2004 AK(M) Flashcards
- Which of the following is an IRREVERSIBLE inhibitor of the enzyme COX-1:
a. clopedriogel (Plavix)
b. Ticlopidine
c. Aspirin
d. Indomethacin
e. Warfarin
answer: C
Aspirin (irreversible inhibitor of COX 1 and COX 2)
Indomethacin (reversible inhibitor of COX 1)
- Which of the following is LEAST likely to cause an upper GI bleed?
a. celecoxib
b. ibuprofen
c. naproxen
Answer: A - only COX2 inhibitor. Fewer GI s/e if used short term.
- What is the commonest cause of death in patients with a tracheostomy?
a. bleeding
b. accidental decannulation and obstruction
c. infection
d. pneumothroax
b. accidental decannulation and obstruction
Are we sure? As long as the trach has been present for a week, if it decanulizes, there’s still a hole so can breath.
Schwarz says this about complications:
Complications of tracheostomy include pneumothorax, RLN injury, tracheal stenosis, wound infection with large-vessel erosion, and failure to close after decannulation
It also says this, but is rare:
The most dramatic complication of tracheostomy is tracheoinnominate artery fistula (TIAF) (Fig. 12-7).58,59 This occurs rarely (~0.3%) but carries a 50% to 80% mortality rate. TIAFs can occur as early as 2 days or as
late as 2 months after tracheostomy. A sentinel bleed occurs in 50% of TIAF cases, followed by a large-volume bleed. Should a TIAF be suspected, the patient should be transported immediately to the OR for fiberoptic evaluation.
- which of the following bacteria can cause a bacteremic infection from a blood transfusion?
a. pseudomonas
b. yersinia enterocolita
c. campylobacter
d. proteus mirabilus
e. staphylococcus epidermis
b. yersinia enterocolita
Answer: uptodate
Psychrophilic organisms (ie, those capable of multiplication at cold temperatures), especially Yersinia enterocolitica and some Pseudomonas species (eg, Pseudomonas fluorescens), can survive and multiply in cold stored bank blood and have been said to account for up to 80 percent of red blood cell-associated TTBI
- Which is the commonest bacteria cultured from indwelling cathether UTIs?
a. proteus mirabilis
b. klebsiella
c. E Coli
d. Staph aureus
Answer: (C) Campbell’s urology: E. coli is still the most common organism isolated, but Pseudomonas, Proteus, and Enterococcus species are very prevalent
- Which of the following bacteria will flourish if
Answer: (A)
- Elderly lady in the ICU post op, intubated. C.I. 1.6 (), CVP of 10 (), PCWP > 20 (), pulmonary artery pressure :30 (). What is your Dx?
a. hypervolemia
b. hypovolemia
c. CHF
d. Sepsis
e. Pulmonary embolus
Answer: e
normal PCWP 12-14; normal pa pressure 12-16. Both elevated here. By elimination: not hypervolemia (CVP low), hypovolemia will not cause elevated PA pressure, CHF would have high CVP, Sepsis has normal to high CO and does not elevated PA and PCWP. PE causes
- HLA matching is routinely performed prior to transplants of the following organs:
a. lung
b. heart
c. kidney
d. liver
c. kidney
- Which of the following is true re: skin infections?
a. mupirocin has a broad spectrum of activity and is considered to be the first line treatment with wound with a locally infected wound
b. Clindamycin is effective against pseudomonas
c. Fucidin is to be used in leg ulcers
d. Topical antibiotics are sufficient in wound with cellulitis
answer: a
Middle aged male with a nodule in the left lower pole. Cold nodule. FNA shows thyroiditis. What do you do now?
a. I 131 therapy
b. Thyroidectomy
c. Repeat FNA
d. Observe
answer: d.
Subacute thyroiditis is self-limiting; therefore, the goals of treatment are to relieve discomfort and to control the abnormal thyroid function. The discomfort can usually be relieved with low-dose aspirin (divided every 4-6 h). In the rare cases that aspirin does not relieve the discomfort, administer prednisone for 1 week and then taper.
