03.2011 surgery

A 48 year old man with left lower quadrant pain. Leukocytosis, low grad fever, no peritoneal signs. Dmission of CT was interpreted showing acute diverticulitis, no perforation or abscess. After 72 hours f treatment with i.v antibiotics and fluid the pain resolved, bowel function and appetite became ormal, leukocytosis resolved, the next step is:

What is the annual risk for rupture, dissection, and death when the diameter of the ascending aorta exceeds 5cm?

Which of the following factors has the strongest affect on the prognosis of breast cancer patient?

A 55 year old woman with ileocecectomy for chron disease undergos cholecystectomy for symptomatic gallstones. Diarrhea and stool frequency are increased markedly postoperatively. Next step:

A 36 year old male was involved in motor cycle accident ,he has an isolated injury that includes a fracture of the right mid femur .what of the following statement is correct?

A healthy 55 year old male is complaining of constipation and rectal bleeding. He is referred to colonoscopy that identifies a rectal ulcerated mass 4 cm from the anal verge. Biopsy demonstrates adenocarcinoma. What is the next step in this patint’s management/treatment?

A 65 years old patient has 3 cm rectal polyp. The lower age of the mass is 6 cm from anal verge. Biopsy shows focus of adenocarcinoma. CT abdomen and chest shows no metastasis. The endorectal ultrasound shows several perirectal lymph nodes. The best management is:

A 4 y old boy, after fracture fixation with cast at the evening. At night felt pain and finger tingling. What is the next treatment?

What is the most common etiology for small bowel obstruction in adults?

A man presents with repeated episodes of bloody stools. Esophagogastroduodenoscopy and colonoscopy are normal. The next step in managment should be:

A 15y boy, after scroatal injury during football. Complains on severe localized pain. On exam. Testicle firm and tender. Next treatment/evaluation:

What is correct regarding deep infection evolving a replaced knee or hip?

A 65-year-old man remains in the ICU one month after coronary artery bypass grafting. He has been treated for two episodes of pneumonia and continues to require ventilatory support. He develops watery diarrhea and abdominal distention. Stool sent for clostridium difficile toxin is positive and oral metronidazole therapy is initiated. Five days later, he develops hypotension requiring vasopressors, renal insufficiency, and an elevated WBC count of 36,000/mm³. The most appropriate management would be:

60 y, M, rectal carcinoma 5 cm above anal verge. No metastasis to distant sites. TRUS shows invasion to perirectala fat (uT3) without regional L.N involvement. Treatment:

What is the main objective in hip or knee joint replacement?

A common physiologic characteristic of septic shock is:

Accepted treatment of malignant cutaneous intermediate thickness melanoma: (Breslow 1-4) on right arm:

Most sergical site infectious become clinecaly evident:

A 55, M, comes to ER with severe epigastric pain. 2 months ago he has completed triple treatment of ulcer in first part of duodenum with positive H.Pylori. On Chest x-ray air under the right diaphragm is detectible. Next step:

The most common couse of a small bowel obstruction is:

A 56-year-old female arrives to the ER because of Jaundice. She has no past medical history. Laboratory finding include a bilirubin of 127 and significantly elevated cholestatic and hepatocellular enzymes. On abdominal Ultrasound the gallbladder is distended with no stones. The CBD is 18mm and there is extra and intra-hepatic bile duct dilatation. Serum CA19-9 Levels are 1200. Abdominal CT identifies a pancreatic head mass without SMV involvement. What is the next step in this patient’s Management?

An abdominal compartment syndrome produces all of the following except:

An 88 years old male comes to the ER because of excruciating inguinal pain. Two weeks ago he suffered an acute myocardial ischemia and is taking aspirin since. On examination he seems to be in pain, with no fever, heart rate of 115 beats pro minute, regular. His abdomen is not distended and there is no evidence of peritonitis. He has an incarcerated, non reducible, tight inguinal hernia. What is the next step in this patient’s Management?

A 42 year-old man hospitalized evaluated for dyspnea plus pleuritic chest pain, fracture of the right femur 3 weeks ago. Suffer of hypertension with the only medics is hydrochlorothiazide. Physical examination, 38.1°C, HR 110/min, RR 22/min, PA 130/78, BMI 24; laboratory studies are normal, toponins undetectable. EKG, elevation light of R waves in V4-V6, QRS has left ward axis. Contrastenhanced CT scan shows emboli in the arteries perfusing lingual and posterior basal segment of left lower lobe. Most appropriate treatment:

A 40 y.o. woman with 1,5 sm palpable brest mass undergoes US guided core needle biopsy. Histology showed cellular fibroadenoma with possibility of a phylloides tumor. Appropriate management includes:

A 20-year-old male is injured a pedestrian in a motor-vehicle accident. At the ER is fully conscious. BP is 110/70, her rate is 95. Room saturation is 92%. On Examination there are abrasions on the right chest and abdomen, deformation of the right arms and normal peripheral pulses. FAST indentifies small amount of abdominal fluid, CT indentifies a stage 4 liver laceration with no active bleeding, and significant right lung contusion. What is the next step in this patient’s Management?

A patient undergoes a segmental mastectomy and negative margins are obtained, two sentil lymph node are identified.on final histological evaluation a 6mm region of macrometastases is found on H&E staining within two of the lymph node, the next step should be:

Paget’s disease is caused by which of the following processes:

A 38 year old female arrives to the ER with fever of 38.5 and right upper abdominal pain. A week prior to her admission she underwent laparoscopic cholecystectomy. On examination she is alert and oriented. Without scleral icterus, and normal appearing surgical incisions. Libratory finding include Leucocystosis 15,000, slightly elevated liver enzymes, and normal bilirubin, what is the next step in this patient’s Management?

A post-menopausal woman with new diagnosis of breast cancer in her left breast elects to undergo mastectomy. Which of the following statement about contralateral prophylactic mastectomy is true?

A 60 y/o man suddenly developed severe abdominal pain. In the emergence department 2 hours later his abdomen was soft and nontender, his white blood cells were 18,300/mm³, and his arterial blood pH was 7,32. The probable diagnosis is?

A usual healthy 35 year old female in complaining of 2 months upper abdominal pain that radiates to right shoulder after a fatty meal. The pain resolves 30 minutes after she takes optalgin. No fever or vomiting is associateted. The patient is now in the ER due to Jaundice for 3 days without fever or abdominal pain. On Examination the abdomen is not tender. Laboratory finding include – no Leucocytosis, however liver function tests are elevated with Bilirubin of 80 (normal <17) in abdominal ultrasound there are stones in the gallbladder, the gallbladder is not distended, gallbladder wall is not thickened. The CBD’s diameter is 9 mm. What is the next step in this patient’s Management?

A patient with cirrhosis has large esophageal varices but has never had bleeding episode. He is unable to tolerate a non selective beta blocker, prevention of an initial bleeding episode is best accomplished by:

A 60 y.o. man comes to the emergency department obtunded and hypotensive with melena and hematochezia. He has no history of prior surgery or alcohol abuse. His physical examination is unrevealing with stigmata of liver disease. The most likely source of bleeding is:

A healthy 50-year-old male arrives to the ER with lower quadrant pain, vomiting, and abdominal distention. Abdominal CT demonstrates mass at the hepatic flexure with no small bowel distention. What is the appropriate treatment?

A 50 y/o man with history of symptomatic GERD has Barrett’s esophagus diagnosed on upper endoscopy, which of the following statement is true?

A 38 old female who is a candidate for a mastectomy due to breast cancer arrives to the clinic seeking consult regarding breast reconstruction .she is a candidate for adjuvant radiation and chemotherapy. What type of reconstruction is most suitable for this Patient?

A healthy 70-year-old male is brought to the trauma unit after being involved in a motor vehicle accident as a seat belt-wearing driver. The collision on in an intercity highway. There are no direct injuries. On examination, BP is 130/80, heart rate is 110 beats per minute, and there is a seat belt sign across the abdomen. FAST demonstrates moderate amount of fluid in the pelvis. The patient is taken to a CT scan that identifies moderate amount of fluid in the pelvis but the abdominal organs appear normal. What is the next step in this patient’s management?

A 55 y/o man present with his first episode of diverticulitis he is hemodynamicaly normal and improve within 48 hrs receiving antibiotics and nothing by mounth. CT reveals stranding of sigmoid esentry. But no free air or evidence of any abscess. The next step in treatment should be:

A 30 year old male with a gunshot to the abdomen arrives to the emergency room. His last meal was 8 hours ago .The patient is taken emergently to operating room. Which of the following is correct?

A 102-year-old male is brought to the ER because of multiple vomiting and abdominal distentions. Past medical history is positive for hypertension, benign prostate hypertrophy, ischemic and valvular heart disease, Alzheimer and Parkinson disease. On examination, the abdomen is very distended, with suprapubic fullness and tenderness. Stool stones are found on digital rectal examination. On abdominal X-ray, the colon is full of stool and air without small bowel dilatation. Which is the next step in this patient’s management?

A12 hours after colonoscopy and removal of 2.5 cm sessile polyp from cercum, 55 years old woman as abdominal pain, fever, leukocytosis, mind tenderness in the right lower quadrant. No free air in the bdomen. The next step should be:

Which of the following is correct regarding an incarcerated hernia in a 2 year old child?

A 57-year-old female physician that is usually healthy is admitted to the ER due to progressively abdominal distention and constipation in the last two months. In the last week her symptoms worsened and her last bowel movement was 10 days ago. She complains of severe nausea with no abdominal pain or vomiting. On examination, the abdomen is very distended, tympanic, with no hernias or scars. On laboratory, hemoglobin – 10.2, WBC – 11,000, and chemistery is normal other than hyponatremia of 132. On abdominal X-ray the right and transverse colon are much dilated with no small bowel distention. Which is the next step in this patient’s management?