ABS 2014 Flashcards
1
Q
CRF on plavix - after removal of dilator for R IJ portacath during preporation for placement of tunnled cath pt become hypotensive then asystolic - managment includes
A
left lat decube
right throacotomy
perc aspiration left vent
2
Q
6 cm MALTOMA tx
A
“abx”
chemo
chemo xrt
resection
3
Q
adeno esoph confined to muscularis mucosa EUS neg managment should include distal esoph
A
MRI for to eval medial stinal nodes
5 cm margins
4
Q
32 cm shorten esoph wiht 4 cm distal stricture that has required mult dilations and failed ppis
A
collis nissen
esophogectomy colon conduit
5
Q
most likely for post splenectomy sepsis
A
blood cancer lymphoma / leukemia
sickle cell
incidental or en block for Colon CA
6
Q
contrainidcaiton for hepatic met resection in colon cancer
A
also pulm met
periaortic lymph nodes pos
bilateral hepatic lobes
7
Q
elderly pt most likely to contribute to ileus
A
PPI
haldol
8
Q
mostly likely to cause enceph
A
flumazinil
benzos
9
Q
sig diffuse bleeding in elderly pt with sigmoidectomy for tic dz on asa what is tx
A
platelets FFP (becasue diffuse realy is factor v lieden def prob)
10
Q
tx for second time spontanous ptx
A
thoroscopic blebectomy
chest tube and pleurodesis
11
Q
sudden onset lower abdominal pain and right shoulder pain
A
ruptured ovarian cyst
ovarian torsion
non-ruptured ectopic
12
Q
next test in 24 wk preg with RLQ pain and N/v
A
us
13
Q
P3 G3; abdoinal pain 28 wk preg MVC neg ct scan O neg blood type and possitve “H-B” test
A
Ig
plasmophresis
emergency c section
14
Q
temp vasc access in while mature right / left
A
right IJ / contralat
15
Q
brachio basilic ptfe graft with good thrill at end of case throbosis that night
A
thrombectomy
look for new site
16
Q
AV graft goes down radio cephalic - next site
A
brachiocephalic
brachobasilic
ptfe graft
start using other arm
17
Q
most appropriate test for 18 yo tpn for chrons that drops pressure to 70/40 p 130 with pulsus paradoxes
A
eccho
ekg
18
Q
sudden hypotension / incr CVP
A
PE
tamponade
19
Q
28 yo chronic renal failure falied medical managment with incr calcium - what is operative treatment
A
“total parathyroidectomy with autioimplantation”
3-gland parathyroidectomy
20
Q
6 cm right pheo with mibig scan postivive BILAERAL in 18 fem with MEN IIa
A
left adrenalectomy
bilateral cortical sparing adrenalectom
21
Q
hepatic metastectomy with right suclavian and aline; just before liver parynchimal incision sudden hypotention and
A
air embo
tenssion ptx
22
Q
most common cuase of long narrowing at desending colon partial obstruction with decompression distal - 3 mo s/p sigmoid ecotmy and liver metastectomy
A
anstomatic recurrence
diffuse peritoneal spread
23
Q
important work up for mass at angle of mandible on xray consistnet with osteoma and mass also seen on scull in 18 f
A
colonoscopy
bx the jaw
nasopharyngeal scope
24
Q
most likely retroperitoneal mass in FAP
A
lipocarcoma
fibrosarcoma
desmoid
25
most common etioloty of 3 cm throid nodue with follicuar cells in 30 yr femal
follicular adenoma
follicular cell carcinoma
papillary carcinoma
26
most important reason to do completion throiectomy in 60 m with follicular variant papillary ca
for effective I131
| "cross lobar metastasis"
27
most comon etiology of 3 cm neck mass dx as squam
oropharyng
breast
lung
28
18 yo with ocult gi bleed work up possitve tech 99 what is intial tx
ppi
| segmental ileal resection
29
crohs fhx pt take to or for negative appy
appy and cecum normal
inflammed distal ileum and dense inflammation of the mesentary
what is next step
bx ileum
| appendectomy
30
32 yo euthroid female
| 4 weeks of swollen and tender thryoid with pain radiating to the left ear
thyroid lymphoma
subacute thryoiditis
hashiomotos
31
42 yo with TBI with increasing abd distention delveoping over several days now
x ray shows a measure right cecum of 10.4 cm prominate folded loops in the right- x ray is cut off but show part of massive colon in sigmoid
neostigmine
| cecetomy
32
75 presents with mental confusion and lung mass sodium is 123
fluid restrict
| 3%
33
mid esophagus stricture dilation in a male now with servere chest pain xray and ekg negative
gastrigraphen swallow
34
gsw to the mid thigh in obese with ABI of 0.8 no hard signs
explore wound
CT
Angio
35
75 yo 400 lb fem with DM with left leg pain and pallor and bilateral foot pain and rubor - most useful test
angio
| abd us
36
3 cm pancreastic mass in the tail - what is the safest lesion to whatch
serous cystadenoma
branch mucinous intraductal papilloma
main duct intraductal papilloma
37
mucin positive CEA positive mass in the tail is most likely
| amylase pos?
