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POS Studying > 2009 exam part II > Flashcards

2009 exam part II Flashcards

1
Q

Guy with NG, output is 1500 cc/day. He becomes lethargic and weak, and has ileus. What is most likely?

a) hypomagnesemia
b) hypochloremic metabolic alkalosis
c) hypokalemic metabolic alkalosis
d) hyponatremia

A

NG = hypokalemia, met alk

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2
Q

Low magnesium, which is a sign?

A

tremor

its when you have HIGH mag that you have loss of DTRs, hence when a patient is on mag you check the reflexes as a way to monitor mag levels and toxicity

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3
Q

Patient with carpal tunnel syndrome, which are you most likely to find?
weak thumb abduction
weak thumb adduction

A

weak thumb abduction

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4
Q

Patient with mediastinitis (picture provided, large wound) post CABG. What is the best management?

A

Debridement, rigid sternal fixation, myocutaneous flap

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5
Q

Shown picture of a child with burn to right thorax and right arm. Erythematous. What is the degree of burn?

A

second or third degree.
second degree = blistering
third degree is fullthickness and extends thru the entire dermis

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6
Q

Shown picture of a large keloid on earlobe. What is the management?

A

intralesional steroid injection ( kenalog)

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7
Q

Shown picture of an ulcer on the sole of a diabetic foot. What is the mechanism by which this occurs?

A

neuropathy

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8
Q

Shown picture of venous stasis ulcer, which is best management?

A

compression stalking/dressings

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9
Q

Shown picture of TRAM to right breast POD#2. Upper part of flap is good cap refill, good pulse by Doppler, and warm. Picture shows upper part is normal color, but lower looks venous congested and has small bullae. What is the best management?

A

leeches

anytime there is venous congestion from a graft or flap its leech therapy. god knows why we cant come up with something better

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10
Q

Shown a picture of mole on face. You do not feel that you can excise the lesion and do primary closure. What is the best management?

  • FNA
  • Incisional biopsy of the mole
  • Incisional biopsy of the mole and normal skin
  • Shave biopsy of entire lesion
A

if its melanoma you need to take the whole thing, plus some normal skin =
incisional + normal skin

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11
Q

Shown picture of big ulcerated lesion over lower leg. Patient had tibia fracture 20 years ago with chronic draining sinus, which has been enlarging for past few months. What is most likely?

  • Superinfection
  • SCC
  • Osteosarcoma
  • Something else
A

SCC

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12
Q

What is the deepest burn that you can get for spontaneous epithelialization to still occur?

A

deep papillary dermis

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13
Q 
Shown picture of carpal tunnel release intraop, with 2 longitudinal lines that are thin and look like veins.  What is the etiology?
Congenital
Systemic disease
Inflammation
Factitious
A

congenital

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14
Q

Shown picture of electrical burn to right hand and arm, no eschar. Patient has extreme pain on passive stretch of fingers. What do you do?

A

immediate fasciotomy

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15
Q

Shown picture of kid with dog bite to face. What is the best management?

A

Irrigate, debride, and careful multiple layer closure

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16
Q

Senior resident never respects gowning and hand-washing procedure during an MRSA outbreak. What CanMEDs competency is he failing to show?

A

professionalism

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17
Q

Anion that is not measured and contributes to your normal anion gap?

A

albumin

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18
Q

What gives you decreased platelet count and qualitative defect in platelet function?

A

VWF

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19
Q

15 year-old guys shows up with retracted testicle, absent cremasteric reflex, 6 hours post start of pain. Best management?
Go to OR urgently for detorsion of left testicle and left orchiopexy
Go to OR urgently for detorsion of left testicle and bilateral orchiopexy.

A

OR, bilateral pexy to correct the congenital bell clapper deformity that is likely present on both sites and is the most common cause of testicular torison

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20
Q

Shown an axial slice of CT showing right SC(sterno clavicular) joint dislocation, with head of clavicle displaced posteriorly. There is no pneumo at the lung apices. Patient has distended neck veins, plethora in the face, and complains of respiratory distress. What is the best management?

A

SC joint reduction

reduce the joint!!

21
Q

Woman with medullary thyroid cancer, has 12 and 15 year old child. What is most appropriate screening test for her children?

A

RET

22
Q

Guy post MVC, presents with tachypnea, tachycardia, decreased air entry on one side, hyperresonant percussion, and trachea deviated to contra-lateral side. What do you do?

A

Needle decompression 2nd ICS mid clavicular line

23
Q 
Which of the following is not an absolute contraindication to a chest tube?
Spontaneous pneumo
Open pneumo
Chylothorax
s/p thoracic surgery for drainage
A

spont pneumo??

24
Q

Patient comes in with trauma, needs blood. His blood is checked for ABO and Rh compatibility, but not cross-matched. What is the chance that he will get an acute hemolytic reaction?

