BANK MIX 2014

Question 1

splenic artery aneurysm treatment

Answer 1

open ligation or transcatheter embolization for:
symptomatic aneurysms,
greater than or equal to 2 cm in size,
women of childbearing years.

Conservative management is indicated for patients over 60 years of age who are asymptomatic and have aneurysms of less than 15 mm in diameter.

Question 2

Surgery may be recommended for pancreatic mass when

Answer 2

greater than 3 cm,
there is mucin present in the patient’s aspirate,
cyst fluid CEA greater than 200,
and/or there is a presence of abdominal pain.

Question 3

High-risk factors which would indicate the need for further preoperative cardiac evaluation?

Answer 3

High-risk factors:
decompensated CHF, 
recent MI, 
high-grade AV block, 
severe valvular heart disease 
significant arrhythmia, such as VF or AF with RVR. 

Intermediate risk factors:
IDDM,
end-stage renal disease,
old MI, or stable angina

consideration for further testing based on the patient’s exercise tolerance and the surgical risk.

Question 4

Stage 3A lung cancer could involve

Answer 4

ipsilateral mediastinal lymph nodes.

Question 5

Contralateral mediastinal lymph node involvement in lung cancer is what stage

Answer 5

would be stage 3B

Question 6

Indications for liver transplant in patients with cholestatic liver disorders.

Answer 6

(1) Liver transplantation is the only effective treatment for liver failure secondary to primary biliary cirrhosis.
(2) Liver transplantation may occasionally be indicated for uncontrolled pruritus.
(3) Liver transplantation is the only effective treatment for decompensated cirrhosis secondary to primary sclerosing cholangitis.
(4) Patients with primary sclerosing cholangitis and cholangiocarcinoma should be excluded from transplantation unless they are enrolled in a clinical trial of experimental therapy. (5) Because of the high incidence of colon cancer, colonoscopies should be performed both before and after transplantation in patients with inflammatory bowel disease. (6) Liver transplantation is indicated in children with biliary atresia if portoenterostomy is unsuccessful or if intractable portal hypertension or liver failure develops despite successful portoenterostomy. (7) Liver transplantation should be considered for its ability to prolong survival and improve quality of life in syndromic and nonsyndromic forms of intrahepatic cholestasis in children. (8) Children with Alagille syndrome should have preoperative assessment for congenital heart disease. (9) In evaluating patients with cystic fibrosis for liver transplantation, assessment of lung disease should be performed.

Question 7

In the treatment of T1 and T2 oropharyngeal squamous carcinoma associated with significant metastatic neck disease, which one of the following interventions is most effective?

Answer 7

Conservation surgery is “defined as a surgical procedure which removes all underlying tumor and which aims to affect the same cure as radical surgery but with preservation of both structure and function.

It is usually combined with either radiotherapy or chemoradiation.” It is indicated for respectable primary tumors, has minimal functional deficit, and is devoid of any negative effect on the patient’s quality of life in the immediate aftermath of surgery and up to 4 years thereafter.

Conservation surgery combined with postoperative radiotherapy is indicated for stage III and IV disease

Question 8

surgical weight loss surgery first choice for adolecences

Answer 8

Roux-en-Y gastric bypass

Question 9

surgical weight loss surgery not approved for adolecences

Answer 9

The adjustable gastric band (AGB) has not been approved by the FDA for use in adolescents - considered investigational

Sleeve gastrectomy should be considered investigational; existing data are not sufficient to recommend widespread and general use in adolescents

NO Biliopancreatic diversion - substantial risks of protein malnutrition, bone loss, and micronutrient deficiencies. These nutritional risks are of particular concern during pregnancy. I

Question 10

The TRAM flap

Answer 10

avoids implants

uses the skin of the lower abdominal wall to create a breast elevation with vascular supply through the rectus abdominis muscle from its axial blood supplies, the deep inferior epigastric, and the superior epigastric vessels.

It utilizes the deep inferior epigastric vessels for the flap and the internal mammary vessels or the thoracodorsal vessels nourishing the area as well.

