Surgery NMS
A 50-year-old man is brought to the emergency department immediately after suffering full-thickness burns over the entire surface 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 solution. The initial resuscitation rate should be approximately which of the following?
300 mL/hour B 600 mL/hour 900 mL/hour 1,200 mL/hour 1,500 mL/hour
A 21-year-old male is brought to the emergency room after an assualt with a baseball bat. He has suffered obvious head trauma. He opens his eyes spontaneously, does not speak but makes incomprehensible sounds, and localizes to pain. What is his Glasgow Coma Scale (GCS) score?
8 9 10 D 11 12
A 72-year-old patient with a history of syncope and dyspnea presents for evaluation for peripheral vascular surgery. Physical examination reveals a systolic crescendo-decrescendo murmur that radiates to the carotid arteries. As he is symptomatic, his diseased valve would typically have an area of less than which of the following?
A 1 cm2 1.5 cm2 2 cm2 3 cm2 4 cm2
The patient responds to treatment. After 8 hours, the fluid rate should be changed to which of the following?
A 300 mL/hour 600 mL/hour 900 mL/hour 1,200 mL/hour 1,500 mL/hour
Preoperative coagulation studies should be obtained on which of the following patients?
A 35-year-old woman on aspirin, prior to varicose vein surgery A 65-year-old diabetic man, prior to inguinal hernia repair C A 70-year-old jaundiced woman, prior to choledochojejunostomy A 45-year-old woman prior to bilateral prophylactic mastectomy with transverse rectus abdominus myocutaneous flap reconstructions A 50-year-old man with stable angina, prior to coronary artery bypass
Which of the following are potential sequelae of benign prostatic hyperplasia?
A Bladder stone formation Recurrent urinary tract infections secondary to prostatitis Prostate cancer Bladder cancer Organic impotence
Which of these statements is true?
A Brain metastases occur more frequently than primary brain tumors. The Cushing's response is the tachycardia and hypertension seen with mass lesions of the pituitary. The Cushing's response is bradycardia and hypotension seen with terminal brain herniation. The Cushing's response is the maintenance of cerebral perfusion pressure against variations in systemic blood pressure. Primary brain tumors are more common than metastatic brain tumors.
A 72-year-old female patient is admitted with unstable angina. Cardiac catheterization reveals severe triple-vessel coronary artery disease. The optimal treatment of this patient would include which of the following?
A Coronary artery bypass surgery Observation Medical management (nitrates, β-blockers) Coronary angioplasty Tissue plasminogen activator
Which of the following physiologic changes occurs as a result of carbon dioxide pneumoperitoneum?
A Decreased pulmonary compliance due to diaphragm elevation and increased abdominal pressure Metabolic alkalosis from systemic absorption of carbon dioxide Increased cardiac output as a result of increased venous return Decreased systemic vascular resistance Decreased mean arterial pressure
A 42-year-old female patient is diagnosed with gastroesophageal reflux and is started on medical therapy. Which of the following would be an indication for surgical antireflux procedure?
A Development of esophageal stricture(s) Barrett's esophagus with severe dysplasia Esophagitis by biopsy High lower esophageal sphincter pressure demonstrated by esophageal manometry Slow and uncoordinated swallowing by barium study
A 5-year-old boy sustains a laceration to the cheek. It is bleeding profusely. What is the best way to initially control the bleeding?
A Direct pressure Clamps Cautery Suture ligature Dissolving clips
A 37-year-old intoxicated man is struck by the bumper of a car while he is crossing the street. He sustains a comminuted closed proximal one-third tibia and fibula fractures. The fractures are stabilized with an external fixator 1 hour after the man arrives at the trauma bay. Approximately 2 hours after surgery, he has a severe pain that is not controlled by intravenous morphine. The physical examination demonstrates 2+ dorsalis pedis and posterior tibial pulses, increased swelling of the leg, decreased sensation and paresthesias of the first web space, and exquisite pain with active and passive motion of the toes. What should be the next step in treatment?
A Four compartment fasciotomies of the leg Femoral angiography with runoff Elevation of the leg above the heart Continued observation Repeat plain radiographs of the leg
A 60-year-old patient who is finishing a course of antibiotic therapy for bacterial pneumonia develops cramping abdominal pain and profuse watery diarrhea. A diagnosis of pseudomembranous or antibiotic-associated colitis is suspected. What would the initial treatment involve?
A Metronidazole Vancomycin Imodium Cephalexin Total abdominal colectomy
The diagnosis for this patient is invasive ductal carcinoma. A mammogram reveals no other lesions in the right breast and no abnormalities in the left breast. A chest radiograph, bone scan, and liver function tests are normal. What should the next step in the management of this patient involve?
A Neoadjuvant chemotherapy Radiation therapy to the breast and axilla Radical mastectomy Modified radical mastectomy Simple mastectomy
A 57-year-old man underwent a laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP). He subsequently develops a persistent output of 100 cc daily 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:
A Octreotide administration Pancreatic duct stricture Infection Nonabsorbable suture in distal pancreatic duct Epithelialization of the tract
A 59-year-old patient undergoes a craniotomy for a benign meningioma. On the tenth postoperative 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 examination Left leg venogram 125I Fibrinogen scan Impedance plethysmography Duplex ultrasonography
After appropriate therapy, the bleeding ceases and the patient stabilizes. He is found to be a Child's C alcoholic cirrhotic who has been abstinent for 1 year. Evaluation for an orthotopic liver transplant has begun. If his variceal bleeding recurs, it could be managed by all except which of the following?
A Portacaval shunt Mesocaval shunt Sclerotherapy Transjugular intrahepatic portosystemic shunt Selective Warren shunt
A 68-year-old man undergoes a CT scan of the abdomen as part of the evaluation for some mild abdominal tenderness after a motor vehicle collision. The scan reveals no evidence of trauma, but a 4-cm solid left renal mass is noted. There is evidence of thrombus in the inferior vena cava. Which of the following treatments is not indicated?
A Preoperative chemotherapy and radiation to downstage tumor Resection of the left adrenal gland Resection of the para-aortic lymph nodes Resection of the left kidney Incision of vena cave and removal of thrombus
Delayed primary closure would be the most appropriate wound closure technique for which of the following procedures?
A Removal of perforated appendix Repair of wound dehiscence 1 week after elective left colectomy Emergency drainage of a diverticular abscess with sigmoid resection and end colostomy Vagotomy and pyloroplasty for bleeding duodenal ulcer Repair of an incisional hernia 12 weeks after an elective left colectomy complicated by a wound infection and a resultant incisional hernia.
