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69 Cards in this Set
- Front
- Back
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A healthy adult presents for a pre-employment physical. What will be the largest component of his body by mass?
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B: Water
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An 80 year old man with a hx of ischemic cardiomyopathy is hypotensive and oliguric after major abd sx. Initial fluid resuscitation produces only transient improvements. He is transferred to the ICU for further management. A pulmonaryartery catheter could be used to measure all of the following except:
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C: Ejection Fraction
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A 25 year old man is injured in the arm with a knife. What is the 1st mechanism responsible for the hemostasis?
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B: Vessel Constriction
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A 27 year old woman is experiencing perioral and extremity numbness the morning after a neck operation. What is the cause of her symptoms?
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C: HYPOcalcemia
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A 55 year olf woman undergoes laparatomy for small bowel obstruction. During lysis of adhesions, an enterotomy is made in the obstructed, but viable, bowel, and a large amount of fecal looking bowel contents are spilled into the abd. The incision would now be considered what kind of wound?
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D: Contaminated
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A critically ill 55 year old man is in septic shock in the icu after removal of a nonviable small bowel. What is the most reliable measurement of arterial blood pressure?
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C: Aterial Line Mean
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Delayed primary closure would be the most appropriate wound closure technique for which of the following procedures?
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A: Removal of Perforated Appendix
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A 55 yo man with insulin dependent diabetes presents to teh ed with acute abd pain. his HR =130 bpm, bp=90/60, and T=101.8F, RR=28 breaths per minute. The adb exam demonstrates diffuse peritonitis. What should be the first step in the evaluation and management of this patient?
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A: Volume Resuscitation
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a 57 yo man underwent a laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP). He subsequently develops a persistant output of 100 cc of amylase rich fluid from a drain placed at the time of surgery. All of the following would be expected to prevent spontaneous resolution of this problem EXCEPT:
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A: Octreotide Administration
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For appropriate procedures, antibiotic prophylaxis for bacterial endocarditis should be adminstered in patients with a hx of which of the following?
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C: Aortic Valve Replacement
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Which of the following procedures would be expected to have the greatest impact on postoperative pulmonary function?
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C: Subtotal Gastrectomy
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Which of the following is a criteria for emergent preoperative dialysis?
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C: Pericardial Friction Rub
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Preoperative coagulation studies should be obtained on which if the following patients?
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C: A 70 year old jaundiced woman, prior to choledochojejunostomy
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Match the clinical situation with the appropriate type of drain:
Nasogastric decompenstation |
D: Sump Drain
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Match the clinical situation with the appropriate type of drain:
Spontaneous pneumothorax |
C: Underwater Seal Drain
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Match the clinical situation with the appropriate type of drain:
Diffuse peritonitis from perforated duodenal ulcer |
B: No drain
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Match the clinical situation with the appropriate type of drain:
Splenectomy for ruptured spleen |
A: Jackson-Pratt closed drain
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A 50 yo man is brought to the ER after falling 20 feet from a roof. He is complaining of dyspnea and BP=70/50. Breathsounds diminished on the left and there is tracheal deviation to the right. What is the best initial tx for this pt?
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C: Needle decompression of the left chest
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A pt undergoes a left scalene node biopsy to rule out CA of the lung. One hour later, the pet is cyanotic and dypneic; a marked tachycardia is accompanied by decreased breath sounds on the left. Which step is most likely to improve the patient's condition?
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D: Insertion of a left chest tube
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A pt is brought to the ED with a stab wound to the right chest in the fourth intercostal space in the midaxillary line. The pt is hypotensive, compains of SOB and is found to have absent breath sounds on the right side of the chest. Which step should come next in the management of this pt?
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C: Needle thoracentesis
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A tall thin 19 yo male presents to the ED with sudden onset chest pain, cough, and SOB. Breath sounds are absent in the left chest. Which of the following is an indication for surgery?
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E: History of one prior episode successfully treated with conservative management on the contralateral side.
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A chest radiograph of a 55 yo man involved in a high speed mva shows a widened mediastinum and pneumomediastinum. EKG shows sinus tachycardia with frequent PVCs.
All of the following maneuvers are appropriate at this time EXCEPT: |
D: Left thoracotomy
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A chest radiograph of a 55 yo man involved in a high speed mva shows a widened mediastinum and pneumomediastinum. EKG shows sinus tachycardia with frequent PVCs.
Expected physiologic changes due to blunt chest trauma include all but which of the following? |
B: Increased compliance
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A 70 yo pt on antibiotic therapy for necrotizing bacterial pneumonia is found to have a large pleural effusion.
