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Abdominal aortic aneurysms (AAA) are fairly common in the vascular surgeon's office and are well-studied. Endovascular aneurysm repair (EVAR) is quickly becoming the standard of care for infrarenal AAA repair. The 30-day mortality for endovascular repair is BLANK#1, whereas open surgery carries a BLANK#2 which is statistically significant

#1 = 1.6% #2 = 4.8%

Surgical resection with microscopic negative margins is the treatment of choice for #1 [large or small], non-BLANK BLANK tumors (XXXTs).

#1 small, #2 non-metastatic gastrointestinal stromal tumors (GISTs).

BD (Branch Duct) IPMN without findings concerning for malignancy and less than [BLANK#1] cm should be reimaged every [BLANK#1 time], those [BLANK#2 #-#] cm should be reimaged [BLANK#2 time] later to ensure no growth, those [BLANK#3 #-#] cm should be reimaged every [BLANK#3 time]

#1) 1cm, 2-3years #2) 1-2cm, 1year #3) 2-3cm, 3-6mon

For ventral hernias greater than [BLANK#1 length] cm, the best repair is [BLANK#2 procedure]

#1) 2cm #2) fascial closure with mesh placement

Patients with suspicion or confirmed diagnosis of Barrett's esophagus (BE) need an endoscopic surveillance. Patients with nondysplastic BE are recommended to have a repeat endoscopy in [#1 Amt of Time], and those with indeterminate dysplasia are recommended to undergo a repeat examination in [#2 Amt of Time] after optimization of proton pump inhibitor therapy. A standardized biopsy protocol for surveillance includes random 4-quadrant biopsies every [#3 Length] in nondysplastic BE and every [#4 Length] in dysplastic BE in addition to targeted sampling of focal mucosal abnormalities.

#1) 3 to 5 years #2) 3 to 6 months #3) 2cm #4) 1cm

BD IPMN greater than [BLANK#1 length] in diameter or those BD IPMN with findings concerning for cancer should undergo a [BLANK#2 surgery name], provided the disease is still resectable.

#1) 3cm #2) Whipple procedure

Which is a better order? #1) 4.0 mg or 4mg #2) 0.4 mg or .4mg

#1) 4mg, no trailing 0s #2) 0.4mg, use leading 0s

Which of the following represents the correct percentage of blood supply of the liver that is provided by the portal vein? #1 What percentage of the blood supply is provided by the hepatic artery? #2

#1) 75% #2) 25%

This patient has a 6 cm incisional hernia from a previous midline laparotomy after a sigmoidectomy. Small hernia defects [< BLANK#1 length] cm may be repaired primarily with [BLANK#2 technique]. For larger defects (> [same blank#1] cm) or multiple small defects in close approximation, [BLANK#3 technique] is preferred to decrease rates of recurrence. The hernia sac should be reduced and the fascia circumferentially cleared of surrounding tissue by [BLANK#4 length] cm in order to provide healthy fascia for repair.

#1) >4cm #2) permanent or long-acting absorbable suture #3) mesh repair #4) 3-4cm

Of the three types of IPMN, [type BLANK#1] IPMN has the least risk of containing malignancy and management is based on size, cross-sectional imaging findings, and fluid analysis. If this type of IPMN is greater than [BLANK#2 length] in diameter, it should be resected.

#1) Branch Duct (BD) or refered to as Side Branch #2) 3cm

The posterior border of the femoral canal is BLANK#1's ligament. The BLANK#2's ligament forms the anterior boarder of the femoral canal.

#1) Cooper's #2) inguinal/Poupart's

[BLANK#1 type] hernias are caused by a weakness in the transversalis fascia and are present in [BLANK#2 age&gender]

#1) Direct inguinal #2) older males

Analysis of Pancreatic Cystic Fluid: SCN: Location: #1 - Evenly or Tail or Head Cytology: #2 - Pigmented histocytes or Bland periodic-acid Schiff + or Mucinous Viscosity: #3 - Low or High or Increased Amylase: #4 - High or Low CEA: #5 - <200ng/mL or <0.5ng/mL or >200ng/mL k-ras mutations: #6 - negative or positive

#1) Evenly #2) Bland periodic-acid Schiff + #3) Low #4) Low #5) <0.5ng/mL #6) negative

Analysis of Pancreatic Cystic Fluid: Pseudocyst: Location: #1 - Evenly or Tail or Head Cytology: #2 - Pigmented histocytes or Bland periodic-acid Schiff + or Mucinous Viscosity: #3 - Low or High or Increased Amylase: #4 - High or Low CEA: #5 - <200ng/mL or <0.5ng/mL or >200ng/mL k-ras mutations: #6 - negative or positive