There is no longer any risk of necrosis of the skin or fat.

Question 11

The best approach to access the proximal left main stem is via

Answer 11

RIGHT right sided thoracotomy.

The arch of the aorta descends over the top of the proximal left mainstem bronchus, making it difficult to access

Question 12

The distal left main stem is best approached

Answer 12

through a LEFT throacotomy

Question 13

Primary hyperaldosteronism is usually due to

Answer 13

either a small (0.5 to 2 cm) benign unilateral cortical tumor,
or
bilateral cortical adrenal hyperplasia.

Approximately 50% of the cases are due to unilateral adrenal tumors (range 33% to 67%).

Question 14

Primary hyperaldosteronism Patients characteristically present with

Answer 14

hypertension, hypokalemia, and weakness,

but it is now recognized that many patients are normokalemic on presentation.

Question 15

A patient presents with agitation, thirst, lethargy, decreased blood pressure, and hyperthermia. Which one of the following conditions is most likely

Answer 15

HYPERnatriemia

Question 16

HYPERnatriemia ssx

Answer 16

An increased extracellular sodium concentration may result from loss of water, inadequate water intake, excessive sodium intake, or ADH insufficiency. Patients with diabetes insipidus produce large volumes of urine due to a deficiency in ADH. Deficiency of vasopressin is known as central diabetes insipidus. Impairment of the tubular function of the kidney results in nephrogenic diabetes insipidus. Hypotension may be the result of hypovolemia. The most common signs are lethargy, mental status change, and thirst.

Question 17

Diabetes, dermatitis, deep venous thrombosis, and depression are symptoms of

Answer 17

glucagonoma

Question 18

characterized by mild diabetes, gallstones, and diarrhea with or without steatorrhea

Answer 18

somatostatinoma

Question 19

watery diarrhea, hypokalemia, and hypochlorhydria, characteristic of Verner-Morrison syndrome occurs with what tumor

Answer 19

VIPoma

Question 20

Which one of the following is the most common operative technique in the surgical repair of indirect inguinal hernias in children?

Answer 20

High ligation and excision of the patent sac with anatomic closure

Question 21

Caroli’s disease is characterized by

Answer 21

hepatic fibrosis with multiple dilations of the intrahepatic biliary tree.

associated with malignancy.

Question 22

anesthetic with minimal effects on hemodynamics,

Answer 22

Nitrous oxide

all other agents result in hypotension due to cardiac depression or a decrease in systemic vascular resistance.

Question 23

pt with INR of 5 for afib what is best preop reversal - give time frames

Answer 23

Vitamin K administered IV INR will fall to 1.5 to 2.0 in 24 hours

Oral vitamin K is a good option if the surgery is over 24 hours away.

fresh frozen plasma within 12 hours

Question 24

intervention for mesenteric ischemia from portal vein thrombosis

Answer 24

anticoagulation

Question 25

Digoxin should be considered for the outpatient treatment of all patients who have

Answer 25

persistent symptoms of heart failure (class II-IV) due to systolic dysfunction despite conventional pharmacologic therapy

Question 26

Digoxin cannot be administered to patients who have

Answer 26

significant sinus or atrioventricular block unless it has been treated with a permanent pacemaker, nor is it a primary therapy for the stabilization of patients with acutely decompensated heart failure. A low dose of 0.125 mg daily is recommended for patients over 70 years of age, those with impaired renal function, or those with a low lean body mass. In the absence of a direct correlation between serum digoxin concentration and the drug’s therapeutic effects, serial assessment of serum digoxin levels is not required in most patients.

Question 27

most frequent surgical procedure for pyloric-prepyloric ulcers

Answer 27

Selective vagotomy with antrectomy or pyloroplasty (in order to prevent an unopposed absence of vagal tone)

Question 28

most frequent surgical procedure for bleeding juxtapyloric ulcer that is refractory to endoscopic techniques.

