Medical Assessment and Management of the Surgical Patient

Question 1

Shortly after the onset of angina, a patient begins to exhibit dyspnea. This is highly suggestive of:

(A) acute right heart failure with pulmonary hypertension.
(B) a right to left shunt with decreased arterial blood oxygenation.
(C) myocardial ischemia with acute left ventricular failure.
(D) right ventricular infarct.

Answer 1

(C) myocardial ischemia with acute left ventricular failure.

COMSSAT: 2019
Explanation:
Source: Hines, R.L. & Marschall, K.E. (Eds.). (5th ed.).(2008). Stoelting’s anesthesia and co-existing disease: Ischemic heart disease. Philadelphia, PA: Churchill Livingstone.

Question 2

A 65 year-old male is referred for removal of multiple carious teeth. He requests the procedure be done under general anesthesia. During his pre-operative history, he states that for the past 2 years he has had increasing difficulty breathing at night and now sleeps on two pillows. He also states that he has an occasional “fluttering” sensation in his chest. Cardiac auscultation reveals
an accentuated first heart sound with a snap. Which of the following would you suspect to be present in this patient?

(A) Mitral stenosis
(B) Aortic stenosis
(C) Aortic regurgitation
(D) Tricuspid stenosis

Answer 2

(A) Mitral stenosis

COMSSAT: 2019
Explanation:
Source: DeTurk, E. & Cahalin, L.P. (2004). Cardiovascular and pulmonary physical therapy: An evidenced-based approach (pp. 136-137). McGraw-Hill.

Question 3

A 68 year-old female states that she was diagnosed with emphysema 10 years ago. Which of the following would you expect to find during a pre-operative pulmonary work-up on this patient?
(A) Inspiratory obstruction
(B) Increased static elastic recoil 
(C) Lung hyperinflation
(D) Increased diffusing capacity

Answer 3

(C) Lung hyperinflation

COMSSAT: 2019
Explanation:
Source: DeTurk, E. & Cahalin, L.P. (2004). Cardiovascular and pulmonary physical therapy: An evidenced-based approach (pp. 136-137). McGraw-Hill.

Question 4

Restrictive lung disease is characterized by:
(A) obstructive airways.
(B) increased elastic recoil.
(C) low expiratory flow rates.
(D) a normal Vital Capacity (VC).

Answer 4

(C) low expiratory flow rates.

COMSSAT: 2019
Explanation:
Source: DeTurk, E. & Cahalin, L.P. (2004). Cardiovascular and pulmonary physical therapy: An evidenced-based approach (pp. 136-137). McGraw-Hill.

Question 5

Gingko Biloba, used to enhance memory, has what potential complication?
(A) Renal failure
(B) Stroke
(C) Clotting disorders 
(D) Elevated LFTs

Answer 5

(C) Clotting disorders

COMSSAT: 2019
Explanation:
Source: Braunwald, E., Fauci, A., et al. (15th ed.). (2001). Harrison’s principles of internal medicine (pp. 726, 1343- 1345, 1493, 1448-49).

Question 6

Of the following patients, which is most likely to be a carrier of MRSA?
(A) An HIV positive 24 year-old male
(B) A 30 year-old Type II diabetic
(C) A sexually active 35 year-old with multiple partners (D) A 81 year-old nursing home resident

Answer 6

(D) A 81 year-old nursing home resident

COMSSAT: 2019
Explanation:
Source: Braunwald, E., Fauci, A., et al. (15th ed.). (2001). Harrison’s principles of internal medicine (pp. 726, 1343- 1345, 1493, 1448-49).

Question 7

Patients taking prednisone and/or methotrexate along with a bisphosponate:
(A) are less likely to develop osteonecrosis.
(B) has no effect on the development of osteonecrosis.
(C) are more likely to develop osteonecrosis sooner.
(D) prednisone and methotrexate help to prevent osteonecrosis.

Answer 7

(C) are more likely to develop osteonecrosis sooner.

COMSSAT: 2019
Explanation:
Source: Marx, Cillo, & Ulloa (2007). Oral bisphosphonate-induced osteonecrosis: Risk factors, prediction of risk using serum CTX testing, prevention, and treatment. Journal of oral and maxillofacial surgery.

Question 8

When thinking about prevention of perioperative complications related to Sickle Cell Disease, which of the following are recommended?
(A) Avoidance of preoperative and intraoperative hypoxemia
(B) Liberal use of narcotic analgesics to prevent bone pain
(C) Aggressive hydration both preoperatively and postoperatively to decrease blood viscosity
(D) Avoidance of acidosis with the use of sodium bicarbonate or other alkalinization
techniques

Answer 8

(A) Avoidance of preoperative and intraoperative hypoxemia

COMSSAT: 2019
Explanation:
Source: Firth, P.G. (2005). Anesthesia for preculiar cells – a century of sickle cell disease. British journal of anesthesia, 95 (3), 287-299.

Question 9

A 20 year-old female complains of a nontender lump in her neck above the clavicle that has been present for a year. She states that has increased and decreased in size over that time. More recently she has been experiencing generalized itching which has been escalating with time. The most likely diagnosis would be:
(A) Hodgkin’s disease. 
(B) neurofibromatosis. 
(C) sarcoidosis.
(D) Addison’s disease.

Answer 9

(A) Hodgkin’s disease.

COMSSAT: 2019
Explanation:
Source: Braunwald, E., Fauci, A., et al. (15th ed.). (2001). Harrison’s principles of internal medicine (pp. 726, 1343- 1345, 1493, 1448-49).

Question 10

Minor bleeding from routine dental extraction in known Von Willebrand’s patients is best managed with:
(A) protamine.
(B) DDAVP.
(C) primary closure.
(D) platelet transfusion and fibrin sealant.

Answer 10

(B) DDAVP

COMSSAT: 2019
Explanation:
Source: Barclay, L. & Vega, C. (2008). Guidelines issued for diagnosis and management of Von Willebrand’s disease. Medscape Medical News.