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101 Cards in this Set
- Front
- Back
Q300. association of BM with SBO
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A300. usually BM at very start of obstruction, followed by increasdd peristalsis and
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Q301. dx if there is stool on DRE of patient with SBO
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A301. ileus, NOT mechanical obstruction
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Q302. what is early post-op SBO
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A302. sx that occur <40d following surgery; results from narrowed lumen, exact cause not known
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Q303. w/u for post-op SBO
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A303. CT to rule out infection; exact cause not needed
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Q304. tx for post-op SBO
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A304. supportive care
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Q305. cause of chronic mesenteric ischemia
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A305. occlussion of 2/3 BV; Dz also seen in 3rd as well
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Q306. Dx of chronic mesenteric ischemia
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A306. if no ATH, use arteriograpyhy
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Q307. tx for chronic mesenteric ischemia
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A307. revasc with antegrade aortomesenteric bypass/perivisceral aortic endarterectomy; angioplasty; retrograde bypass from iliac artery
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Q308. when to operate on acute mesenteric ischemia
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A308. this is a surgical emergency!
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Q309. causes of acute mesenteric ischemia
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A309. embolism in SMA or celiac artery
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Q310. which part of the small intestines is spared in acute mesenteric ischemia? why?
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A310. prox jejunum b/c of collaterals
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Q311. tx for acute mesenteric ischemia
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A311. embolectomy; 2nd-look laparotomy should also be done if bowel doesn't appear viable
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Q312. when should a AAA be repaired
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A312. 5cm
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Q313. #1 cause of morbidity and mortality in AAA repair
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A313. cardiac complications
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Q314. how should AAA found on physical exam be confirmed
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A314. CT scan; don't use arteriography b/c it just shows the lumen of BV, can't dx aneurysm from this, although it will help to plan the operation
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Q315. what are the 2 types of AAA repairs; benefits of each
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A315. EVAR (endovascular aneurysm repair) - pts with copd, obesity, malig, etc get more protection from rupture with EVAR; open repair - stood the test of time, est as a tx
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Q316. disadvantages to EvAR
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A316. rquire imaging f/u every 3-6 mos; patient mortality of 2-3%
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Q317. presentation of AAA rupture
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A317. back pain; pulsaltile mass; hypotension
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Q318. management of acute pancreatitis
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A318. resuscitative measures/supp O2; monitor cardio-pulm status; CT abdomen
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Q319. complications of acute pancreatitis
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A319. hemorrhage; necrosis; fluid collection; infection; pleural effusion; -> pulm/renal probs
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Q320. process of infected pancreatic necrosis
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A320. 2/2 infx by bowel organisms; occurs w/i first few weeks of onset
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Q321. pancreatic abscess cause and tx
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A321. accumulation of pus and infectious debris; tx with surgical drainage
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Q322. tx of infectious pancreatic pseudocyst
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A322. percutaneous/operative drainage
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Q323. Ranson's criteria seen on admission
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A323. WBC >16,000; glucose >200; age > 55yo; AST >250; LDH >350
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Q324. Ranson's criteria following 48 hrs
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A324. HCt fall by 10%; Ca <8; BUN increase of 5; fluid requirement >6 L; base excess of >4; P02 <60
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Q325. value of Ranson's criteria
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A325. more criteria have more severe dz and increased risk of comlication and death
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Q326. what indicates severe acute pancreatitis
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A326. necrosis of pancreas; 50% have inx and increased microvasc permeability; -> increased volume los; decreased perfusion of kidneys, lungs, etc
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Q327. when should a contrast-enhanced CT of the pancreas be done?
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A327. if pancreatitis dx is in question; if no improvement in 3-5 days; severe pancreatitis based on ranson score (looking for necrosis)
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Q328. what, if seen on CT, wouldu indicate severe dz and increased risk of complications
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A328. 2+ extrapancreatic fluid collections or necrosis of >50% of pancreas
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Q329. management of necrotizing pancreatitis
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A329. 50% of time,; complicate by infection, so must adminster proph Antibiotics when necrosis is confirmed on CT
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Q330. how should gallstone pancreatitis be treated?
