Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sample Exams > PSGS Review 2019 > Flashcards

PSGS Review 2019 Flashcards

1
Q

50/F came in with 1 cm left breast mass. Mammogram showed architectural deformity. Ultrasound showed a hypoechoic, microlobulated mass. 1 xillary node noted as well 5cm in size with fatty hilum. What would be the next best step in management?

A) excision biopsy of breast mass
B) excision biopsy of breast mass and axillary node
C) ultrasound-guided core needle biopsy of breast mass
D) ultrasound-guided core needle biopsy of breast mass and axillary node

A

C) ultrasound-guided core needle biopsy of breast mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q 
35/F underwent partial mastectomt with sentinel node biopsy for breast cancer. Histopath report as follows: invasivd mammary carcinoma 1cm Grade I, 0 out of 4 sentinel lymph nodes positive for tumor, ER + PR + Her2neu -. Next step in management would be:
A) adjuvant anastrazole
B) Oncotype DX
C) Chemotherapy
D) Radiotherapy
A

B) Oncotype DX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

38/F came in for a 4cm breast mass. Ultrasound-guided core needle biopsy showed ductal carcinona in situ, grade 2. Surgical options for the patient would include:
A) Lumpectomy with sentinel node biopsy
B) Mastectomy with sentinel node biopsy
C) Mastectomy with axillary node dissection with immediate reconstruction
D) Mastectomy with axillary node dissection eith delayed reconstruction

A

B) Mastectomy with sentinel node biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
50/F diagnosed with Stage I (T1N0M0) breast cancer underwent mastectomy with sentinel node biopsy. Intraoperstivelt, frozen section relayed showed isolated tumor cells in 2 of 4 sentinel nodes. Appropriate surgical action for this patient is:
A) node picking
B) level I and II node dissection
C) nothing more
D) level I, II and III dissection
A

C) nothing more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

45F underwent mastectomy with sentinel node biopsy. Final histopath showed: ductal carcinoma in situ, 30mm in widest diameter, grade 1, with areas of necrosis, nearest margin is basal margin 3mm, with 2mm foci of invasion, 2 sentinel nodes negative for tumor xells; ER + PR + Her2neu +. Appropriate postoperative management is

A) Tamoxifen 20mg OD
B) Tamoxifen 20mg OD, followed by chemotherapy
C) Tamoxifen 20mg OD, followed by chemotherapy and Trastuzumab
D) Tamoxifen 20mg OD, followed by chemotherapy and Trastuzumab, followed by radiotherapy

A

A) tamoxifen 20mg OD

Importance of Her2neu in DCIS has not yet been elucidated
ALND not recommended
25% of DCIS will have invasive component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

60F recently underwent partial mastectomy with sentinel node biopsy for breast cancer. Final histopath showed mucinous carcinoma, 4cm widest diameter, Grade I, negative for lymphovascular space invasion, nearest margin is basal margin 1mm, 3 sentinel nodes negative for tumor cells ER + PR + Her2neu -. Appropriate management is

A) Letrozole 2.5mg OD, followed by radiotherapy
B) Letrozole 2.5mg OD, followed by chemotherapy
C) Letrozole 2.5mg OD, followed by chemotherapy, followed by radiotherapy
D) Tamoxifen 20mg OD

A

A) Letrozole 2.5mg OD, followed by radiotherapy

90% of mucinous are ER PR positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

50F came in due to eczematous lesion of the right nipple. Most appropriate next step is:

A) punch biopsy
B) mammogram and breast ultrasound
C) MRI
D) refer to dermatology

A

B) mammogram and breast ultrasound

Consider Paget’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

55F recently underwent mastectomy with axillary node dissection fof breast cancer. The following histopath: invasive mammary carcinoma, 50mm, Nottingham grade III, with lymphovascular invasion, nearest margin anterior margin 1mm, 1 of 20 axillary nodes positive for tumor cells ER - PR + Her2neu -. Appropriate management is

A) Tamoxifen 20mg OD
B) Tamoxifen 20mg OD, chemotherapy
C) Tamoxifen 20mg OD, chemotherapy, radiotherapy
D) Tamoxifen 20mg OD, chemotherapt, radiotherapy, Trastuzumab

A

C) Tamoxifen 20mg OD, chemotherapt, radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

60F underwent partial mastectomy with sentinel nodevbiopsy. Histopath showed:

Invasive mammary carcinoma, 1cm, Nottingham grade I, no lymphovascular space invasion, 1/4 sentinel nodes positivd for tumor cells. ER+ PR+ Her2neu-. According to the Z11 trial, appropiate management is:

A) minimal axillary node dissection followed by Anastrazole @mg OD
B) Anastrazole 1mg OD, chemotherapy, radiotherapy
C) Anastrazole 1mg OD
D) Tamoxifen 20mg OD

A

B) Anastrazole 1mg OD, chemotherapy, radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

58F underwent right modified radical mastectont for a 3cm invasive ductal carcinoma. Lymph nodes are negative. The tumor is ER+ PR- Her2neu 1+. The next step is:

A) Fluorescence in situ hybridization testing of the breast tumor
B) Aromatase inhibitor may be included in adjuvant treatment
C) Postoperative radiation is warranted
D) Treat with Trastuzumab for 1 year

A

A) Fluorescence in situ hybridization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Level III axillary lymph nodes are:

A) lateral to the pectoralis minor muscle
B) Rotter’s nodes
C) medial to the pectoralis minor muscle
D) usually removed during modified radical mastectomy

A

C) medial to the pectoralis minor muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Mammographic findings highly suggestive of benignity:
A) clustered microcalcifications
B) changing microcalcifications
C) pleomorphic calcifications
D) scattered macrocalcifications
A

D) scattered macrocalcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

35M presented with a non-movable mass in the left hemiabdomen. Magnetic resonance imaging showed a 23 x 16 x 14 cm retroperitoneal tumor involving the aorta thus seemed unresectable. There is no sign and symptom of bowel obstruction. Next option is:

A) radiation therapy followed by chemotherapy
B) chemotherapy
C) core needle biopsy of the tumor
D) radiofrequency ablation

A

C) core needle biopsy of the tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

56M with a 1.5 cm ulceration in the forehead. Incision biopsy done showing basal cell carcinoma. Your next procedure of choice is:

A) wide excision with sentinel node biopsy
B) mohs surgery
C) interleukin injection of tumor
D) wide local excision with flap rotation surgery

A

B) Moh’s surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A patient with a necrotizing soft tissue infection on his right lower extremity was admitted to the ER. His vital signs were: BP 70/50 HR 110 RR 25 T 39. O2 sat 88%. ABGs showed pH 7.25 PaCO2 25mmHg HCO3 12 PaO2 79mmHg FiO2 0.3. His electrolytes were Na 133 K 3.8 Cl 100. Despite adequate initial fluid infusion, patient remained hypotensive. The best hemodynamic drug to give is:

A) dopamine
B) norepinephrine
C) dobutamine
D) epinephrine

A

B) norepinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A patient with a necrotizing soft tissue infection on his right lower extremity was admitted to the ER. His vital signs were: BP 70/50 HR 110 RR 25 T 39. O2 sat 88%. ABGs showed pH 7.25 PaCO2 25mmHg HCO3 12 PaO2 79mmHg FiO2 0.3. His electrolytes were Na 133 K 3.8 Cl 100.

The acid base abnormality is:
A) normal anion gap metabolic acidosis
B) high anion gap metabolic acidosis
C) partially compensated respuratory acidosis
D) mixed respiratory alkalosis and metabolic acidosis

A

B) high anion gap metabolic acidosis

17
Q

Adequacy of fluid resuscitation in septic patients is best assessed with:

A) serial Hgb and Hct determination
B) anion gap
C) CVP
D) serum lactate

A

D) serum lactate

18
Q

65kg man was brought to the ER due to perforated gastric ulcer. On examination, he had dry oral mucosa, slight postural hypotension and tachy ardia. Assuming that he lost 10% TBW, how much IV fluid would you give?

A) 3L
B) 4L
C) 5L
D) 6L

A

B) 4L

19
Q

60M admitted at the SICU had breathlessness and Ow desaturation. He was intubated and hooked to mechanical ventilation. CXR sjowed pneumonic infiltrates. Which is true regarding the case:

A) has no risk factors for increased mortality
B) piperacillin-tazobactam is an adequate antibiotic forcempiric treatment
C) mechanical ventilation with high TV (>8ml/kg) is needed to improve oxygenation
D) IV antibiotic use within the past 90 days is a risk factor for MDR Pseudomonas, other gram negative bacilli and MRSA

A

D) IV antibiotic use within the past 90 days is a risk factor for MDR Pseudomonas, other gram negative bacilli and MRSA

20
Q

A patient at the ER with acute abdomen is hypotensive and tachycardic with a serum lactate of 4.0 mmol/L. Fluid resuscitation was done and a repeat serum lactate was 2.5mmol/L. Which statement is true regarding serum lactate?

A) serum lactate is a tissue-specific parameter used in measuring endpoints in resuscitation
B) lactate clearance is a prognostic indicator for improved survival
C) arterial sampld is superior to a venous sample
D) lactate measurement is not useful in traumatic hemorrhagic shock

A

B) lactate clearance is a prognostic indicator for improved survival

21
Q

Refeeding syndrome is associated with

A) severe hypoglycemia
B) fatal arrhythmias
C) thiamine is not essential
D) associated with enteral feeding

A

B) fatal arrhythmias

22
Q

65yo smoker has the following arterial blood gases:

pH 7.4
PaCO2 55mmHg
PaO2 60mmHg
HCO3 42mmol/L
FiO2 0.3
The acid-base disturbance is:
A) uncompensated respiratory acidosis
B) compensated respiratort acidosis
C) mixed respiratory acidosis /metabolic alkalosis
D) compensated metabolic alkalosis
A

C) mixed respiratory acidosis /metabolic alkalosis

23
Q

If you did an ABG in a patient with high output enterocutaneous fistula, the acid-base derangement most likely present is:

A) normal anion gap metabolic acidosis
B) high anion gap metabolic acidosis
C) mixed metabolic acidosis and respiratory alkalosis
D) no specific acid-base derangement can be predicted

A

A) normal anion gap metabolic acidosis

24
Q 
Which of the following antimicrobials does not possess anti-Pseudomonal activity?
A) cefotaxime
B) cefepime
C) levofloxacin
D) aztreonam
A

A) cefotaxime

25
Q

True regarding adrenal insufficiency in critical illness:

A) adrenal insufficiency is uncommon in critically ill patients
B) the principal manifestation of CIRCI is hypotension that is not responsive to volume resuscitation
C) trauma and cardiogenic shock are the leading causes of adrenal suppression in critically ill patients.
D) the glucocorticoid of choice in the treatment of CIRCI is intravrnous methylprednisolone.

A

C) trauma and cardiogenic shock are the leading causes of adrenal suppression in critically ill patients.

26
Q

What is the minimum MAP to ensure adequate tissue perfusion?

A) 45mmHg
B) 55mmHg
C) 65mmHg
D) 75mmHg

A

C) 65mmHg

27
Q

Total parenteral nutrition should be instituted in the following situations

A) inability to enteral feed for 1-2 days
B) sepsis
C) high output enterocutaneous fistula
D) none of the above

A

C) high output enterocutaneous fistula

28
Q

Refeeding syndrome is associated with which electrolyte imbalance?

A) hyperkalemia
B) hypocalcemia
C) hypernatremia
D) hypophosphatemia

A

D) hypophosphatemia

29
Q

45M was brought to the ER awake, complaining of abdominal pain. History revealed ingestion of a cup full of toilet cleaner 4 hours PTC. BP 140/90 HR 110 RR 24. Abdomen was soft with direct tenderness on the epigastric area. What will you do next:

A) NPO, givd IVF, stat blood workups, secure clearance for exploratory laparotomy
B) put patient on close VS monitoring and abdominal examination to monitor progress of abdominal pain, request for immediate EGD
C) insert NGT and do charcoal lavage to detoxift the ingested chemical, serial PE
D) give omeprazole IV stat one dose and request fot an abdominal CT with triple contrast

A

B) put patient on close VS monitoring and abdominal examination to monitor progress of abdominal pain, request for immediate EGD

30
Q

24F came in for the chief complaint of dysphagia to solid food, a barium swallow revealed a bird’s beak deformity

A) esophageal manometry will reveal an elevated lower esophagral sphincter pressure
B) esophageal manometry will reveal frequent peristalsis in the esophageal body
C) esophageal manometry will reveal increased intragastric pressure relative to the esophagral baseline
D) none of the above is true

A

A) esophageal manometry will reveal an elevated lower esophagral sphincter pressure

31
Q

35M came in for the chief complaint of epigastric pain. This has been recurring for the last 6 months and now he noticed difficulty in swallowing solid foods. EGD showed gastric rufal folds seen above the ceura of the diagram.
A) request for an upper GI study or an abdkminal CT scan with triple contrast to confirm the diagnosis
B) give antacids and PPIs for the medical treatment of the reflux dosease
C) request for an esophagral manometry to determine lower esophageal sphincter pressure
D) none of the above is an option

A

A) request for an upper GI study or an abdkminal CT scan with triple contrast to confirm the diagnosis

32
Q

60F with abdominal pain brought EGD finding of mass at the gadtric antrum and a biopsy of adenocarcinoma moderately differentiated. Abdominal CT scan done revealed a gastric antral mass woth noded at the celiac trunk and splenic hilum. What will you do next?
A) admit patient for clearance, subtotal gastrectomy with D1 plus lymphadenectomy
B) admit patient for clearance and advise tube jejunostomy then chemotherapy
C) admit patient for clearance and prepare for subtotal gastrectomy with lymphadenectomy and splenectomy
D) admit patient for clearance and subtotal gastrectomy with chemotherapy

A

C) admit patient for clearance and prepare for subtotal gastrectomy with lymphadenectomy and splenectomy

33
Q

In the treatment of gastric adenocarcinoma, the criteria for unresectability includes:

A) patient with CT scan finding of para-aortic lymoh nodes highly suspicious on imaging for malignancy
B) A patient with intraop finding of encasement of the splenic vessels
C) a patient with positive peritoneL dlyid cytology after diagnostic laparososcopy and peritoneal washings
D) none of the above

A

A) patient with CT scan finding of para-aortic lymoh nodes highly suspicious on imaging for malignancy

34
Q

65M on prolonged NSAID use for osteoarthritis came in for abdominal pain, epigastric arra with melenic stools. Which is true?

A) the overall risk of serious adverse GI evebts in patients taking NSAIDs is more than 3x for that of controls
B) age >60 is a factor that puts patients at increased risk of GI complications
C) PPIs are better in preventing GI complications compared to H2 blockers
D) all of the above is correct

A

D) all of the above is correct

Sample Exams (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions