2012 Flashcards
A 65-year old smoker presented with anorexia, fatigue, and vomiting. UGI Endoscopy revealed an ulcerative lesion of the incisura. Where is the incisura located? 2012
a. Body
b. Fundus
C. Greater Curvature
d. Gastrocolic ligament
e. Lesser Curvature
e. Lesser Curvature
How would you resuscitate a patient in shock? 2012
a. Standardized size lumen Femoral Central Line
b. Bilateral 16g Peripheral Cannula
c. Bilateral 22g Peripheral Cannula
d. Unilateral 16g Peripheral Cannula
e. Unilateral 22g Peripheral Cannula
b. Bilateral 16g Peripheral Cannula
What is an indication for proctocolectomy in UC patients?
Toxic megacolon
Which of the following structures has venous drainage to both the portal vein and IVC? 2012
a. Stomach
b. Duodenum
c. leum
d. Rectum
d. Rectum
A stone in the ureteropelvic junction of 10 mm in size. How will you treat it? 2012
a. PCNL
b. Ureteroscopy
c. ESWL
c. ESWL
*For upper ureteric stones > 5 mm we start with ESWL and if failed -> flexible Ureteroscopy + laser. Maybe the question had info to help exclude one of them; like mentioning rigid ureteroscopy, which is used for lower ureteric stones. ESWL is contraindicated in pregnancy, if the patient is on anticoagulation, active UTI, acute urinary obstruction.
A 27-year-old female in her late first trimester was diagnosed with acute bacterial cystitis on routine U/A. What is the most appropriate treatment? 2017, 2012
a. Nitrofurantoin for 3 days
b. Trimethoprim for 5 days
c. Cephalosporin for 7 days
d. Cefazolin for 7 days
e. Ciprofloxacin for 7 days
f. Levofloxacin for 7 days
a. Nitrofurantoin for 3 days
13.A 74-year old male complains of LLQ pain. Physical examination revealed localized tenderness. No peritonitis. Abdominal x-ray was normal. WBC count was 16×10°. What is the investigation? 2012
a. Barium enema
b. Abdominal ultrasound
C. Abdominal CT
d. Colonoscopy
e. Laparoscopy
C. Abdominal CT
A 29-year-old woman presents with a recent history of obstructive jaundice and abdominal pain. She was found to have a high level of conjugated bilirubin and an INR of 1.8. Dilated common bile duct was detected on abdominal ultrasound. What would be the cause of her elevated INR? 2012
a. Chronic liver dysfunction
b. Vitamin K deficiency
b. Vitamin K deficiency
A 27 year old female patient with biliary pancreatitis. What would be the definitive treatment for her condition? 2013, 2012, 2011
a. Cholecystectomy in the same admission when the pain resolves
b. Cholecystectomy when the amylase becomes normal
c. Endoscopic retrograde cholangiopancreaticography
a. Cholecystectomy in the same admission when the pain resolves
13.A hypertensive man post TURP. His creatinine is 5000 and is euvolemic. What do you give him? 2012
a. ACEI
b. CCB
c. Diuretics
c. Diuretics
28.A 40-year old female came with positive nuclear imaging of a hot nodule on the right thyroid lobe. What’s the next step? 2012
a. Radioactive iodine
b. Resection of the nodule with negative 1-cm margins
c. Right hemithyroidectomy
d. Total Thyroidectomy
b. Resection of the nodule with negative 1-cm margins
32.In patients with BRCA1 gene mutation, which of the following has proven to be effective to prevent the risk of breast cancer? 2012
a. Close follow up
b. Prophylactic bilateral mastectomies
c. Radiation Therapy
d. Tamoxifen
e. Yearly MRI
b. Prophylactic bilateral mastectomies
27.Which brachial arch gives rise to superior parathyroid glands? 2012
a. I
b. Il
c. Ill
d. IV
e. V
d. IV
Sign and symptoms and labs of septic arthritis with normal x-ray. What is the appropriate next step in management along with IV antibiotics?
a. Open total debridement
b. Arthroscopic aspiration
b. Arthroscopic aspiration
*Must do aggressive arthroscopic aspiration and irrigation or open debridement if tools are not available
A 50-year old lady known to have gallstones came with Epigastric pain radiating to the back. On P/E, tve sign of peritonitis, Serum amylase was 650. Which of the following indicate a poor prognostic factor? 2012
a. Arterial PO2 = 7
b. Pyrexia= 38.5 Celcius
c. WBC count= 10 X 109
d. Age > 50
e. Serum Amylase > 650
a. Arterial PO2 = 7
(Ranson’s criteria)
31.A patient with a history of breast cancer that was resected now presented with back pain.