Which of the following is not associated with an increased incidence of invasive ductal carcinoma of the breast?
A Sclerosing adenosis Lobular carcinoma in situ Atypical ductal hyperplasia Epithelial hyperplasia Papillomatosis
Which of the following is the best treatment for melanoma?
A Surgical excision Chemotherapy Radiation therapy Immunotherapy Regional hyperthermic perfusion
uring exploration for a transverse colon tumor, a surgeon incidentally notices a 2-cm diverticulum of the small bowel located 2 ft proximal to the ileocecal valve. Which of the following statements are not true?
A This diverticulum should be resected when found due to an associated increased risk of malignancy This is an example of the most common type of diverticulum of the gastrointestinal tract, present in 2% of the population It is more commonly found in men than women When symptomatic in children, it presents as a source of bleeding It can cause obstruction via intussusception
Optimal treatment of the primary tumor should include which of the following?
A Total laryngectomy Vertical hemilaryngectomy Supraglottic (horizontal) laryngectomy Right cordectomy Chemotherapy
A 55-year-old man with insulin-dependent diabetes presents to the emergency department with acute abdominal pain. His heart rate is 130 beats per minute, his blood pressure is 90/60 mm Hg, and his oral temperature is 101.8°F. His respiratory rate is 28 breaths per minute. The abdominal examination demonstrates diffuse peritonitis. What should be the first step in the evaluation and management of this patient?
A Volume resuscitation Abdominal radiograph Intravenous antibiotics Computed tomography (CT) scan Immediate laparotomy
A 50-year-old hypertensive man has definitive biochemical evidence of a pheochromocytoma. Computed tomography (CT) scan and magnetic resonance imaging (MRI) do not reveal any abnormalities, and m-iodobenzylguanidine scanning is not readily available. What should be the next step in the management of this patient?
Abdominal exploration Continued clinical observation Mediastinoscopy D Selective venous sampling Mediastinal exploration
Which of the following describes the most appropriate treatment regimen for a newly diagnosed primary osteogenic sarcoma of the distal femur?
Above-knee amputation and chemotherapy Radiation therapy Limb-salvage surgery with marginal excision D Neoadjuvant and adjuvant chemotherapy with surgical excision A combination of chemotherapy and radiation therapy
Mastitis
Abx
Can usually be successfully treated with high doses of immunosuppression, such as methylprednisolone
Acute Rejection
Usually a temporary condition or poor renal function that lasts from 1-14 days related to preservation, ischemia, and reperfusion of the transplanted kidney
Acute Tubular Necrosis
A 65-year-old woman with a long history of atrial fibrillation presents to the emergency department with a history of sudden onset of severe, constant abdominal pain. After the onset of pain, she vomited once and had a large bowel movement. No flatus has been passed since that time. Physical examination reveals a mildly distended abdomen, which is diffusely tender, although peritoneal signs are absent. Ten years ago, she underwent an abdominal hysterectomy. What is the most likely diagnosis in this patient?
Acute cholecystitis Perforated duodenal ulcer Acute diverticulitis D Acute embolic mesenteric ischemia Small bowel obstruction secondary to adhesions
A 15-year-old boy awakens with sudden onset of right lower quadrant and scrotal tenderness accompanied by nausea and vomiting. Which of the following is the most appropriate diagnosis and represents a surgical emergency?
Acute prostatitis Acute epididymitis C Torsion of the testicle Acute appendicitis Gastroenteritis
A 45-year-old man presents to the emergency room with 24 hours of left lower quadrant abdominal pain. Examination reveals fever and focal tenderness in the left lower quadrant but no generalized peritoneal signs. CT scan reveals a collection containing air and fluid. Optimal management of this patient includes which of the following?
Admission for intravenous antibiotics and serial abdominal exams Urgent operation with resection of diseased bowel and primary anastomosis Urgent operation with resection of diseased bowel and diverting colostomy Colonoscopy to rule out the possibility of a perforated cancer followed by CT-guided drainage E CT-guided drainage followed by bowel resection once the patient has fully recovered
A previously healthy 43-year-old man presents with a 6-month history of nonbloody diarrhea, fever, and 10-pound weight loss and now develops urosepsis. On evaluation, an enterovesical fistula (from the ileum to the bladder) is found. At laparotomy, findings include inflammation and "fat wrapping" of three separate segments of ileum. Each segment is approximately 20 cm in length and is separated by less than 20-cm segments of normal-appearing bowel (skip areas). The distal- most of the three segments is more severely inflamed than the others and involves the terminal ileum all the way to the cecum. This segment of ileum is densely adherent to the right superior aspect of the bladder. Which of the following is true?
All of the abnormal-appearing bowel should be resected. This patient has complications of Meckel's diverticulitis. All of the bladder wall involved in the inflammatory process must be removed. Extensive resection can reduce the potential for a recurrence to less than 10%. E Closure of the fistula and resection of the involved bowel are preferred.
The patient returns to the office 3 years later complaining of abdominal pain, abdominal distention, bloating after meals, and intermittent constipation interspersed with diarrhea. He has lost 20 pounds during the last 3 months, which he ascribes to the aforementioned abdominal symptoms. An upper gastrointestinal series with a small bowel follow-through reveals one area of tight stricture in the distal small bowel. The stricture appears to be 10 cm in length. Which of the following is true?
All strictures require resection; bypass of the involved segment is not an option. B Postoperatively, this patient's chance of another recurrence requiring surgery is 50%. Because this patient requires surgery for the second time, his risk of cancer is extremely high, and he should have an extensive small bowel resection. Postoperative anastomotic strictures typically cause symptoms years later. Because of the patient's prior surgery, folate replacement is essential.
A 24-year-old woman was admitted to the hospital complaining of dysuria and urinary frequency. She had a temperature of 101°F, pyuria, and bacteriuria. Her chest was clear and her abdomen normal on physical examination. Tenderness was noted at the costovertebral angle. With which of the following should this patient be treated?
