31 (3) JUL - 03 AUG 2022 (studied 27 DEC)

Question 1

pathogenesis of ARDS

Answer 1

• poor oxygenation and lung compliance
• bilateral pulmonary infiltrates
• capillary endothelial injury
• widespread alveolar damage

Question 2

Berlin definition of ARDS

Answer 2

• acute onset (<7 days)
• bilateral pulmonary infiltrates
• P:F ratio < 300 with minimum PEEP of 5
• not fully explained by cardiac failure or volume overload

Question 3

a 40-year-old woman who underwent a highly selective vagotomy 1 year ago for intractable ulcer disease returns with recurrent abdominal pain. What is the most likely cause of her symptoms?

Answer 3

recurrent ulcer (incomplete vagotomy - likely missed criminal nerve of Grassi)

Question 4

pathophysiology of blind loop syndrome

Answer 4

• bacterial overgrowth
• bacteria compete for vitamin B12 - produce weakness and paresthesia
• bacteria deconjugate bile - steatorrhea

Question 5

treatment for hepatic artery aneurysms is reserved for aneurysms > ___ cm in diameter

Answer 5

> 2 cm

Question 6

ductal carcinoma in situ (DCIS) is a premalignant lesion for which surgical excision is recommended due to a ___% chance of invasive ductal carcinoma being present in the specimen

Answer 6

20%

Question 7

the standard of care for DCIS is:

Answer 7

lumpectomy and radiation (and hormonal therapy)

Question 8

sentinel lymph node is not recommended for DCIS unless the following apply:

Answer 8

• lesion greater than 4 cm
• palpable mass
• mastectomy
• microinvasion

Question 9

what type of ulcer?

appear 24 to 72 hours after the initial insult and are characterized by tissue reaction, organization around a clot, and inflammatory exudate

Answer 9

late stress ulcer

Question 10

what type of ulcer?

multiple shallow lesions in the proximal stomach

Answer 10

early stress ulcer

Question 11

what type of ulcer?

single and deep

Answer 11

cushing

Question 12

what medications decrease vascularity of the thyroid gland, and make it firmer and easier to resect?

Answer 12

• lugol solution
• propanolol

Question 13

for penetrating renal injuries, regardless of the mechanism what is the standard of care?

Answer 13

observation

Question 14

what is the standard adjuvant therapy for gall bladder carcinoma?

Answer 14

gemcitabine and cisplatin

Question 15

boundaries of the femoral triangle

Answer 15

• adductor longus (medial)
• sartorius (lateral)
• inguinal ligament (superior)

Question 16

what is borchardt triad? what does it indicate?

Answer 16

• severe epigastric pain
• inability to vomit
• inability to pass an NG tube

acute gastric volvulus

Question 17

how is Hirschsprung confirmed after rectal biopsy is taken?

Answer 17

• lack of ganglion cells
• hypertrophic nerve trunks
• abnormal cholinesterase staining
• absent calretinin staining

Question 18

what is the most common location of blunt thoracic aortic injury?

Answer 18

distal to the left subclavian artery at the aortic isthmus (aorta has a relatively fixed nature because of the ligamentum arteriosum)

Question 19

most commonly accepted cause of Paget disease?

Answer 19

migration of neoplastic cells from the cancer to the nipple via the ductal system

Question 20

gold standard of surgical treatment for chronic anal fissures

Answer 20

lateral internal sphincterotomy