ABSITE:

THE NITTY, GRITTY STUFFPART 3

The pre-transplant crossmatch involvesA) recipient lymphocytes & donor plasmaB) recipient plasma & donor lympocytesC) recipient macrophages & donor

globulinsD) recipient globulins & donor

macrophages

Adherence of leukocytes to the endothelium is due toA) integrinsB) P-selectinC) L-selectinD) E-selectin

The fluoroquinolonesA) are primarily effective in gram +

bacteremiaB) have low concentrations in bileC) chronic liver disease dramatically

affects pharmacokineticsD) are greater than 50% excreted

unchanged in the urine

The source of free oxygen radicals in reperfusion injury isA) superoxideB) hydrogen peroxideC) hydroxy radicalsD) xanthine oxidase

Marfan’s syndrome is associated with all of the following exceptA) aortic valve insufficiencysB) incomplete collagen formationC) abnormal bleedingD) decreased bone mass

The changes associated with a mucous producing villous adenoma of the sigmoidA) metabolic acidosisB) hypokalemiaC) urine pH 8.0D) serum HCO3 of 15

Complications of hypothermia includeA) convulsionB) tachycardiaC) diuresisD) hypercoagulation

A 30yo female attempts suicide with the ingestion of lye. Examination of the mouth & pharynx demonstrates erythema. Appropriate management isA) IVF, antibiotics & observationsB) esophagoscopy to level of the 1st burnC) esophagoscopy to include the stomachD) laparotomy, gastrostomy & TPN

A 68yo presents with signs of sepsis, substernal chest pain & air crepitus in the left neck. These symptoms & signs developed 16hr ago after forceful vomiting of a heavy meal. Treatment should includeA) chest tube, IVF & antibioticsB) left thoracotomy & repairC) right thoracotomy & repairD) laparotomy & repair

12hr following esophagoscopy & biopsy of an obstructing esophageal cancer, the patient presents with fever & substernal chest pain. Esophagogram reveals perforation of the distal esophagus. Appropriate treatment isA) esophageal tube suction, IVF &

antibioticsB) chest tube, esophageal suction, IVF &

antibioticsC) closure of the perforation, chest tube, IVF

& antibioticsD) esophagectomy & esophagogastrostomy

A patient is placed on IVF & NPO following an uneventful laparotomy. 12hr later the patient develops palor, sweating, hypotension & abdominal pain. On exam the upper abdomen is distended & tympanic with a succussion splash. Appropriate action isA) increase IVF & transfuse pRBCsB) return to the ORC) insert NGTD) provide ventilatory support

Splenectomy may be useful in the management ofA) hairy cell leukemiaB) malariaC) chromic myelogenous leukemiaD) sickle cell disease

A pulmonary function that would prohibit a successful pneumonectomy is A) FEV1 of 1000B) pCO2 47C) ability to climb 2 flights of stairsD) previous MI

The most common complication of a popliteal aneurysm is A) thrombosisB) embolizationC) ruptureD) neurolysis

The IMVA) drains the distal rectumB) passes lateral to the ligament of treitzC) joins the portal veinD) is medial to the aorta

The right renal artery passesA) anterior to the vena cavaB) anterior to the renal veinC) anterior to the renal pelvisD) anterior to the IMV

The muscle anterior to the femoral artery in the Hunter’s canal isA) adductor minimusB) adductor magnusC) quadriceps femorisD) vastus medialis

Which of the following group of drugs will provide effective treatment for hypertrophic subaortic stenosisA) inotropesB) Ca channel blockersC) ACE inhibitorsD) loop diuretics

The etiology of myasthenia gravis isA) insufficient AchB) motor nerve axonal degenerationC) decreased number of Ach receptorsD) overproduction of Ach esterase

The earliest sign of uncal herniation isA) unilateral pupil dilatationB) deep comaC) contralateral decerebrate posturingD) bilateral decerebrate posturing

A 30yo female with a history of dysmenorrhea & dyspareunia is found to have a tender 3cm smooth submucosal rectal mass. Appropriate treatment isA) danazolB) FlagylC) LARD) TAH-SBO

Treatment of a malignant melanoma 2mm in depth isA) excision with 1cm marginsB) excision with 2cm margins & sentinel

node biopsyC) excision with 4cm margins & prophylatic

node dissectionD) excision with 1cm margins & interferon

Malignant pheochromocytoma is clearly identified by which of the followingA) capsular invasionB) venous invasionC) invasion of adjacent structuresD) histological examination

The only certain sign of parathyroid malignancy isA) histologic featuresB) renal diseaseC) bone diseaseD) recurrence after resection

Proper treatment for a 3cm papillary thyroid cancer with tumor involving 4 lymph nodes isA) ipsilateral lobectomy with resection of

involved lymph nodesB) total thyroidectomyC) total ipsilateral lobectomy, near total

lobectomy on the contralateral side, & resect involved lymph nodes

D) total thyroidectomy, central compartment node dissection & modified radical neck dissection

Appropriate treatment for family members (without tumor) having a heterozygous RET proto-oncogene isA) observationB) total parathyroidectomyC) total thyroidectomyD) bilateral adrenalectomy