Propranolol can be used to reduce signs and symptoms of hyperthyroidism.
Low-dose levothyroxine may be necessary in some patients who develop hypothyroidism.
- Male presents with a mass anterior to his ear.
a. FNA
b. CT scan…
answer: FNA?
is this what they’re getting at?
Actinic keratosis (AK) is one of the most common premalignant lesions encountered on the ear. It most often is observed in individuals with fair complexions. The average age of onset is 62 years. Both sexes are affected equally. Sun exposure is thought to be the cause of AK-emedicine
- Women presents with feeling unwell. Retching and vomiting. There is subcutaneous crepitus just left of her midline of the neck. After a CXR what should you order next?
a. contrast esophagogram
b. CT
c. MRI
d. 24 hr pH study
no official answer given.
a for exam, b for real life? Both can be done.
Esophageal rupture is a rupture of the esophageal wall. Iatrogenic causes account for approximately 56% of esophageal perforations, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery.[1] In contrast, the term Boerhaave’s syndrome is reserved for the 10% of esophageal perforations which occur due to vomiting.[2]
As in: “stop vomiting and Boerhaave properly!”
- All of the following HLA types are routinely checked prior to transplantation EXCEPT?
a. HLA A
b. HLA B
c. HLA C
d. HLA DR
e. HLA DQ
e. HLA DQ
cause there’s no need to H-ol-LA if your going to the DQ
but for real:
There are many HLA markers. Each HLA marker has a name. The names are letters or combinations of letters and numbers. Doctors review at least 8 HLA markers for these minimum requirements: two A markers, two B markers, two C markers, and two DRB1 markers. Some doctors look for an additional marker, called DQ, to match.
bethematch.org
- Woman is about to be the recipient of an allographic transplant from her sister. What is the probability that BOTH her sisters will NOT be HLA identical to her? [Schwartz page 366-67]
a. 25%
b. 12.5%
c. 6.25 %
d. 3.15%
e. 0%
answer: a. 25%
each has a 0.5 chance of not being identical
chance of both NOT being is 0.5x0.5=0.25
I think this is true for any given HLA, but to be a perfect match, as 6/6 I think the probability of being a match goes up. I have seen some questions answered as only 0.25 chance of each sibling being a match, so 0.75 chance of not being a match, so neither being a match would be 9/16.
- Following are indications of using IVC filters in pulmonary embolisms EXCEPT?
a. recurrent P.E. despite adequate anticoagulation
b. allergic reaction to heparin
c. first time pulmonary embolism
answer: c
- Child sustained a supracondylar humeral fracture and it underwent a closed reduction. Now he is complaining of ++ pain and he screams on passive finger extension. What should you do?
a. split the cast
b. remove the cast
c. check the blood flow to the fingertips with a pulse oximeter.
d. OR for immediate fasciotomy
e. arteriogram
a. split the cast
wow. A question that actually applies to us.
- Patient was positioned in a lateral decubitus manner for hip surgery. Post op he woke up complaining of arm/hand weakness. Which of the following weaknesses would you expect?
a. finger flexion
b. wrist extension
c. finger adduction
d. finger abduction (ulnar nerve)
e. thumb flexion
b. wrist extension
radial nerve, I suppose this is most common when positioned lateral
- Lady with weakness of right fifth finger flexion and pain along the medial side of her forearm. Dx?
a. Thoracic outlet syndrome
b. Cubital tunnel syndrome
c. Carpal tunnel syndrome
d. Meralgia paresthetica
e. Pronator Syndrome
answer: b. Cubital tunnel syndrome
- Old lady brought into the ED. Received i.m. diazepam and 30 minutes later became obtunded. Tx?
a. observe
b. bag mask
c. Intubate
d. tracheostomy
answer: c
other answers were made up by me.
