Pre-Test (Skin and friends, Trauma, Transplant/Immunology/Oncology)

Question 1

Nerve that innervates most of the intrinsic muscles of the hand

Answer 1

Ulnar nerve

Question 2

Nerve involved with extension of wrist

Answer 2

Radial

Question 3

Margins of excisions for melanoma

Answer 3

4 mm- 3 cm margin

Question 4

Frostbite tx

Answer 4

Rapidly warming by immersion in water slightly above normal body temp (40-44 c)

Question 5

Another name for SCC form chronic skin wound

Answer 5

Marjolin ulcer

Question 6

Silver nitrate AE

Answer 6

Hyponatremia and hypokalemia

Question 7

Silver sulfa AE

Answer 7

Neutropenia

Question 8

Most common malignant tumor of the lip

Answer 8

SCC (esp lower)

Question 9

What do composite tissue grafts contain

Answer 9

Tissue in addition to dermis/epidermis

Question 10

How long should a clean would be present before it should no longer be closed

Answer 10

6 hours

Question 11

Tx for a trauma pt with a seatbelt sign

Answer 11

Worried for enteric or mesenteric injury, the patient should be held and observed regardless of test results

Question 12

Surgical treatment of choice for a ruptured vein in an unstable patient

Answer 12

Ligation, rather than repair

Question 13

CT scan sensitivity for penetrating abdominal trauma

Answer 13

Low, good for blunt abdominal trauma

Question 14

Insulin levels after acute trauma? BS levels?

Answer 14

Shot drop in insulin followed by a significant rise

Still hyperglycemia due to elevated insulin resistance

Question 15

Best surgery for common bile duct transection in stable patient? Unstable?

Answer 15

Stable: Roux-en-Y choledochojejunostomy
Unstable: T tube placement

Question 16

Absolute indications for surgical neck exploration

Answer 16

Acute signs of airway distress (stridor, hoarseness, dysphonia)
Visceral injury (sub-q air, dysphagia, hemoptysis)
Hemorrhage
Neuro signs referable to carotid injury (stroke, AMS)

Question 17

Duodenal obstruction following BAT likely? Management?

Answer 17

Likely a duodenal hematoma

Mgt conservative: NG tube and observation

Question 18

Blunt carotid artery injuries should be treated with?

Answer 18

Full systemic anticoagulation in the absence to any contraindications to prevent stroke

Question 19

Cushing triad in inc ICP

Answer 19

Hypertension
Bradycardia
Irregular respirations

Question 20

What nerve innervates most of the flexors of the hand? What else does it get

Answer 20

Medinan nerve, also gets pronator muscles of forearm and lots of hand sensation

Question 21

Two good ionotropes for cariogenic shock

Answer 21

Dobutamine and Dopamine

Question 22

Why are popliteal artery injuries associated with knee dislocations?

Answer 22

Extreme force required to dislocate the joint

Question 23

Nitrogen balance in sepsis

Answer 23

Negative, due to breakdown and increased urinary loss

Question 24

What should be requested for suspected colonic perf?

Answer 24

CT abdomen

Question 25

When is surgery indicated in orbital trauma

Answer 25

Enopthalmos greater than 2mm Diplopia on primary or inferior gaze Entrapment of EOM Fracture greater than 50% of orbital floor

Question 26

What happens to the Lactate in LR solutions

Answer 26

Metabolized to HCO3 in the liver --> helps correct metabolic acidosis

Question 27

Mgmt of low grade renal injuries

Answer 27

Strict bed rest for 24-72 hours with serial Hgb levels

Question 28

Tx for injury of major pancreatic duct to left left of the mesenteric vessels

Answer 28

Distal prancreatectomy

Question 29

In absence of sepsis, management of patients with enterocutaneous fistulas

Answer 29

Bowel rest, TPN, and correction of electrolyte abnormalities

Question 30

initial management of extraperitoneal bladder injuries

Answer 30

Initial catheter drainage followed by repeat imaging to confirm healing

Question 31

Pos DPL criteria

Answer 31

10cc gross blood > than 100,000 ul RBC > 500 uL WBC Elevated amylase, bili, or alk phos

Question 32

First step in treating neurogenic shock? Then?

Answer 32

``` Restore volume (Normal CP is 2-6) Then vasoconstrictors ```

Question 33

Ideal tx of pericardial tamponade from trauma

Answer 33

Pericardiocentesis under local anesthesia in the OR (that way able to surgically explore after)

Question 34

Guidelines for thoracotomy in hemothorax patients

Answer 34

> 1500 mL of immediate drainage or >200 mL/h for several hours after

Question 35

Pulmonary contusion def

Answer 35

hemorrhage and edema of the lung parenchyma without parenchymal disruption

Question 36

Initial tx of open tension pneumothorax

Answer 36

Place occlusive dressing over the defect

Question 37

What makes TNF

Answer 37

Monocytes/macrophages

Question 38

Chronic liver transplant rejection characterized by

Answer 38

Paucity of bile ducts on biopsy due to immune-mediated injury to biliary epithelium

Question 39

What is the cross match done before transplant

Answer 39

Donor lymphocytes with recipient serum and compliments

Question 40

Tumor lysis syndrome is mediated by?

Answer 40

Cytotoxic T cells

Question 41

Cyclosporin inhibits?

Answer 41

IL-2

Question 42

Acute kidney rejection mgmt

Answer 42

Renal biopsy, steroid boost, and immunoglobulin therapy

Question 43

Most common post transplant infections

Answer 43

Viral (CMV, EBV, HSV, VSV)

Question 44

Best drug for severe acute rejection that does not respond to steroid tx

Answer 44

Muromonab-CD3

Question 45

Wilms tumor ass w/

Answer 45

Aniridia, GU abnormalities, MR

Question 46

Tx for early stage seminoma

Answer 46

Orchiectomy and external beam radiation

Question 47

Who should get sentinel node biopsies in breast Ca

Answer 47

Pt's who do not have clinically positive lymph node disease

Question 48

How are cardiac allografts matched

Answer 48

Only by size and ABO type

Question 49

GIST drug

Answer 49

Imatinib (TKI)

Question 50

Mammogram rec for BRCA1 carriers

Answer 50

Once every 6 months (biannual) starting at age 25

Question 51

BRCA1 vs BRCA2

Answer 51

BRCA1: likely ER neg, colon and prostate ca in males BRCA2: likely ER+, also GI cancers

Question 52

Post transplant lymphoproliferative disorder ass w/?

Answer 52

EBV

Question 53

What is tertiary hyperparathyroidism? Tx?

Answer 53

Persistant hypercalcemia 2/2 autonomous parathyroid function after renal transplant Tx: total parathyroidectomy

Question 54

Neg margin for colon cancer should be

Answer 54

5cm

Question 55

Azothioprine AE

Answer 55

Bone marrow suppression