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A330. cholecystectomy after pancreatitis has resolved
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Q331. which Antibiotics penetrate pancreas
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A331. imipenem; cilistatin
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Q332. Tx for carotid artery dz
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A332. surgery should always be done on sx side 1st, if both are affected
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Q333. when should elective CEA be done
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A333. if 60% stenosis is seen, unless patient is high risk
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Q334. what is complication o fCEA or medical management of carotid artery dz
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A334. stroke can occur with either
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Q335. how is amt of stenosis determined in carotid artery dz
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A335. US; if that is unclear, do MR angiogram, carotid angiogram or CT reconstruction angiogram
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Q336. what are risk factors for CEA
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A336. prior radiation to the neck; coronary artery stent; recrrent coronary artery stenosis
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Q337. what is a short term tx for carotid artery dz
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A337. stent
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Q338. When should barium enema be used in dx diverticulitis
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A338. never- there is sig risk involved with intraeritoneal leakage of barium
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Q339. dx of diverticulitis
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A339. CT scan will show colonic wall thickening, mesenteric fat stranding; can see diverticulae
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Q340. complications of diverticulitis
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A340. perforation; abscess; bowel obstruction; fistula (#1 cause of fistulas in adults)
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Q341. tx of abscesses from diverticulitis
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A341. if small, Antibiotics; if big, CT-guided drainage + Antibiotics; if no imrpovement after 72 hrs, surgery
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Q342. if there is an increased risk of recurrence with diverticulitis, management?
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A342. elective surgical resection with primary anastamosis even if prior flare-up was treated conservatively
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Q343. how should uncomplicated diverticulitis be treated?
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A343. monitor hydration, give IV Antibiotics, bowel rest and observation
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Q344. how should complicated diverticulitis be treated?
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A344. surgical resection; colostommy; closure of the rectal stump; reanastomosis performed at a later date
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Q345. what is fascial dehiscence?
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A345. disruption of fascial closure within 3 days of operation, with or without operation
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Q346. complications of fascial dehiscence
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A346. enterocutaneous fistula; evisceration; incisional hernia
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Q347. risk factors for fascial dehiscence
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A347. failure of surgical technique, anesthetic relaxation; >70 yo; DM; infx; malnutrition; pulm dz
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Q348. tx of fascial dehiscence
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A348. wound care; elective repair of defect
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Q349. time frame that fascial dehiscence is most likely to occur?
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A349. up to 3 weeks following surgery, after that, fibrous scar formation has enough strengthh to prevent evisceration
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Q350. vitamins involved in wound healing
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A350. vitamin c, a, b6; (collagen cross linking)
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Q351. tx of ptx
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A351. tube thoracostomy/needle aspiration
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Q352. difference btwn primary and 2ndary spontaneous ptx
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A352. 1ary: from spont rupture of blebs; 2ndary: from bullous emphysematous dz, CF, CA, PCP, necrotizing infx, copd
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Q353. sx of tension ptx
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A353. dyspnea; jvd; decreased breath sounds; increased resondance; trachea shifts away from affected side
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Q354. tx perf of duo ulcers
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A354. if no h/o prior ulcers or + HP, omental patch closure and HP tx; if + h/o prior ulcers and - HP, highly selective vagotomy
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Q355. tx of perf gastric ulcer
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A355. + closure of perf or excise/resect ulcer w 1ary repair or Billroth I/II
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Q356. tx of obstructing gastric ulcer
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A356. antretomy and Whipple
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Q357. are H2 blockers or PPIs more effective in tx ulcers
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A357. PPIs
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Q358. string sign
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A358. seen in hypertrophic pyloric stenosis, showing narrowed pylorus
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Q359. stack of coins sign
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A359. intestinal obstruction
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Q360. tx for intussusception
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A360. radiographic reduction; if fails, open surgery
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Q361. incision through previous scar- good or bad?
