10.2011 surgery

A 72-year-old man undergoes an aortobifemoral graft for symptomatic aortoiliac occlusive disease. The inferior mesenteric artery (IMA) is ligated at its aortic attachment. Twenty-four hours after surgery the patient has abdominal distention, fever, and bloody diarrhea. Which of the following is the most appropriate diagnostic study for this patient?

38 y.old woman should go laparoscopic cholicystectomy, no family history of thromboembolic events and no personal medical history of thromboembolic events. Which is indicated for perioperative DVT prophylaxis?

Herediatry spherocytosis:

A 38-year-old woman has a 1.5-cm mass in her left breast. Clinical examination reveals no suspicious adenopathy. Mammogram-guided biopsy demonstrates infiltrating ductal carcinoma. The patient would prefer a lumpectomy followed by radiation therapy. Which of the following statements about sentinel lymph node biopsy (SLNB) is TRUE:

Preoperative biochemical evaluation of patient for parathyroidectomy is dune for PHPT (primary hyperparathyroidism) show Ca+ 12 and intact PTH (200pg/ml). 1cm hypercellular parathyroide adenoma is resected . Postoperatively the patient complaint on perioral tingling, numbness and carpopedal spasm. The ECG will show:

02.01.PreTest-Surgery-13e.01.07
A 75-year-old man with a history of myocardial infarction 2 years ago, peripheral vascular disease with symptoms of claudication after walking half a block, hypertension, and diabetes presents with a large ventral hernia. He wishes to have the hernia repaired. Which of the following is the most appropriate next step in his preoperative workup?

Postmenopausal women choose mastectomy and sentinel lymph node biopsy (SLNB) for a new diagnosed Breast carcinoma. Final pathology reveals 1cm infiltrating ductal carcinoma with negative SLN. It is estrogen receptor/progesterone receptor (ER/PR) positive and HER2/neu negative The most appropriate adjuvant therapy would be:

Common complication of RYGB:

A healthy 38 year old woman is rescued from a house fire after 20 minutes. In the emergency room she has anterior chest wall burns and is weak, confused, and lethargic. The most likely diagnosis is?

A victim of blunt abdominal trauma undergoes a partial hepatectomy. During surgery, he receives twelve units of packed red blood cells. In the recovery room, he is noted to be bleeding from intravenous puncture sites and the surgical incision. Which of the following statements regarding the coagulopathy is most likely true?

38 years old women with right colon cancer, her history meet Amsterdam criteria, also has a 10 years old son. Which of the following statements is true?

18 year old men went inguinal hernia reaper with spinal anesthesia. What is correct regarding preoperative:

A 65-year-old man has an enterocutaneous fistula originating in the jejunum secondary to inflammatory bowel disease. Which of the following would be the most appropriate fluid for replacement of his enteric losses?

55 years old with 1st episode of diverticulitis, hemodynamicaly stable and improve within 48h receiving antibiotic and nothing by mouth. CT show stranding of sigmoid mesentery, but no free air evidence of an abscess. The next step should be:

A 88-year 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 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the second postoperative day, she begins to complain of a tingling sensation in her hands. She appears quite anxious and later complains of muscle cramps. Which of the following is the most appropriate initial management strategy?

40 years old women, history of chron’s disease and many prior small bowel resections, present with intractable non bloody diarrhea, weight loss and several recent admissions for vol depletion and electrolyte disturbance. The most likely diagnosis:

Small bowl obstruction from bezoar is more common after:

A 24-year-old firefighter sustains 30% total body surface area (TBSA) burns to his torso, face, and extremities. His wounds are treated topically with silver nitrate. Which of the following complications is associated with use of this agent?

A 48 years old man with a history of alcohol use presents evaluation reveals a linear disruption of the gastric mucosa high on the lasser curvature at the gastroesophageal junction.Endoscopic attempts to control the bleeding fail. The patient has received 6 units of packed RBCs and his heart rate is115/min with a systolic blood pressure of 85mmHg. The most appropriate management would be:

All are compensatory mechanism in hypovolemic shock except:

A 10-year-old boy was the backseat belted passenger in a high-speed motor vehicle collision. On presentation to the ER, he is awake, alert, and hemodynamically stable. He is complaining of abdominal pain and has an ecchymosis on his anterior abdominal wall where the seatbelt was located. Which of the following is the best next step in his management?

A 51 years old man with a history of peptic ulcer disease presents with abdominal pain and free air.during operation a duodenal perforation is identified with significant associated peritonitis .A modified Graham patch is performed.Acid reduction therapy is initiatedand serology for Helicobacter pylori is obtained.seven days after operation an operativedrain begins draining copious amounts of bile.Management of this duodenal fistula includes all of the following except:

Recommended to colorectal liver metastasis that localized to one liver lobe is:

A patient is brought to the ER after a motor vehicle accident. He is unconscious and has a deep scalp laceration and one dilated pupil. His heart rate is 120 beats per minute blood pressure is 80/40 mm/Hg, and respiratory rate 35 per min. Despite rapid administration of 2 L normal saline, and patients vital signs do not change significantly. Which of the following is the most appropriate next step in the workup of his hypotension?

A 75 years old woman presents with the acute onest of abdominal pain . on physical examination ,she has a palpable abdominal mass that is painful with contracture of the abdominal muscles. She has no peritoneal irritation .she is receiving anticoagulation for recent onest atrial fibrillation . the underlying vessel causing this problem is most likely the:

A 55y.old woman no history evaluation for melena has 2cm GIST (gastrointestinal stromal tumor) in the anterior wall of the stomach. The diagnosis confirmed by immunohistochemical, no evidence for adjacent organ invasion or metastasis. The recommended treatment is:

A 25-year-old woman is diagnosed with bilateral breast cancer. She undergoes genetic testing to assess whether she has a mutation in either BRCA1 or BRCA2. Which of the following statements is true regarding BRCA mutations?

Six months after laparoscopic splenectomy for immune thrombocytopenic purpura ,a 38 years old woman with lupus remains thrombocytopenic (platlet count42,000 cell/mm^3). The next step should be:

In the ER, 60 year-old male with no previous medical history is found to have an obstructing tumor in the sigmoid colon on combined CT and gastrografin enema , no distant metasteses are identified and the cecum’s diameter is 15 cm. What is the recommended treatment?

A 35-year-old woman with a history of previous right thyroidectomy for a benign thyroid nodule now undergoes completion thyroidectomy for a suspicious thyroid mass. Several hours postoperatively, she develops progressive swelling under the incision, stridor, and difficulty breathing. Orotracheal intubation is successful. Which of the following is the most appropriate next step?

A 20 years old man has a 2 cm right adrenal mass found during a work up for low back pain.the left adrenal is of normal size .the next step should be:

A cirrotic patient that is a liver transplant candidate is admitted for esophageal bleeding varices . Treatment with somatostatin and endoscopy including sclerotherapy and failed banding don’t stop the bleeding. What is the next step?

A 15-year-old otherwise healthy female high school student begins to notice galactorrhea. A pregnancy test is negative. Which of the following is a frequently associated physical finding?

A 56 years old postmenopausal woman has serium calcium of 10.9 mg/dl (normal 7.5 to 9.5) and a serum PTH of 85 pg/ml(normal 20 to 60 pg/ml) . She has no family history and is asymptomatic .she is an avid jogger . Bone densitometry (DEXA scan) shows minimal osteoporosis. Which of the following is true?

A 45-year-old man with a history of chronic peptic ulcer disease undergoes a truncal vagotomy and antrectomy with a Billroth II reconstruction for gastric outlet obstruction. Six weeks after surgery, he returns, complaining of postprandial weakness, sweating, light-headedness, crampy abdominal pain, and diarrhea. Which of the following would be the best initial management strategy?

A 72-year-old man status post–coronary artery bypass graft (CABG) 5 years ago presents with hematochezia, abdominal pain, and fevers. Colonoscopy reveals patches of dusky-appearing mucosa at the splenic flexure without active bleeding. Which of the following is the most appropriate management of this patient?

A 44 years old woman has papillary thyroid carcinoma of the right lobe confirmed by fine-needle aspiration. Ultrasound study stages the tumor as T1 (1.5 CM). Optimal surgical management would be:

A 58 year-old man with a mass in the left side of his neck. The patient noticed the mass several weeks ago, and was given antibiotic by his primary care physician. The mass appeared to subside somewhat, but is still present. U.S. shows a 2 cm solid mass. On examination, the mass is 2 cm, firm and fixed to the underlying tissue. The best step now would be:

A 46 years old women ask about the need for surgery, since she was recently diagnosed with Crhon’s Disease. Indication for operation in Chron’s include all except:

14 year-old girl with a six month history of sudden , rapid ,asymmetric enlargement of the right breast. On physical examination, there is a large palpable mass occupying the breast with marked nippleareolar stretching, prominent dilated veins, and skin ulceration. Mammography and US show a dense, well-circumscribed 7 cm homogenous mass occupying the left breast. The most likely diagnosis is ?

A 28-year-old woman who is 15 weeks pregnant has new onset of nausea, vomiting, and rightsided abdominal pain. She has been free of nausea since early in her first trimester. The pain has become worse over the past 6 hours. Which of the following statments about appendicitis during pregnancy is correct?

Abnormalities in all of the following variables have been used to suggest the need for damage control (or abbreviated) laparotomy in trauma patients except :

A 51 year-old blond, light ,complexioned man had undergone laparotomy for progressive small bowel obstruction. A desmoplastic reaction is causing this small bowel obstruction. Which of the following best describes the diagnosis?

A 41-year-old man complains of regurgitation of saliva and of undigested food. An esophagram reveals a bird’s-beak deformity. Which of the following statements is true about this condition?

A 36 years old man has a blood pressure of 70/40 mm/Hg after a motor vehicle crash .resuscitation is initiated. Focused assessment with sonography for trauma (FAST) is positive for fluid in the abdomen. on examination of the pelvis ,fracture – related crepitus and an enlarging perineal hematoma are appreciated .the patients blood pressure does not improve with resusciatation .the next step in management should be:

Which of the following statements about laparoscopic Roux-en-Y gastric bypass (RYGB) compared with laparoscopic adjustable gastric banding (AGB) is not true?