#1) Evenly #2) Pigmented histocytes #3) Low #4) High #5) <200ng/mL #6) negative

Analysis of Pancreatic Cystic Fluid: Intraductal papillary mucinous neoplasm (IPMN): Location: #1 - Evenly or Tail or Head Cytology: #2 - Pigmented histocytes or Bland periodic-acid Schiff + or Mucinous Viscosity: #3 - Low or High or Increased Amylase: #4 - High or Low CEA: #5 - <200ng/mL or <0.5ng/mL or >200ng/mL k-ras mutations: #6 - negative or positive

#1) Head #2) Mucinous #3) High #4) High #5) >200ng/mL #6) Positive

BLANK#1 is the most common primary hepatic malignancy and is one of the most prevalent solid malignancies worldwide. About BLANK#2 [%] of cases arise in patients with chronic liver disease. Although any condition that produces cirrhosis may lead to this condition, the most common cause is BLANK#3

#1) Hepatocellular carcinoma (HCC) #2) 90% #3) viral hepatitis

[BLANK#1 type] inguinal hernias are repaired in an urgent and emergent fashion, respectively. [BLANK#2 type] inguinal hernias can be repaired in an elective manner. [BLANK#3 type] inguinal hernias can be observed, but [BLANK#4 type] femoral hernias should be repaired.

#1) Incarcerated or strangulated #2) Symptomatic, reducible #3) Asymptomatic #4) asymptomatic

The central calcification surrounded by multiple cysts is pathognomonic for serous cystadenoma and the fluid in the cyst of a serous cystadenoma is BLANK#1 in carcinoembryonic antigen (CEA) while that in the mucinous cystic neoplasm is BLANK#2 in CEA.

#1) Low (<200ng/mL) #2) High (>200ng/mL)

BLANK#1 is a common complication after a roux-en-y gastric bypass surgery. It may occur in up to BLANK#2 of patients following roux-en-Y gastric bypass.

#1) Marginal ulceration #2) 15%

Diastasis - Regardless of approach (surgery or weight loss/exercise), to provide an effective repair, BLANK#1 of the BLANK#2 is required.

#1) Plication #2) Rectus Sheath

Diastasis - Surgical repair can be offered in patients suffering from poor BLANK#1 function and BLANK#2 effects.

#1) Poor Abdominal Wall Function #2) Pulmonary effects

What are the 6 relative contraindications to laproscopic hernia repairs?

#1) Previous or planned pelvic or lower abdominal operation #2) Pelvic radiation #3)Recurrent hernia following previous laparoscopic repair #4) Incarcerated hernia #5) Large scrotal hernia (greater than 3 cm) #6) Ascites (TAPP should be avoided; however, TEP is an option in some patients)

Pelvic Radiation is a [RELATIVE or ABSOLUTE] contraindication of laproscopic hernia repair?

#1) Relative contraindication Due to difficulty accessing the preperitoneal space. Open approach is generally used for these patients.

Analysis of Pancreatic Cystic Fluid: MCN: Location: #1 - Evenly or Tail or Head Cytology: #2 - Pigmented histocytes or Bland periodic-acid Schiff + or Mucinous Viscosity: #3 - Low or High or Increased Amylase: #4 - High or Low CEA: #5 - <200ng/mL or <0.5ng/mL or >200ng/mL k-ras mutations: #6 - negative or positive

#1) Tail #2) Mucinous #3) Increased #4) Low #5) <200ng/mL #6) Positive

#1) What is the treatment of choice for perforated appendicitis with abscess (or phlegmon)? (stable patient) #2) What is the treatment for acute appendicitis?

#1) percutaneous drainage and IV antibiotics #2) laparoscopic appendectomy

The most common cause of esophageal varices is BLANK#1 usually caused by liver cirrhosis due to hepatitis C, non-alcoholic steatohepatitis (NASH), or alcoholic hepatitis. When endoscopic/beta-blockade fails or when the problem recurs the next best option is BLANK#2

#1) portal hypertension #2) transjugular intrahepatic portosystemic shunt (TIPS).

A BLANK#1 is a common finding following inguinal herniorrhaphy. Generally, no specific intervention is indicated, and it is best managed with BLANK#2.

#1) scrotal hematoma #2) reassurance

What are the 3 absolute contraindications to laparoscopic inguinal hernia repair?

#1) strangulated hernia #2) Inability to tolerate insufflation/pneumoperitoneum #3) Active infection

Epigastric hernias are defects in the abdominal midline between the BLANK#1 and the BLANK#2.

#1) umbilicus #2) xiphoid process

Abdominal wall hernias are broadly classified according to the region of the abdominal wall in which they occur. These regions include the BLANK X4 #1, #2, #3, and #4. Abdominal wall hernias can also be classified by etiology as either BLANK#5 or BLANK#6.

