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A ORAL BOARDS 2016 > ABS 2014 > Flashcards

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

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2
Q

6 cm MALTOMA tx

A

“abx”
chemo
chemo xrt
resection

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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

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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

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5
Q

most likely for post splenectomy sepsis

A

blood cancer lymphoma / leukemia
sickle cell
incidental or en block for Colon CA

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6
Q

contrainidcaiton for hepatic met resection in colon cancer

A

also pulm met
periaortic lymph nodes pos
bilateral hepatic lobes

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7
Q

elderly pt most likely to contribute to ileus

A

PPI

haldol

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8
Q

mostly likely to cause enceph

A

flumazinil

benzos

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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)
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10
Q

tx for second time spontanous ptx

A

thoroscopic blebectomy

chest tube and pleurodesis

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11
Q

sudden onset lower abdominal pain and right shoulder pain

A

ruptured ovarian cyst
ovarian torsion
non-ruptured ectopic

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12
Q

next test in 24 wk preg with RLQ pain and N/v

A

us

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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

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14
Q

temp vasc access in while mature right / left

A

right IJ / contralat

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15
Q

brachio basilic ptfe graft with good thrill at end of case throbosis that night

A

thrombectomy

look for new site

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16
Q

AV graft goes down radio cephalic - next site

A

brachiocephalic
brachobasilic
ptfe graft
start using other arm

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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

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18
Q

sudden hypotension / incr CVP

A

PE

tamponade

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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

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20
Q

6 cm right pheo with mibig scan postivive BILAERAL in 18 fem with MEN IIa

A

left adrenalectomy

bilateral cortical sparing adrenalectom

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21
Q

hepatic metastectomy with right suclavian and aline; just before liver parynchimal incision sudden hypotention and

A

air embo

tenssion ptx

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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

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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

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24
Q

most likely retroperitoneal mass in FAP

A

lipocarcoma
fibrosarcoma
desmoid

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25
Q

most common etioloty of 3 cm throid nodue with follicuar cells in 30 yr femal

A

follicular adenoma
follicular cell carcinoma
papillary carcinoma

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26
Q

most important reason to do completion throiectomy in 60 m with follicular variant papillary ca

A

for effective I131

“cross lobar metastasis”

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27
Q

most comon etiology of 3 cm neck mass dx as squam

A

oropharyng
breast
lung

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28
Q

18 yo with ocult gi bleed work up possitve tech 99 what is intial tx

A

ppi

segmental ileal resection

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29
Q

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

A

bx ileum

appendectomy

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30
Q

32 yo euthroid female

4 weeks of swollen and tender thryoid with pain radiating to the left ear

A

thyroid lymphoma
subacute thryoiditis
hashiomotos

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31
Q

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

A

neostigmine

cecetomy

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32
Q

75 presents with mental confusion and lung mass sodium is 123

A

fluid restrict

3%

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33
Q

mid esophagus stricture dilation in a male now with servere chest pain xray and ekg negative

A

gastrigraphen swallow

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34
Q

gsw to the mid thigh in obese with ABI of 0.8 no hard signs

A

explore wound
CT
Angio

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35
Q

75 yo 400 lb fem with DM with left leg pain and pallor and bilateral foot pain and rubor - most useful test

A

angio

abd us

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36
Q

3 cm pancreastic mass in the tail - what is the safest lesion to whatch

A

serous cystadenoma
branch mucinous intraductal papilloma
main duct intraductal papilloma

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37
Q

mucin positive CEA positive mass in the tail is most likely

amylase pos?

A

adenocarcinoma
mucinous carcinoma
mucinus intraductal papilloma

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38
Q

injury RLN during thryoidectomy in 75 yo no with hoars breathy voice and aspiration of liquids

A 
medialization of cords via thyroplasty or injection
traceostomy with cuff inflation
NGT with speach therapy
gastrec feeding tube
reoperaiton and repair of nerve
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39
Q

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)

A

renal exploration and repair

observation

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40
Q

new born with juanice total of 8 (indirect 3?) with cystic dilitaiton of CBD

A

hepatico J

ERCP

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41
Q

new born term baby at the umbuilicus with partially detached umbulicus wiith bowel exposed with out peritoneal covering

A

gastroschesis
omphalocele
prunebelly

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42
Q

most likely complicaiton for crycothyroidotomy

A

tracheal stenosis

oropharyngeal stenosis

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43
Q

massive facial trauma with stridor and bleeding

A

tracheostomy (cric not an option)

bronch and intubation

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44
Q

most common complication from component seperation

A

UTI
wound infection
pneumonia

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45
Q

75 yo about to under go elective sigmoid with

ph 7.40/pco2 40/ pao2 70/. what next

A

these are normal for patients age

pre operative intermitent positive pressure ventitaiton

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46
Q

best test to work up severe COPD pre-op who wishes to under go elective hernia

A

spirometry with and with out brochodialators

blood gas
pulse ox

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47
Q

diffuse upper mucosal bleeding from the body what is best

A

heater prob

partial gastrectomy

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48
Q

best treatment for 1.5 cm lieomyoma at 32 cm in 42 yo man with dysphagia

A

extramucosal excision
wedge
enodluminal

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49
Q

best shunt of polycythemia vera with acites when TIPS does not work

A

side to side portocaval
distal splenorenal
proximal splenorenal
atrial meso

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50
Q

best shunt in patient on transplant list with esophageal varicies and moderate gastric varicies that are not actively bleeding

A

distal splenorenal

proximal splenorenal

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51
Q

treatment of anal canal 3 cm sqaumous cell

A

chemoradation
wedge
APR

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52
Q

best (definitive?) treatment for perforated posterior bleeding duodenal ulcer 32 yo female sclerosis is unsucessfull during EGD

A

epi and clips
heater probe and clips
band
heater probe and band

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53
Q

“previously healthy” 32 yo female found to anterior duodenal perf ulcer 6 mm with minimal solage - found on laparoscopic exploration

A

repair and omental patch

highly selective vagtomy and repair

pull omentum through with a scope and endoluminally tack in place

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54
Q

greatest risk of radiation injury to bowel

A

size of field
dose
pelvic radiation
thin patient

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55
Q

most cost effective initial treatment for anal fissure

A

nitro paste
botox
calcium channel block topical

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56
Q

chronic GS during elective lap chole can not definitve see cystic duct entering GB

A

(convert to open / cholangiogram not and option)

partial cholecystectomy overshowing the infundibulum

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57
Q

cirrhotic during elective lap chole for chronic GS a clear plane can not be established between liver bed and posterior wall

A

partial cholecystectomy and thermoablate the retained posterior wall

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58
Q

post lap chole path comes back GB cancer limited to the mucosa on the peritonealized survase

A

observe
seg 4b / 5 and node resection
chemo
chemo radiation

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59
Q

trauma shattered spleen take taken out pt turn damage control - what to do with 30% of right lobe liver lack

A

pack

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60
Q

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)

A

staple off each injury without anastamoses

en block resection of jejunum - without anast

repaire injuries in single layer

repair injuries in double layer

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61
Q

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

A

suction management of stool and tpn
(output rate of fistula not given)

close fistula

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62
Q

contraindication for closing the fasica

A

incr in peak airway pressures by 12

constant abdominal compartment pressure of 10

(cvp of 10)

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63
Q

ureter trapped in L1-3 harware - discovered when patient symptomatic a week later

A

transureteroureterostomy
perc nephrostomy
primary repair

64
Q

5mm stone at ureterocystic junction with patient with 54 hyrdronephrosis and constant pain

A

shockwave lythotripsy

percnephrostomy

65
Q

30 yo female MVC Abd CT right peritoneal hematoma - lower urinary tract ok with hematuria; stable; mild abd pain

A

retrograde urethrogram and cysOSCOPY (not cystogram)

renal angio

explore kidney and repair

66
Q

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

A

right nephrectomy
observe
renal artery repair of right kidney

67
Q

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

A

XRT and SLB

XRT and tamoxafin

68
Q

shattered right kidney no blush, with gross hematuria stable patient

A

observe

nephrectomy

69
Q

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

A

excision

observe and repeat mammo in 1 yr

tamoxofen

70
Q

30 obese female with halo surrounding lesion - heterogenous - calcified rim

A

fat necrosis

adenoma

…

71
Q

45 60% TBSA inhilation injury torso and upper extremities intubated and carboxyhemoglobin level of 20

A

tx with 100% O2

hyperbarric O2

72
Q

24 hr of ressuss 16 yo femal 40% TBSA burn vitals normal urine output ok - base def and lactic acid still up

A

continue fluids

test for..
(pe?, ).. rhabdo??

73
Q

60 yo male massonry worker 6mm wide by 0.4 mm deep melanoma excised from cheek with closest margin 1.2 cm

A

superfical parotidectomy
observe
SLNB
neck dissection

74
Q

nasty oozing purple papules leg of patient post chemo for lymphoma

A

kaposies

75
Q

incidentally “simple” focus of small bowel low grade lymphoma (without spread)

A

observe

chemo

76
Q

400 lb female with 4 cm medial leg venous stasis ulcer - best INITIAL treatment

A

INelastic compression
(is that a una boot)
superficial throbectomy
saphenous vein ligation

77
Q

findings most consistent with hepatorenal syndrome rather than tubular necrosis

A

renal sodium less than 10
FENA less than 1
BUN / CR 20
fractional excretion of sodium

78
Q

most common complicaiton from lazer ablation for vicose veins

A

thermal

recanulation

79
Q

16 hot nodule 3 cm hyperthyroid 1 mo depsite antithyroid - tachy improves with bisphos - best treatment

A

continue bisphos

hemilobectomy

80
Q

18 yo male with ASX testicle lesion that transilluminates. It bothers him and he wants taken care of.

A

inguinal excision
obs 3 mo re-eval / (us?)
aspirate
inject sclerosant

81
Q

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)

A

nissen
duble dose PPI
collis
esophagectomy

82
Q

durring nissen the GE junction is found 1 cm below the hiatus after disseciton of the funds - what is next step

A

mobilation of distal thoracic esophagus

take down short gastrics

collis

83
Q

18 yo sallow dive complete parlysis no other observed injury. mentating BP 70/40 (pulse not given) after crystaloid.

A

phenylephrin

blood

84
Q

inhibits wound contracture the most

A

deep dermis graft
topical steroids
split thickness

85
Q

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

A

STSG

tissue plasma activator topical

colligenase debride

86
Q

lidocaine minor procedure 30 yo f syncopy brady 60/40 p 43 most effective single treatment

A

atropine

entubate

87
Q

translate immaging findings to birads

A

then rec f/u

88
Q

massive trauma transfusion with 18 units blood 4 of FFP now normal vitals in ICU with platelet count of 18 - most likely cause

A

hemodilution

DIC

89
Q

most important agent to stop for before patient on chemo undergoes elective sigmoidectomy and transition to serolomus

A

tacrolumis

cyclophosphomide
mmf

90
Q

NEC kid with necrotic bowel

A

resect with out anastamosis
resect and bring out throug abdomin
resect with anastamosis

91
Q

most likely nerve to injure while taking the IJ for a MRND

A

hypoglossal

vagus
recurrent laryngeal

92
Q

most likely site of ectopic inferiro parthyroid

A

thymus

93
Q

most likely site of missed parathyroid adenoma (inf or sup not specified)

A

in normal anatomic location

94
Q

18 yo with persistant hyper ca with normal renal fxn most common cause

A

parathyroid adenoma
parathyroid hyperplasia
secondary hyperparthyoridism

95
Q

adult with colon intussusception

A

resection

96
Q

biggest risk factor for mediastinitis (medialstinal infection?)

A

urosepsis
redo CABG
harvest LIMA

97
Q

no stone seen xray imaging for history of multiple relapse UTI for renal colic (renal calculi?) despite correct abx - with hydronephrosis

A

perc nephrostomy

lithotripsy

98
Q

52 yo f vomiting and diarrea - hypo na, hyop ch, bcarb down, marked alcalosis

A

0.9
hydrochoic acid
lactated ringers

99
Q

4 days post pucture to P1 now with pain on extention

A

pyogenic flexor tenosynovitis

100
Q

late second term / early third preg - breast cancer

A

chemo

xrt

101
Q

preg female intervention performed for PE recs now

A

IVC fliter

low molecular weight heparin
comadin

102
Q

female body builder vein thrombus

A

thrombolysis
thrombectomy
first rib

103
Q

best way determin PERIPHERAL oxygen utilization in patient in shock

A

mixed venous sat
transcutaneous dopler
pulse ox
mucus oxygen tension?

104
Q

best determinate of addequate ressus in shock trauma

A

correcting base def

uop

105
Q

80 kg COPD ARDs patient already on PEEP of 18-20 best vent setting

A

pressure relase vent p high 35
pressure support pressure 30
volume control vol 460cc

106
Q

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

A

no

107
Q

most important to rule out in new born with bili emesis and few scatered air in bowel distal

A

malro

108
Q

low grade phyloids tumor comes back on path after enucleation of the 4 cm mass

A

observation
chemo
xrt
tamoxafin

re excision with 3 cm margin

109
Q

rectus hematoma on anticoagulation - not expanding

A

observe

excise

110
Q

peritoneal cath fungal infection

A

remove cath and antifungal

antifungal and keep cath

111
Q

post spleen preservation distal panc for mass (cancer?) pt is seen to have a 4 cm (6cm) inferior pole irregular hypodensity - concering for abscess

A

drainage
splenorraphy
splenectomy

112
Q

what is released in component separation

A

external oblique aponearosis

transversus aponerosis

lateral rectus

113
Q

trauma CBD injury lateral D2 injury through and through 1-2 cm

A

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
Q

8 cm pancreatic cyst communicating with main duct in chronic panc

A

tranampulary stent

endoscopic cyst gastro

per drain

115
Q

new born baby with dilated CBD and jandice demonstrtatee on US - what is management