Failure to identify gamma radiation or blue dye in a sentinel node biopsy procedure is due toA) no evidence of metastatic diseaseB) incorrect FNA diagnosis of cancerC) failure of dye & radiolabeled colloid to

migrateD) absence of axillary lymph nodes

The appropriate ultrasound probe for examination of a breast mass isA) 1.5-2.5 mHzB) 3-3.5 mHzC) 5-5.5 mHzD) 7.5-10 mHz

Which of the following is the mediator that leads to relaxation of the sphincter of Oddi, is partially mediated by cholinergic stimuli, & has a diminished effect following vagotomyA) somatostatinB) glucagonC) cholecystokininD) gastrinE) secretin

The ilioinguinal nerveA) is a branch of the femoral nerveB) has a motor componentC) can be injured easily at the internal

spermatic ringD) provides sensation for the penis &

upper scrotumE) runs along the hypogastric vein

The spleen filters all of the following particles/cells exceptA) malformed erythrocytesB) T lymphocytesC) malarial parasitesD) steptococcus pneumoniaeE) platelets

After undergoing complete axillary node dissection for sentinel node positive breast cancer, your patient has difficulty with forced should adduction. She is having difficulty pulling herself out of her chair. There is concern about injury to which nerve?A) intercostal brachial nerveB) thoracodorsal nerveC) long thoracic nerveD) lateral pectoral nerveE) ulnar nerve

Stercoral perforations are defined asA) linear tears of the colon without

ischemic changesB) perforated ulcers caused by an

enlarging colonic carcinomaC) perforated colonic ulcers with necrotic &

inflammatory edgesD) perforated ischemic ulcers of the

terminal ileum

The most common cause of intrahepatic presinusoidal portal hypertension isA) alcoholic cirrhosisB) congential hepatic fibrosisC) schistosomiasisD) splenic vein thrombosisE) Budd-Chiari syndrome

Which of the following statements about burns is not trueA) in major burns, clinically significant

interstitial edema is seen in distant soft tissues secondary to a combination of mediators generated in the wound & hypoproteinemia

B) using the modified Brooke formula, during burn resuscitation adults should receive 2-4mg/kg/%burn/24hr of LR (1/2 in 1st 8 hr)

C) pigment (myoglobin) induced ATN is most common in patients who have sustained high-voltage electrical injury or deep thermal burns

D) patients who suffer chemical burns as a result of concentrated hydrofluoric acid may experience life threatening hypercalemia

Ranson’s criteria on admission for prediction of severity of acute non-biliary pancreatitis include all of the following exceptA) age >55B) WBC >16,000C) glucose >200mg/dlD) serum magnesium >1.5mg/dl

Which of the following statements about blunt carotid injury is not trueA) blunt carotid injury is frequently

associated with closed head injury or cervical spine injury

B) neurological deficits associated with blunt carotid injury are frequently absent on admission, but do develop within 12hr of injury

C) more than 50% of patients with uncomplicated carotid artery dissection as a result of blunt trauma have a reasonably good neurologic outcome

D) arterial dissections as a result of blunt trauma are best managed by anticoagulation

Enterocutaneous fistula management in a stable patient should include all of the following exceptA) establishment of controlled drainage &

skin protectionB) immediate corrective surgeryC) provision of adequate nutritionD) prevention of fluid & electrolyte

depletion

A 47yo paraplegic patient is brought to the ER with abdominal distention. He has not had a bowel movement in several days. The abdomen is distended & minimally tender without evidence of peritoneal signs. A KUB massive distention of the colon. The next step in management should includeA) IV vancomycinB) IVF & immediate laparotomyC) colonoscopic decompressionD) CT of the abdomenE) diagnostic laparoscopy

A 7 yo child undergoes general anesthesia for repair of an inguinal hernia. 10min into the operation, the patient is noted to have a temp of 104, tachycardia, & diffuse skeletal muscle rigidity. The most appropriate treatment for this situation isA) hyperventilation to achieve pCO2

<25mmHgB) dantrolene sodiumC) SC heparin sodiumD) IM epinephrineE) none of the above

A 67yo smoker undergoes a chest CT to evaluate a 1cm lung nodule on chest x-ray. The CT scan demonstrates mediastinal adenopathy. The next step in the workup should beA) MRI of the chest & abdomenB) liver-spleen scan to evaluate for

metastasesC) chemotherapy consultationD) radiation consultationE) bronchoscopy & mediastinoscopy

A 65 yo man presents with moderate epigastric pain of 2 wks duration radiating to his back. Evaluation reveals a 3cm tumor in the head of the pancreas. All the following conditions would preclude tumor resectability, exceptA) presence of extrapancreatic diseaseB) evidence of tumor extension to the SMAC) evidence of tumor extension to the

celiac axisD) a patent SMV-portal vein confluenceE) involvement of a single lymph node in

the hepatic hilum

An established indication for coronary artery bypass grafting remainsA) critical left main diseaseB) triple vessel disease with normal

ventricular functionC) 2 vessel disease of the right coronary &

left circumflex arteriesD) distal left anterior descending artery

diseaseE) right coronary artery disease with

congestive heart failure

When performing ERCP, a sphincterotomy is indicated inA) acute biliary pancreatitis with common

bile duct stone at ERCPB) gallstone pancreatitis without CBD stone

present at ERCP when cholecystectomy is not possible

C) recurrent acute pancreatitis with sludge present in the biliary tract in the post-cholecystectomy patient