Answer 28

Truncal vagotomy with pyloroplasty and stitching of the bleeding ulcer =| three stich

Question 29

most frequent surgical procedure for for duodenal ulcer

Answer 29

Proximal gastric vagotomy

Question 30

most appropriate for patients presenting with a long fibrous stenosis of the postpyloric region after several courses of short-term medical treatment for duodenal ulcer.

Answer 30

Truncal vagotomy with a gastroenterostomy,

Dragstedt’s classical operation is

Question 31

volatile agents effects on respiration

Answer 31

increased respiratory rate
decreased tidal volume.
increase the apneic threshold for CO2.

bronchodilating properties

attenuate the bronchial reactivity to airway manipulation.

attenuate hypoxic pulmonary vasoconstriction.

Question 32

volatile anesthetics physiologic effects

Answer 32

increase blood flow to the brain, muscle and skin,

increase respiratory rate, decrease tidal volume and have bronchodilatory properties.

decrease blood flow to the kidney, liver and intestines

decrease the urine output and GFR.

Question 33

While placing a suture in the diaphragmatic crus during a Fundoplication, bright red blood is noted to be emitting from the mediastinum, below the crus. what is the blood vessel that has been hit

Answer 33

the aorta

Question 34

elevated arm stress test (EAST)

Answer 34

EAST asks the patient to hold their arms up with 90 degree shoulder abduction and external rotation (“surrender position”) for 3 minutes. Patients with neurogenic TOS develop symptoms of pain and paresthesias within 60 seconds.

Question 35

Venous TOS presentation and treatment

Answer 35

arm edema due to subclavian vein stenosis or thrombosis.

Initial management of venous TOS consists of thrombolysis or anti-coagulation followed by 1st rib resection.

Question 36

Arterial TOS presentation and treatment

Answer 36

arm fatigue with exertion
or
evidence of digital ischemia or emboli.

Arterial TOS has the strongest association with an anomalous cervical rib.

There is no acceptable non-interventional therapy for arterial TOS.

Treatment may involve thrombectomy, embolectomy, subclavian artery aneurysm resection, and anomalous cervical rib resection.

Question 37

direct thrombin inhibitors

Answer 37

argatroban, bivalirudin, or lepirudin i

Question 38

respiratory alkalosis defined as is

Answer 38

a pH greater than 7.45 with a PaCO2 less than 35 mm Hg.

is.

Question 39

percentage of neck masses malignant in adults

Answer 39

(80%) malignant!

Most of these malignancies are metastatic head and neck squamous cell carcinoma (HNSCC) from the nasopharynx, oropharynx, or hypopharynx.

malignant lymph nodes, neuromas or neurofibromas, carotid body tumors, brachial cleft cysts, lipomas, sebaceous cysts, parathyroid cysts, or soft tissue tumors.

Question 40

the optimal treatment for pediatric Graves’ disease

Answer 40

thyroidectomy!?

Whereas most adult patients undergo a trial of antithyroid drug therapy, there is a high failure rate with this treatment and alternative therapies become important. Although the remission rates are similar for high-dose RAI and surgery with virtually all patients requiring thyroid hormone supplementation, the small but increased risk of death, nonthyroid neoplasms, hyperparathyroidism, and potential increase in thyroid malignancy make surgery a more appealing option than high-dose RAI, especially in children.

Question 41

cell of origin of papillary Thyroid cancer

Answer 41

The follicular cell

also is the cell of origin of follicular, and Hürthle cell cancer,

produce thyroglobulin as a tumor marker.

The Hürthle cell is an inflamed follicular cell. The chief and oxyphil cells are found in parathyroid tissue.

Question 42

cell origin Medullary thyroid cancer

Answer 42

parafollicular or C cells.

CEA and calcitonin are both tumor markers for medullary thyroid cancer.

Question 43

T staging of oropharyngeal cancer

Answer 43

T1 = tumors less than or equal to 2 cm
T2 = tumors greater than 2 cm and less than 4 cm
T3 = tumors greater than 4 cm
T4 = tumors with local tissue invasion.

