2015 exam Q&A

Question 1

what is the most obvious clinical sign of impending compartment syndrome

Answer 1

pain out of proportion to what is expected and severe pain with stretch of the affected compartment

Question 2

75 yr male kidney transplant POD 1 unable to extend knee + numbness/pain to anterior thigh. What was injured?

Answer 2

femoral nerve

Question 3

what does clark 4 level melanoma classification indicate re invasion level

Answer 3

reticular dermis is effected

Question 4

what is MOA of diabetic foot ulcers?

Answer 4

neuropathy

Question 5

what antobiotic do you use to treat cat bite?

Answer 5

amox-clav

Question 6

most common cause of carpal tunnel

Answer 6

tenosynovitis (repeptitive movement gives your tendon strain= tenosynovisit)

Question 7

what is the most sensitive method to detect Cdiff?

Answer 7

stool test

Question 8

in what trimester does the fetus receive the most exposure to raditation with xrays?

Answer 8

first is the most vulerable time, but you get the same exposure level no matter when you xray them

Question 9

patient with perioral tingling after receiving lidocaine. What are the other sns of lido toxicity?

Answer 9

seizure, perioral tingling

Question 10

a 21 yr old girl has injury causing possible exposure to tetanus. She had all childhood vaccinations and a bootster at age 18. What do you do?

Answer 10

no treatment, she is within the ten year mark

Question 11

woman in ED, injuries consistent with IPV. 2 children are at home, what do you do?

Answer 11

you cannot report anything as the children are not harmed/you have no evidence. Warn her you are worried for the children, but she is an adult and has to report it.

Question 12

what are the difference between LMWH and heparin?

Answer 12

we first started with UFH, but we got smarter and made LMWH ( dalt and enoxaparin). these are better than heparin b/c:
1) 99% SC bioavailability more 2) = more predictable anticoagulant
response,
3) less inter-patient variability
4) and longer duration
of action than heparin

Question 13

how do you reverse heparin?

Answer 13

protamine sulfate

Question 14

steroid hormones modify cell physiology by binding to regulatory units on DNA. For this to occur the molecule must first be bound by an appropriate receptor. These receptors are located where?

Answer 14

???cytoplasm?

Question 15

what anesthetic has longest half life and least cardiotoxcitiy?

Answer 15

ropivicaine

other options are procaine, lidocaine, bupivicaine

Question 16

what is the most sensitive marker of fascial infection

Answer 16

grey dish water appearance - you have nec fasc!!!

Question 17

how does coag work vs cautery

Answer 17

…..

Question 18

What causes pulomary vasoconstriction?

Answer 18

low alveolar 02

Question 19

what medication will decrease the therapeutic effect of warfarin? aka makes it work more

Answer 19

oral contraceptives

Question 20

peridtric patient comes to the hospital in shock. peripheral IV is not available, what is your next option?

Answer 20

proximal tibia intraosseus line

Question 21

what describes the correct anatomical position of a saphenous vein cut down?

Answer 21

2cm superior and anterior to the medial malleolus

Question 22

Th bacille calmette -Guerin vaccine is an exmaple of which type of immunity?

Answer 22

active non specific

Question 23

which vasopressor is also an inotrope?

Answer 23

epinephrine

Question 24

you are a plastic surgery trying to do an elective rhinoplasty on a patient who recently had an MI and drug eluting stends put it and is now on plavix. When should you plan to do this surgery?

Answer 24

?delay surgery for ten months then operate…???

Question 25

what is the first sign of malignant hyperthermia?

Answer 25

increased end tidal CO2 ( ET c02) - this is because the MH makes your muscle cells contract alot, which creates c02

Question 26

why do we use a c02 colorimeter detector?

Answer 26

to confirm ETT placement in the correct location - aka the lungs

Question 27

what is the most common cause of esophageal perforation?

Answer 27

esophageal instrumentation

Question 28

if a patient has AAA, what lifestyle change should you recommend to them as being the best bang for their buck?

Answer 28

smoking cessation-The magnitude of risk with smoking eclipses all other modifiable risk factors for prevalent AAA

Question 29

what is the most accurate way to diagnose a post op MI

Answer 29

ECG

Question 30

what is the unmeasured ion that contributes to a non-anion gap metabolic acidosis

Answer 30

albumin, but also phosphate incase you are asked. recall that an anion gap is calculated by POSTIVIES - NEGATIVES =
Na - (Cl+ HCO3)
As you can see albumin isnt in here or phosphate

Question 31

Hyponatremia causes which of the following?

1. Increased urine output(?)
2. loss of DTR
3. tachycardia
4. hypotension

Answer 31

choose loss of DTR, as a sign of decreased cell excitability.
This occurs because hypoNa means low Na in the extracellular fluid. Fluid then shifts into cells, causing decreasd cell function, and decreased excitability.

Question 32

***What is the most important cause of post operative ventricular arrythmias?

Answer 32

hypokalemia

replace that shit with KDUR 40 yo!

Question 33

patient in MVC, found to have tibial fracture and a closed head injury. The patient remains tachycardic and hypotensive despite resuscitation with 2L of crystalloid. What is the most likely cause?

1. intra-cranial hemorrhage
2. hemorrhage from fracture site
3. missed intra-abdominal injury

Answer 33

3) missed abdo injury, their vitals are concerning for hemorrhage

its not 1 because head injury means cushings which is high BP, bradycardic

its not 2 because its a closed fracture and the stem doesnt say there is local swelling or anything

Question 34

during a lap chole, pt becomes bradycardic to 40. What should the anesthetist give re medicaioin?

Answer 34

atropine - blocks the parasympathetic response

Question 35

pt with new unstable atrial fibrillation, what should you do?

Answer 35

cardioversion

Question 36

Pt is post op day 2 TURP, with Na 122 and low BP. What do you do?

Answer 36

give a bolus of NS though some say above Na 120 just fluid restrict + lasix because the issue is dilutional your body absorbs the hypotonic glycine fluid.

only give hypertonic saline if there are neurological manifestations of HypoNa.

Question 37

A patient presented to the ER and is found to have dead bowel. His INR is 2.5 and he is taking warfarin at home. What should you do?

Answer 37

Give PCC to reverse the INR (intrinsic cascade) and then take to the OR

Question 38

If a patient was anticoagulated with Rivaroxaban and needs to be reversed for surgery what would you administer?

Answer 38

theres no reversal agent

recall dabigatran, apixaban and rivaroxaban are factor Xa direct inhibitors has

Question 39

What happens to old stored units of packed RBC’s over time?

1. Decreased O2 carrying capacity
2. increased 2-3 DPG
3. metabolic alkalosis
4. decrease K+

Answer 39

3) metabolic alkalosis

Question 40

How can you prevent the coagulopathy associated with a massive transfusion

Answer 40

2. Give a 1:1 or 1:1.5 PRBC to FFP ratio

Question 41

Clinical scenario describes thyroid storm in a patient. What is the initial treatment?

1. Steroids
2. Lugol’s solution
3. Propythiouracil
4. Ablation with radioactive iodine

Answer 41

this question has to be recalled wrong because its a multifactorial treatment:

1) BBlocker- to protect the heart
2) PTU or methimazole - to block new hormone synthesis
3) steroids - to block conversion of T3 to T4
4) iodine solution to block release of T4