Surgery - END (Part 1) Flashcards
- When is open surgical drainage indicated for intraabdominal abscess? *
A. Good window for percutaneous puncture
B. Ongoing contamination is identified
C. Multiple abscesses less than 1 cm
D. Large solitary abscess
B. Ongoing contamination is identified
This option is the most appropriate for open surgical drainage because it addresses situations where the contamination or infection cannot be controlled adequately by less invasive means. In cases of ongoing contamination, such as from a gastrointestinal tract perforation or complex abscesses that cannot be resolved with percutaneous drainage alone, open surgery allows for direct access to thoroughly manage and eliminate the source of infection, clear the abscess, and potentially repair any associated anatomical defects. This approach helps prevent further spread of infection and facilitates more effective treatment of the underlying condition.
- What is the risk of Hepatitis C and HIV-1 transmission with blood transfusion? *
A. 1:1,000,000
B. 1:10,000,000
C. 1:500,000
D. 1:100,000
A. 1:1,000,000
Transmission of hepatitis C and HIV-1 has been dramatically minimized by the introduction of better antibody and nucleic acid screening for these pathogens. The residual risk among allogeneic donations is now estimated to be less than 1 per 1,000,000 donations and hepatitis B approximately 1 per
300,000 donations. (See Schwartz 10th ed., p. 102.)
- During inspiration the inflamed gallbladder touches the examiners fingers resulting in the sudden cessation of inspiration *
A. Charcot sign
B. Rovsing’s sign
C. Obturator sign
D. Murphy’s sign
D. Murphy’s sign
Rationalization: Murphy’s sign is a clinical sign where palpation of the inflamed gallbladder during inspiration causes pain and a sudden stop in inspiratory effort. This is typically indicative of acute cholecystitis.
- Which of the following is commonly seen in Ehlers-Danlos syndrome (EDS)? *
A. Spontaneous thrombosis.
B. Small bowel obstructions.
C. Abnormal scarring of the hands with contractures.
D. Direct or recurrent hernias in children.
D. Direct or recurrent hernias in children.
Ehlers-Danlos syndrome (EDS) is a group of 10 disorders that present as a defect in collagen formation. Over half of the affected patients manifest genetic defects encoding alpha chains of collagen type V, causing it to be either quantitatively or structurally defective. These changes lead to “classic” EDS with phenotypic findings that include thin, friable skin with prominent veins, easy bruising, poor wound healing, atrophic scar forma-tion, recurrent hernias, and hyperextensible joints. Gastrointestinal (GI) problems include bleeding, hiatal hernia, intestinal diverticula, and rectal prolapse. Small blood vessels are fragile, making suturing difficult during surgery. Large vessels may develop aneurysms, varicosities, arteriovenous fistulas, or may spontaneously rupture. (See Schwartz 10th ed., p. 246.)
- A chronically debilitated patient with spinal cord injury develops a 3 cm diameter non healing ulcer over the greater trochanter and malleolus is best managed by *
A. Wound debridement
B. Frequent turning
C. Adequate nutrition
D. All of the above
D. All of the above
All of the above
Rationalization: Management of pressure ulcers in patients with spinal cord injury includes a multifaceted approach: wound debridement to remove necrotic tissue, frequent turning to relieve pressure, and adequate nutrition to support healing and tissue repair.
- Which of the following statement/s is/are TRUE *
A. The initial insult, whether hemorrhage, injury or infection, initiates both neuroendocrine and inflammatory mediator response
B. Magnitude of the physiologic response is not proportional to the degree and duration of the shock
C. Etiology of shock varies, qualitative nature of response to shock is similar, with common pathways in all types
D. A and C
E. All of the above
D. A and C
Rationalization:
* (A) The initial insult (be it hemorrhage, injury, or infection) does initiate both a neuroendocrine and inflammatory mediator response, which is crucial in the body’s adaptive mechanism to stress.
* (B) The magnitude of the physiological response is indeed proportional to the degree and duration of the shock, indicating that more severe or prolonged insults result in a more intense response.
* (C) While the etiology of shock can vary (hypovolemic, cardiogenic, distributive, etc.), the qualitative nature of the body’s response involves common pathways, including the activation of stress and inflammatory responses.
- A 74 year old woman with a history of coronary artery bypass surgery and myocardial infarction is brought to the hospital because of severe abdominal excruciating pain that suddenly began 8 hours ago. She is confused and disoriented. The patient appears gravely ill with unstable vital signs. Abdomen is distended without muscle guarding and tenderness is difficult to evaluate. What do you think is happening to the patient with regards to her abdomen? *
A. Inflammation
B. Perforation
C. Obstruction
D. Ischemia or infarction
Ischemia or infarction
Rationalization: Given the patient’s history of cardiovascular disease and the sudden onset of severe abdominal pain accompanied by confusion, disorientation, and unstable vital signs, the most likely diagnosis is mesenteric ischemia or infarction. This condition can present with abdominal distension and pain out of proportion to physical findings, often making it a challenging diagnosis.