D) acute biliary pancreatitis during pregnancy

E) all of the above

Guidelines for minimizing morbidity during lap ccy in patients with hepatic cirrhosis include all of the following exceptA) using an open technique with the Hasson

trocarB) using a right paramedian trocar approachC) using an argon beam coagulatorD) performing a subtotal cholecystectomy in

cases of severe inflammationE) using open cholecystectomy more

frequently

Which of the following is true concerning necrotizing pancreatitisA) less than 30% of patients develop

infected necrosisB) infection is the main determinant of

prognosisC) infected necrosis is an uncommon

indication for surgery in acute necrotizing pancreatitis

D) sterile necrosis is usually treated operatively

E) surgery is not indicated in acute necrotizing pancreatitis

A 27yo umpire wearing no protective gear is inadvertently struck in the chest by a player’s bat. He lost consciousness for 30sec after impact. During EMS transport, vital signs are 102/76, 114, 22, 97% on 2L NC. On arrival to the ER, the patient is awake & alert, c/o chest pain. He has ecchymosis & tenderness over his sternum. Lungs are clear, heart sounds tachycardic with no murmurs. His physical exam is otherwise normal.

Which of the following is the best screening tool for assessing blunt cardiac injury?A) CK, CK-MBB) EKGC) transesophageal echoD) transthoracic echoE) troponin

A 65 yo woman presents to the ER with a swollen right calf. She has a hx of lung ca & is receiving chemotherapy. DVT is suspected, & a D-dimer test is ordered, the result of which is highly positive. Records of previous blood tests show that this patient’s D-dimer levels were always higher than normal.

What is the next step in the management of this patient?A) order a BNP to rule out heart failure

caused by chemotherapyB) order compression ultrasonographyC) order a venogramD) no further evaluation

The patient is found to have DVT of the calf with extension to the right proximal vein. Anticoagulation therapy should be initiated. Which of the following is a relative contraindication to anticoagulation?A) brain metastasisB) GI bleeding in the past 6 monthsC) platelet count < 60,000D) severe hypotension

The patient is prescribed unfractionated heparin. All the following are adverse effects associated with unfractionated heparin exceptA) elevated PTTB) osteoporosisC) thrombocytopeniaD) worsening renal failure

EMBRYOLOGY

Ileal atresiaVascular insult

Duodenal atresiaLack of revacuolization from solid cord

Name 2 pancreatic enzymes that are secreted in their active formsAmylaseLipase

True or FalseGlucagon increases myocardial

contractility & HRTRUE

Most common cause of pneumaturiaDiverticulitisSigmoid cancerOthers: crohn’s disease, radiation colitis

Where is the SA node Junction of SVC & RA

Where is the AV node Junction of coronary sinus & RA

Most likely reason for inguinal hernia recurrence after laparoscopic repairMigration of mesh

Treatment for urokinase overdoseAmicar (e-aminocaproic acid)

Inhibits fibrinolysis blocks the conversion of plasminogen to plasmin

What is the first muscle to be paralyzedEyes, face

What is the last muscle to be paralyzeddiaphragm

True or FalseLast to go….first to come backTRUE!!!!

HEAD & NECK TUMORS

0.5cm squamous cell cancer of vocal cord which is mobileRadiationT1 lesion

1cm lesion extending to supraglotic larynx with impaired mobility, clinically negative nodeRadiationT2 lesion

HEAD & NECK

Squamous cell cancer of vocal cord that is fixed & extends to contralateral cordResection & radiationT3 lesion

HEAD & NECK

True or FalseAdenoid cystic carcinoma of parotid gland

invades into the facial nerveTRUEMalignant cancer total parotidectomy, resection facial nerve, ipsilateral MRND, radiation

4 malignancies that are decided on clinical basis (can’t depend on histology)Cystosarcoma phylloidesPheochromocytomaMalignant thymic tumorParathyroid cancer

CROHN’S OR ULCERATIVE COLITIS

Crypt abscessesUlcerative colitis

GranulomasCrohn’s

CobblestoningCrohn’s

CROHN’S OR ULCERATIVE COLITIS

Serpiginous ulcersCrohn’s

PseudopolypsUlcerative colitis

ORDER OF TREATMENT

MEN 1Total parathyroidectomy with auto-

transplantationPancreatic tumorPituitary tumor

MEN2aAdrenalectomyThyroidectomyPituitary

ORDER OF TREATMENT

MEN2bAdrenalectomyThyroidectomy

Most common pancreatic endocrine tumor Insulinoma

Most common pancreatic endocrine tumor in MEN syndromesGastrinoma