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A361. good. promotes wound healing
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Q362. featuress of large bowel ischemia
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A362. minimal pain; see thumbprinting on barium enema; BVs are usually patent
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Q363. when should a colectomy be done on a patient with UC
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A363. 10-20 yrs with dz... (after 10 yrs, CA risk increases 4x)
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Q364. complication of typhoid fever
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A364. Peyer's patches bleed /perf in 2-3rd week following sx
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Q365. how to stop intractable bleeding
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A365. use laparoscopic towels to pack abdomen
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Q366. what is seen on EKG of patient with high Mg?; how can it be reversed
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A366. sim to increased K; CaCl2
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Q367. what is seen with low Na on EKG
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A367. nothing
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Q368. what is seen with low K on EKG
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A368. flattened T waves and U waves
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Q369. when is succussion splash seen in the abdomen
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A369. any sort of obstruction
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Q370. what are the most common causes of pyloric obstruction
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A370. duo ulcer; gastric CA
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Q371. how is mild Na deficiency tx?; severe Na defic?
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A371. fluid restriction; if CNS sx present, give hypertonic saline
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Q372. how is ARDS monitored
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A372. ABG
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Q373. surgery = physiological stress
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A373. surgery = physiological stress
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Q374. benefits of enteral feeding
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A374. preserves gut mucosal mass and nml gut flora
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Q375. benefits of parenteral feedings
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A375. good for rapid administration
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Q376. what happens if TPN is suddenly DCd?
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A376. rebound hypoglycemia,; give D10W when TPN is suddennly DCd
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Q377. what does surgery do to fluid levels
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A377. following surgery, increased cortisol levels --> increased sugar in serum --> increased urine output
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Q378. what TPN additive is good for liver encephalopathy
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A378. lactulose
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Q379. how is AAA dx?
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A379. U/S then CT scan to det true size
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Q380. A patient is diagnosed with invasive ductal adenocarcinoma. What is the most important factor in the staging of this patient’s cancer?
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A380. Lymph Node Involvement
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Q381. Which nerve, if damaged in an axillary dissection, will result in only a sensory deficit?
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A381. Intercostobrachial nerve
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Q382. What cancer drug can cause pulmonary fibrosis?
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A382. Bleomycin
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Q383. A 59-yo male presents with complaints of recurrent UTIs. On further questioning, it sounds as if the patient is also experiencing pneumaturia. What is the most likely underlying cause for this patient’s symptoms?
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A383. Diverticulitis; (Colorectal fistula is also a cause, but is very rare)
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Q384. What is considered the triangle of Calot in GB surgery?
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A384. Cystic Duct,; Common Hepatic Duct,; Cystic Artery
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Q385. A 73-yo female presents with nausea, vomiting, obstipation and abdominal distention. She is afibrile, with slight tachycardia and a distended abdomen without peritoneal signs. She has no History of surgery. What is the most likely cause of this patient’s bowel obstruction?
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A385. Gallstone Ileus; (may also present with pneumobilia)
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Q386. A critically ill hemodynamically unstable intubated patient on vasopressors with History of recent MI and long ICU course begins having fevers. Labs are: WBC 19,000, AST 100, ALT 45, ALK Phos 345, total bilirubin 3.0, direct bilirubin 2.8. Abdominal ultrasound shows no stones in the gallbladder. Dx?; What is next step in Tx given patient’s condition?
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A386. Dx: Acute Acalculous Cholecystitis; (due to biliary sludge secondary to inactivity of the biliary tree. It is seen in critically ill patients with prolonged periods of fasting or Parenteral nutrition, or in patients with multiple transfusions or trauma patients); Tx: Percutaneous Cholecystostomy; (until patient is stable enough to undergo a cholecystectomy)
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Q387. Type of Shock:; An 18-yo male restrained driver with tachycardia, hypotension, and a rigid abdomen
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A387. Hypovolemic shock
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Q388. Type of Shock:; An 80-yo nursing home resident, febrile, unresponsive, hypotensive, with gram-negative rods cultured in urine.