Antibiotics for 1 day B Antibiotics for 1 week Antispasmodics Fluids and observation Bethanechol
A chest radiograph of a 55-year-old man involved in a high-speed motor vehicle accident shows a widened mediastinum and pneumomediastinum. Electrocardiogram shows sinus tachycardia with frequent premature ventricular contractions. All of the following are appropriate except
Aortogram Bronchoscopy Continuous cardiac monitoring D Left thoracotomy Endotracheal intubation
A critically ill 55-year-old man is in septic shock in the intensive care unit after removal of a nonviable small bowel. What is the most reliable measurement of arterial blood pressure?
Arterial line diastolic Noninvasive systolic C Arterial line mean Arterial line systolic Noninvasive mean
A 52-year-old alcoholic man with known cirrhosis presents to the emergency department with hematemesis. After resuscitation and stabilization, which procedure should take place?
Arteriography Upper gastrointestinal series C Endoscopy Tagged red cell scan Liver biopsy
A 55-year-old man presents with a 24-hour history of increasingly severe left lower quadrant abdominal pain. On examination, he has tenderness localized in the left lower quadrant with rebound. Fever and leukocytosis are present. The clinical suspicion of diverticulitis would best be confirmed by which of the following?
Barium enema Colonoscopy C CT scan of the abdomen and pelvis Magnetic resonance imaging of the abdomen and pelvis Chest radiograph
An 80-year-old male patient is referred for dysphagia with reflux of undigested food. The patient occasionally notices a bulging in his left neck. Which of the following is the most appropriate definitive treatment?
Barium swallow Upper endoscopy C Cricopharyngeal myotomy Computed tomography (CT) scan of the chest Liquid diet
Which of the following is true regarding intestinal absorption of nutrients?
Bile or bile salts are essential for absorption of vitamin B12. An iron-deficient individual can absorb up to 80% of dietary iron. C Parathormone increases the intestinal absorption of dietary calcium. Intestinal epithelial cells resynthesize triglycerides before their release into the portal circulation. Triglycerides are absorbed intact in a bile salt micelle-dependent process.
Laparoscopic cholecystectomy is indicated for all of the following conditions except which?
Biliary dyskinesia B Initial treatment in patients with severe cholangitis Acute cholecystitis Symptomatic cholelithiasis Biliary pancreatitis
Postoperatively, the patient requires an indwelling bladder catheter for 5 days to treat urinary retention. He does well until the tenth postoperative day, at which point he develops a fever of 103 F, right lower quadrant pain, and an ileus. The midline wound is not inflamed. Which of the following is most likely to have developed?
Blind loop syndrome Pyelonephritis Recurrent Crohn's disease D Intra-abdominal abscess Pseudomembranous enterocolitis
A patient undergoes a left scalene node biopsy to rule out carcinoma of the lung. One hour later, the patient is cyanotic and dyspneic; a marked tachycardia is accompanied by decreased breath sounds on the left. Which step is most likely to improve the patient's condition?
Blood transfusion Insertion of a right subclavian catheter and administration of intravenous fluids Endotracheal intubation D Insertion of a left chest tube Re-exploration of the wound
A 45-year-old woman with diabetes presents with a 2-day history of acute perirectal pain. On examination, a tender fluctuant mass is present to the left of the anus. What treatment should be administered at this time?
Broad-spectrum antibiotic therapy Abscess drainage and excision of the fistulous tract C Incision and drainage of the abscess Continued observation Treatment of Crohn's disease
A 22-year-old female is referred for evaluation of a 2-cm posterior mediastinal mass discovered on routine chest radiograph. What is the most likely diagnosis?
Bronchogenic cyst Lymphoma C Neurogenic tumor Thymoma Adenocarcinoma
A 60-year-old female patient 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. What is the best choice for localizing this tumor?
CT scan MRI Selective arteriography Percutaneous catheterization of the portal vein with selective venous sampling E Surgical exploration and intraoperative ultrasound
A 32-year-old woman undergoes a laparoscopic cholecystectomy for biliary colic. Forty-eight hours after the operation, she complains of fever and right upper quadrant pain. Laboratory studies reveal an elevated white blood cell count as well as an elevated total bilirubin. Which of the following is not part of the initial management?
CT scan of the abdomen Hydroxy iminodiacetic acid (HIDA) biliary scan C Surgical exploration Endoscopic retrograde cholangiopancreatography (ERCP) Broad spectrum antibiotics
A 32-year-old man is referred for a 1.0-cm lesion of the right upper lobe of the lung. The lesion appears calcified. Previous chest radiograph taken 1 year prior demonstrates the lesion to be present at the same size. Further workup and treatment would include which of the following?
CT scan-guided biopsy Radiation therapy Surgical excision Antibiotics E Observation with repeat chest x-ray
Ten days into his course of pancreatitis, this patient is found to have a fluid collection measuring 4 cm in diameter near the tail of his pancreas. He had a recurrence of his abdominal pain when he was restarted on a diet 2 days prior but is otherwise asymptomatic. He remains on total parenteral nutrition. Appropriate management of this collection would include which of the following?
CT-guided aspiration to assess for infection Endoscopic drainage via an ultrasound-guided cystogastrostomy Operative debridement and external drainage CT-guided percutaneous drainage E Observation alone
The son of a 74-year-old woman calls her primary care physician for advice. He says that his mother has been complaining of headache and vertigo for several hours and is vomiting. Apart from a deep venous thrombosis in her left leg 2 months ago, she has been healthy. They shared dinner the night before, and she had been fine. She now is asking for a prescription for the same motion sickness pills that she used to help her son when she drove him to camp. What should the physician do?
Call in a prescription for droperidol Make arrangements to see the patient in clinic tomorrow Make arrangements to see the patient in clinic today D Recommend that the patient be taken to the emergency department in an ambulance Order V/Q Scan
A 35-year-old man has right-sided serous otitis media and a right upper neck mass. 2. It is most important to evaluate this patient for which of the following?
Cancer of the right ear Cancer of the right tonsil Cancer of the right maxillary sinus D Cancer of the nasopharynx Hodgkin's lymphoma
A 45-year-old woman who has had a hysterectomy presents to the emergency department with abdominal pain and vomiting. A mechanical small bowel obstruction is seen on the abdominal radiograph. What is the most likely cause for this obstruction?
Carcinoma of the colon Small bowel cancer C Adhesions Incarcerated inguinal hernia Diverticulitis
In which of the following situations would the best results be obtained for an emergency department thoracotomy?
Cardiac arrest in a construction worker after falling from a scaffold eight stories high Cardiac arrest following a motor vehicle accident with expulsion of the individual from the car Cardiac arrest following a gunshot wound to the abdomen External cardiac massage that has failed after more than 10 minutes in a trauma patient E Cardiac arrest following a stab wound to the chest
A first-degree relative of a patient found to have advanced medullary carcinoma of the thyroid gland is referred for further evaluation. Which screening measure is the choice for detection of medullary thyroid pathology?
Careful physical examination Serum calcitonin level C Stimulated serum calcitonin level (calcium and pentagastrin) Gastrin level Carcinoembryonic antigen (CEA) level
A patient is brought to the emergency department with a stab wound to the right chest in the fourth intercostal space in the midaxillary line. The patient is hypotensive, complains of shortness of breath, 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 patient?
Chest radiograph Chest tube insertion C Needle thoracentesis Local wound exploration Pericardiocentesis
A 50-year-old man is brought to the emergency room after falling 20 feet from a roof. He is complaining of dyspnea, and his blood pressure is 70/50 mm Hg. Breath sounds are diminished on the left, and there is tracheal deviation to the right. What is the best initial treatment for this patient?
Chest radiograph Close observation C Needle decompression of the left chest Computed tomography (CT) scan of the thorax Emergent surgical exploration
Slow decline in renal function over months or years resulting from humoral and cellular events that are generally not treatable or reversible
Chronic Rejection
After recovery from the acute illness, the patient returns in 6 months, complaining of persistent leg swelling. Which of the following would be the optimal long-term management as initial treatment?
Chronic diuretic therapy Venous thrombectomy Venous bypass using an autologous vein Venous bypass using a prosthetic graft E Support hose
A 55-year-old woman undergoes laparotomy 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 abdomen. The incision would now be considered what kind of wound?
Clean contaminated Secondary Infected D Contaminated Clean
With the increasing use of ultrasound, prenatal diagnosis of abdominal wall defects is becoming more common. You are asked to consult a family with this prenatal diagnosis. Which of the following points and discussion is not true?
Closure may require more than a single operation. B If gastroschisis is strongly suspected, amniocentesis is essential to rule out chromosomal abnormalities. Total parenteral nutrition is frequently used. The outcome of this category of patient is related both to the integrity of the gastrointestinal tract or to associated anomalies. One of the primary goals of treatment with abdominal wall defects is to protect the exposed contents of the abdomen.
A 70-year-old man who is a new patient presents with a history 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 patient has a large pulsatile nontender abdominal mass. All of the following studies would be appropriate except
Computed tomography (CT) scan of the abdomen Pulmonary function tests Arteriogram D Colonoscopy Persantine thallium scan
A 65-year-old patient has been treated with pharmacologic therapy for an antral gastric ulcer for 12 weeks. A repeat upper gastrointestinal series shows approximately 50% shrinkage of the ulcer. What further management should the patient undergo at this time?
Continued pharmacologic therapy with a repeat upper gastrointestinal series in 8-12 weeks Change pharmacologic therapy with a repeat upper gastrointestinal series in 12 weeks C An upper endoscopy with multiple biopsies Total gastrectomy Surgery with limited excision of the ulcer
A calcineurin inhibitor that became the mainstay of immunosuppressive regimens in the 1980s and continues as the basis of many immunosuppressive regimens with toxicities that include hypertension, gingival hyperplasia, and nephrotoxicity
Cyclosporin
Disadvantages of laparoscopy when compared with laparotomy include all of the following except which?
Difficulty controlling severe bleeding B Poorer visualization of the operative field Greater difficulty placing sutures Loss of tactile sensation Higher operating room costs
A 47-year-old woman presents with dysphagia to both solids and liquids equally. She has experienced a 10-kg weight loss over the last several months. A barium swallow reveals a birdlike narrowing in the distal esophagus. What is the underlying cause of her symptoms?
Disorganized, strong nonperistaltic contractions in the esophagus B Failure of the lower esophageal sphincter to relax Hiatal hernia Barrett's esophagus Esophageal stricture secondary to untreated gastroesophageal reflux
Which of the following statements about laparoscopic surgery is true?
Due to the minimally invasive nature of laparoscopy, preoperative evaluation of patients is less critical than for laparotomy. Routine use of orogastric tubes and urinary catheters is unnecessary uring advanced laparoscopic procedures. C The abdomen is always prepared and draped for potential laparotomy. Antithromboembolic pumps are not needed during laparoscopic procedures, as the risk of deep venous thrombosis is less than for laparotomy. Spinal anesthesia is sufficient for most advanced laparoscopic procedures.
High association with trisomy 21
Duodenal Atresia
This complication may have been prevented by all of the following measures except
Early mobilization after surgery Routine use of support hose Routine use of pneumatic sequential compression devices on both lower legs D Daily administration of a single dose of subcutaneous unfractionated heparin starting 12 hours after the completion of surgery Daily administration of low molecular weight heparin starting in the preoperative holding area
Expected physiologic changes due to blunt chest trauma include all but which of the following?
Elevated PCO2 B Increased compliance Elevated A-a gradient Decreased ventricular contractions Elevated shunt fractions
Which testicular cancer cell type is extremely radiosensitive?
Embryonal carcinoma Yolk sac tumor C Seminoma Choriocarcinoma Teratocarcinoma
Massive bleeding from the lower gastrointestinal tract is occurring in a 55- year-old man who is otherwise healthy. After continued bleeding equivalent to one unit of blood, what should be the initial management?
Emergency laparotomy and total colectomy and ileoproctostomy Emergency laparotomy and colostomy with operative endoscopy C Arteriography to identify the bleeding site after anoscopy and sigmoidoscopy have ruled out a distal site Infusion of vitamin K and fresh frozen plasma Colonic irrigation with iced saline solution
A patient is involved in a high-speed motor vehicle collision. The patient has a GCS score of 7 on arrival. Which of the following is not indicated
Emergent intubation Placement of an intraventricular catheter C Nasogastric tube to prevent aspiration Spinal cord immobilization Urgent CT scan of the brain
An adult male is brought to the emergency department for evaluation and treatment following injury in a house fire. The patient was found in a closed room. He has singed facial hair and full-thickness burns over approximately 30% of his body surface area. All of the following are important in his initial stabilization and treatment except which?