- The key to the correction of metabolic alkalosis will be the replacement of *
A. Chloride
B. Bicarbonate
C. Carbonic acid
D. None of the above
Chloride
Rationalization: Metabolic alkalosis often results from a chloride-deficient state, which can occur with conditions like vomiting or diuretic use. Replacing chloride, typically with saline solutions, helps restore the balance of electrolytes and correct the alkalosis.
- The 1st line formula for stable patient with intact GI tract. *
A. High protein formula
B. Isotonic formula with fiber
C. Low residue isotonic formula
D. Calorie Dense formula
Isotonic formula with fiber
Rationalization: For a stable patient with an intact gastrointestinal tract, an isotonic formula with fiber is generally recommended. This type of formula supports normal bowel function and prevents complications related to feeding, such as diarrhea or constipation.
- The infection involves apocrine glands in axilla, inguinal and perineal regions *
A. Cellulitis
B. Hidradenitis suppurativa
C. Furuncle
D. Carbuncle
Hidradenitis suppurativa
Rationalization: Hidradenitis suppurativa is a chronic inflammatory condition affecting the apocrine sweat glands, especially in areas like the axilla, groin, and perineal regions. It is characterized by recurrent abscesses, nodules, and scarring.
- Supplementation of which of the following micronutrients improves wound healing in patients without micronutrient deficiency? *
A. Vitamin A
B. Selenium
C. Zinc
D. Vitamin C
A. Vitamin A
Rationalization:
* Vitamin A: The supplementation of vitamin A is beneficial in wound healing even in non-deficient individuals. It enhances collagen synthesis, increases the inflammatory response necessary for healing, and improves the function of macrophages at the wound site. Vitamin A has been shown to overcome the negative effects on wound healing caused by conditions like corticosteroid use, diabetes, tumor formation, cyclophosphamide, and radiation exposure. In severely injured or stressed patients, increased doses of vitamin A are recommended, and supplementation can significantly improve wound healing outcomes.
* Vitamin C: Although vitamin C is crucial for collagen formation and immune function, which are vital for wound healing, there is no evidence that supplementation in non-deficient patients offers additional benefits in wound healing.
* Zinc: Zinc is critical for wound healing, but the benefits of supplementation have only been demonstrated in zinc-deficient patients. There is no evidence to support improved wound healing with zinc supplementation in patients who are not deficient.
* Selenium: There is no specific evidence suggesting that selenium supplementation improves wound healing in non-deficient individuals.
- What is FALSE about peritoneal adhesions? *
A. Intra-abdominal adhesions are the most common cause of small bowel obstruction.
B. Operations in the upper abdomen have a higher chance of causing adhesions that cause small bowel obstruction, especially involving the jejunum.
C. Most peritoneal adhesions are a result of intra-abdominal surgery.
D. Adhesions are a leading cause of secondary infertility in women.
Operations in the upper abdomen have a higher chance of causing adhesions that cause small bowel obstruction, especially involving the jejunum.
Rationalization: This statement is false because operations in the lower abdomen, particularly involving gynecological and colorectal surgeries, are more likely to cause adhesions that lead to small bowel obstructions. Upper abdominal surgeries typically have a lower incidence of causing obstructive adhesions.
- Which of the following in NOT commonly seen in healing of cartilage? *
A. Slow to heal
B. Often heal without structural defects
C. Hyaline cartilage restores functional and structural integrity
D. Synthesis of collagen dependent on chondrocyte
Often heal without structural defects
Rationalization: Cartilage is known to be slow to heal due to its avascular nature. When it does heal, it often does so with structural defects; typically, hyaline cartilage does not restore functional and structural integrity fully and forms fibrocartilage instead, which is structurally and functionally different.
- Who is the physician who reduced mortality of puerperal fever by requiring caregivers to rinse their hands with chlorine water prior to examination of patients? *
A. Joseph Lister
B. Louis Pasteur
C. William Osler
D. Ignaz Semmelweis
Ignaz Semmelweis
Rationalization: Ignaz Semmelweis, a Hungarian physician, is famous for dramatically reducing the incidence of puerperal fever by introducing hand disinfection with chlorine water for doctors who performed autopsies before examining patients in maternity wards.