Question 44

how do diagnose the difference between cystosarcoma phyllodes and phyllodes tumor from fibroadenoma

Answer 44

core needle biopsy

Question 45

Cystosarcoma phyllodes

Answer 45

also called phyllodes tumour

very rare but locally aggressive fibroepithelial tumour in its malignant form, and accounts for 0.3 to 1% of all breast neoplasias.

A core needle biopsy with results favoring fibroadenoma should allow the breast physician to treat the lesion as a fibroadenoma, with observation and close follow-up or with enucleation.

Core needle histologic examination of phyllodes tumor allows the physician to preoperatively plan the definitive management at one surgical procedure, reducing the need for reoperations.

Open excisional breast biopsy for smaller lesions or incisional biopsy for large lesions is the definitive approach in diagnosing cystosarcoma phyllodes, whereas mammography and ultrasonography are unreliable in differentiating benign cystosarcoma phyllodes (CSP) from the malignant form of the condition or from fibroadenomas.

Also, no specific hematologic tumor markers or other blood tests are available and fine-needle aspiration for cytologic examination usually is inadequate.

Question 46

In high-risk cancer patients undergoing surgery, VTE prophylaxis regimens include

Answer 46

pneumatic compression ± gradient elastic stockings

plus— unfractionated heparin 5,000 2 hours preoperatively,

then unfractionated heparin 5000 units every 8 hours

For extended prophylaxis:
enoxaparin 40 mg or dalteparin 5,000 IU daily, (in selected high-risk patients):

Question 47

A patient with a RUL 5cm NSCLC with chest wall invasion and positive mediastinal lymph nodes. Treatment includes which one of the following treatment options

Answer 47

Neoadjuvant chemoradiotherapy

followed by right upper lobectomy with chest wall resection

Question 48

what cancer occurs most frequently in the duodenum and is also the most common small-bowel cancer

Answer 48

Adenocarcinoma is the most common small-bowel cancer (33%)

followed by carcinoid tumors (29%),

GI lymphomas (19%),

GI sarcomas (19%).

Adenocarcinomas were located most frequently in the duodenum

Question 49

most common locations of adenocarcinoma and small bowel

Answer 49

duodenum jejunum and ileum,

Question 50

most common location of carcinoid tumors in the small bowel

Answer 50

predominantly in the ileum

Question 51

most common location of Sarcomas and the small bowel

Answer 51

jejunum

Question 52

most common location of lymphomas and the small bowel

Answer 52

occurred almost equally in the jejunum and ileum. the

Question 53

Chloride-responsive metabolic alkalosis would his urine versus blood chloride level and what is extracellular fluid volume status; example of cause

Answer 53

involves urine chloride levels of less than 10 mEq/L and is characterized by decreased ECF volume and low serum chloride levels,

as occurs with vomiting.

Question 54

Chloride-resistant metabolic alkalosis

Answer 54

(e.g., primary aldosteronism)

involves urine chloride levels of more than 20 mEq/L a

increased ECF volume.

Question 55

how is elevated anion gap metabolic acidosis created

Answer 55

inorganic acid (e.g., phosphate or sulfate),

organic acid(e.g., ketoacids or lactate)

exogenous acid(e.g., salicylate) acids

incompletely neutralized by bicarbonate

Question 56

a normal anion gap metabolic acidosis results from

Answer 56

an excessive loss of bicarbonate from the gastrointestinal tract or kidneys

or

when hydrogen ions cannot be secreted because of renal failure.

Question 57

Normal portal pressure is

Answer 57

hepato- venous pressure gradient 5 to 8 mmHg,

Question 58

clinically significant portal hypertension is defined as

Answer 58

hepato-venous pressure gradient HVPG of at least 10 mmHg, and diagnosis is conformed at a level greater than 12 mmHg.

Question 59

Portal hypertension sinusoidal

Answer 59

(e.g., cirrhosis),

Question 60

portal hypertension pre-sinusoidal

Answer 60

(e.g., portal vein thrombosis),

Question 61

portal hypertension post-sinusoidal

Answer 61

(e.g., hepatic venoocclusive disease; drugs).