Endotracheal intubation Intravenous fluid resuscitation Insertion of a ureteral catheter Tetanus toxoid administration E Systemic antibiotics
A 35-year-old man is involved in a high-speed motor vehicle collision. He arrives in the emergency room in respiratory distress. Radiographs taken during the initial evaluation reveal an air-fluid level in the left chest. Management includes all of the following except
Establishment of a secure airway Immediate placement of a nasogastric tube C Urgent thoracotomy to repair the injury Placement of adequate peripheral vascular access Urgent laparotomy to repair injury
Chronic Subareolar Abscess
Excision of Sinus Tract
A victim of a motor vehicle accident who was thrown from the vehicle is brought to the emergency department. The patient is unconscious and hypotensive. He is found to have a dilated left pupil, decreased breath sounds over the right chest, a moderately distended abdomen, an unstable pelvis, and severe bruises over the thighs. After resuscitation with 2 L of crystalloid and 2 units of type-specific packed red blood cells, the patient remains hypotensive with a systolic blood pressure in the low 80s. What is the least likely explanation for this patient's hypotension?
External blood loss Bleeding into the chest Retroperitoneal bleeding D Severe closed head injury Femoral fractures
A 25-year-old man is injured in the arm with a knife. What is the first mechanism responsible for hemostasis?
Extrinsic clotting system B Vessel constriction Intrinsic clotting system Platelet activation Fibrinolytic system
A tall, thin 19-year-old male presents to the emergency department with sudden onset of chest pain, cough, and shortness of breath. Breath sounds are absent in the left chest. Which of the following is an indication for surgery?
Family history of recurrent spontaneous pneumothorax Persistent air leak after 3 days of chest tube drainage Identification of an apical bleb on chest CT Evidence of life-threatening respiratory compromise on initial presentation E History of one prior episode successfully treated with conservative management on the contralateral side
A 65-year-old woman with no other significant past medical history presents with a large mass in the right breast. The mass measures approximately 6 cm in diameter and appears to be fixed to the chest wall. In addition, 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?
Fine-needle aspiration B Incisional or core biopsy Excisional biopsy Modified radical mastectomy Radical mastectomy
A 63-year-old man presents with a 3-day history of increasing cramping abdominal pain, constipation, and intermittent vomiting. He continues to pass gas. Other than the present complaints, he has been healthy. Examination reveals a distended abdomen with high-pitched bowel sounds. No localized tenderness and no rectal masses are present. The stool is heme positive. Therapeutically, the first step should be which of the following?
Fleet enema, clear liquids by mouth, and careful observation Emergency colonoscopy for colonic decompression C Intravenous fluids, nasogastric suction, and careful observation Colonoscopic decompression with use of a rectal tube, if necessary Immediate exploratory laparotomy
A 21-year-old male patient is brought to the emergency department for evaluation after a motor vehicle accident. As part of this secondary survey, the patient is found to have blood at the urethral meatus. What is the next maneuver?
Foley catheter insertion followed by cystogram B Urethrogram IVP CT scan Diagnostic peritoneal lavage
More prevalent in small bowel transplantation than in other organ transplants related to the large amount of lymphoid tissue associated with the graft
GVHD
A 45-year-old male executive is seen because he is vomiting bright red blood. There are no previous symptoms. The man admits to one drink a week and has no other significant history. In the hospital, he bleeds five units of blood before endoscopy. What is the most likely diagnosis?
Gastritis B Duodenal ulcer Esophagitis Mallory-Weiss tear Esophageal varices
A 34-year-old female patient in previous good health presents in the emergency department with spontaneous intraperitoneal hemorrhage. Her only medication is an oral contraceptive that she has been taking for the past 5 years. During resuscitation, a bedside ultrasound reveals a large amount of intraperitoneal blood and a 3-cm mass in the right lobe of the liver. What is the likely cause of her hemorrhage?
Hepatoma Hemangioma Focal nodular hyperplasia D Hepatic cell adenoma Metastatic neoplasm
Which of the following major joint dislocations constitutes the most dire surgical emergency?
Hip dislocation B Knee dislocation Shoulder dislocation Elbow dislocation Subtalar dislocation
A 47-year-old patient with a history of left-sided nephrectomy for trauma 20 years ago presents with right flank pain and hematuria. Laboratory studies reveal a creatinine of 2.5 mg/dL. Which of the following is the appropriate management plan?
Hydration overnight, followed by repeat evaluation of serum creatinine Intravenous pyelography (IVP) CT scan of abdomen and pelvis with oral and intravenous contrast D Ultrasonography followed by urgent cystoscopy Percutaneous nephrostomy tube placement
Occurs when there is cross-match incompatibility
Hyperacute Rejection
Which of the following is not a risk factor for coronary artery disease?
Hypertension Smoking Diabetes D Renal failure Hypercholesterolemia
A 27-year-old woman is experiencing perioral and extremity numbness the morning after a neck operation. What is the cause of her symptoms?
Hypokalemia Hypercalcemia C Hypocalcemia Hypochloremia Hyperkalemia
After successful surgery and discharge from the hospital, which of the following is true?
If the diseased bowel is removed, therapy with prednisone and metronidazole can best prevent a recurrence. The chance of a cure is greater than 60%. The recurrence rate is higher than 50% during the next 5-10 years. If the terminal ileum is removed, the risk of a recurrence is less. If the terminal ileum is removed, the patient will require long-term therapy with oral iron to prevent anemia.
A 68-year-old woman has a Mohs' excision on the tip of her nose. A full- thickness skin graft with a tie-over dressing is used. On the fifth postoperative day, the dressing is removed, and the graft is pink. What is the most likely reason for this?
Imbibition B Inosculation Infection Fibrination Collagenesis
Although part of the VATER complex (vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia), it is associated more commonly with renal malformations
Imperforate anus
A 55-year-old female patient is evaluated for new onset of diabetes mellitus. Her medical history is largely unremarkable. Her physical examination is unrevealing except for the presence of an erythematous skin rash. Her further evaluation should include an investigation of the possibility of which of the following?
Insulinoma Glucagonoma Gastrinoma Carcinoid tumor Pancreatic cholera
A 33-year-old man with no significant past medical history presents to the emergency room with abdominal pain and nausea. He is afebrile, and laboratory studies reveal a serum amylase level of 1200 U/L. Which of the following would not be part of initial management?
Intravenous hydration Nasogastric decompression Abdominal imaging with ultrasound and/or CT scan D ERCP to evaluate pancreatic duct anatomy Intravenous narcotic pain medicine
A 40-year-old man has a subtotal thyroidectomy performed for Graves' disease. Several hours later, he complains of difficulty breathing. On examination, he has stridor and a markedly swollen, tense neck wound. What should be one of the first steps in the management of this patient?