- Which enteral formula has glutamine, arginine omega 3 fatty acid. *
A. Elemental formula
B. Isotonic formula with fiber
C. Immune enhancing formula
D. Calorie Dense formula
Immune enhancing formula
Rationalization: Immune-enhancing formulas contain specific nutrients such as glutamine, arginine, and omega-3 fatty acids, which are known to support the immune system and are beneficial in critical care and surgical patients to help reduce complications and promote healing.
- What type of cell peak at about a week post injury and bridge the transition from inflammatory to the proliferative phase of healing? *
A. Fibroblast
B. Polymorphonuclears
C. Lymphocytes
D. Macrophage
Macrophage
Rationalization: Macrophages play a crucial role in wound healing, peaking in number about a week after injury. They help in transitioning from the inflammatory phase to the proliferative phase by removing debris, releasing growth factors, and attracting fibroblasts that synthesize new tissue.
- A 38 y/o male seafarer developed abdominal pain that localized to the right lower quadrant 3 days ago. Physical examination showed a BP of 130/ 80, PR 105, Temperature of 39 C, his abdomen is tender on Right lower quadrant with hypoactive bowel sounds. White blood cell count is 25,000 with predominance of neutrophils. What is the body’s response to limit progression of disease? *
A. Diaphragmatic pumping mechanism
B. Phagocytosis and mucus trapping of microbes
C. Containment by omentum
D. Presence of resident microflora
Containment by omentum
Rationalization: The omentum plays a critical role in containing intra-abdominal infections by adhering to and walling off areas of inflammation or infection, such as an inflamed appendix, thereby limiting the spread of infection within the abdominal cavity.
- What polypeptides are named from cells from which they first derived and produced to stimulate cellular migration and proliferation? *
A. Growth factors and cytokines
B. G proteins
C. Ion channels
D. Enzyme linked receptors
Growth factors and cytokines
Rationalization: Growth factors and cytokines are polypeptides produced by various cells in the body. They are crucial in signaling during cellular processes, particularly in stimulating migration and proliferation of cells during processes such as wound healing and tissue regeneration.
- Which growth factor has been formulated and approved for treatment of diabetic foot ulcers? *
A. Keritinocyte growth factor
B. IGF-1
C. Laminin-5
D. IL-8
E. PDGF
PDGF (Platelet-Derived Growth Factor)
Rationalization: PDGF is approved for use in the treatment of diabetic foot ulcers. It promotes the growth of new blood vessels and granulation tissue, which can help in healing chronic, non-healing ulcers.
- Tensile strength of wound reaches normal levels after how many days? *
A. Never
B. 7 days
C. 30 days
D. 1 year
1 year
Rationalization: While wounds can gain significant tensile strength in the first few months after injury, it typically takes up to a year for a wound’s tensile strength to approximate normal levels, usually reaching about 70-80% of the strength of uninjured skin.
- The early integrity of anastomosis is dependent on what factors? *
A. Mucosal repair
B. Fibrin seal on the serosa
C. Both of the above
D. None of the above
Both of the above
Rationalization: The early integrity of an anastomosis relies on mucosal repair to restore continuity of the gastrointestinal tract and on fibrin seal formation on the serosa to provide immediate stability and prevent leakage.
- When a long bone fracture is repaired by internal fixation with plates and screws *
A. Callus at the fracture site forms more rapidly.
B. Direct bone-to-bone healing occurs without soft callus formation.
C. Endochondral ossification is more complete.
D. Delayed union is prevented.
Direct bone-to-bone healing occurs without soft callus formation.
Rationalization:
Precise racture reduction and fixation allows the racture to heal bone-to-bone without the soft callus formation and endochondral ossification, which are characteristic of closed fracture management. However, internal reduction does not prevent delayed union, especially when infection for poor blood supply are present. (See Schwartz 10th ed., p. 249.)
- Which of the following is FALSE regarding healing of full-thickness injuries of the GI tract? *
A. Extraperitoneal segments of bowel that lack serosa have higher rates of anastomotic failure.
B. Serosal healing is essential to form a water-tight barrier to the lumen of the bowel.
C. The greatest tensile strength of the Gl tract is provided by the serosa.
D. Collagen synthesis is done by fibroblast and smooth muscle cells.
E. There is an early decrease in marginal strength due to an imbalance of greater collagenolysis versus collagen synthesis.
The greatest tensile strength of the GI tract is provided by the serosa.
Rationalization: This statement is false. The greatest tensile strength of the gastrointestinal tract is provided by the muscularis layer, not the serosa. The serosa contributes to sealing and isolating the injury but does not provide significant tensile strength.
- The minimum volume of urine to expel body waste is *
A. one liter
B. 500 cc
C. 800 cc
D. 600 cc
500 cc
Rationalization: The minimum volume of urine required to expel waste from the body in a day is approximately 500 cc. This amount is necessary to eliminate waste products and maintain a stable internal environment effectively.