A

ERCP

hepatico J

116
Q 
45 with chronic gs admitted to hopital with panc
sick
vent  
ICU
CT 80% necrosis - no air
A

MRI

FNA of panc

117
Q

ilius at 8 days after whipple in 65 yo with DM still requires NGT drainage and TPN

A

PPI
erythromycin
revise enteroanast

118
Q

patient has dysphasia after scope of esophagus most likely incision that will be needed

A

left cervicle

right throcotomy

119
Q

best position for patient with suspected air embo

A

left lat decube / trend
right lat decube / trend
left lat decube rev trend
right lat decube rev trend

120
Q

75 yo female sig GI bleed procto negative requires 6 unit of blood with hypotension

A

upper scope

ex lap and colen resection

121
Q

55 yo male

on going persistant hematemessis patient with normal vital in no distress

A

angio

protective bronchio blocing intubation

122
Q

most likely fat solb vitamin def barriatric procedure

A

Panc bilio bypass

gastric band
gastric sleeve

123
Q

23 you f DM failed prokinetics for gastroperesis

A

neck vagal intervention
(is this gastric pacemaker)

gastro J

124
Q

75 f with constant moaning - non focal abd tenderness - plain film demonstrates pneumotsis dx

A

angio

CT scan

125
Q

hiccups and bloat with something else fishy in patient hx of bariatric bypass - manage

A

revise J-J

CT scan

126
Q

78 yo male with high rectal cancer (maybe even sigmoid) cancer and intermitent inconinance tx

A

APR

LAR
trans anal

127
Q

preg female with intermit bloody bm moderate external hemorrhoids and internal hemorroids tx

A

stool soft and water

band

128
Q

paget of skin dx best indication for breast conservation therapy

A

2 cm sub nipple mass

MRI negative

129
Q

painful breast eyrthema 2 wks post partum breast feeding s/p 10 day of ancef - no improvement. what is management

A

change abx to MRSA coverage

skin bx

130
Q

breast way to eval nodes in breast cancer

A

SLNB
MRI
ax dissection

131
Q

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

A

none needed

24 h urine, metaneph, cortisol, …

…

132
Q

tx of sub ungual melanoma

A

amputation to next phalanx

MLE of nail bed

133
Q

chronic decube now with pearly raised lesion

A

squma

134
Q

what throws off pulse ox

A

lymphsurian (methalene blue not an option)

anemia below 15

fetal hemogolobin

135
Q

most common injury with L1 fx hyperflexion injury

A

“small bowel”
spleen
liver
pancreas not listed

136
Q

pt returns with fever urin incont parylysis lower extrem 10 day after epidural for flail

A

epidural absess

137
Q

epidural with narcotic and lidiocaion after simoid resection that night pressure 90/60 p 100 uop 0.4 cc/kg/h

A

500 ml fluid
turn down narcotic
turn down lido

138
Q

palliative care pt with obstrucitn small bowel mass with servere pain states 6/10 associated with eating - best tx

A

fenatnyl patch
spinal stim
oral morphine

139
Q

how to you place probe when looking at spleen site for FAST

A 
transvere LUQ
vert LUQ
btw 8-9 ribs
btw 11-12 ribs
parralle to 12 rib
140
Q

2 wks with empyemia tx still there with ct in place

A

thorscopic

add ct

141
Q

best indication the BKA will heal

A

palp pedal puse

transcutanous oxygen tention 10

142
Q

coverage for dorsal hand exposed tendons

A

radial forearm graft

143
Q

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

A

risk of bleeding

Consumptive of platelets

PE

144
Q

most common presentaiton of TOS

A

ulnar

145
Q

fingers numb hand cool and pulses only by dopler 2 weeks after brachial av fistula

A

ARTERIAL steal

median nerve injury

146
Q

best confirmation of brain death after clinical critera met

A

nuc med no flow

corneal reflex gone

single EEG

147
Q

best chance of have doner family sign up based on who asks

A

ICU doc

tranplant coordinator

148
Q

best confirmation that that is chylothrozx

A

trgl 40

milky

149
Q

what is seen on thryoglossal duct cyst exam that is different from base of thryoid

A

move with swallow

protrossion of tongue

150
Q

thryogolossal duct cyst path

A

“THROUGH” hyoid bone

foramen cecum

151
Q

Prosthetic Mesh Infections - Management

A

Prosthetic Mesh Infections - Management

152
Q

Esophageal Perforation - Spontaneous

A

Esophageal Perforation - Spontaneous

153
Q

kid with short gut 12 hold on tpn - excema behind the knees what is def

A

zinc

copper
selenium
chromium

154
Q

glucose absorption gut vs IV

A

but incr via hepatic independent path

155
Q

up in trauama glucocon vs insulin

A

both up but gluocone more

A ORAL BOARDS 2016 (30 decks)

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