2009 Exam Flashcards
Principle of beneficence is defined as:
doing an action that benefits another person
for longterm TPN. what is the best IV site used to access the SVC?
Internal jugular
however notable is that the basicili is great for short term TPN
what are the changes of a morbidly obese patient losing weight and maintaining it by dieting?
10% or lower,
the other option was 3% we weren’t sure
The five year risk of rupture of a 5.5cm AAA is?
25%
-if youre over 8cm then you have a 30-50% risk of rupture
which of the following is not a canmeds role? Teacher Manager Health advocate Medical expert
teacher! Its actually called scholar
Resident always shows up late to OR, after prepping and draping. Which CanMEDs role is he lacking?
professional
Which of the following is an indication for thrombolytics in PE?
lobar PE with shock
agents to use: alteplase, streptokinase, tPa
what are other indications for thrombolytics
acute MI within 6 hrs, PE with hemodynamic compromise, puml HTN,
POD#5 colon cancer surgery, patient develops crushing retrosternal chest pain. The following are all part of management EXCEPT:
streptokinase
O2 by NP
Admit to ICU
Do an EKG
admit to ICU - they don’t necessarily need to go in
Which of the following is most sensitive way to diagnose post-op MI? EKG CK CK-MB Trops
some day tropes, the other ECG. I say tropes.
Which of the following resp conditions is most commonly associated with morbid obesity?
OSA
Asthma
Restrictive lung disease
Something else
OSA
When performing a split thickness skin graft, the harvest site on the thigh, what is the cross-sectional depth. Epidermis Deep papillary dermis dermis Reticular dermis (under papillary) Superficial papillary dermis
superficial papillary dermis
what is the caloric rate perday for a sedentary person
25cal/day, with trauma this can go to 35-40kcal/day
Melanoma Clark IV, invades all the way down to?
reticular dermal layer
what is the Breslow Scale?
it helps prognosticate melanoma, whereas clarks system is for staging.
under 1mm = 90-100% survival
4mm = only 50% survival
Patient is bleeding, has normal INR but increase PTT what is the blood abnormality?
unrecognized blood dyscrasia
Cyclosporine A, which is false? Inhibits calcineurin Phenytoin will increase its blood level Suppresses T cell activation and IL 2 production Can be nephrotoxic
false: phenytoin will NOT increase its blood level
Interferon-alpha does what?
it plays a role of chemotaxis of monocytes apparently?
what factor initates acute inflammation
factor VII - 7
SIRS is associated with all the of the following except?
aspiration
spinal cord injury
acute pancreatitis
spinal cord injury was the answer from the guide, not sure if thats right
Most common cause of death in patient with burn?
Bronchopneumonia #2 staph/pseudo
what is the most common cause of line sepsis (bug)?
Most common cause is coagulase-positive S. aureus and coagulase-negative staph.
Untreated chylothorax, which do you NOT get? hypoproteinemia electrolyte imbalance b cell leucopenia deficiency in fat-soluble vitamins
b cell leucopenia
Several days post op, patient develops effusion. Thoracocentesis shows milky fluid. What is the management?
A chest tube and TPN for treatment of chyle leak.
you need OR if:
1)there is greater than 1L of fluid per day x 5 days
2) loculated
3) nutrtional or metabolic complications.
tx is thoracic duct ligation
Which of the following will most likely result in respiratory arrest with administration of 100% oxygen?
pH 7.3; pCO2 60; O2 sat 96%
the idea is that this set of labs refers to a COPD patient and if they are already sattign 96%, targetting them at 100% is going to drop their respiratory drive
ATN, which is most likely? hemoglobinuria hyaline casts UNa 80 Urine specific gravity 1.010
UNA 80
- recall the diagnosis of ATN is made by FeNA over 3 and granular casts
in ATN you have a high urinare NA, as opposed to prerenal where the FeNA is low
In SIADH, which do you see?
comment on hypo/hypernatremia, volume status, urine concentration.
hyponatremia,
euvolemic
concentrated urine, veyr concentrated
With hyponatremia, which is false?
