrate posturing


Absite the nitty gritty stuff part 3

  • A 30yo female with a history of dysmenorrhea & dyspareunia is found to have a tender 3cm smooth submucosal rectal mass. Appropriate treatment is

    • A) danazol

    • B) Flagyl

    • C) LAR

    • D) TAH-SBO


Absite the nitty gritty stuff part 3

  • Treatment of a malignant melanoma 2mm in depth 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


Absite the nitty gritty stuff part 3

  • Malignant pheochromocytoma is clearly identified by which of the following

    • A) capsular invasion

    • B) venous invasion

    • C) invasion of adjacent structures

    • D) histological examination


Absite the nitty gritty stuff part 3

  • The only certain sign of parathyroid malignancy is

    • A) histologic features

    • B) renal disease

    • C) bone disease

    • D) recurrence after resection


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • Appropriate treatment for family members (without tumor) having a heterozygous RET proto-oncogene is

    • A) observation

    • B) total parathyroidectomy

    • C) total thyroidectomy

    • D) bilateral adrenalectomy


Absite the nitty gritty stuff part 3

  • Failure to identify gamma radiation or blue dye in a sentinel node biopsy procedure is due to

    • A) no evidence of metastatic disease

    • B) incorrect FNA diagnosis of cancer

    • C) failure of dye & radiolabeled colloid to migrate

    • D) absence of axillary lymph nodes


Absite the nitty gritty stuff part 3

  • The appropriate ultrasound probe for examination of a breast mass is

    • A) 1.5-2.5 mHz

    • B) 3-3.5 mHz

    • C) 5-5.5 mHz

    • D) 7.5-10 mHz


Absite the nitty gritty stuff part 3

  • Which of the following is the mediator that leads to relaxation of the sphincter of Oddi, is partially mediated by cholinergic stimuli, & has a diminished effect following vagotomy

    • A) somatostatin

    • B) glucagon

    • C) cholecystokinin

    • D) gastrin

    • E) secretin


Absite the nitty gritty stuff part 3

  • The ilioinguinal nerve

    • 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


Absite the nitty gritty stuff part 3

  • The spleen filters all of the following particles/cells except

    • A) malformed erythrocytes

    • B) T lymphocytes

    • C) malarial parasites

    • D) steptococcus pneumoniae

    • E) platelets


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • Stercoral perforations are defined as

    • 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


Absite the nitty gritty stuff part 3

  • The most common cause of intrahepatic presinusoidal portal hypertension is

    • A) alcoholic cirrhosis

    • B) congential hepatic fibrosis

    • C) schistosomiasis

    • D) splenic vein thrombosis

    • E) Budd-Chiari syndrome


Absite the nitty gritty stuff part 3

  • Which of the following statements about burns is not true

    • 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


Absite the nitty gritty stuff part 3

  • Ranson’s criteria on admission for prediction of severity of acute non-biliary pancreatitis include all of the following except

    • A) age >55

    • B) WBC >16,000

    • C) glucose >200mg/dl

    • D) serum magnesium >1.5mg/dl


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • When performing ERCP, a sphincterotomy is indicated in

    • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • 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.


Absite the nitty gritty stuff part 3

  • Which of the following is the best screening tool for assessing blunt cardiac injury?

    • A) CK, CK-MB

    • B) EKG

    • C) transesophageal echo

    • D) transthoracic echo

    • E) troponin


Absite the nitty gritty stuff part 3

  • 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.


Absite the nitty gritty stuff part 3

  • What is the next step in the management of this patient?

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

    • B) order compression ultrasonography

    • C) order a venogram

    • D) no further evaluation


Absite the nitty gritty stuff part 3

  • 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


Absite the nitty gritty stuff part 3

  • The patient is prescribed unfractionated heparin. All the following are adverse effects associated with unfractionated heparin except

    • A) elevated PTT

    • B) osteoporosis

    • C) thrombocytopenia

    • D) worsening renal failure


Embryology

embryology

  • Ileal atresia

    • Vascular insult

  • Duodenal atresia

    • Lack of revacuolization from solid cord


Absite the nitty gritty stuff part 3

  • Name 2 pancreatic enzymes that are secreted in their active forms

    • Amylase

    • Lipase

  • True or False

    • Glucagon increases myocardial contractility & HR

      • TRUE


Absite the nitty gritty stuff part 3

  • Most common cause of pneumaturia

    • Diverticulitis

    • Sigmoid cancer

    • Others: crohn’s disease, radiation colitis


Absite the nitty gritty stuff part 3

  • Where is the SA node

    • Junction of SVC & RA

  • Where is the AV node

    • Junction of coronary sinus & RA


Absite the nitty gritty stuff part 3

  • Most likely reason for inguinal hernia recurrence after laparoscopic repair

    • Migration of mesh

  • Treatment for urokinase overdose

    • Amicar (e-aminocaproic acid)

      • Inhibits fibrinolysis  blocks the conversion of plasminogen to plasmin


Absite the nitty gritty stuff part 3

  • What is the first muscle to be paralyzed

    • Eyes, face

  • What is the last muscle to be paralyzed

    • diaphragm

  • True or False

    • Last to go….first to come back

    • TRUE!!!!


Head neck tumors

Head & neck tumors

  • 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

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

    • Resection & radiation

    • T3 lesion


Head neck1

Head & neck

  • 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


Absite the nitty gritty stuff part 3

  • 4 malignancies that are decided on clinical basis (can’t depend on histology)

    • Cystosarcoma phylloides

    • Pheochromocytoma

    • Malignant thymic tumor

    • Parathyroid cancer


Crohn s or ulcerative colitis

Crohn’s or ulcerative colitis

  • Crypt abscesses

    • Ulcerative colitis

  • Granulomas

    • Crohn’s

  • Cobblestoning

    • Crohn’s


Crohn s or ulcerative colitis1

Crohn’s or ulcerative colitis

  • Serpiginous ulcers

    • Crohn’s

  • Pseudopolyps

    • Ulcerative colitis


Order of treatment

Order of treatment

  • MEN 1

    • Total parathyroidectomy with auto-transplantation

    • Pancreatic tumor

    • Pituitary tumor

  • MEN2a

    • Adrenalectomy

    • Thyroidectomy

    • Pituitary


Order of treatment1

Order of treatment

  • MEN2b

    • Adrenalectomy

    • Thyroidectomy

  • Most common pancreatic endocrine tumor

    • Insulinoma

  • Most common pancreatic endocrine tumor in MEN syndromes

    • Gastrinoma


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