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A388. Distributive shock; (Sepsis or Anaphylaxis)
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Q389. Type of Shock:; A 16-yo male victim of a motor vehicle crash with hypotension, bradycardia and the inability to move or feel both lower extremities
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A389. Neurogenic shock; (seen in patients with spinal cord injuries; caused by a decrease in sympathetic output; CO, CVP, PCWP and SVR are all decreased)
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Q390. Type of Shock:; A 67-yo male in the medical ICU on 15L of oxygen by facemask, hypotension and crackles in the bases of both lungs
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A390. Cardiogenic shock; (seen in patients with acute MI and respiratory distress; CO is decreased and everything else is increased)
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Q391. What is Duke’s staging for Colon Cancer (A-D)?
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A391. A: limited to Mucosa; B1: into the Muscularis Propria; B2: through the Muscularis Propria; C1: into MP with positive LN; C2: through the MP with positive LN; D: Metastasis or Unresectable
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Q392. What is the proper medical Tx (post-colectomy) for Duke’s stage C Colon Cancer?; What common cancer Tx is not used in colon cancer?
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A392. 5-FU and Leucovorin (Levamisole); Radiation is not used in colon cancer; (only in rectal cancer)
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Q393. What is the Diagnostic Test for patients with Rectal Cancer?; What is the adjuvant Tx for T3-T4 Rectal Cancer? (2)
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A393. Diagnostic test: Endorectal Ultrasound; Tx: Pre-op Radiation Therapy and 5-FU
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Q394. A 52-yo female presents with 5-day history of increasing LLQ pain, N/V and fever. Two previous episodes of the pain were treated with Antibiotics. She is tachycardic, has LLQ pain and diffuse peritoneal signs. A CT shows air in the abdomen. Dx?; Next step?
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A394. Dx: Perforated Diverticulum; Next step: Emergency resection of the Sigmoid colon with diverting colostomy
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Q395. A 27-yo male presents with severe RLQ and testicular pain that began 5 hours ago. The pain is the worst he has ever experienced and is assoc with nausea. He is writhing in pain and cannot hold still as you talk to him. He is afebrile and has a WBC of 10,300. Diagnostic test?; Dx?
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A395. Diagnostic test: Urinalysis; (on every patient with RLQ pain); Dx: Kidney Stone
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Q396. An 80-yo female presents with vomiting 5 times that day which was thick and brown in appearance. She also complains of severe abdominal pain that began the previous night and has gotten worse and that she has had no BM or flatus throughout the day. She has no History of previous surgery and underwent a colonoscopy 1 month ago for chronic constipation, which elicited normal results. What is the most likely cause of this bowel obstruction?
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A396. Sigmoid Volvulus
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Q397. How is Total Body Water calculated in men and women?
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A397. Men: 60% of body weight; Women: 50% of body weight
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Q398. A patient’s recent blood glucose levels have been high at 500 mg/dL. This morning her sodium was 134 mmol/L. What is the corrected sodium level? (Eqn)
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A398. (Na + [glucose – 100] x 0.016) =; (134 + [500 – 100] x 0.016) = 140 mmol/dL
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Q399. How is plasma osmolality calculated? (Eqn); An osmolar gap is present if the measured and calculated osmolarity differ by how much?
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A399. (2 x Na) + (glucose/18) + (BUN/2.8); Differ by 15 mOsm/kg
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Q400. What causes a bluish discoloration of the periumbilical area?; What is another sign of this?
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A400. Fox’s sign: Retroperitoneal Hemorrhage; (ex: acute hemorrhagic pancreatitis); another sign: Ecchymosis or discoloration of flank; (Grey Turner’s sign)
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