In expanded ECF with peripheral edema, administration of NS will help the edema
Regarding cancer cells. Stages of initiation, promotion, and progression. What does promotion refer to?
serial genetic changes
- initiation= mutation of cancer gene
- promotion= clonal expansion
- progression= further mutations of gene
Intravasation of tumor refers to?
Malignant cells go from tumor to lymph and vessels
recall that extravastaion means cells are going from the blood stream to the tumor site ( so the extravsation is from the point of view of the blood vessel)
Percentage of posterior urethal injuries in pelvic fractures?
10%
Patient metastatic lung ca, patient wants full code. What can you use to discuss with patient?
rationing was one of the answers that seemed wrong
Gastric outlet obstruction in 45 year old male, which is most likely?
- K of 3.7
- Aciduria
- Increase in BUN with normal creatinine
- pH of 7.3
B.
what GOO, its usually due to cancer. You get a very specific and rare electrolyte disturbance :
you get aciduria
metabolic alkalosis
hypokalemia
hypochloremic ( like with pyloic)
Post-op ileus, NG. 48 hours later, lab work will likely show: hyperkalemia hypochloremia hypernatremia ?
B hypochloremia
because youre sucking HCL out of the stomach, they get hypochloremic, hypokalemia
Compartment syndrome of anterior lower leg compartment, which is false?
hyperesthesia in sural nerve distribution
Which is not a feature associated with necrotizing soft tissue infection?
Bullae (hemmorahgic)
hypotension
no pain
no pain
thats bullshit it should be pain out of proportion extending outside the wound edges
45 year old male abrasion while cleaning basement 24 hours ago. Comes in with cellulitis to lower leg associated bullae, has pain at the area, which extends around redness. WBC 18,000. What is your management?
CT scan of leg
Surgical debridement
Admit and put on triple antibiotic therapy
Trial of PO abx and reassess in 24 hours
B- surgical debridement
What happens if trach is inserted through 1st tracheal ring (increased risk of what?)
subglottic stenosis
All have been proven to decrease wound infection except?
Preop administration of antibiotics for parotidectomy
Supplemental O2
Keeping patient above 36.8 during the OR
Strict sterile technique
preop abx for a sterile and small procesure like a parotidectomy
Which have been proven to decrease SSI – all EXCEPT:
Closed-suction drain
Pre op abx for clean-contaminated cases
Keeping patient normothemic
closed suction drain
Patient in house fire, ++ burns, CO poisening suspected. Which is most likely. Pale skin, sat 70% Pink/red skin, sat 70% Pale skin, sat 100% Pink/red skin, sat 100%
pink/red with sat 100% ( but the sat probe is reading inaccurately)
Which is most likely cancer post transplant?
lymphoma
Kaposi
Epidermoid skin cancer
Epidermoid skin cancer is the most common following solid body organ transplant due to the ongoing immunosuppressive drugs we ask this pts to be on
What is a hydrocele?
fluid accumulation in tunica vaginalis
What has not been proven beneficial in septic shock?
Anti-inflammatory modalities
Hypoxic vasoconstriction happens because of?
Low alveolar 02 : PA02
What does the adrenal medulla secrete?
recall the cortex or outside does the salt (Aldo), sugar (cortisol), and sex ( testost and estrogen).
the inside or medulla does epi and norepi
What is not an effect of steroids?
Increase in fat deposition
Delayed closure of physis
Ulcers (GI)
delayed closure of physis - it actually promotes closure? Not sure I would have known that honestly. Not srue i know what a physis is referring to
What is the best determinant of prognosis post TBI?
initial GCS
Patient with botulism and a nosocomial infection, which of the following is contraindicated in terms of abx/medications?
aminoglycosides- Aminoglycosides may potentiate neuromuscular blockade.
In a patient with a genetic alteration in cholinergic receptor (vs. acetylcholine esterase?), which of the following drugs will cause prolonged depolarization?
a- succinylcholine
Which is not consistent with significant PE?
