TrueLearn Pretest

Question 1

Treatment for DVT in pregnancy?

Answer 1

Lovenox > heparin gtt, or SQH.

Question 2

Flail chest EAST guidelines for pain mgmt?

Answer 2

Epidural analgesia. Improve pain and PFTs compared to narcotics. Less mech vent days, shorter ICU, decrease VAP.

Question 3

Management of cecal volvulus?

Answer 3

Surgical resection with ileocolonic anastomosis if bowel not gangrenous. Do not decompress endoscopically.

Question 4

TeamSTEPPS. Team Strategies and Tools to Enhance Performance and Patient Safety?

Answer 4

Systematic approach to integrate teamwork into practice. Introduce strategies for the TEAM.

Question 5

Failure mode and effects analysis tool?

Answer 5

Forward looking approach - inductive reasoning to figure out what will fail.

Question 6

Human factors design?

Answer 6

recognize deficient designs that hinder workflow or allow people to bypass safety features. (like making people do a checklist)

Question 7

PDSA Plan Do Study Act cycle?

Answer 7

Test a change that is implemented.

Question 8

Where is stress induced gastritis seen?

Answer 8

Linear ulcerations noted in the gastric body and fundus.

Question 9

Modified JOHNSON peptic ulcer classification?

Answer 9

I. Lower lesser curve
II. Lower lesser and duodenal (acid)
III. Prepyloric (acid)
IV: Higher lesser curve
V. NSAIDs.

Question 10

Whipple triad?

Answer 10

Insulinoma. Neuroglycopenic sx (dizzy, sz, anx, confusion, personality change), low BG (<45), relief of sx with glucose.

Question 11

Frey syndrome after parotidectomy?

Answer 11

Gustatory sweating unilaterally when eating.
paras reinnervating sweat glands (starch iodine test). Tx: deodorant.

Question 12

Reported excess body weight loss with lap band, sleeve, RNY? at 2, 1.5, and 1.5 years respectively

Answer 12

Band: 35-60%
Sleeve 45-60%
RYGB 60-75%

Question 13

Recurrent Anal SCC?

Answer 13

APR.

Question 14

Anterior component separation?

Answer 14

External oblique

Question 15

Posterior component separation?

Answer 15

transversus abdominis

Question 16

Baseline energy requirement.

Answer 16

25 Cal/day

Question 17

Hodgkin lymphoma staging. I-IV

Answer 17

I. single site
II. 2+ sites above or below diaphragm
III. above & below
IV. involves nonlymphatic organs
Add a B (IIIB) if constitutional symptoms

Question 18

Portal perfusion pressure estimated by what hepatic vein measurement?

Answer 18

Hepatic venous pressure gradient (portal = wedged HV pressure) and hepatic vein (transjugular I.e.)

Question 19

Hepatic venous pressure gradient and clinical correlation?

Answer 19

<5 mm Hg normal
6-9 mm portal HTN clinically asx
10-12 varices
12+ variceal bleeding and ascites

Question 20

pediatric inguinal hernia mgmt?

Answer 20

reduce, admit for 24-48 hours to decrease edema, operate.

Question 21

CCK

Answer 21

I cells (small intestine)

Question 22

Gastrin

Answer 22

G cells (antrum, duo)

Question 23

Ghrelin

Answer 23

P/D1 cells, fundus

Question 24

Glucagon

Answer 24

alpha cells, pancreas

Question 25

Glucagon like peptide GLP

Answer 25

L cells, small and large intestine

Question 26

Glucose dependent insulinotropic peptide GIP

Answer 26

Kcells, small intestine

Question 27

Histamine

Answer 27

ECL and mast cells, stomach

Question 28

Motilin

Answer 28

Mo cells, small intestine

Question 29

Peptide YY

Answer 29

L cells, small and large intestine

Question 30

Pancreatic polypeptide

Answer 30

PP, pancreas

Question 31

Secretin

Answer 31

S cells, small intestine

Question 32

Somatostatin

Answer 32

Delta cells, pancreas, stomach, intestine

Question 33

Where is the cricopharyngeal/Killians triangle

Answer 33

between oblique fibers of thyropharyngeus and horitzontal fibers of the cricopharyngeus mm

Question 34

Pulsion vs traction diverticulum in esophagus

Answer 34

Pulsion: FALSE - Zenker/epiphrenic Traction: TRUE - mid esophagus (Histoplasmosis)

Question 35

LIfespan of platelet? Albumin?