She is diagnosed with a compression fracture. What imaging technique will you perform next? 2012, 2010
a. Bone scan
b. No further imaging is needed
a. Bone scan
Bloody nipple discharge. What is the least likely diagnosis? 2012
a. Breast cyst
b. Ductal carcinoma
a. Breast cyst
A 30 year old woman with 5 days Post Laparoscopic Cholecystectomy was discharged and came back to the hospital complaining of fever and RUQ pain. Bilirubin and Liver Enzymes were NORMAL. What is the most appropriate next step? 2012
a. Abdominal
b. U/S
c. HIDA Scan
d. ERCP
e. MRCP
(People argued between HIDA scan and U/S because of possibility of an Abscess - Also this question is part of the 5-Ws of post-op fever)
This is a case of post-cholecystectomy syndrome. First thing to do is LFTs and US. If it showed fluid collection or stones or pancreatitis, you treat accordingly. And if there’s a leak, we would do HIDA.
12.The major blood source of the liver comes from: 2013, 2012
a. Common Hepatic Artery
b. Cystic Artery
c. Left Hepatic Artery
d. Portal Vein
e. Right Hepatic Artery
d. Portal Vein
23.An elderly patient known to have AFib had an episode of acute mesenteric ischemia after surgery. What is the most likely origin of the embolism/thrombus? 2012
a. Heart
b. Calves
c. Upper extremity
a. Heart
A 2-months year old child with developmental dysplasia of the hip (DDH), what’s the management?
Pelvic harness
21.A patient post-thyroidectomy, four hours later developed perioral numbness, confusion, and prolonged QT interval in the ECG, what is the next step in management? 2012
a. Order blood count, BUN, and corrected calcium
b. Give oral calcium
c. Give IV calcium Gluconate
c. Give IV calcium Gluconate
Parkinon’s patient, has dysuria and turbid urine. Which of the following is he likely to have? 2012
a. Cysteine
b. Uric acid stone
c. Magnesium ammonium phosphate
c. Magnesium ammonium phosphate
A female patient with recurrent UTI and on chronic laxatives for constipation, what kind of stone do you think she has? 2012
a. Calcium oxalate
b. Uric acid
c. Cysteine
d. Magnesium ammonium phosphate
d. Magnesium ammonium phosphate
13.What will you give the patient in the previous question? 2012
a. ACE inhibitor
b. Adrenaline
c. Beta blockers
d. Promethazine
(The nurse called you because a patient who took penicillin now has swollen lips and cannot breathe.)
b. Adrenaline
How long do you stop aspirin for before an elective hernioplasty? 2012
a. 1-4 hours
b. 1 day
c. 3 days
d. 5 days
e. 7 days
e. 7 days
*The life cycle of platelets ranges from 7-10 davs
Patient came with an acute onset of RLQ pain. The patient said that the pain started as umbilical pain followed by nausea and vomiting then RLQ pain. The patient was diagnosed with appendicitis. Blood samples were taken from the patient. What is the first step in taking blood samples from the patient according to protocol? 2012
a. Clean patient’s hand
b. Wear gloves
c. Identify the patient info and reason for blood sampling
d. Place tourniquet
c. Identify the patient info and reason for blood sampling
A young male who has a 2.5 cm renal stone with negative urine culture. What is the next step of management?
ESWL
A 13-year old obese boy with hypothyroidism presents with hip pain and limping. Which is the likely diagnosis?
-
What is the most common symptom of testicular cancer? 2012
a. Metastasis
b. Asymptomatic mass
c. Painful swelling
b. Asymptomatic mass
Patient presented in the ward with Erythema and tenderness at the surgical site 2 days after he had a knee surgery. How do you treat this patient?
Antibiotics with Arthroscopy
A young man presents to the surgery clinic with a history of chronic anal fissure. What is the treatment option available for this patient? 2013, 2012, 2011
a. GTN ointment
b. Fissurectomy
a. GTN ointment
Note: Chronic anal fissures should be initially treated with topical pharmacologic agents, e.g., calcium channel blockers or nitrates. Patients who fail to respond to conservative or medical therapy can be referred to surgery.
11.Bleeding varices refractory to medical and endoscopic treatment. What is the next step of management?
Sengstaken-blakemore tube
13.You were called by the ICU to assess a 43 year old male 2 hours after inserting an internal jugular vein catheter after uncomplicated partial liver surgery. He has a history of myocardial infarction and bronchial asthma. The patient appears to be short of breath and is unwell. Vital signs are HR 120, BP 95/50, T 37.2, O, sat. 87%. What is the diagnosis or cause?
2012, 2010
a. Atelectasis
b. Aspiration pneumonia
c. Myocardial infarction
d. Pneumothorax
e. Pulmonary embolism
d. Pneumothorax
*Common after inserting a central line, that’s why you might order a CXR
A 50 year old diabetic presented with a history of BPH he did not pass urine for the last 12 hours. What is the condition called?
Acute urinary retention
Patient was involved in a car accident and presented with bleeding. He is known to be on warfarin. What can we give to counteract the effect of warfarin immediately? 2013, 2012
a. Cryoprecipitate
b. Factor 7
c. Fresh Frozen Plasma
d. Platelets
c. Fresh Frozen Plasma
Acute bleeding = stop warfarin + give FFP
Supratherapeutic IN without bleeding = stop warfarin + give vit K (reduces IN with 1-2
days)
22.Which of the following causes upper Gl bleeding in a major traumatic brain injury? 2012
a. AV malformation
b. Curling Ulcer
c. Cushing’s Ulcer
d. Dieulafoy Ulcer
c. Cushing’s Ulcer
Which mutation is in patients with no family history of colon polyps or cancer? 2012
a. APC
b. Kras
c. P53
d. MLH1
a. APC
A young male with recurrent swelling in the submandibular area (painful?) during an oral examination of his current presentation found a tender mass in the floor of the mouth. What is the best next step to investigate? 2012
a. CT neck
b. Neck ultrasound
c. Ultrasound guided needle aspiration
d. X-ray of the mandible
d. X-ray of the mandible
The likely diagnosis is sialolithiasis which can be easily visualized on an x-ray of the mandible. This might be correct since they’re asking about the ‘next’ test.
What is an absolute indication for internal fixation of the shaft of the humerus? 2012
a. Segmental injury
b. Fracture angulated more than 20°
c. Brachial artery injury
d. Radial nerve injury
e. Comminuted
a. Segmental injury
(Indications for ORIF: failure to reduce fracture, bilateral humeral fractures, segmental fracture, open fracture + secondary radial nerve injury, extension to the joint, delayed union malunion non-union)
(If Radial nerve injury is primary, it’s treated conservatively)
A young obese boy with a history of hypothyroidism reports a history of severe hip pain that is causing him to limp as he is unable to bear weight. On flexion of the hip there’s a forced external rotation. What is the likely diagnosis? 2016, 2012, 2011, 2010
a. Juvenile osteoarthritis
b. Development Dysplasia of the Hip (DDH)
c. Limb Length Discrepancy (LLD)
d. Legg-Calve-Perthes Disease (LCPD)
e. Slipped Capital Femoral Epiphysis Disease (SCFE)
e. Slipped Capital Femoral Epiphysis Disease (SCFE)
A patient with a horseshoe kidney. What prevents the kidney from rising further upwards during the embryology process? 2012
a. Superior mesenteric artery
b. Inferior mesenteric artery
b. Inferior mesenteric artery
What is the most common type of bladder cancer? 2012
a. Secondary metastasis
b. Sarcomatous carcinoma
a. Secondary metastasis
Colon Cancer Metastasis to the liver occurs by which route of spread? 2012
a. Direct Extension
b. Portal Circulation
c. Lymphogenous
d. Hematogenous
b. Portal Circulation
A male patient underwent a surgery for rectal adenocarcinoma. He now presents with abdominal distention and pain (maybe fever too). White cell count was high, CT showed a 12x10 mass in the right iliac fossa around the drain. It is serosanguinous. How to elicit the diagnosis? 2012
a. Drain creatinine
b. Drain bilirubin
c. Repeat CT
d. Colonoscopy
a. Drain creatinine
(diagnostic approach to rule out ureteral injury with urine leak)
A 13-year old patient fell off his bike and presented with arm pain. X-ray showed an ill-defined region with a poor transitional zone. What’s the next step?