In addition to continued antibiotics, what should be the next step in management of this pt? |
C: Thoracentesis
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A 70 yo pt on antibiotic therapy for necrotizing bacterial pneumonia is found to have a large pleural effusion.
A sample of pleural fluid is cloudy and thick, with a pH of 7.2. What should be the next therapeutic step? |
B: Chest tube drainage
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A routine chest radiograph for a 55 yo man with a 50py smoking history shows a peripherally located 1.5cm noncalcified lesion of the upper lobe of the left lung. No evidence of this lesion appeared on a chest radiograph 5 years earlier. What should be the next step in this pt's management?
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D: Bipsy
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A 35 yo man is involved in a high speen mvc. He arrives in the ER in respiratory distress. Radiographs taken during the initial eval reveal an air fluid level in the left chest. anagement includes all of the following EXCEPT:
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C: Urgent thoracotomy to repair the injury
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Which of the following forms of congenital heart disease is most common?
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E: Ventricular spetal defect
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A 32 yo man is referred for a 1.0 cm lesion of the right upper lobe of the lung. The lesion appears calcified. Previous chest radiographs taken 1 year prior demonstrates teh lesion to be present at the same size. Further workup and treatment would include which of the following?
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E: Observation and repeat chest xray
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A 57 yo male pt with a 60py smoking history is refered for a 1.5cm solitary mass in the right upper lobe. CT scan demonstrates no evidence of lymph node involvement. What should further workup or treatment include?
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D: Right upper lobectomy
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A 22 yo female is referred for evaluation of a 2 cm posterior mediastinal mass discovered on routine chest radiograp. What is he most likely diagnosis?
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C: Neurogenic tumor
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A 78 yo previously healthy man is admitted to the ED complaining of angina, dyspnea, and near syncope. EKG is normal and a loud systolic murmur is hear in teh second right interspace with radiation to the carotids. What is the most likely diagnosis in this patient?
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D: Aortic stenosis
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Which of the following is not a risk factor for coronary artery disease?
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D: Renal filure
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A 72 yo female pt is admitted with unstable angina. Cardiac cath reveals severe triple vessel coronary artery disease. The optimal treatment of this pt would include which of the following?
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A: Coronary artery bypass surgery
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A 72 yo pt with a hx of syncope and dyspnea presents for evaluation for peripheral vascular surgery . Physical exam reveals a systolic crescendo-decrescendo murmur that radiates to the carotid arteies. As he is symptomatic, his diseased valve would typically have an area of less that which of the following?
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A: 1 cm2
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A 29 yo man is evaluated for a cerebral vascular accident. Physcal exam reveals a systolic ejection murmur at the left second interspace and a fixed split second heart sounds. What is the most likely diagnosis?
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B: Atrial septal defect
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A 65 yo woman with a long hx of atrial fibrillation presents to teh ED with a hx of sudden onset of severe constant abd pain. After the onset of pain, she vomited once and had a large bowel movement. No flatus hasbeen passed since that time. Physical exam reveals a mildly distended abd, which is diffusely tender, although perotineal signs are absent. Ten years ago, she underwent an abd hysterectomy. What is the mst likely diagnosis in this patient?
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D: Acute embolic mesenteric ischemia
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A 60 yo woman develops weakenss in her right arm and leg, and she has some difficulty speaking. This condition resolves after 5 minutes and she has no residual symptoms. Her physician does not hear a carotid bruit and her EKG is normal. A carotid duplex ultrasound shows a 75% stenosis of the left carotid artery and an 80% stenosis of teh right carotid artery; both are confirmed by carotid arteriogram. What should be the next step in teh management of this patient?
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B: Left carotid endarterectomy
(repair the symptomatic one first--repairing both can result in a trache due to recurrent laryngeal nerve damage) |
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A 70 yo man who is a new pt presents with a hx of insulin dependent diabetes mellitus; renal insufficiency (serum creatinine 2.5); chronic obstructive pulmonary disease; and two myocardial infarctions, the most recent being 1 year ago. His ejection fraction is 35% and he has a right below the knee amputation, which he says was secondary to "peripheral vascular disease." Now the pt has a large pulsatile nontender abd mass.
All of the following studies would be appropriate EXCEPT: |
D: Colonoscopy
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A 70 yo man who is a new pt presents with a hx of insulin dependent diabetes mellitus; renal insufficiency (serum creatinine 2.5); chronic obstructive pulmonary disease; and two myocardial infarctions, the most recent being 1 year ago. His ejection fraction is 35% and he has a right below the knee amputation, which he says was secondary to "peripheral vascular disease." Now the pt has a large pulsatile nontender abd mass.