Question 62

The duct of Wirsung

Answer 62

is the main pancreatic duct.

It drains the entire pancreas from tail to head,

it lies mid-gland more posterior than anterior,

it joins the common bile duct and terminates at the ampulla of Vater.

Question 63

The duct of Santorini

Answer 63

is the minor pancreatic duct.

It drains the anterosuperior portion of the pancreatic head

it may empty into the duct of Wirsung
or
terminate in the duodenum via the minor papilla.

Question 64

Which one of the following lipid-lowering therapies requires monitoring of serum creatinine kinase (CK) in patients complaining of muscle pain, or who are at high risk of developing myopathy or rhabdomyolysis

Answer 64

cholesterol absorption inhibitors and statins

Question 65

can cause erroneous reading of the dual-wavelength pulse oximeter. a

Answer 65

methemoglobin

injection of dyes such as indocyanine green and methylene blue,

certain colors of nail polish

Fetal hemoglobin has the similar absorption spectrum, as adult hemoglobin and will not affect significantly the readings.

Bilirubin does not affect the accuracy of the dual-wavelength pulse oximeter.

Question 66

stage I lung cancer defined by tumor finding on CT scan the lung.

Answer 66

T1a (tumor is 2 cm or less)
or
T1b (tumor is greater than 2cm and 3cm or less).

Question 67

Diaphragmatic pacing indicated for what patient’s

Answer 67

high cervical spine lesions

central alveolar hypoventilation.

limited success with intractable hiccups and COPD

Question 68

in the United States The peak age of HCC is

Answer 68

greater than 65 in the United States

Question 69

United States, HCC rates are highest in which ethnicity

Answer 69

Asians, followed by African Americans and whites.

Males are two to fourfold more likely to develop HCC

Question 70

Liver transplantation Living donor transplantation may be offered for HCC if the waiting time is

Answer 70

long enough to allow tumor progression leading to exclusion from the waiting list.

Question 71

The major causes of hypercalcemia include

Answer 71

primary hyperparathyroidism,
vitamin D intoxication,

diseases associated with high bone turnover and solid tumor metastases, otherwise known as the humoral hypercalcemia of malignancy.

Question 72

Signs and symptoms of hypercalcemia develop when calcium levels reach what and may include

Answer 72

15 mg/100m mL

mental status changes, 
vomiting, 
PROXIMAL muscle weakness, 
renal dysfunction, 
cardiac conduction problem

Question 73

A 24-year-old woman with asthma requires postoperative intravenous analgesia. Which one of the following medications should be avoided

Answer 73

Morphine and Meperidine has significant histamine release which can contribute to asthma exacerbation and should be avoided in asthma patients.

Question 74

Epiphrenic diverticula

Answer 74

present with Dysphagia and regurgitation

result of distal esophageal dysmotility - result of a hypertensive distal esophageal muscle

Usually a right thoracotomy is used with exclusion of the diverticulum and a distal myotomy across the lower esophageal sphincter onto the stomach.

Question 75

indications for Whipple with trauma

Answer 75

Pancreaticoduodenectomy is indicated for
massive, uncontrollable retropancreatic hemorrhage arising from vascular injuries to the:

portal vein to
superior mesenteric artery
superior mesenteric vein

obvious irreversible injury to the head of the pancreas involving the:

main pancreatic duct
intrapancreatic portion of distal common bile duct
portions of the duodenum

Question 76

list order most frequent occurrence of anal cancer types

Answer 76

80% are squamous cell cancers, 16% are adenocarcinomas,

4% other .

Question 77

The most common symptoms of anal cancer presentation

Answer 77

anal bleeding (45%) 
mass sensation (30%)

Question 78

Anal cancer has been associated with

Answer 78

human papillomavirus infection, history of receptive anal intercourse, HIV infection, history of sexually transmitted diseases, history of cervical cancer, and use of immunosuppressive medication after solid organ transplantation.

