Lecture Questions Flashcards
In which operative case is a cephalosporin usually given as a preoperative antibiotic and discontinued within 24 hours
post-operatively?
elective hernia repair
because clean procedure
Patients undergoing which surgery would be best evaluated by the Revised Cardiac Risk Index for risk of perioperative
major adverse cardiac event, (MACE)?
a. aortic valve replacement
b. hip surgery
c. coronary stent placement
d. coronary artery bypass grafting
b. hip surgery
An adult male has “bloating” abdominal pain, anorexia, and nausea. On examination he is afebrile with a non-peritonitic but distended tympanic abdomen, no bowel sounds, and a mass in his right groin that cannot be reduced. what will abdominal radiographs most likely show?
dilated loops of bowel
A 53 year old female presents with vomiting and colicky abdominal pain for 2 days. She has had no flatus or bowel movements for a day. Her medical history includes hypertension and her surgical history is significant for cholecystectomy at age 31. She is tachycardic to 101 and afebrile. Her abdomen is distended and tympanic but not peritonitic. Obstructive series shows multiple distended loops of small
bowel, air-fluid levels, and no gas in the colon. What is the most likely diagnosis?
small bowel obstruction
Which metabolic disorder is often associated with hypokalemia?
alkalosis
A 23-year-old female presents to the emergency department after falling off the back of a motorcycle. Her heart rate is 145, systolic blood pressure is 85 and she is tachypneic to 23 but oxygenating well on
room air at 97%. She is GCS 14, minus one for confusion. Her pupils are 3mm equal, round and reactive. Her capillary refill is greater than 2 seconds. Which intravenous fluid prescription strategies is most likely to be utilized initially in this patient?
fluid resuscitation
A 75-year-old lady is admitted for planned elective knee replacement surgery the next day. She has long-standing hypertension for which she takes amlodipine. She has no other medical problems. Laboratory parameters are all within normal limits. She is to be placed on intravenous fluids, and her weight at admission was 80 kg. Which one of the following
is the correct choice and rate per hour?
0.9% saline at 100mL/hour
A 64-year-old male develops supraventricular arrhythmias after undergoing open-heart surgery. The laboratory measurements
indicate that the potassium levels are 6.7. After administering calcium, what is the next step in management ?
insulin + glucose
A 36-year-old female presents to the primary care clinic complaining of a 2-month history of chest discomfort she describes as substernal, worsened by meals, and sometimes nocturnal but denies weight loss or odynophagia. She is currently asymptomatic. Her medical history is
non-contributory. She takes no daily medications. Her physical examination is without abnormality. Which of the following is the most appropriate next step in managing this patient?
trial of H2 receptor antagonist
A patient with a history of alcoholism reports vomiting bright red blood after several hours of vomiting and retching. He presents to the emergency department with chest pain, low-grade fever, and nausea. What physical findings would suggest he has a rupture of the esophagus?
subcutaneous emphysema
popping due to air
A 62-year-old male presents to the emergency department with a 6-hour history of sudden onset, severe abdominal pain. He reports a 3-month history of epigastric pain after meals, for which he has been taking over-the-counter antacids. His vital signs include a temperature of 38.1C, pulse 120 beats/min, respiratory rate 22/min, and blood pressure 100/50 mmHg. On exam, bowel sounds are absent, and the abdomen is rigid with involuntary guarding. Plain films show air under the diaphragm. Which of the following is the most likely diagnosis?
perforated duodenal ulcer
Which of the following common causes of small bowel obstruction is most likely to occur in the adult population?
postsurgical adhesions
A 35-year-old woman presents with symptoms of an acute bowel obstruction. Her past surgical history is significant for a total
abdominal hysterectomy with bilateral salpingo-oophorectomy three years previously. Which of the following is most likely present and best explains these findings in this patient?
adhesive intra-intestinal bands
According to the Ranson criteria, presence of which factor indicates a poor prognosis for an adult male with an acute episode of gallstone pancreatitis on admission?
WBC of 25,000/microliter
In the patient with epigastric pain, which of the following is most useful in differentiating the etiology from chronic pancreatitis to acute pancreatitis?
elevated serum amylase and lipase
Which of the following associations with chronic pancreatitis is most important to consider prior to surgical treatment?
pancreatic duct abnormality
A 56-year-old male with known pancreatic cancer is scheduled for a distal pancreatectomy. He asks you why this procedure has been recommended. What is the most likely explanation for recommending this procedure to this patient?
his previous pancreaticoduodenectomy has failed
A 21-year-old male is brought to the emergency room after being struck on
his left chest with a baseball bat. Clinical suspicion is high for splenic injury. Presence of which of the following findings is most likely to indicate an alternative diagnosis?
a. WBC count of 16,000
b. left 8th and 9th transverse rib fractures
c. presence of Kehr sign
d. free air below diaphragm
e. diffuse peritonitis
free air below the diaphragm
A patient with left upper quadrant pain and fever is found to have splenic abscess. Which of the following is the best treatment for this condition?
splenectomy
A 53-year-old man presents with a distended abdomen. Examination reveals a protuberant abdomen without specific point tenderness. A
fluid wave is appreciated. Right upper quadrant percussion demonstrates hepatomegaly. There is yellowing of the skin, reddening of the palms, and the proximal nail beds are rounded. Which of the following is most likely included in this patients past medical history?
a. diverticulosis
b. asbestos exposure
c. croh’s disease
d. alcohol abuse
alcohol abuse