Neoadjuvant Therapy and Tumor Resection
18.A young patient with Crohn’s disease developed severe pain which was diagnosed to be caused by ileus stenosis. What’s the next step of management? 2012
a. Intensive course of corticosteroids
b. Humira
c. Surgery
d. Continue the same treatment and follow up
c. Surgery
A 24-year-old female diagnosed with breast cancer; her genetic testing revealed BRCA1 mutation. What other type of cancer is it commonly associated with? 2017, 2012
a. Ovarian
b. Parathyroid
c. Prostate
a. Ovarian
A boy came with symptoms of testicular torsion of 4 hours duration. You want to take him for surgical exploration but his father is worried and thinks you might have the wrong diagnosis. What do you do? 2012
a. Urgent Ultrasound
b. Urgent Nuclear scan
c. Convince the father that this is an urgent procedure
a. Urgent Ultrasound
*Nuclear scan will take a long time; we consulted urologists about this question (bc of the father issue)
10.If the same patient needs an emergency surgery, what can we give to stop the effects of aspirin? 2012
a. Cryoprecipitate
b. Factor 7
c. Fresh Frozen Plasma
d. Platelets
e. Prothrombin concentrate
d. Platelets
A 30 year old female came with a 2 month history of tremor that prevented her from doing her job properly, she is a typist. she had weight loss around 7 kg. neck examination of thyroid was normal. what could be the cause? 2012
a. Grave’s
b. Toxic adenoma
c. Toxic multinodular goiter
b. Toxic adenoma
A 40-year old patient came to the clinic with dysuria and frequency. He denied having hematuria, or throat infection. Previous Medical history showed Well-Controlled Glucose levels and that he had straddle injury 10 years ago while riding a horse. What is the diagnosis? 2012
a. Urethral injury
b. Diabetic Neuropathy
a. Urethral injury
Note: Neuropathy is a microvascular complication that can be prevented with glucose controlled
A 2-month-old male child with suspected DDH. He is the first born, and the mother had a normal delivery. What is the most appropriate test? 2012
a. U/S
b. Ortolani and Barlow test
a. U/S
A 34-year-old male came to the clinic following hernia repair 5 weeks ago. He complains of ipsilateral small testes. What can explain his symptoms?
Injury to testicular artery
*It should be injury to the pampiniform plexus of veins not injury to the testicular artery.
Ischemic orchitis happens more commonly due to thrombosis of the venous plexus causing eventual blood flow reduction, arterial injury is a much less common cause. It’s a tricky question
Fistula involving the internal sphincter muscle. How do you manage? 2012
a. Seton placement
b. Lateral sphincter dissection
a. Seton placement
14.Where does the volvulus mostly occur? 2012
a. Cecum
b. Ileocecal valve
c. Sigmoid
d. Stomach
c. Sigmoid
Patient present with foot drop. Which nerve is affected?
Common Peroneal Nerve
A 35-year-old man has a history of chronic lower back pain that sometimes shoots along his left lower limb. He is a labor worker and once after lifting a few heavy boxes, he suddenly developed a markedly severe back pain associated with lower limb weakness. Spine MRI showed disc prolapse at L5-S1 level. What is expected to be found on neurological examination of the lower limb? 2012, 2011
a. Loss of plantar flexion and an absent ankle reflex
b. Loss of great toe extension and an absent ankle reflex
c. Loss of knee extension and absent jerk reflex
a. Loss of plantar flexion and an absent ankle reflex
Note: A prolapsed disc affects the nerve root below it. In this vignette, S1 spinal root is compressed leading to loss of the neurological functions it mediates, i.e. plantar flexion and ankle reflex.