Question 79

Standardized techniques for intra-abdominal pressure measurement

Answer 79

transduction at the midaxillary line at the iliac crest

installation 25 cc or less

Question 80

Long-term bile obstruction is thought to lead to liver cirrhosis, which can be associated with which one of the following disorders

Answer 80

autoimmune disorders such as celiac disease, hypothyroidism, Raynaud’s phenomenon, and/or Sicca syndrome (dry eyes or mouth).
and
Primary biliary cirrhosis

Question 81

treatment relative effectiveness for meconium ileus

Answer 81

SURGERY-Regardless of the surgical technique, there is an improved survival for MI with surgery.

Bishop-Koop ileostomy is effective and time-tested.

toIn appropriate clinical cases, primary resection and anastomosis may have a lower surgical morbidity. the

Question 82

treatment of transmediastinal lung lesions: right lobe adenocarcinoma left upper lobe bronchoalveolar carcinoma

Answer 82

treated as synchronous primaries and should be individually treated as such.

A bronchoalveolar carcinoma is treated with either a wedge resection or a lobectomy.

In this instance, it is a small lesion and is amenable to wedge resection.

adenocarcinoma-is an invasive lung cancer is treated with lobectomy.

Question 83

most common tumor types can originate from the nasopharynx

Answer 83

Nasopharyngeal carcinoma is the most common

Question 84

Nasopharyngeal carcinoma is strongly correlated to

Answer 84

ethnicity (Asian), Epstein-Barré virus infection, and dietary habits.

Symptoms vary depending on exact location but may include ear, nasal, and throat symptoms as well as cranial nerve palsies.

Question 85

usual treatment of nasopharyngeal carcinoma

Answer 85

Radiation and chemotherapy is the usual treatment

Question 86

preferred treatment for symptomatic patients with duodenal cancer

Answer 86

Whipple procedure

Question 87

best test to evaluate diaphragm function

Answer 87

The sniff test

fluoroscopic exam where the patient is asked to “sniff” while the motion of the diaphragm is observed.

It is the best test to demonstrate functional abnormalities of the diaphragm.

Question 88

Anterior mediastinal tumors

Answer 88

four T’s: 
thymoma, 
teratoma, 
thyroid cancer, 
terrible lymphoma.

Question 89

Posterior or paravertebral mediastinal tumors are likely to be of what tissue source given example

Answer 89

neurogenic, such as neurofibroma.

Question 90

The differential diagnosis of esophageal varices/hemorrhage includes

Answer 90

anything that Leads to portal hypertension:

schistosomiasis, 
severe congestive heart failure, 
hemochromatosis, 
Wilson's disease, 
autoimmune hepatitis, 
portal/splenic vein thrombosis, 
sarcoidosis, 
Budd-Chiari syndrome, 
chronic pancreatitis, 
hepatitis B, hepatitis C, alcoholic cirrhosis, 
primary biliary cirrhosis (PBC), 
primary sclerosing cholangitis (PSC).

Question 91

the workup for head and neck masses.

Answer 91

Panendoscopy
directed biopsies
mucosal site sampling under general anesthesia should include the nasal cavity, nasopharynx, oropharynx, hypopharynx, and larynx. Bronchoscopy, esophagoscopy, and ipsilateral tonsillectomy to

Question 92

the course of a replaced left hepatic artery

Answer 92

The replaced left hepatic artery originates off the left gastric artery and courses to the right through the lesser sac, through the fissure for the ligamentum venosum, and into the umbilical fissure to perfuse the left hepatic lobe

Question 93

management of chylous ascites and being treated with chemotherapy for small bowel lymphoma

Answer 93

Treatment includes treatment of the lymphoma with chemotherapy, a low fat medium chain triglyceride diet and diuresis

Chylous ascites presents in patients with lymphoma and retroperitoneal lymph node involvement.

Question 94

use of succinylcholine in renal failure

Answer 94

In renal failure, succinylcholine is not contraindicated if the potassium level is normal, since it does not cause excessive release of potassium

Question 95

cisatracurium metabolism

Answer 95

metabolized via Hoffman elimination and ester hydrolysis and is the best muscle relaxant to use with patient in renal failure

Question 96

contraindications a halothane

Answer 96

halothane causes hepatitis

avoided in liver failure;

cranial pressure and is a good choice for induction

Question 97

contraindication of vecuronium

Answer 97

vecuronium undergoes in part metabolism and excretion in the liver and may have prolonged action.

