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?
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Question 2 of 49
2. Question
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?
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Question 3 of 49
3. Question
Herediatry spherocytosis:
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Question 4 of 49
4. Question
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:
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Question 5 of 49
5. Question
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:
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Question 6 of 49
6. Question
A 64 year-old man has a solitary thyroid nodule discovered during a screening carotid duplex. Fine-nedeel aspiration of the nodule shows a predominance of Hurthle cells with scant amounts of colloid and no evidence of malignancy. the next step should be:
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Question 7 of 49
7. Question
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?
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Question 8 of 49
8. Question
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:
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Question 9 of 49
9. Question
Common complication of RYGB:
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Question 10 of 49
10. Question
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?
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Question 11 of 49
11. Question
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?
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Question 12 of 49
12. Question
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?
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Question 13 of 49
13. Question
18 year old men went inguinal hernia reaper with spinal anesthesia. What is correct regarding preoperative:
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Question 14 of 49
14. Question
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?
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Question 15 of 49
15. Question
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:
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Question 16 of 49
16. Question
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?
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Question 17 of 49
17. Question
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?
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Incorrect
Question 18 of 49
18. Question
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:
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Question 19 of 49
19. Question
Small bowl obstruction from bezoar is more common after:
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Question 20 of 49
20. Question
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?
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Question 21 of 49
21. Question
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:
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Question 22 of 49
22. Question
All are compensatory mechanism in hypovolemic shock except:
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Question 23 of 49
23. Question
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?
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Question 24 of 49
24. Question
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:
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Question 25 of 49
25. Question
Recommended to colorectal liver metastasis that localized to one liver lobe is:
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Question 26 of 49
26. Question
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?
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Question 27 of 49
27. Question
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:
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Incorrect
Question 28 of 49
28. Question
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:
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Question 29 of 49
29. Question
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?
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Incorrect
Question 30 of 49
30. Question
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:
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Question 31 of 49
31. Question
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?
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Question 32 of 49
32. Question
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?
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Question 33 of 49
33. Question
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:
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Question 34 of 49
34. Question
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?
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Question 35 of 49
35. Question
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?
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Question 36 of 49
36. Question
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?
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Question 37 of 49
37. Question
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?
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Incorrect
Question 38 of 49
38. Question
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?
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Incorrect
Question 39 of 49
39. Question
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:
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Question 40 of 49
40. Question
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:
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Incorrect
Question 41 of 49
41. Question
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:
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Question 42 of 49
42. Question
Which of the following is the most useful in identifying patients at high risk for familial medullary thyroid cancer?
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Question 43 of 49
43. Question
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 ?
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Question 44 of 49
44. Question
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?
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Question 45 of 49
45. Question
Abnormalities in all of the following variables have been used to suggest the need for damage control (or abbreviated) laparotomy in trauma patients except :
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Question 46 of 49
46. Question
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?
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Question 47 of 49
47. Question
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?
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Question 48 of 49
48. Question
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:
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Question 49 of 49
49. Question
Which of the following statements about laparoscopic Roux-en-Y gastric bypass (RYGB) compared with laparoscopic adjustable gastric banding (AGB) is not true?