His workup demonstrates a 6.0 cm infrarenal aortic aneurysm with a 4cm left common iliac artery aneurysm and mormal remal arteries. He has normal external iliac arteries bilat with relatively normal femoral vessels. Pulmonary function tests indicate a forced expiratory volume in 1 sec (FEV1) to be 75% of the predicted value. The Persantine thallium scan shows an old scar but no reperfusion defect. What is the next step in this patient's management? |
Z: Get him a nicely padded box... but no really, the answer is:
D: Performing an aorto-bi-iliac bipass |
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A 67 yo woman notices a swollen right leg following a 6 hour plane flight. Which of the followin would be a reasonable next step for the treating physician?
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D: Order a venous duplex evaluation
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A 59 yo pt undergoes a craniotomy for a benign meningioma. On the tenth postop day, he is noted to have a swollen left calf and thigh.
What is the LEAST accurate method to diagnose the cause of the swollen leg? |
A: Physical Exam
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A 59 yo pt undergoes a craniotomy for a benign meningioma. On the tenth postop day, he is noted to have a swollen left calf and thigh.
If deep venous thrombosis is documented, initial treatment should include which of the following? |
B: Intravenous Heparin Therapy
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A 59 yo pt undergoes a craniotomy for a benign meningioma. On the tenth postop day, he is noted to have a swollen left calf and thigh.
After recovery from the acute illness, the pt returns in 6 months, complaining of persistant leg swelling. Which of the following would be the optimal long term management as initial treatment? |
E: Support Hose
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A 59 yo pt undergoes a craniotomy for a benign meningioma. On the tenth postop day, he is noted to have a swollen left calf and thigh.
This complication may have been prevented by all of the following measures except: |
D: Daily administration of a single dose of subQue unfractionated heparin starting 1 hours after the completion of surgery
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A 40 yo man has a subtotal thyroidectomy performed for Graves' isease. Several hours later, he complains of difficulty breathing. On exam, he has stridor and a markedly swollen, tense neck wound. What should be one of the first steps in the management of ths patient?
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D: Open the wound to evacuate the hematoma
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A 50 yo hypertensive man has a definitive biochemical eveidence of a pheochromocytoma. CT scan and MRI do not reveal any abnormalities and m-iodobenzylguanidine scanning is not readily available. What should be the next sep in the management of this patient?
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D: Selective venous sampling
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A 55 yo woman with progressive but pisodic muscle weakness is diagnosed as having myastenia gravis. Her chest radiograph is normal and reveals no evidence of mediastinal mass or tumor. Wha tis the most definitive treatment that can be offered this patient?
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C: Thymectomy
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A first degree relative of a patient found to hve advanced medullary carcinoma of the thyroid gland is referred for further evalution. Which screening measure is the choice for detection of medullary thyroid pathology?
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C: Stimulated serum calcitonin level (calcium and pentagastrin)
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If a firstdegree relative of a patientwith MEN-2A syndrome is found to have medullary pathology requiring surgical exploration of the thyroid gland, what should the preoperative screening include?
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E: Urinary vanillylmandelic acid and metanephrines
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A 60 yo female pt has a workup for episodic symptoms of palpitations, nervousness, and bizarre behavior, all of which tend to occur during fasting states. Biochemically, she is diagnosed as having an insulinoma. Wat is the best choice for localizing this tumor?
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E: Surgical exploration and intraoperative ultrasound
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A 55 yo female patient is evaluated for new onset diabetes mellitus. Her medical hx is largely unremarkable. Her physical exam is unrevealing except for the presence of an erythematous skin rash. Her further eval should include an investigation of the possibility of which of the following?
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B: Glucagonoma
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A 35 yo man presents with a left unilateral tinnitus and mild left sensorineural hearing loss. Which of the following statements is true?
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D: The patient should be assumed to have an acoustic neroma until proven otherwise.
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A 35 yo man has right sided serous otitis media anda right upper neck mass.
It is most important to evaluate this patient for which of the following? |
D: Cancer of the nasopharynx
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A 35 yo man has right sided serous otitis media anda right upper neck mass.
Which of the following will be the primary treatment for this tumor? |
E: Bilateral radiotherapy
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A 65 yo man is found to have a small invasive squamous cell carcinoma of the right vocal cord. The right vocal cord is paralyzed and a lymph node in the right anterior neck is 4 cm in diameter.
The stage of the tumor s which of the following? |
D: T3N2a
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A 65 yo man is found to have a small invasive squamous cell carcinoma of the right vocal cord. The right vocal cord is paralyzed and a lymph node in the right anterior neck is 4 cm in diameter.