Question 98

age is most commonly responsible trigger malignant hyperthermia

Answer 98

Succinylcholine and halogenated anesthetic agents can trigger malignant hyperthermia and should not be used;

Question 99

alternative agent to use for malignant hyperthermia

Answer 99

nitrous oxide and intravenous anesthetic agents can be used safely.

Question 100

best agency used for asthma intubation

Answer 100

Ketamine is a bronchodilator and is a good anesthetic choice in asthma; hydromorphone and fentanyl.

NO morphine causes histamine release

Question 101

contraindications for ketamine

Answer 101

head injury

Ketamine increases the cerebral blood flow and intracranial pressure and should be avoided in the setting of intracranial hypertension

Question 102

best agent for head injury induction

Answer 102

propofol decreases the cerebral metabolic rate, blood flow and intracranial pressure and is a good choice for induction.

Question 103

The major causes of hypokalemia

Answer 103

excessive renal loss,

gastrointestinal losses due to vomiting and diarrhea.

Question 104

When potassium levels are in the range of 2 to 2.5 mEq/L symptoms are likely to include

Answer 104

muscular weakness, ST changes, T wave depression, and U wave elevation on EKG

Question 105

the superior pubic ligament shares the same tissue plane and is derived from the same tissue origin as the

Answer 105

transversus aponeurosis and the transversalis fascia,

Question 106

McVay and Anson use what structure for reconstructing the posterior wall of an inguinal hernia.

Answer 106

the superior pubic ligament

It is used in large and difficult hernia repairs, including incisional hernias.

Question 107

In Halsted operation

Answer 107

the external oblique aponeurosis is closed under the spermatic cord,

involves a 4-layer repair of the canal’s posterior wall.

Question 108

The Bassini repair

Answer 108

apposition of the inguinal ligament to the:
transversus abdominis,
transversalis fascia,
lateral rectus sheath

In Modified Bassini, the posterior wall is not opened while the sutures placed between the transversus arch and the inguinal ligament creates tension on the tissues involved.

Question 109

The Shouldice repair

Answer 109

imbricated posterior wall closure with continuous monofilament suture;

it warrants close patient follow-up

Question 110

This alloimmune response is predominantly driven by what cell and reduction of organ transplant

Answer 110

T cell recognition of foreign major histocompatibility complexes (MHC).

the reason for T-cell inhibiting drugs

This alloimmune response is predominantly driven by

Question 111

symptoms of hyponatremia

Answer 111

headache, nausea, vomiting, muscle cramps, lethargy, restlessness, disorientation, and depressed reflexes. In serious cases, seizures, coma, permanent brain damage, respiratory arrest, brain stem herniation, and death occur.

Question 112

Atracurium can cause

Answer 112

histamine release in higher dose and after rapid administration and can contribute to hypotension on induction; cisatracurium in clinical doses does not have such an effect.

Question 113

A 55-year-old male undergoes a screening EGD for GERD. He is found to have Barrett’s Esophagus without dysplasia. His next EGD should be done at which one of the following time frames

Answer 113

Barrett’s esophagus should be followed up with EGD every 6 months until 2 EGD’s demonstrate no dysplasia. At that point screening can go to every year.

Question 114

present as a swelling or tract anterior to the sternocleidomastoid muscle

Answer 114

95% of branchial cleft abnormalities originate from the second arch.

surgical excision is the treatment.

Question 115

Thyroglossal duct cysts present

Answer 115

in childhood as a midline mass.

Question 116

Internal hernia leading to bowel obstruction most common site and cause after lap roux en y

Answer 116

jejunojejunal anastomosis, at the passage in the transverse mesocolon allowing the retrocolic Roux limb, and behind the Roux limb (Petersen hernia)

but decreased when the Roux limb is in an antecolic position.