- Hepatitis C causes all EXCEPT?
a. cryoglobulinemia
b. lymphoma
c. hepatocellular carcinoma
d. chronic carrier
e. cirrhosis
official answer: c
previous explanation was that Hep C causes cirrhosis, and the cirrhosis causes HCC
That’s like if I said: I didn’t kill that person, the knife I stabbed them with did…
- Which of the following is the most infectious agent for a blood transfusion?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. HIV
e. CMV
e. CMV
Answer: CMV 1/7500 (most common virus transmitted)
- TMN staging has exerted its validity in all of the following EXCEPT?
a. better communication
b. reproducible results in trials
c. provides information on prognosis
d. widely used by professionals
b. reproducible results in trials
Some of the aims for adopting a global standard are to:
Aid medical staff in staging the tumour helping to plan the treatment.
Give an indication of prognosis.
Assist in the evaluation of the results of treatment.
Enable facilities around the world to collate information more productively.
wiki
- What is the most prevalent cancer among Canadian males?
a. squamous cell cancer of the prostate
b. adenocarcinoma of the prostate
c. leukemia
d. Lung cancer
e. Colon cancer
b. adenocarcinoma of the prostate
most prevalent, lung causes most deaths
After a trial in which it was shown that symptomatic carotid stenosis > 80% does better with carotid endarterectomy another group of researchers showed that carotid endarterectomy also is beneficial in those with > 60% asymptomatic carotid stenosis. The first group of researchers then decide to go back to their date and perform a sub group analysis amongst those with > 60% asymptomatic stenosis to see if this can be substantiated. Uonfortunately the results will lack validity because?
a) it is potentially biased
a) it is potentially biased
I suppose. Anything is “potentially” biased
- Coin toss of randomization
whats the question?
- What is the commonest cause of primary hyperaldosteronism?
a. unilateral adrenal carcinoma
b. bilateral adrenal hyperplasia
c. solitary adrenal adenoma
answer: c
Most Common:
Unilateral adrenal gland adenoma (2/3)
Bilateral adrenal gland hyperplasia (1/3)
- What is the commonest cause of hypokalemia associated with INCREASED urine potassium?
a. prolonged thiazide diuretic use
b. spironolactone use
c. primary hyperaldosteronism
a. prolonged thiazide diuretic use
28.Young trauma fellow. Crushing chest injury. Initial chest tube drained 1500 cc of blood and now is draining 500 cc per hour. What is the next course of action?
a. emergency thoracotomy
b. needle decompression
c. chest tube
d. observe
answer: a. emergency thoracotomy
Blunt thoracic injury with the following conditions:
Previously witnessed cardiac activity (prehospital or in-hospital) Rapid exsanguination from the chest tube (>1,500 mL immediately returned) Unresponsive hypotension (SBP
- What is the MOST important determinant in reducing the amount of fluid in the lungs in ARDS?
a. Positive end expiratory pressure
b. Tidal volume and minute ventilation
official answer a.
not sure, I think low tidal volume
In an ARDS Network study, patients with ALI and ARDS were randomized to mechanical ventilation either at a tidal volume of 12 mL/kg of predicted body weight and an inspiratory pressure of 50 cm water or less or at a tidal volume of 6 mL/kg and an inspiratory pressure of 30 cm water or less; the study was stopped early after interim analysis of 861 patients demonstrated that subjects in the low-tidal-volume group had a significantly lower mortality rate (31% versus 39.8%).[32]
- Young fellow came into the ER with a circumferential abrasion and laceration of his right arm. It looks dirty. After irrigation what should you do?
a. Primary closure in the ER
b. Primary closure in the OR
c. Mechanical debridement
d. Skin graft
c. Mechanical debridement
31.
Clinical picture consistent with ARDS with Pa O2 / FiO2
answer c: Decrease tidal volume to 5-7 cc/kg as per card 29.
- What is the cytokine responsible for the proliferation of fibroblasts?
a. TGF beta
b. TGF α
c. Il 2
d. Il 6
TGF beta
TGF beta blasts!