Optimal treatment of the primary tumor should include which of the following? |
A: Total laryngectomy
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A 55 yo woman presents with complaint of a mass overlying the angle of the right mandible. She says the mass has been lowly enlarging over the past 2-3 years and that the mass is painless. On physical exam, it is firm and overlies the angle of the right mandible and the area between the angle and the tragus of the ear. Neurologic exam of the head and neck is completely normal.
Which ofthe following does this mass mostly likely represent? |
C: Benign mixed tumor of the parotid gand (pleomorphic adenoma)
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A 55 yo woman presents with complaint of a mass overlying the angle of the right mandible. She says the mass has been lowly enlarging over the past 2-3 years and that the mass is painless. On physical exam, it is firm and overlies the angle of the right mandible and the area between the angle and the tragus of the ear. Neurologic exam of the head and neck is completely normal.
What will be the optimal treatment for this lesion? |
D: Superficial parotidectomy
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In which of the following situations would the best results be obtained for an emergency department thoracotomy?
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E: Cardiac arrest following a stab wound to the chest
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A trauma patient undergoes exploraory laparotomy for severe blunt injury with a psotive diagnostic peritoneal lavage. After splenorrhaphy is performed for a splenic laceration, a retroperitoneal hematoma overlying the pancreas is explored. The pancreas is found to be transected overlying the vertebral bodies. What is the optimal management of this injury?
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B: Resection of the distal pancreas
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A 21 yo male is brought to teh ER after an assualt with a baseball bat. He has suffered obvious head trauma. He opens his eyes spontaneously, does not speak but makes incomprenesible sounds, and localizes to pain. What is his Glascow Coma score?
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D: 11
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A 50 year old man is brought to the ED immediately after suffering full thickness burns over the entire surgace of both upper extremities and the anterior chest and abdomen. His weight is approximately 155 pounds. Initial fluid resuscitation has been started with lactated Ringer's soln.
The initial resusciation rate should be approximately which of the following? |
B: 600 mL/hour
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A 50 year old man is brought to the ED immediately after suffering full thickness burns over the entire surgace of both upper extremities and the anterior chest and abdomen. His weight is approximately 155 pounds. Initial fluid resuscitation has been started with lactated Ringer's soln.
The patient responds to treatment. After 8 hours, the fluid rate should be changed to which of the following? |
A: 300 mL/hour
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A 22 yo previously healthy male presents with a 2 month history of fevers, night sweats and a 30 pound weight loss. On physical exam, he is found to have palable cervical and inguinal lymphadenopathy. A CT scan of the chest and abdomen reveals mediastinal and abdominal para aprtic enlarged lymph nodes. Excisional biopsies are performed on a cervical and inguinal lymph node. Both of these biopsies reveal lymphocyte depleted Hodgkins disease. What should be the next step in the management of this patient?
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D: Systemic chemotherapy
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A 55 yo patient with alcoholism who is still activly drinking present to the ED with hematemesis. The bleeding stops, and he undergoes upper endoscopy. This reveals large varices in the gastric fundus. Physical exam is notable for splenomegally and the absence of ascites. His PT is 14s, but his bilirubin and albumin are normal. An U/S and Dopple exam of teh abdomen reveal a small nodular liver, a large spleen, calcifications throughout the pancreas, a thrombosed splenic vein, and patent superior mesenteric and protal veins with hepaopetal flow. What is the recommended treatment for this patient?
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E: Splenectomy
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A 65 yo woman with no other significant part medical history presents with a large mass in teh right breast. The mass measures approc 6 cm in diameter and appears to be fixed to the chest wall. In additon, bulky adenopathy is present in the right axillary region. The patient states that the mass has been enlarging for the last several years.
Following mammography, what should be the next step in this patient's evaluation? |
B: Incisional or core biopsy
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A 65 yo woman with no other significant part medical history presents with a large mass in teh right breast. The mass measures approc 6 cm in diameter and appears to be fixed to the chest wall. In additon, bulky adenopathy is present in the right axillary region. The patient states that the mass has been enlarging for the last several years.
The diagnosis for this patient is invasive ductal carcinoma. A mammogram reveals no other lesion in the right breast and no abnormalities in the left breast. A CXR, bone scan, and iver function tests are all normal. What should the next step in the management of this patient involve? |
A: Neoadjuvant chemotherapy
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A 47 yo patient with a history of left sided nephrectomy for trauma 20 years ago presents with right flank pain and hematuria. Lab studies reveal a creatinine of 2.5mg/dL. WHich of the following is the appropriate management plan?
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D: Ultrasonography followed by urgent cystoscopy
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