- ventilation-perfusion mismatch
- PaO2 > 60
- Abnormal vascular markings on lateral CXR
- Non-specific ST and T wave changes
Pa02 being above 60 is not in keeping
In laparoscopic surgery, what happens when CO2 is insufflated into peritoneal cavity?
volume-related changes in cardiac output
Which of the following signs is associated with abdominal compartment syndrome?
increase in peak airway presssures,
increase in CVP,
All of the following increase CVP except? Cardiac tamponnade Simple PTX Cardiac dysfunction Over resuscitation
simple PTX
recall CVP is a static indicator of right atrial pressures
Rationale for using PEEP in ARDS is:
Decrease in FRC
Decrease extracellular lung water
Improve V/Q mismatch
increase FRC
reduce extracellular water
improve the V/Q mismatch
What is an example of orginal categorical data?
breast cancer staging
the idea is that its not a numerical or yes no kind of set information, it a number that has to be put into a framework to make sense eg like staging
For dichotomous outcomes, which can’t you use? Chi-square Fishers exact test Students T test ANOVA
D : ANOVA
i need to read more about what this means honestly..
how to do you calculate ARR?
CER-EER
you need to read more baout this
Male patient with trauma with T8 fracture dislocation, complete sensory and motor loss below that level. No perirectal sensation or rectal tone, no bulbocavernosus reflex. Which is most true?
Patient in spinal shock so prognosis cannot be determined at this point
( but the definition of spinal shock is that they will recover some function, atleast the bulbocarvernosus reflex)
Sensory level of umbilicus?
T10
Patient sustained laceration over hand 6 weeks ago. On exam, cannot flex IP joint (FPL rupture). Why can’t you repair?
retraction of the myotendinous unit
Patient with distal radius fracture many weeks ago, now has paresthesias over 1st and 2nd fingers. Which nerve is more likely affected?
i think its radial, but apparently the answer is media
In a study, a new beta-blocker decreases the risk of MI by 25%. Mortality with MI is 1%. What is the ARR and NNT for this new beta-blocker? 0.25%, 400 2.5%, 40 25%, 4 1%, 100
ARR is 0.25 (1-.75=.25)
and then NNT is 1/0.25 = 400
Hyperadrenalism, what are the results of this on the body?
Addision disease is characterized by hypotension, hyperkalemia (no aldsosterone), and hyponatremia (due to inability to lose free water)
Most common organism in a cat bite?
Pastruella
Overwhelming sepsis post splenectomy, most likely
strep Pneumo
Advantage of LMWH over UFH?
less risk of bleeding, as there is less inhibition of platelet function
- higher bioavailability
- dosing more predictable
- have to dose less frequently
With regards to LMWH and regional anesthesia, when do you need to stop it eg to get a spinal or epidural?
12 hours before
Which of the following is true about platelets?
When activated, they attract fibrinogen
- then also degranulate when they are activated
Massive transfusion can lead directly to what?
hypokalemia
metabolic alkalosis
it leads to: hyperkalemia thrombocytopenia (most commonly) hypothermia ( second most commonly) met alkalosis
In rhabdo, can get all except
hypokalemia
hypotension
hypokalemia
actually you get hyperkalemic from the lysis of cells that release K
Which mineral can lead to tetany?
magnesium
calcium was not an optino
Which of the following does not result in problems with wound healing? Zinc Calcium Copper Vitamin C
for wound healing you need zinc, vita A, vit C, copper. Recall zinc and iron are cofactors for healing
so calcium is not involved
Which of the following is necessary for wound healing? Vitamin A Vitamin B Iron Zinc
Vit A - super important
Preop lady, very anxious and hyperventilating. Complains of perioral numbness and painful spasm in her hands. What will you most likely find on blood work?
A hypocalcemia - perioral tingle
met alkalosis - because of hyperventilation
All can be used to treat hyperkalemia except? Cation-binding resin Insulin and glucose Calcium gluconate Some random thing that started with M
the rando thing that started with M
Patient has potassium of 6.7 with peaked T waves. What would you do first?
calcium gluconate to stabilize the myocardium
In studying wear rates for 4 sizes of femoral heads (24, 28, 30, 32). Which of the following should you use for your statistical analysis?