- All the following drug when administered will cause hypokalemia except?
a. Insulin
b. Vitamin B12
c. Salbutamol
d. corticosteroids
e. Digoxin
e. Digoxin causes hyper K
(Note the caveat: can cause low K when taken on a chronic basis)
Digitalis glycosides bind specifically to Na+/K+ -ATPase, inhibit its enzymatic activity, and impair active transport of extruding sodium and transport of potassium into the fibers (3:2 ratio). As a result, intracellular sodium ([Na+]i) gradually increases, and a gradual, small decrease in intracellular potassium ([K+]i) occurs
- Elderly man brought into the ER after a fall. Past history includes a pacemaker. Although he could not recall the incident he is now mentally clear with nothing to find on exam except for a malar fracture. What is the most appropriate investigation?
a. CT scan with contrast
b. MRI
c. Stress EKG
d. Resting EKG and pacemaker check.
d. Resting EKG and pacemaker check.
this answer seems pretty intuitive
- TPN patient. What is the best test to see if more AA needs to be added to the TPN?
a. Serum creatinin
b. Blood urea nitrogen
c. blood pH
d. ALT
b. Blood urea nitrogen
Here AA must refer to amino acid, not the battery.
- Which of the following is true regarding branched chain amino acids?
a. arginine is an example of BCAA
b. they are metabolized by the liver
c. they are contraindicated in renal failure
d. increased caloric density
answer d. increased caloric density
arginine is an example of BCAA (false. Only leucine, isoleucine and valine are BCAAs)
they are metabolized by the liver (they are the ONLY AA metabolized outside the liver!) they are metabolized by the muscles. [RUSH]
- The following are true of autologous blood transfusion EXCEPT:
a. increased subsequent transfusion post operatively
b. increased risk of infection
answer. a
- What is the daily fluid requirement in a 6 kg child?
official answer 800cc.
I get 6x4/hrx24hr=576
- Trauma patient with flank pain and gross hematuria. CT shows a non expanding subcapsular hematoma. What is the most appropriate course of action?
a. Bed rest and repeat U/S in 3 days
b. OR now
c. OR in 3 days
a. bed rest and repeat U/S in 3 days
Surgical therapy is usually reserved for patients with signs of ongoing bleeding or hemodynamic instability. In some institutions, CT scan–assessed grade V splenic injuries with stable vitals may be observed closely without operative intervention, but most patients with these injuries will undergo an exploratory laparotomy for more precise staging, repair, or removal. Adult surgeons may be more likely to operate in cases of splenic injury but less likely to transfuse than their pediatric surgical colleagues. emedicine
- Old man on coumadin for a prosthetic value has an INR of 3.3 and is scheduled for cholecystectomy (did not mentioned the word ‘open’). What is the most appropriate course of action?
a. stop coumadin 7 days pre op, then start low molecular weight heparin daily
b. stop coumadin 4 days pre op then start LMWH
c. stop coumadin and admit patient then start iv heparin (UFH)
d. stop coumadin and reverse INR with vitamin K
lower the dose of coumadin till the INR is 1.3 to 1.5 then operate.
answer: b
a: 7 days would be for plavix
c: pt shouldn’t need admission preop
d: urgent sx
e: pt at high risk of clot, ok for afib.
- Which of the following will NOT cause hypercalcemia?
a. Thiazide diuretics
b. Sarcoidosis
c. Pagets
d. Multiple fractures
e. ?
d. Multiple fractures
- Heparin does all of the following EXCEPT:
a. Reduces available thrombin
b. Potentiates antithrombin III activity
c. Decreases thromboxane A2 production
d. Decreases platelet activation
e. ? decreases secondary platelet aggregation and binding? (odd wording)
c. Decreases thromboxane A2 production
Mechanism of Action: Potentiates the action of antithrombin III and thereby inactivates thrombin (as well as activated coagulation factors IX, X, XI, XII, and plasmin) and prevents the conversion of fibrinogen to fibrin; heparin also stimulates release of lipoprotein lipase (lipoprotein lipase hydrolyzes triglycerides to glycerol and free fatty acids)
Heparin seems to increase thromboxane A2 production (Thromboxane A2 is released by activated platelets and is a prothrombic)
Heparin seems to activate platelet activation/aggregation, in vitro anyways.
