NBME Clinical Science Mastery Series: Surgery Form 3

Question 1

In a patient s/p MVC, what is “the best” modality to screen for cervical trauma?

Answer 1

Lateral x-ray

Question 2

A guy gets a dozen units of pRBCs in an aortic repair and then is oozing from his IVs. What happened?

Answer 2

Dilutional thrombocytopenia –those units don’t have platelets

Question 3

What is a common cause of post-op PVCs?

Answer 3

Respiratory acidosis

Question 4

A woman has dysphagia for three months and barium swallow shows a tapering stricture. What do you do next?

Answer 4

Need to do endoscopy with biopsy to ensure it is benign

Question 5

Patients with peripheral vascular disease should be on _____________.

Answer 5

aspirin

Question 6

Chronic subdural treatment?

Answer 6

Craniotomy (even with low sodium)

Question 7

True or false: preformed antibodies to donor proteins presents immediately on transfusion of blood.

Answer 7

False

Hemolytic transfusion reactions can occur hours after transfusing.

Question 8

A woman on high dose steroids for a long time undergoes surgery and then is hypotensive after propofol induction. What should you do?

Answer 8

Could be two things:

• Hypovolemia (so give 500 mL NS bolus)
• Adrenal insufficiency from long-term steroid use (so give hydrocortisone)

Question 9

A Jehovah’s Witness has signed an order saying he does not want blood transfusions. He has an HCT of 18% and needs an ex-lap due to peritoneal signs. What should you do?

Answer 9

Do the ex-lap

Peritoneal signs –indicating peritonitis –have a very dire prognosis (~50% mortality). Although an ex-lap with an HCT of 18% and inability to transfuse is also risky, there is a better chance of saving him.

Question 10

If a person seems to have hyperparathyroidism, don’t forget ________________.

Answer 10

to screen for cancer; renal cell carcinoma and squamous cell carcinoma of the lung can both mimic hyperparathyroidism by the release of PTHrp

Question 11

_______________ can show an air-fluid level in the posterior mediastinum on chest x-ray.

Answer 11

Achalasia

Question 12

A man has a Billroth II reconstruction and then develops persistent diarrhea after taking antibiotics for another illness. What is the likely cause?

Answer 12

SIBO

Small intestinal bacterial overgrowth

Question 13

In addition to the continuous, multiphasic murmur heard over the pulmonic area, those with patent ductus arteriosus can also have what murmur?

Answer 13

Loud S2

Question 14

What is the cornual area of the uterus?

Answer 14

The superior area near the entrance to the fallopian tubes

Question 15

If a patient develops swelling of their arm with a PICC in, what likely occurred?

Answer 15

DVT 2/2 to the catheter

Question 16

A woman with COPD comes in for a pre-op assessment for a pneumonectomy. What test is best at predicting her function on one lung?

Answer 16

FEV