Intubate with an endotracheal tube Perform a tracheostomy Control the bleeding site in the operating room D Open the wound to evacuate the hematoma Aspirate the hematoma
Which of the following statements is true about the performance of a parietal cell vagotomy?
It divides the vagus nerve at the gastroesophageal junction. B It maintains innervation of the pylorus so that a drainage procedure is not required. The recurrence rate is less than 5%. It cannot be performed laparoscopically. It is contraindicated for bleeding or perforated ulcers.
Splenectomy for ruptured spleen
JP Closed Drain
A 73-year-old previously healthy man presents to the emergency room with several days of jaundice followed by 12 hours of right upper quadrant pain and fever. He is mildly hypotensive. CT scan of the abdomen reveals dilatation of the biliary tree. The next step in management includes which of the following?
Laparoscopic cholecystectomy Open cholecystectomy and T tube placement Open cholecystectomy and choledochojejunostomy D Fluid resuscitation, antibiotics, and endoscopic retrograde cholangiopancreatography (ERCP) Fluid resuscitation and hepatitis serologies
Proximal lesser curvature of stomach
Left Gastric Artery
An 80-year-old man with a history of ischemic cardiomyopathy is hypotensive and oliguric after major abdominal surgery. Initial fluid resuscitation produces only transient improvements. He is transferred to the intensive care unit for further management. A pulmonary artery catheter could be used to measure all of the following except:
Left atrial filling pressure Cardiac output C Ejection fraction Mixed venous oxygen saturation Systemic vascular resisitance
His workup demonstrates a 6.0-cm infrarenal abdominal aortic aneurysm with a 4- cm left common iliac artery aneurysm and normal renal arteries. He has normal external iliac arteries bilaterally, with relatively normal femoral vessels. Pulmonary function tests indicate a forced expiratory volume in 1 second (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?
Letting the patient live with the aneurysm because he is too high a surgical risk for elective surgery Checking the size of the aneurysm with ultrasound every year until it starts to enlarge Not performing surgery until he develops back pain because he is currently asymptomatic D Performing an aorto-bi-iliac bypass Repairing the abdominal aortic aneurysm with a tube graft
Which of the following will be the primary treatment for this tumor?
Local excision to negative margins Wide local excision and radical neck dissection Neoadjuvant chemotherapy followed by resection of residual tumor Unilateral radiotherapy with combined chemotherapy E Bilateral radiotherapy
Which of the following procedures would be expected to have the greatest impact on postoperative pulmonary function?
Low anterior resection Femoropopliteal bypass C Subtotal gastrectomy Open cholecystectomy Total abdominal hysterectomy
Complete intestinal necrosis is most feared complication
Malrotation
For appropriate procedures, antibiotic prophylaxis for bacterial endocarditis should be administered in patients with a history of which of the following?
Mitral valve prolapse without regurgitation Automatic implantable cardiac defibrillator placement C Aortic valve replacement Coronary artery bypass graft Surgically repaired ventricular septal defect
A 23-year-old man has a solid mass in his left testis. When it is removed, the pathology reveals an embryonal carcinoma with a teratoma. A CT scan of the chest and abdomen reveals 8 cm of lymphadenopathy in the periaortic nodes. What is the recommended treatment?
Modified nerve-sparing retroperitoneal lymph node dissection Full bilateral retroperitoneal lymph node dissection Chemotherapy with paclitaxel (Taxol), gemcitabine, and cisplatin D Chemotherapy with cisplatin, etoposide, and bleomycin Chemotherapy plus retroperitoneal radiation
A 55-year-old woman presents with complaint of a mass overlying the angle of the right mandible. She says the mass has been slowly enlarging over the past 2-3 years and that the mass is painless. On physical examination, it is firm and overlies the angle of the right mandible and the area between the angle and the tragus of the ear. Neurologic examination of the head and neck is completely normal. Which of the following does this mass most likely represent?
Mucoepidermoid cancer of the parotid gland Acute parotitis C Benign mixed tumor of the parotid gland (pleomorphic adenoma) Malignant mixed tumor of the parotid gland Hemangioma of the parotid gland
An antimetabolite used as part of triple immunosuppression therapy
Mycophenolate
A 78-year-old previously healthy man is admitted to the emergency department complaining of angina, dyspnea, and near syncope. Electrocardiogram is normal, and a loud systolic murmur is heard in the second right interspace with radiation to the carotids. What is the most likely diagnosis in this patient?
Myocardial infarction Pericarditis Mitral regurgitation D Aortic stenosis Aortic insufficiency
Mondor's Disease
NSAIDs
Diffuse Peritonitis from Perforated Duodenal Ulcer
No Drain
A 75-year-old male patient presents to the emergency room 2 hours after developing severe chest pain with repeated episodes of vomiting. He is tachycardic and febrile. A chest radiograph demonstrates a left pleural effusion. Emergent barium swallow reveals extravasation of contrast into the left chest. Proper definitive treatment of this patient would include which of the following?
Observation B Emergent surgical intervention Placement of left chest tube Intravenous antibiotics and admission to the hospital Upper endoscopy
The patient continues to bleed and requires transfusion. What further treatment should be undertaken?
Observation in the intensive care unit Right hepatic artery ligation Right hepatic lobectomy D Angiographic embolization of hepatic artery CT portogram
A routine chest radiograph for a 55-year-old man with a 50 pack-year smoking history shows a peripherally located 1.5-cm, 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 patient's management?
Observation with serial chest radiographs Thoracotomy Bronchoscopy D Biopsy Sputum cytology
A 55-year-old patient with alcoholism who is still actively drinking presents to the emergency department with hematemesis. The bleeding stops, and he undergoes upper endoscopy. This reveals large varices in the gastric fundus. Physical examination is notable for splenomegaly and the absence of ascites. His prothrombin time is 14 seconds, but his bilirubin and albumin are normal. An ultrasound and Doppler examination of the abdomen reveal a small nodular liver, a large spleen, calcifications throughout the pancreas, a thrombosed splenic vein, and patent superior mesenteric and portal veins with hepatopetal flow. What is the recommended treatment for this patient?
Orthotopic liver transplant Peritoneovenous shunt Mesocaval shunt Distal splenorenal shunt E Splenectomy
A 15-year-old boy is admitted with a history and physical findings consistent with appendicitis. Which finding is most likely to be positive?