- All of the following increase the risk of pulmonary embolism EXCEPT:
a. Chest trauma
b. Surgery within last 3 months
c. Cancer
d. History of DVT
e. Decreased mobility
a. Chest trauma
Unclear about the answer though… Could be b. as well
Surgery
- All the following are effects of adrenal hyperplasia EXCEPT:
a. Aseptic necrosis of bone
b. Osteoporosis
c. Fat redistribution
d. Prolongation of closure of physis
e. Peptic ulcer disease
d. Prolongation of closure of physis
Most congenital adrenal hyperplasia conditions cause excessive sex hormones being produced. Decreased cortisol/aldosterone and shift towards androgens.
Late onset: accelerated linear growth but early fusion of physis (decreased growth height)
Adrenal hyperplasia is a cause of Cushing's syndrome. Fat redistribution (Cushingoid)
Osteonecrosis (aseptic necrosis) of the femoral heads and rarely the humeral heads, usually only with chronic high-dose glucocorticoid therapy (ex: postop resection of tumor, the high dose cortisol has blunted the corticotropin-releasing hormone and ACTH so they need exogenous steroids)
Glucocorticoids increase risk of peptic ulcer disease (uptodate says predominantly when also taking NSAIDs)
- Pancreatitis causes all of the following EXCEPT:
a. Fat necrosis
b. Pleural effusion
c. Dyspnea
d. Diarrhea
d. Diarrhea
Severe pancreatitis can cause dyspnea secondary to pleural effusion
- Young male in MVC, sustains # T8 level, BP = 90/50, HR = 50, despite 4l crystalloid. Has been stable as above for 2h (unchanged since admission). No evidence of peritoneal fluid on fast U/S. What is the likely cause of persistent hypotension?
a. Inadequate fluid resuscitation
b. Neurogenic shock
c. Intra-abdominal source of bleeding
d. Anemia
e. ?
b. Neurogenic shock
- Patient is POD#2 following simple repair of inguinal hernia (elective), presents with diaphoresis, SOB, dyspnea, CXR shown (shows black right lung, ? pneumothorax, with tracheal deviation towards left, white left lung, ? pleural effusion). What is the diagnosis?
a. Diaphragmatic hernia left
b. Pleural effusion left
c. Pneumothorax left
d. Pneumothorax right
e. Left sided pneumonia
d. Pneumothorax right
- Patient presents following MVC with left hip injury (X-ray shows posterior dislocation of hip…and they specify for non-orthopods). Which nerve is most likely injured?
a. Sciatic
b. Femoral
c. Obturator
d. Superior gluteal
e. Iliofemoral
a. Sciatic
- All of the following fractures are associated with avascular necrosis EXCEPT:
a. Scaphoid
b. 4 part proximal humerus
c. intertrochanteric hip fracture
d. talar neck
e. capitellum (humerus)
c. intertrochanteric hip fracture (0.5% risk of AVN as per orthobullets)
Previous answer: e. capitellum (humerus)
Scaphoid/talar neck classic high-risk # for AVN
4-part proximal humerus up to 21-75% risk AVN in some fracture patterns
Avascular necrosis is uncommon after open reduction
and internal fixation of these fractures, despite the
fact that the capitellar fragments usually have no
soft tissue attachments (Bryan and Morrey, 1985;
Holdsworth and Mossad, 1990; McKee et al., 1996).
Although the incidence of this complication has been
reported variably as 10 % and 30% (Jupiter et al., 1988;
Lansinger and Mare, 1981; Liberman et al., 1991;
Scapinelli, 1990), other authors have never encountered
this complication (Grantham et al., 1981; Inoue and
Horii, 1992; McKee et al., 1996; Poynton et al., 1996;
Silveri et al., 1994). Because of this low incidence of
avascular necrosis, encountering a free capitellar fragment
should not discourage the use of internal fixation
(Mehdian and McKee, 2000).
- How long can amputated digits survive prior to microvascular reimplantation if properly stored on ice?
a. 6h
b. 8h
c. 10h
d. 12h
e. 18h
e. 18h
Time to replantation:
• proximal to carpus
o warm ischemia time