#1-4) ventral region, pelvis, groin, and flank #5) congenital #6) acquired

spontaneous bacterial peritonitis (SBP) It is usually treated with BLANK#1 unless cultures require other antibiotic coverage. BLANK#2 can be given as an adjunct therapy to decrease in-hospital mortality.

1) Cefotaxime 2) IV albumin

What are the 4 ways you can repair a Femoral Hernia?

1) Cooper's Ligament repair, 2) Mesh Plug 3) Suture Repair 4) Laparoscopic Techniques

Bergman's triad & what is it associated with?

1) mental status change, 2) petechiae (axilla/thorax), 3) dyspnea Associated with: fat emboli syndrome

Borchardt's triad? and what is it associated with?

1) sudden onset of severe upper abdominal pain 2) recurrent retching without vomitus 3) inability to pass an NGT Associated with: Gastric Volvulus

Spontaneous bacterial peritonitis develops in approximately #-#% of patients with ascites for over a year.

10-25%

Up to BLANK cm of unilateral advancement of the abdominal wall can be achieved with release of the external oblique aponeurosis.

10cm

spontaneous bacterial peritonitis (SBP) The diagnosis requires an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count of at least #??? cells/mm3 (0.25 x 109/L) and a positive ascitic fluid bacterial culture without an obvious intra-abdominal source of infection.

250

Hepatic abscesses occur in only [#-#%] of individuals with amebiasis.

3% to 7%

Approximately BLANK% of femoral hernias will present emergently due to incarceration or strangulation.

40%

The expected excess weight loss after 2 years following Roux-en-Y gastric bypass is approximately:

60%

Using this modality, what is the maximum size of a bleeding vessel that can be safely sealed with minimal thermal spread?

7mm

How high should the temperature be in order to completely vaporize the cells leading to cellular destruction?

90-100Deg C, 194-212Deg F

Which of the following increases the risk of developing a surgical site infection after synthetic mesh repair of a ventral hernia?

Drain Placement

Patients with a history of gastroesophageal reflux disease (GERD) who present with dysphagia need an BLANK to rule out an intraluminal pathology

EGD

BLANK with BLANK and BLANK stent placement is the best option of abscess cavities communicating with a bile duct.

Endoscopic retrograde cholangio pancreatography (ERCP) with endoscopic papillotomy and transpapillary stent placement is the best option of abscess cavities communicating with a bile duct.

BLANK are midline defects in the linea alba, between the xiphoid and umbilicus.

Epigastric Hernias

Medical records can be emailed to unencrypted email addresses - True or False

FALSE - According to the U.S. Department of Health and Human Services, even though the Privacy and Security Rules require reasonable safeguards to be in place to protect PHI when using electronic communication, patients do have the right to receive a copy of their medical records by unencrypted email if the individual requests this (HHS.gov, 2016).

The risk of incarceration and/or strangulation is much higher in a BLANK hernia.

INGUINAL Due to the narrow neck, the risk of incarceration and/or strangulation is much higher than in an inguinal hernia

BLANK are due to failure of fascial tissues to heal and close following laparotomy (or laparoscopy),

Incisional Hernias

What is the most common complication of PEG placement?

Infection at the PEG Site

Which should be used for writing an order for International Unit? IU, International Unit

International Unit

The most recent data show that the following are the estimated weight loss for various bariatric procedures: Laparoscopic banding ?% Sleeve gastrectomy ?% Gastric bypass ?% Duodenal switch ?%

Laparoscopic banding ~40-55% Sleeve gastrectomy ~54-69% Gastric bypass ~61% Duodenal switch ~70%

Irish Node?

Metastatic left axillary lymph node

Which is the best way to write an order? MS, MS04, MgSO4, Morphone Sulfate, Magnesium Sulfate

Morphone Sulfate, Magnesium Sulfate

Krukenberg Tumor?

Ovarian mass from gastric metastasis

Abdominal aortic aneurysms (AAA) are fairly common in the vascular surgeon's office and are well-studied. Endovascular aneurysm repair (EVAR) is quickly becoming the standard of care for infrarenal AAA repair. Studies have shown a decrease in mortality for those patients with diameter:

Over 5.5CM

What is the treatment for h. pylori?

PPI plus 2 antibiotics. best choices are: amoxocillian, metronidazole, tetracycline, and clarithromycin

First line therapy for acute lymphangitis is:

Penicillin

BLANK is a drug of choice in the asymptomatic patient with esophageal varices. This will not, however, reduce the incidence of new varices.

Propranolol

Prior history of gallstonesDiabetes mellitus suggests [Pyogenic or amebic] liver abscess?

Pyogenic

Serum bilirubin concentration is often elevated for [Pyogenic or amebic] liver abscess?

Pyogenic

What's the N Staging of Gastric Cancer?:

REGIONAL NODES N1 = 1-6 Nodes N2 = 7-15 Nodes N3 = >15 Nodes

BLANK is an anatomic term describing a condition in which the two rectus muscles are separated by an abnormal distance.