Pelvic crepitus B Iliopsoas sign Murphy sign Flank ecchymosis Periumbilical ecchymosis
What innerves the stomach resulting in parietal cell secretion and gastrin release?
Phrenic nerve B Vagus nerve Greater splanchnic nerves Celiac ganglion T4 root
Which of the following is a criteria for emergent preoperative dialysis?
Potassium (K+) 5.0, without arrhythmia Arterial pH 7.30, anion gap 8 C Pericardial friction rub Blood urea nitrogen 105 Creatinine 5.5
A 55-year-old woman with progressive but episodic muscle weakness is diagnosed as having myasthenia gravis. Her chest radiograph is normal and reveals no evidence of mediastinal mass or tumor. What is the most definitive treatment that can be offered this patient?
Prednisone Neostigmine C Thymectomy Plasmapheresis Atropine
A 67-year-old woman notices a swollen right leg following a 6-hour plane flight. Which of the following would be a reasonable next step for the treating physician?
Prescribe compression stockings and leg elevation Start 6 months of warfarin anticoagulation Prescribe one baby aspirin per day D Order a venous duplex evaluation Order a pelvic CT scan to look for lymphadenopathy
A 65-year-old patient presents with a history significant for obstructive jaundice and weight loss. A workup reveals a 2.5-cm mass in the head of the pancreas; needle aspiration reveals adenocarcinoma. Which of the following findings on preoperative CT scan would preclude operative exploration for curative resection?
Presence of replaced right hepatic artery Loss of fat plane between tumor and portal vein Loss of fat plane between tumor and superior mesenteric artery Occlusion of gastroduodenal artery E Occlusion of superior mesenteric vein
A healthy adult presents for a pre-employment physical. What will be the largest component of his or her body by mass?
Protein WATER Calcium Sodium Potassium
A 57-year-old male patient with a 60 pack-year smoking history is referred for a 1.5-cm solitary mass in the right upper lobe. CT scan demonstrates no evidence of lymph node involvement. What should further workup or treatment include?
Radiation therapy Open lung biopsy Chemotherapy D Right upper lobectomy Repeat chest x-ray in 6 months
A 22-year-old previously healthy male presents with a 2-month history of fevers, night sweats, and a 20-pound weight loss. On physical examination, he is found to have palpable cervical and inguinal lymphadenopathy. A computed tomography (CT) scan of the chest and abdomen reveals mediastinal and abdominal para-aortic enlarged lymph nodes. Excisional biopsies are performed on a cervical and inguinal lymph node. Both of these biopsies reveal lymphocyte-depleted Hodgkin's disease. What should be the next step in the management of this patient?
Radiation therapy Surgical debulking of the enlarged lymph nodes followed by chemotherapy Staging laparotomy to include splenectomy, liver biopsy, and biopsies of intra-abdominal lymph nodes D Systemic chemotherapy Mediastinoscopy
What will be the optimal treatment for this lesion?
Radiation therapy Total parotidectomy with preservation of the facial nerve Total parotidectomy including resection of the facial nerve D Superficial parotidectomy Enucleation
After further diagnostic work-up, the patient is found to have a gastric adenocarcinoma. Metastatic work-up is negative. Therapy with curative intent would involve which of the following?
Radiation therapy followed by chemotherapy alone Distal gastrectomy followed by adjuvant chemoradiotherapy Total gastrectomy Total gastrectomy and splenectomy Local excision of the ulcer with clear margins followed by radiotherapy
A 32-year-old male executive with long-standing Crohn's disease presents with a complete obstruction of the small bowel. At laparotomy, scarring of the distal ileum and cecum cause an obstruction. A 10-cm segment of mid small bowel shows moderate nonobstructive Crohn's disease. Which operative procedure should be performed at this time?
Radical resection of the involved segment of mid small bowel, all of the ileum, the cecum, and the right colon Resection of the distal ileum and right colon with the involved mesentery and lymph nodes Bypass of the obstructing segment with a side-to-side anastomosis between the ileum and the right colon and no resection Stricturoplasty of the obstruction plus resection of the short involved segment of mid small bowel E Resection of the distal ileum and cecum
A 50-year-old man is admitted with massive bright red rectal bleeding. He recently had a barium enema that demonstrated no diverticular or space-occupying lesion. Nasogastric suction reveals no blood but does produce yellow bile. The patient continues to bleed. What is the next diagnostic step?
Repeat barium enema Colonoscopy Upper gastrointestinal series D Mesenteric angiography Small bowel follow-through with barium
Distal greater curvature of stomach
Right Gastroepiploic Artery
A 60-year-old woman develops weakness 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 electrocardiogram is normal. A carotid duplex ultrasound shows a 75% stenosis of the left carotid artery and an 80% stenosis of the right carotid artery; both are confirmed by a carotid arteriogram. What should be the next step in the management of this patient?
Right carotid endarterectomy B Left carotid endarterectomy Superficial temporal artery to middle cerebral artery bypass Percutaneous transluminal angioplasty of the left carotid artery Bilateral carotid endarterectomy
Duodenum and head of pancreas
SMA
If a first-degree relative of a patient with MEN-2 A syndrome is found to have medullary pathology requiring surgical exploration of the thyroid gland, what should the preoperative screening include?
Serum cortisol level Fasting glucose and insulin CT scan of the head Urinary aldosterone and renin E Urinary vanillylmandelic acid and metanephrines
While considering a vascular accident, there is an associated finding of cystic fibrosis in a patient with this gastrointestinal problem
Small bowel (jejunal and ileal) atresia
Body and tail of pancreas
Splenic Artery
A 21-year-old male suffers a severe comminuted fracture of the right lower extremity with considerable soft tissue loss after a motorcycle accident. He has exposed bone and tendon in his wound after external fixation. Which is the appropriate management?
Split-thickness skin graft Full-thickness skin graft Allograft followed by full-thickness skin graft Z plasty E Muscle flap
A 70-year-old patient 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 patient?
Sputum culture and sensitivity Chest tube insertion C Thoracentesis Thoracotomy and decortication Rib resection and open drainage
A 38-year-old previously healthy female presents with a single partial seizure. Physical examination is unremarkable. A CT head scan shows a lesion that enhances with contrast measuring 1.5 × 1 cm in the tip of the right temporal lobe surrounded by a rim of local edema. What is the best way to proceed?
