USMLEasy

Question 0

Young straight male pt with pain with defection, slight bright red bleeding - most common cause?

Answer 0

Anal fissure > external hemorrhoid

Question 1

Esophageal hiatal hernia - when surgery?

Answer 1

Esophagitis or stenosis

Question 4

Patient after kidney transplant has elevated calcium – cause? Management?

Answer 4

Tertiary hypothyroidism (hypercalcemia secondary to time this parathyroid function after transplant)

Total parathyroidectomy and autotransplantation into forearm

Question 5

Epispadias – incomplete development of? Associated with?

Answer 5

Anterior urethra

#Cordee (ventral curvature of the penis)
#Undescended testes
#Inguinal hernias

Question 6

How to distinguish between acute and chronic DVT’s on duplex?

Answer 6

Large collaterals suggest chronic

Question 7

Patient is exposed to radiation – chance of developing thyroid tumor? Type of thyroid tumor? Treatment?

Answer 7

40%; papillary; total thyroidectomy

Question 8

Patient has splenic injury from trauma – only contraindication for non-operative management?

Answer 8

Peritoneal signs on abdominal exam (CT imaging of shattered spleen not an indication, positive DPL is not indication)

Question 9

Resuscitation for bleeding child?

Answer 9

#20 mg per kilogram bolus
#Repeat bolus
#Repeat bolus
#Blood transfusion

Question 10

Preferred thrombolytic agent in occlusion of bypass graft? Reocclusion rate?

Answer 10

Urokinase; 20% reocclusion rate within one year

Question 11

Pt with injury to common bile duct – surgical management?

Answer 11

choledochojejunostomy (Preferred over choledochoduodenostomy because less fistula formation)

Question 12

Contrast CT shows small, circular hypodense lesion with ring-like contrast enhancement

1. Cause if immunocompetent?
2. Cause if Immunocompromise?
3. If systemic signs of infection?

Answer 12

1. Metastatic cancer
2. Toxoplasmosis and CNS lymphoma’s
3. Brain abscess

Question 13

Positive crossmatch means?

Answer 13

Recipient has circulating antibodies that are cytotoxic to the donor lymphocytes

Question 14

Thrombin time assesses?

Answer 14

Fibrinogen

Question 15

Management of gunshot wound to the pancreas?

Answer 15

#Most which is simple drainage
#Injury to the major pancreatic duct – distal pancreatectomy
#Injury to head of the pancreas – Roux-en-Y Pancreaticojejunostomy

Question 16

Sign of left-sided portal hypertension? Acute hemorrhage due to this is treated with?

Answer 16

Gastric varices

Splenectomy

Question 17

Treatment for renal cell tumor?

Answer 17

#If under 4 cm, partial nephrectomy
#If larger, radical nephrectomy (remove a kidney, adrenal gland, perirenal fat)

Question 18

Large pulsatile mass found in right popliteal fossa. Likely diagnosis? Complications? When/what Surgery?

Answer 18

Popliteal artery aneurysm

#Embolization – 25%
#Thrombosis – 40% with resultant gangrene
#Aneurysm rupture – 5%

Surgery if symptomatic or greater than 2 cm

repair with excision of aneurysm and surgical bypass

Question 19

Ogilvie syndrome?

Answer 19

Massive cecal and colonic dilation without mechanical obstruction

#if under 10 cm without ischemia, NPO, NG tube, resuscitation
#It's over 10 cm, cautious colonoscopy

Question 20

Hurthle cell CA similar to what cancer? Differences?

Answer 20

Type of follicular cancer

#often multifocal and bilateral
#More likely to spread to local nodes and distant sites (higher mortality rate)

Question 21

Surgical management of ruptured esophagus?

If Patient has underlying motility disorder, stricture, or malignancy?

Answer 21

Primary repair and mediastinal drainage

Esophagectomy

Question 22

Patient with persistent gastric ulcer refractory to medical therapy. Also located 2 cm above pylorus – surgical management?

Answer 22

Partial gastrectomy with vagotomy and Billroth I reconstruction

Question 23

CEA level of 100 after colorectal resection – suggests?

Answer 23

Liver involvement

Question 24

Tracheostomy – where to enter trachea?

Answer 24

Second or third cartilage ring

Question 25

Patient with annular pancreas – surgical therapy?

Answer 25

Duodenoduodenostomy

Question 26

Carcinoid tumor at tip of appendix – surgical management?

Answer 26

#If 1 cm – appendectomy
#If 2 cm – right hemicolectomy

Question 27

How to evaluate patient for early ischemia of the colon?

Answer 27

Sigmoidoscopy