-Chi-square
ANOVA
T-test
B _ ANOVA for comparing more than 2 groups
For which of the following will hand washing be most effective? Rubella Hepatitis A Hepatitis B TB
Hep A as it is fecal oral
Which of the following stimulates fibroblasts to produce collagen? TGF-alpha TGF-beta IFN gamma IL-2
TGF-beta
Most common radiographic abnormality found in the thoracic and lumbar spine when metastic lesions are present
vertebral body collapse
In a patient with sickle cell anemia, what is the most common complication after transfusion?
infection, allo-immunization
What is the fluid bolus amount for a pediatric patient?
20cc/kg
The difference between a split thickness and full thickness skin graft include:
- Better take of the split thickness skin graft in an infected area
- More durable coverage
- Easier to match pigmentation
A apparently better take of the split graft to an infected area
i guess esp if you mesh it??
It is possible to place a skin graft on a wound infected with all of the following bacteria except:
Answer: B, strept secretes streptokinase so you cant form a clot
Cardiac index is calculated by:
Cardiac output divided by body surface area
All are true about starvation except:
There are enough carbohydrate stores to supply energy for 5 days
Which is true regarding nutrition in renal failure?
Increase calorie:nitrogen ratio
Patients on TPN often develop elevated cholestatic enzymes because of overfeeding. Which is true:
Can occur without any predisposing abnormalities
Nerve injury with an intact axon and local conduction block is called
neuropraxia
Man is post-op AAA repair, uncomplicated. Received 6 L of crystalloid and 4 U PRBC intraop. Is now in ICU. CVP 5, BP 90/60. HR 100. What is your next step.
give more fluid
Most sensitive way to determine is there is gas present in an infected diabetic foot? Smell Soft tissue radiographs Clinically Aspiration with needle
sot tissue radiographs
With regards to remodeling after fracture, which is true:
Overgrowth is a feature
Osteoclasts have an important role
The bone will never reach normal strength
osteoclasts have an important role
In SIADH, all except: Hyponatremia Low urine output High urine osmolarity Increase ECF
D increased ECF
Which is not associated with paralytic ileus?
Myxedema
Retroperitoneal hematoma
Hyperkalemia
hyperkalemia!
its actually hypokalemia that causes the ileus so you should replace that K when the nurse is always calling about it
Which is best to diminish toxic effect of radiation on the skin?
brachytherapy
cobalt
brachytherapy
bCG is an example of what type of immunotherapy? active, specific active, non-specific inactive, specific inactive, non-specific
active non specific
Which of the following carries the most risk of cardiac complications in patients undergoing non-cardiac surgery? MI 18 months ago Severe aortic stenosis Peripheral vascular disease A fib on EKG
Aortic stenosis
Patient POD#2 of uncomplicated OR (? Abdominal), has fever of 38.9.
What is your management?
Ensure physio helps ambulate and do breathing exercises
Starts on IV antibiotics
Do a CT chest
ensure physio helps ambulate and breathing exercises
Patient was put on 10 days of prednisone 20mg for asthma exacerbation. What will happen if you discontinue it?
no adverse effect
significant depression of adrenal function
tapering would hasten adrenal dysfunction
A no effect
people have have supresision of their HPA axis include:
pt with 20mg/day pred x 3 wks
-any pt with clinical cushings
Child gets deep laceration to the arm from being bitten by neighbor’s dog. What is the most appropriate course of action?
the key says just observe the dog, but I googled and a deep penetration means irrigate, abx,
In a child in whom you cannot get IV access, what is the best place to insert intraosseous catheter?
One fingerbreath below tibial tubercle, aiming 45 degrees away from knee - aim away from the growth plate
Patient sustains a hemothorax, chest tube inserted elsewhere. Initial drainage unknown. What is the minimal amount of hourly blood output that will prompt you to go to the OR for a thoracotomy?
1500 initially then over 200cc/hr - just means they are losing ALOT of blood and that should probably be looked into
Best indicator of alveolar ventilation:
PaC02 - so the c02 concentration in the blood ( arterial)
Patient has a certain pre-test probability for x disease. What property of your diagnostic test will be most helpful in calculating a post-test probability? Relative risk Likelihood ratio Predictive value (positive or negative) Sensitivity
predictive value