Stereotactic needle biopsy Open biopsy Tumor resection Electroencephalography (EEG) E Brain magnetic resonance imaging (MRI), chest radiograph
A 60-year-old patient who is finishing a course of antibiotic therapy for bacterial pneumonia develops cramping abdominal pain and profuse watery diarrhea. A diagnosis of pseudomembranous or antibiotic-associated colitis is suspected. Which of the following is the quickest way to establish the diagnosis?
Stool culture Barium enema Stool titer for Clostridium difficile toxin D Proctoscopy Blood culture
Nasogastric decompression
Stump Drain
If deep venous thrombosis is documented, initial treatment should include which of the following?
Subcutaneous unfractionated heparin therapy B Intravenous heparin therapy Thrombolytic therapy with urokinase Aspirin therapy Warfarin treatment
A 35-year-old man presents with left unilateral tinnitus and mild left sensorineural hearing loss. Which of the following statements is true?
Such signs and symptoms are common and should not be worked up unless they worsen. An MRI scan should be obtained, but gadolinium enhancement and its attendant risks are not necessary. Brain stem evoked response audiometry is likely to be normal. D The patient should be assumed to have an acoustic neuroma until proven otherwise. Conditions that cause such problems do not affect the other ear.
A trauma patient undergoes exploratory laparotomy for severe blunt injury with a positive 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?
Sump drainage B Resection of the distal pancreas End-to-end repair of the pancreatic duct Whipple resection Anastomosis of the jejunum to the severed pancreatic duct
Abscess
Surgical Drainage
A 65-year-old 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 is which of the following?
T2N1 T2N2a T3N1 D T3N2a T4N3
Which of the following is true about pediatric hernias?
The incidence is roughly equal in males and females, with males becoming more common as age increases. Congenital pediatric hernias are bilateral 50% of the time. Inguinal hernias often close spontaneously in children, and repair should be delayed until 2 years of age. Incarcerated hernias in children should never be reduced. Emergency repair is mandatory. E Right-sided inguinal hernias are twice as common as left-sided inguinal hernias
A 2,600-g newborn without any obvious anomalies turns blue during her first feeding. An attempt at passing an oral gastric tube to decompress the stomach is unsuccessful. Which of the following statements is correct?
The most likely form of tracheal esophageal malformation is a blind pouch without a tracheal fistula. No further workup for other anomalies is indicated owing to the normal appearance of the patient. Because the orogastric tube does not pass, it should be removed to prevent gagging. D Primary repair can be undertaken if the defect is less than 2 cm in length If the lung fields are clear to auscultation after the cyanotic episode, an immediate chest radiograph would not aid in the newborn's management.
If this patient's lesion is resected and it turns out to be a glioblastoma, which of the following is true?
The patient's median expected survival is 2 years. Additional surgery is not meaningful. The patient's prognosis is unchanged by radiation therapy. D Age is an important prognostic factor for this tumor. The clinical presentation of the tumor was uncommon for this patient.
A 47-year-old woman is undergoing a left mastectomy for a large breast cancer. Postoperative chemotherapy is planned. Which of the following is not true?
Tissue expander can be placed at the time of the initial operation to provide reconstruction. Latissimus dorsi flap can provide adequate tissue for reconstruction. C Reconstruction must be delayed until after treatment for the primary tumor is complete. Contralateral reduction mammoplasty can provide symmetry. Nipple reconstruction is typically performed as a separate procedure.
A 63-year-old man presents with a 3-day history of increasing cramping abdominal pain, constipation, and intermittent vomiting. He continues to pass gas. Other than the present complaints, he has been healthy. Examination reveals a distended abdomen with high-pitched bowel sounds. No localized tenderness and no rectal masses are present. The stool is heme positive. Diagnostically, the first step should be to perform which of the following?
Total colonoscopy Mesenteric angiography C Flat plate and erect abdominal radiographs Upper gastrointestinal radiographs with small bowel follow-through Barium enema
A 59-year-old patient undergoes exploration for a 4-cm mass in the head of the pancreas that has caused obstructive jaundice. The patient had a biliary stent endoscopically placed prior to the procedure with complete resolution of jaundice. At the time of surgery, two small liver metastases are noted. Which of the following is not part of appropriate management at this point?
Transduodenal pancreatic biopsy Hepaticojejunostomy Gastrojejunostomy Cholecystectomy E Celiac ganglion nerve block
Work-up reveals acutely bleeding esophageal varices. What should the next treatment be?
Transjugular intrahepatic portosystemic shunt Emergency portacaval shunt Splenectomy D Sclerotherapy Gastroesophageal devascularization
Which of the following forms of congenital heart disease is most common?
Transposition of the great vessels Tetralogy of Fallot Atrial septal defect Patent ductus arteriosus E Ventricular septal defect
Spontaneous Pneumothorax
Underwater Seal Drain
A 25-year-old man is admitted with a history of sudden onset of severe midepigastric abdominal pain. Upright chest radiograph reveals free intraperitoneal air. What is the therapy for this patient?
Upper endoscopy Barium swallow Gastrografin swallow Observation E Laparotomy
After several hours in the hospital, he begins to have recurrent bleeding. He is transferred to a critical care bed and is persistently hypotensive despite trasnfusion of nine units of packed red blood cells. Which is the most appropriate next step in management of this patient?
Upper endoscopy with attempt at cauterization of bleeding Transport to the interventional radiology unit to identify and embolize bleeding source Placement of a Blakemore tube to temporarily tamponade bleeding and to allow for stabilization of blood pressure D Laparotomy to control bleeding Infusion of vasopressin and additional units of blood
A 45-year-old man is seen in the emergency department after vomiting bright red blood. He has no previous symptoms. He drinks one alcoholic beverage a day. What is the most reliable method for locating the lesion responsible for the bleeding?
Upper gastrointestinal series Exploratory laparotomy C Upper endoscopy Arteriography Radionuclide scanning
Fundus of Stomach
Vasa Brevia (short gastric arteries)
A 29-year-old man is evaluated for a cerebral vascular accident. Physical examination reveals a systolic ejection murmur at the left second interspace and a fixed split second heart sound. What is the most likely diagnosis?
Ventricular septal defect B Atrial septal defect Mitral stenosis Aortic insufficiency Ventricular aneurysm
A 70-year-old patient 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?
Video-assisted thorascopic surgery with talc pleurodesis B Chest tube drainage Repeat thoracentesis Thoracotomy and decortication Rib resection drainage