Test Q's

Question 1

You find a small lipoma on your pt. You are working at a small aid station. What can you do?

Answer 1

You can remove a small lipoma

• be careful they can be icebergs
• can be vascular

Question 2

3-0 vs 2-0?

Answer 2

0.001 vs 0.01

3-0 is smaller than 2-0

2 is rope (chest tubes)

Question 3

High spine injury can lead to

Answer 3

PE 2/2 immobilization

Question 4

Spinal vs epidural anesthesia where does the anesthetic go?

Answer 4

Spinal (suparachnoid block) - into the subarachnoid space (CSF)

Epidural - into the epidural space

Question 5

Spinal vs epidural anesthesia who administers?

Answer 5

Spinal - anesthesiology service

Epidural - can be don by others

Question 6

Spinal vs epidural anesthesia uses?

Answer 6

Spinal - lower abd, lower extremity, GU and GYN procedures

Epidural - rib fractures

Question 7

Spinal vs epidural anesthesia volume of anesthesia?

Answer 7

Spinal - small amount of fluid

Epidural - continuous drip

Question 8

Spinal vs epidural anesthesia each block?

Answer 8

Spinal - sympathetic, sensory AND motor

Epidural - sensory BUT NOT motor

Question 9

Post op pt who is oliguric or anuric (MC complication of central nerve block)

You find >1L of fluid in the bladder, what do they need?

Answer 9

Foley catheter

• they DO NOT need superpubic or a diuretic

Question 10

Reversal agents

Narcotic:

Benzodiazepine:

Answer 10

Narcotic: naloxone

Benzo: flumazenil

Question 11

Be able to differentiate

• Pulmonary edema
• atalectisis
• ARDS

Answer 11

Pulmonary edema
- volume overload (CHF etc)

ARDS

• interstitial fluid
• doesnt respond to diuretics
• must intubate

Atalectisis
- collapsed alveoli from not coughing

Question 12

Presentation of fat emboli vs pulmonary emboli

Answer 12

Fat

• 6-24hrs pst injury
• petechiae
• normal D dimer

Pulmonary embolus

• time: whenever (prob DVT)
• pos D dimer
• verchow’s triad (high spine inj)

Question 13

Pt was in a car/motorcycle crash not wearing a helmet. Suffered a high spinal injury. What is the concern?

Answer 13

They can’t move so they get a PE

- stasis

Question 14

What are the MC causes of post operative oliguria?

Answer 14

BPH

Dehydration

Question 15

Post operative oliguria with BPH as the cause. What is the tx?

Answer 15

1st thing to try is to cannulate the bladder

• NOT SUPRAPUBIC DRAIN

Question 16

MC nosocomial infection?

Answer 16

Surgical site infections

- 36%

Question 17

Post op pt with small fever , x ray has streaky lines

Answer 17

Atalectasis

- not pneumonia (that would have higher fever)

Question 18

“On my exam” Pleural effusion pt will have ___ fluid caused by ____?

Answer 18

Exudative fluid

Pneumonia

Question 19

AAA’s are at an increased risk for rupture if?

Answer 19

> 6cm in size

Expansion >0.6cm/yr

Question 20

Elective AAA repair?

Answer 20

Misnomer, >5.5cm and asymptomatic; you must get it repaired

- elective means its not an emergency and you can get it repaired with a scheduled surgery not an emergent one

Question 21

Not mentioned specifically as a test q but he keeps saying it:

How to avoid the MC 5 causes of death with trauma pts?

Answer 21

1. Talk to the pt
2. Get them naked
3. Roll them over and shoot a side CXR

Question 22

Chronic Mesenteric ischemia pts will present w?

Answer 22

• Food fear - post prandial abdominal pain
• weight loss
• diarrhea
• N/V

Question 23

Pt with low(ish) ABI
Smoker
Pain when walking

Answer 23

Atherosclerotic peripheral disease

• stop smoking
• increase exercise

Question 24

Hard signs for surgery with a vessel injury?

Answer 24

Pulsatile bleed
Expanding hematoma
Bruit/thrill
Pulseless/cool extremity
Sensory deficit

Question 25

Penetrating injuries in the extremities can be observed (not surgerized) if?

Answer 25

Hemodynamically stable No fx No hard signs of arterial injury ABI >0.9

Question 26

MC hernia?

Answer 26

Inguinal Femoral is most commonly found in women but the MC in women is still inguinal Men MC = inguinal

Question 27

(Endo lecture) B blockers treat? A blockers treat?

Answer 27

B-blocker - thyrotoxicosis - prevent thyroid storm A-blocker - pheochromocytoma (adrenals)

Question 28

MEN 1

Answer 28

Werner’s syndrome | - hyperparathyroidism

Question 29

Men 2

Answer 29

Sipples syndrome - medullary thyroid ca - pheochromocytoma

Question 30

Pheochromocytoma tx?

Answer 30

Control HTN w A-blocker then a B-blocker (in this order)

Question 31

Type of surgeon for the following: 1. Pituitary adenoma 2. SC lung ca 3. Carcinoid tumor (gut) 4. Medullary carcinoid (thyroid)

Answer 31

1. Pituitary adenoma - neurosurgeon 2. SC lung ca - thoracic surgeon 3. Carcinoid tumor (gut) - anybody 4. Medullary carcinoid (thyroid) - head/neck

Question 32

Management of hormonally inactive adrenal mass?

Answer 32

>5 cm - adrenalectomy <5 cm - confirmed benign - repeat CT in 3-6 mo

Question 33

Differentiate acute mastitis from breast abscess

Answer 33

Mastitis: - no organization or mass (abscess) - continue to breast feed Abscess (cellulitis) - definite mass, organizing infection - systemic symptoms - stop nursing

Question 34

Risk factor for breast cancer?

Answer 34

``` Female Age 1st degree relative Bx w atypia High fat diet BRCA 1 - 50-70% risk BRCA 2 - 40% risk ```

Question 35

Not risk factors for breast cancer?

Answer 35

``` Breast feeding FMHx (not 1st degree) OCPs Breast augmentation Mastitis hx Fibrocystis ```

Question 36

Which pathology results have the worst prognosis?

Answer 36

Triple negative breast cancer

Question 37

Eczematoid/crusted lesion on the nipple or areola that is refractory to steroids >1 week

Answer 37

Paget’s disease (breast cancer) | BAD sign

Question 38

When i sentinel node BX is done and found to have spread what is a treatment that will be done after removing the node?

Answer 38

External beam radiation