A

0.1%

25
Q 
Answer: A
Which of the following is not a feature of acute rejection in kidney transplant.
hypertension
pancytonia
tenderness at graft
increased graft size
A

pancytopenia Im guessing is what they were trying to say

26
Q 
Regarding acute rejection in transplant, all true except?
Cell mediated
Most common rejection reaction
Most are asymptomatic
Biospy shows intravascular coagulation
A

asymptomatic - thats not true at all

27
Q 
Which of the following causes reversible nephrotoxicity?
Cyclophosphamide
Azathioprine
Cyclosporin A
Steroids
A

cyclosporin A

28
Q

In heart transplant, all are used except?
methotrexate
tacrolimus
azathioprine

A

methotrexate

29
Q 
Patient with pH 7.55, pCO2 24, PO2 60 on 30% O2.  He is on respirator at RR 12 and tidal volume 10cc/kg, PEEP 5.  What is the first step?
increase FiO2
increase tidal volume
increase dead space of tubing
sedate patient more
A

increase FiO2

30
Q 
Which of the following is the most common mechanism of hypoxia in acute lung injury?
diffusion problem
right to left shunt
ventilation perfusion mismatch
something else
A

diffusion problem

31
Q

What is the rate of transmission of HCV from a single unit PRBC transfusion?

A

1 in 300,000

32
Q 
What is not a criteria for SIRS?
respiratory rate > 20
temp > 38.5
HR < 85
sBP < 90
A

recall that SIRS is actually just heart rate, resp rate, temp and white count.

BP is not in there,
and the HR value they gave here is incorrect

33
Q 
Which is not consistent with severe PE?
increased CVP
increased wedge pressure
decrease in PaCO2
increase in A-a gradient
A

increased PCWP pulm cap wedge pressure. this is a reflection of pressure in the left atrium

34
Q

What is a contraindication to tPA?
Surgery 10 days ago
Old stroke on CT
Failure of urokinase

A

A- surgery ten days ago

35
Q 
Patient with pmhx of dvt, gets into MVC.  Fracture L femur and R medial malleolus.  Cerebral edema on MRI, rest of scans normal.  What is the best way to anticoagulate?
SCDs
Unfractionated heparin q12h
LMWH
Warfarin
A

LMWH

36
Q

What determines dBP?
peripheral vascular resistance
cardiac output
blood volume

A

peripheral vascular resistance

37
Q 
Lady with breast ca, getting intramedullary nail of femur for impending fracture.  Anesthetist alerts you that she has become hypotensive, tachypneic, and difficult to ventilate.  What is the diagnosis?
Acute PE
Fat embolus
MI
Anaphylaxis
Answer: B
A

fat embolus

38
Q 
Guy with open fracture of tibia, loss of anterior coverage of 6 cm.  What is the best option for coverage?
Primary closure
Rotational flap
medial gastroc flap
free tissue transfer
A

free tissue transfer

39
Q

What is the best option to eliminate dead space post debridement of dead bone?
Myocutaneous flap
Closed suction drain
Skin graft

A

myocutaneous flap

40
Q

What is an absolute indication to reimplantation?
Complete ring avulsion of 4th digit in 45 year old woman
15 year old had saw injury with amputation at MCP joint of thumb

A

any amputation through the thumb is an indication for surgery

41
Q

Which is true about management of a contaminated open fracture?

A

early immobilization decreases infection risk

42
Q

Shown an outlet view of a pelvis, obvious open book fracture. What is the mechanism?
AP compression
Lateral compression
Vertical shear

A

AP compression

43
Q 
During ureteral repair, which of the following is not true?
Debridement
Stent placement is optional
Water tight closure
Tension-free anastomosis
A

stent placement is optional

44
Q 
Which of the following has the highest metabolic rate 1 week post injury?
Major burn
Peritonitis/sepsis
Elective abdominal procedure
Skeletal procedure
A

major burn

45
Q 
omeone with 6th and 7th rib fractures, has failed SQ and PO narcotics, what do you do?
Chest physio
Epidural
Surgical fixation of fractures
Bracing
A

epidural

46
Q 
What tissue has longest warm ischemia time?
skin
muscle
kidney 
small bowel
A

skin

47
Q 
What is the general recognized maximal ischemia time for muscle and nerve?
4 hours
6 hours
8 hours
10 hours
Answer: B
A

6 hrs

you have to get a pulseless limb to the OR in 6 hrs

48
Q

Young chap with 20% grease burn to hand and upper extremity. What is the management?
Start Ringers at 3500 cc/hr, give tetanus toxoid, and local wound care
Start resuscitation, give tetanus shot and transfer to tertiary burn unit

A

resus, give tetanus, transfer to burn center

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