Answer 35

9 days, 21 days

Question 36

Warfarin reversal

Answer 36

PCC (II, VII, IX, X); and give Vit K (12 hours to work, longer lasting) FFP (has all factors fibrinogen, albmin, lytes, C/S/antithrombin, tissue factor) but larger volume

Question 37

beztoluzumab

Answer 37

recurrent C diff with fidaxomicin

Question 38

Urethral injuries graded by AAST I-V

Answer 38

I. contusion (Foley) II. urethral stretch injury (Foley) III. partial disruption (surgical alignment) IV. complete disruption without separation (cystostomy) V: extensive separation (cystostomy endoscopic realignment)

Question 39

UES (15 cm cricopharyngeus) LES (40 cm) resting pressure?

Answer 39

UES: 50-70mm, 15 when swallowing LES: 10-20mm, 0 when swallowing

Question 40

Gastrin and motilin effect on LES

Answer 40

Increases

Question 41

Kenalog in scars? MOA

Answer 41

Increase FGF (fibroblast growth), decrease transforming growth factor B1 production/VEGF, insulin like growth factor-1 (AKA decrease colagen)

Question 42

preferred repair fo femoral hernia

Answer 42

McVay (mesh free) - conjoint (transv and internal) tendon suture to Coopers; with transition suture to incorporate sheving edge of inguinal ligament

Question 43

carotid triangle superior border (separates from submandibular triangle)

Answer 43

digastric posterior belly

Question 44

submandibular triangle vs submental triangle

Answer 44

digastric anterior belly

Question 45

submental vs muscular triangle

Answer 45

hyoid bone

Question 46

What do you monitor for dosing of heparin during vascular surgery

Answer 46

Activated clotting time 50-100 IU/kg cross clamping with ACT > 200.

Question 47

bowen disease

Answer 47

actininc keratosis > bowel CIS (4-6 mm margin resectino) > SCC

Question 48

GIST origin

Answer 48

interstitial cells of cajal; 90% have cKIT CD 117 mutation

Question 49

anterior vagus

Answer 49

arises from plexus of R/L vagus; 2 DIVISIONS hepatic division to liver and biliary anterior gastric: (ant nerve of Latarjet) to ant stomach

Question 50

posterior vagus

Answer 50

arises from plexus R/L vagus; 2 DIVISIONS celiac division to plexus (parasympathetic inflow) posterior gastric: (criminal nerve of grassi) to post stomach

Question 51

mycophenalate mofetil SE

Answer 51

leukopenia

Question 52

cyclosporine

Answer 52

renal, brain toxicity, gingival hyperplasia

Question 53

azathioprine

Answer 53

myelotoxicity

Question 54

sirolimus/everolimus SE

Answer 54

hypercholesterol, hyperTg, oral ulcer, proteinuria, thrombocytopenia

Question 55

mafenide acetate / sulfamylon

Answer 55

metabolic acidosis

Question 56

sulfadiazene ; silvadene

Answer 56

leukopenia

Question 57

silver nitrate

Answer 57

methemaglobinemia

Question 58

division during hepatectomy after chole & IOC; order of division

Answer 58

hepatic aa, portal vein, then bile duct

Question 59

how to repair positive leak test during pyloromyotomy?

Answer 59

single layer, absorbable, transversely with omental patch

Question 60

common gestation/development milestones

Answer 60

4th: esophagus/trach separation 6th: vagal innervation to esophagus, mucosal coating 7th: aortic blood to esophagus 9th muscular coating to esophagus

Question 61

rectal prolapse surgical options

Answer 61

modified ripstein: mobilize intraabdominally secure mesh to presacral fascia and lateral rectum altemeier: exteriorize through anus, full thickness incision and coloanal staple/handsewn delorme: circumferential mucosal incision 1 cm above dentate, remove mucosa longitudinal plication of muscularis propria, anastomose mucosal edges