adenocarcinoma
mucinous carcinoma
mucinus intraductal papilloma
38
injury RLN during thryoidectomy in 75 yo no with hoars breathy voice and aspiration of liquids
```
medialization of cords via thyroplasty or injection
traceostomy with cuff inflation
NGT with speach therapy
gastrec feeding tube
reoperaiton and repair of nerve
```
39
30 yo f mvc with renal injury moderate abdominal tenderness and stable vitals - gross hematuria - CT shows perinephric hematoma and urine extrav (no blush mentioned)
renal exploration and repair
| observation
40
new born with juanice total of 8 (indirect 3?) with cystic dilitaiton of CBD
hepatico J
| ERCP
41
new born term baby at the umbuilicus with partially detached umbulicus wiith bowel exposed with out peritoneal covering
gastroschesis
omphalocele
prunebelly
42
most likely complicaiton for crycothyroidotomy
tracheal stenosis
| oropharyngeal stenosis
43
massive facial trauma with stridor and bleeding
tracheostomy (cric not an option)
| bronch and intubation
44
most common complication from component seperation
UTI
wound infection
pneumonia
45
75 yo about to under go elective sigmoid with
| ph 7.40/pco2 40/ pao2 70/. what next
these are normal for patients age
pre operative intermitent positive pressure ventitaiton
46
best test to work up severe COPD pre-op who wishes to under go elective hernia
spirometry with and with out brochodialators
blood gas
pulse ox
47
diffuse upper mucosal bleeding from the body what is best
heater prob
| partial gastrectomy
48
best treatment for 1.5 cm lieomyoma at 32 cm in 42 yo man with dysphagia
extramucosal excision
wedge
enodluminal
49
best shunt of polycythemia vera with acites when TIPS does not work
side to side portocaval
distal splenorenal
proximal splenorenal
atrial meso
50
best shunt in patient on transplant list with esophageal varicies and moderate gastric varicies that are not actively bleeding
distal splenorenal
| proximal splenorenal
51
treatment of anal canal 3 cm sqaumous cell
chemoradation
wedge
APR
52
best (definitive?) treatment for perforated posterior bleeding duodenal ulcer 32 yo female sclerosis is unsucessfull during EGD
epi and clips
heater probe and clips
band
heater probe and band
53
"previously healthy" 32 yo female found to anterior duodenal perf ulcer 6 mm with minimal solage - found on laparoscopic exploration
repair and omental patch
highly selective vagtomy and repair
pull omentum through with a scope and endoluminally tack in place
54
greatest risk of radiation injury to bowel
size of field
dose
pelvic radiation
thin patient
55
most cost effective initial treatment for anal fissure
nitro paste
botox
calcium channel block topical
56
chronic GS during elective lap chole can not definitve see cystic duct entering GB
(convert to open / cholangiogram not and option)
partial cholecystectomy overshowing the infundibulum
57
cirrhotic during elective lap chole for chronic GS a clear plane can not be established between liver bed and posterior wall
partial cholecystectomy and thermoablate the retained posterior wall
58
post lap chole path comes back GB cancer limited to the mucosa on the peritonealized survase
observe
seg 4b / 5 and node resection
chemo
chemo radiation
59
trauma shattered spleen take taken out pt turn damage control - what to do with 30% of right lobe liver lack
pack
60
4 injuries less than 50% in cercumference over 80 cm of jejunum in 18 yo that requires damage control (16 units blood pressure in the 70s)
staple off each injury without anastamoses
en block resection of jejunum - without anast
repaire injuries in single layer
repair injuries in double layer
61
poly trauma damage control belly left open then 2 wks after small bowel anast and putting in vicryl mesh to close belly - enteric content is seen midline
suction management of stool and tpn
(output rate of fistula not given)
close fistula
62
contraindication for closing the fasica
incr in peak airway pressures by 12
constant abdominal compartment pressure of 10
(cvp of 10)
63
ureter trapped in L1-3 harware - discovered when patient symptomatic a week later
transureteroureterostomy
perc nephrostomy
primary repair
64
5mm stone at ureterocystic junction with patient with 54 hyrdronephrosis and constant pain
shockwave lythotripsy
| percnephrostomy
65
30 yo female MVC Abd CT right peritoneal hematoma - lower urinary tract ok with hematuria; stable; mild abd pain
retrograde urethrogram and cysOSCOPY (not cystogram)
renal angio
explore kidney and repair
66
young female mvc pt in OR for splenectomy - stable - non expanding right perinephric hematoma (bad grade of injury) - intra op urogram right does not light up - left contralteral does
right nephrectomy
observe
renal artery repair of right kidney
67
48 yo f at the time of simple mastectomy with path of DCIS HIGH grade comedo necrosis - and micro (microfocus of invasion) most appropriate next step
XRT and SLB
| XRT and tamoxafin
68
shattered right kidney no blush, with gross hematuria stable patient
observe
| nephrectomy
69
65 ref for new micro calcs seen by radiology s/p stereotactic bx with path of NON-proliferative dysplasia and sclerosing adenitis - marker left behind
excision
observe and repeat mammo in 1 yr
tamoxofen
70
30 obese female with halo surrounding lesion - heterogenous - calcified rim
fat necrosis
adenoma
...
71
45 60% TBSA inhilation injury torso and upper extremities intubated and carboxyhemoglobin level of 20
tx with 100% O2
| hyperbarric O2
72
24 hr of ressuss 16 yo femal 40% TBSA burn vitals normal urine output ok - base def and lactic acid still up
continue fluids
test for..
(pe?, ).. rhabdo??
73
60 yo male massonry worker 6mm wide by 0.4 mm deep melanoma excised from cheek with closest margin 1.2 cm
superfical parotidectomy
observe
SLNB
neck dissection
74
nasty oozing purple papules leg of patient post chemo for lymphoma
kaposies
75
incidentally "simple" focus of small bowel low grade lymphoma (without spread)
observe
| chemo
76
400 lb female with 4 cm medial leg venous stasis ulcer - best INITIAL treatment
INelastic compression
(is that a una boot)
superficial throbectomy
saphenous vein ligation
77
findings most consistent with hepatorenal syndrome rather than tubular necrosis
renal sodium less than 10
FENA less than 1
BUN / CR 20
fractional excretion of sodium
78
most common complicaiton from lazer ablation for vicose veins
thermal
| recanulation
79
16 hot nodule 3 cm hyperthyroid 1 mo depsite antithyroid - tachy improves with bisphos - best treatment
continue bisphos
| hemilobectomy
80
18 yo male with ASX testicle lesion that transilluminates. It bothers him and he wants taken care of.
inguinal excision
obs 3 mo re-eval / (us?)
aspirate
inject sclerosant
81
45 yo female with chronic esophageal reflux and dysphgia 1 year of PPI 4 cm stricture of mid esophagus that has required multiple dilations for relief of dysphagia - path shoes intestinal metaplasia (no mention of dysplasia)
nissen
duble dose PPI
collis
esophagectomy
82
durring nissen the GE junction is found 1 cm below the hiatus after disseciton of the funds - what is next step
mobilation of distal thoracic esophagus
take down short gastrics
collis
83
18 yo sallow dive complete parlysis no other observed injury. mentating BP 70/40 (pulse not given) after crystaloid.
phenylephrin
blood
84
inhibits wound contracture the most
deep dermis graft
topical steroids
split thickness
85
60 yo DM 3 wks s/p nec soft tissue debride of thigh 8x 15 cm good granulation tissue no signs of infection best way to get fastive definitive healing
STSG
tissue plasma activator topical
colligenase debride
86
lidocaine minor procedure 30 yo f syncopy brady 60/40 p 43 most effective single treatment
atropine
| entubate
87
translate immaging findings to birads
then rec f/u
88
massive trauma transfusion with 18 units blood 4 of FFP now normal vitals in ICU with platelet count of 18 - most likely cause
hemodilution
DIC
89
most important agent to stop for before patient on chemo undergoes elective sigmoidectomy and transition to serolomus
tacrolumis
cyclophosphomide
mmf
90
NEC kid with necrotic bowel
resect with out anastamosis
resect and bring out throug abdomin
resect with anastamosis
91
most likely nerve to injure while taking the IJ for a MRND
hypoglossal
vagus
recurrent laryngeal
92
most likely site of ectopic inferiro parthyroid
thymus
93
most likely site of missed parathyroid adenoma (inf or sup not specified)
in normal anatomic location
94
18 yo with persistant hyper ca with normal renal fxn most common cause
parathyroid adenoma
parathyroid hyperplasia
secondary hyperparthyoridism
95
adult with colon intussusception
resection
96
biggest risk factor for mediastinitis (medialstinal infection?)
urosepsis
redo CABG
harvest LIMA
97
no stone seen xray imaging for history of multiple relapse UTI for renal colic (renal calculi?) despite correct abx - with hydronephrosis
perc nephrostomy
| lithotripsy
98
52 yo f vomiting and diarrea - hypo na, hyop ch, bcarb down, marked alcalosis
0.9
hydrochoic acid
lactated ringers
99
4 days post pucture to P1 now with pain on extention
pyogenic flexor tenosynovitis
100
late second term / early third preg - breast cancer
chemo
xrt
101
preg female intervention performed for PE recs now
IVC fliter
low molecular weight heparin
comadin
102
female body builder vein thrombus
thrombolysis
thrombectomy
first rib
103
best way determin PERIPHERAL oxygen utilization in patient in shock
mixed venous sat
transcutaneous dopler
pulse ox
mucus oxygen tension?
104
best determinate of addequate ressus in shock trauma
correcting base def
| uop
105
80 kg COPD ARDs patient already on PEEP of 18-20 best vent setting
pressure relase vent p high 35
pressure support pressure 30
volume control vol 460cc
106
18 yo female with 2 paternal aunts with cancer after the age of 50. maternal grandmother with breast cancer at age 70 reck screening for BRCA
no
107
most important to rule out in new born with bili emesis and few scatered air in bowel distal
malro
108
low grade phyloids tumor comes back on path after enucleation of the 4 cm mass
observation
chemo
xrt
tamoxafin
re excision with 3 cm margin
109
rectus hematoma on anticoagulation - not expanding
observe
excise
110
peritoneal cath fungal infection
remove cath and antifungal
antifungal and keep cath
111
post spleen preservation distal panc for mass (cancer?) pt is seen to have a 4 cm (6cm) inferior pole irregular hypodensity - concering for abscess
drainage
splenorraphy
splenectomy
112
what is released in component separation
external oblique aponearosis
transversus aponerosis
lateral rectus
113
trauma CBD injury lateral D2 injury through and through 1-2 cm
primary repair of D ; hepatico J
primary repair of d, drains and pyloric exclusion
primary repair of d and primary repair of CBD
whipple
114
8 cm pancreatic cyst communicating with main duct in chronic panc
tranampulary stent
endoscopic cyst gastro
per drain
115
new born baby with dilated CBD and jandice demonstrtatee on US - what is management
ERCP
hepatico J
116
```
45 with chronic gs admitted to hopital with panc
sick
vent
ICU
CT 80% necrosis - no air
```
MRI
| FNA of panc
117
ilius at 8 days after whipple in 65 yo with DM still requires NGT drainage and TPN
PPI
erythromycin
revise enteroanast
118
patient has dysphasia after scope of esophagus most likely incision that will be needed
left cervicle
right throcotomy
119
best position for patient with suspected air embo
left lat decube / trend
right lat decube / trend
left lat decube rev trend
right lat decube rev trend
120
75 yo female sig GI bleed procto negative requires 6 unit of blood with hypotension
upper scope
ex lap and colen resection
121
55 yo male
| on going persistant hematemessis patient with normal vital in no distress
angio
protective bronchio blocing intubation
122
most likely fat solb vitamin def barriatric procedure
Panc bilio bypass
gastric band
gastric sleeve
123
23 you f DM failed prokinetics for gastroperesis
neck vagal intervention
(is this gastric pacemaker)
gastro J
124
75 f with constant moaning - non focal abd tenderness - plain film demonstrates pneumotsis dx
angio
CT scan
125
hiccups and bloat with something else fishy in patient hx of bariatric bypass - manage
revise J-J
CT scan
126
78 yo male with high rectal cancer (maybe even sigmoid) cancer and intermitent inconinance tx
APR
LAR
trans anal
127
preg female with intermit bloody bm moderate external hemorrhoids and internal hemorroids tx
stool soft and water
band
128
paget of skin dx best indication for breast conservation therapy
2 cm sub nipple mass
| MRI negative
129
painful breast eyrthema 2 wks post partum breast feeding s/p 10 day of ancef - no improvement. what is management
change abx to MRSA coverage
skin bx
130
breast way to eval nodes in breast cancer
SLNB
MRI
ax dissection
131
best workup for asx adrenal mass in 40 yo f with neg serum pheo test - no htn, no lyte abormalities, no endocrine disterb, normal vitals - most important test
none needed
24 h urine, metaneph, cortisol, ...
...
132
tx of sub ungual melanoma
amputation to next phalanx
MLE of nail bed
133
chronic decube now with pearly raised lesion
squma
134
what throws off pulse ox
lymphsurian (methalene blue not an option)
anemia below 15
fetal hemogolobin
135
most common injury with L1 fx hyperflexion injury
"small bowel"
spleen
liver
pancreas not listed
136
pt returns with fever urin incont parylysis lower extrem 10 day after epidural for flail
epidural absess
137
epidural with narcotic and lidiocaion after simoid resection that night pressure 90/60 p 100 uop 0.4 cc/kg/h
500 ml fluid
turn down narcotic
turn down lido
138
palliative care pt with obstrucitn small bowel mass with servere pain states 6/10 associated with eating - best tx
fenatnyl patch
spinal stim
oral morphine
139
how to you place probe when looking at spleen site for FAST
```
transvere LUQ
vert LUQ
btw 8-9 ribs
btw 11-12 ribs
parralle to 12 rib
```
140
2 wks with empyemia tx still there with ct in place
thorscopic
| add ct
141
best indication the BKA will heal
palp pedal puse
transcutanous oxygen tention 10
142
coverage for dorsal hand exposed tendons
radial forearm graft
143
18 yo f with varicose venin port wine stain on thigh and leg 2 inches longer than the other side - what is biggest with doing venous stripping
risk of bleeding
Consumptive of platelets
PE
144
most common presentaiton of TOS
ulnar
145
fingers numb hand cool and pulses only by dopler 2 weeks after brachial av fistula
ARTERIAL steal
median nerve injury
146
best confirmation of brain death after clinical critera met
nuc med no flow
corneal reflex gone
single EEG
147
best chance of have doner family sign up based on who asks
ICU doc
tranplant coordinator
148
best confirmation that that is chylothrozx
trgl 40
| milky
149
what is seen on thryoglossal duct cyst exam that is different from base of thryoid
move with swallow
| protrossion of tongue
150
thryogolossal duct cyst path
"THROUGH" hyoid bone
| foramen cecum
151
Prosthetic Mesh Infections - Management
Prosthetic Mesh Infections - Management
152
Esophageal Perforation - Spontaneous
Esophageal Perforation - Spontaneous
153
kid with short gut 12 hold on tpn - excema behind the knees what is def
zinc
copper
selenium
chromium
154
glucose absorption gut vs IV
but incr via hepatic independent path
155
up in trauama glucocon vs insulin
both up but gluocone more