Rectus abdominis diastasis (RAD; diastasis recti, divarication of the rectus abdominis, abdominal muscle separation)

BLANK testing in patients with hydatid disease of the liver is associated with varying rates of false positives and false negatives.

Serological

T Staging for Gastric Cancer

T1 = Invades lamina propria T2 = Invades muscularis propria or subserosa T3 = serosa T4 = adjacent structures

EQUATION: Sensitivity is:

TP/(TP+FN)

True or False - Providers may utilize text message communication with a patient to discuss a patient's protected health information.

TRUE - HIPAA does not specifically prohibit text messages or email communication of protected health information.

Diagnosis of hepatic metastases of colon adenocarcinoma is typically made by:

abdominal CT scan

Although there is no standard way to access the abdominal cavity prior to pneumoperitoneum, [BLANK method] with access under direct visualization may provide a safer route for complex patients.

an open cut-down technique

In patients with penicillin allergy requiring treatment for coverage of gram-negative infections, [BLANK] is a valuable alternative to penicillin and penicillin based derivatives

aztreonam

The most common arrhythmia created by laparoscopy is:

bradycardia

Acute lymphangitis is most commonly caused by:

group A streptococci

Sister Mary Joseph nodule

hard nodule in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary, or pancreas

A BLANK is the most important predictor of malignant potential and poor prognosis in gastrointestinal stromal tumor

high mitotic index

SURGICAL ENERGY: In the coagulation mode, the electrosurgical unit generates an [interrupted (or modulated) or continuous (unmodulated)], [low or high] voltage current, dispersed over a [small or large] surface area

interrupted (modulated) & high-voltage & large surface area

After a roux-en-y gastric bypass surgery, a ulcer is most likely to form on the BLANK side of the anastomosis.

jejunal side The jejunal mucosa is irritated from the gastric acid it is now exposed to at the new gastrojejunal anastomosis.

What is the best antibiotic choice for a resistant MRSA infection?

linezolid

Virchow Node?

metastatic left supraclavicular lymph node

The treatment of Amoebic liver abscesses is a course of:

metronidazole

Incarcerated hernias should be repaired using an BLANK approach in most cases.

open

Strangulated hernias should be repaired using an BLANK approach

open

Which of the following treatment modalities provides the least chance of reoccurrence of a 6 cm incisional ventral hernia? (Open)

open repair with primary tissue repair and synthetic mesh placement

An indirect hernia is noted by a sac that resides lateral to the inferior epigastric vessels and is primarily the result of a BLANK.

patent processus vaginalis.

Epigastric hernias usually contain BLANK

pre-peritoneal fat

A Spigelian hernia occurs along the BLANK line

semilunar

Which of the following is the most common site of perforation during colonoscopy?

sigmoid colon

Which should be used in writing an order for Units? U, u, unit, cc

unit others may be mistaken

How does the ultrasonic scalpel cut through tissue?

vibrating at 50,000 Hz

Exposure to resource-limitedsettings suggests [Pyogenic or amebic] liver abscess?

Amebic

Serum bilirubin concentration is usually normal for [Pyogenic or amebic] liver abscess?

Amebic

Blumer Shelf

An anterior nodule palpable on rectal examination suggesting drop in metastasis

BLANK [technique] to access the lateral abdominal wall during components separation is associated with major wound morbidity.

Creation of large lipocutaneous flaps

What is the major cause of pyogenic liver abscesses?

Cholangitis Currently, cholangitis is the major cause of pyogenic liver abscess, due to obstruction from biliary malignancies and stone disease.

What is the risks of a surgical site infections based on wound classification? Clean: ? Clean-contaminated: ? Contaminated: ? Dirty: ?

Clean: 1-5% Clean-Contaminated: 3-11% Contaminated: 10-17% Dirty: >27%

C-BLANK, C-BLANK, or C-BLANK plus M-BLANK are appropriate parenteral prophylactic antibiotics for surgeries of the colon.

Cefoxitin, cefotetan, or cefazolin plus metronidazole

All BLANK hernias should be repaired

Femoral

The primary treatment of diastasis is BLANK and BLANK;

Weight Loss & Excercise

SURGICAL ENERGY: In the cutting mode, the electrosurgical unit generates an [interrupted (or modulated) or continuous (unmodulated)], [low or high] voltage current, dispersed over a [small or large] surface area

continuous (unmodulated), low voltage, small area - more rapid tissue heating.

CHOP Chemotherapy?

cyclophosphamide, doxorubicin, vincristine, prednisone

Which should be used for writing an order for time between doses? Q.D., QD, q.d., qd (daily), Q.O.D., QOD, q.o.d., qod, daily, every other day

daily or every other day