ABSITE EXAM – QUESTIONS WITH A+ SOLUTIONS
Hard signs of extremity vascular injury Right Ans - 1) expanding or
pulsatile hematoma 2) limb ischemia 3) palpable thrill or audible bruit 4)
ongoing hemorrhage with shock 5) absent distal pulses 6) arterial bleeding
Blunt Sternal fracture management Right Ans - Rule out blunt cardiac
injury with EKG. If abnormal but otherwise HDS, observe for 24-48 hr
Zones and triangles of the neck in trauma Right Ans - Anterior triangle:
anterior to the SCM; Posterior: posterior to the SCM and bounded posteriorly
by trapezius and inferiorly by clavicle. Zone I above the clavicle; zone II: from
cricoid to the angle of mandible; III: above angle of the mandible. Operate if:
unstable, hard signs of vascular injury, or tracheal injury. If none of the above:
CXR, esophagram, CTA
Most common organ injured in blunt trauma Right Ans - liver
Management of extraperitoneal bladder injuries Right Ans - Most can be
managed non-operatively with foley drainage
When should a crossmatch of blood be repeated Right Ans - After
transfusion of 8-10 units
Treatment for locally recurrent anal cancer Right Ans - APR with inguinal
lymph node dissection if positive
Treatment of anal cancer per stage Right Ans - I (T1N0, T2N0): wide local
excision with 1 cm margins ( if no sphincter involvement); T2 advanced CRT
(5-FU and cisplatin); T3 and T4 or LN positive: CRT and if inguinal LN
positive: radiation to pelvis
Criteria for transanal excision of anal cancer Right Ans - 1) < 30% circum
2) < 8 cm from the anal verge 3) < 3 cm in diameter 4) clear margins > 3mm
5) mobile not fixed 6) T1 (invades submucosa only) 7) no lymphovascular or
perineurial invasion 8) well to moderately differentiated
, Treatment for anal melanoma Right Ans - local excision, chemo and
radiation don't work well. Often anal melanoma when already advanced and
metastatic, so often local excision is done for palliative measures
Parotid tumor that can be bilateral, associated with smoking Right Ans -
Warthin's tumor, aka papillary cystadenoma lymphomatosum
Types of choledochal cysts Right Ans - I: saccular or fusiform dilation of a
portion or entire cBD with normal intrahepatic duct
II: isolated diverticulum protruding from the CBD
III: (choledochocele) dilation of duodenal portion of CBD or where pancreatic
duct meets; IVa: multiple dilations of the intrahepatic and extra hepatic duct
trees
IVb: multiple dilations involving only the extra hepatic ducts
V: (aka Caroli's disease): cystic dilation of intrahepatic biliary ducts
How does hypomagnesium decrease Ca level? Right Ans - Decreases end
organ's responsiveness to PTH and severe levels suppress PTH release. Of
note, high levels of Mg can bind to the calcium-sensing receptor on the
parathyroid gland imitating hypercalcemia
Growth factor that is a major contributor of smooth muscle cell proliferation
Right Ans - Platelet derived growth factor
What is in the lipid core and what is in the fibrous cap? Right Ans - Lipid
core: LDL, proteins, inflammatory cells; Fibrous cap: smooth muscle cells and
connective tissue
Dumping syndrome Right Ans - Affects 5-10% of patients that undergo
pyloroplasty, pyloromyotomy, or distal gastrectomy. Sx include
lightheadedness, tachycardia, diaphoresis, weakness. Early dumping
syndrome occurs 30 min after eating and is due to hyperosmotic load being
delivered to the duodenum in the absence of a pylorus causing a fluid shift.
Late dumping syndrome occurs 2-3 hours after a meal and is due to a large
insulin release when a large bolus hits the duodenum.
kcal of energy for lipids, proteins, dextrose, and carbs Right Ans - lipids= 9
kcal/g, proteins 4 kcal/g, dextrose 3.4 kcal/g, carbs 4 kcal/g
Hard signs of extremity vascular injury Right Ans - 1) expanding or
pulsatile hematoma 2) limb ischemia 3) palpable thrill or audible bruit 4)
ongoing hemorrhage with shock 5) absent distal pulses 6) arterial bleeding
Blunt Sternal fracture management Right Ans - Rule out blunt cardiac
injury with EKG. If abnormal but otherwise HDS, observe for 24-48 hr
Zones and triangles of the neck in trauma Right Ans - Anterior triangle:
anterior to the SCM; Posterior: posterior to the SCM and bounded posteriorly
by trapezius and inferiorly by clavicle. Zone I above the clavicle; zone II: from
cricoid to the angle of mandible; III: above angle of the mandible. Operate if:
unstable, hard signs of vascular injury, or tracheal injury. If none of the above:
CXR, esophagram, CTA
Most common organ injured in blunt trauma Right Ans - liver
Management of extraperitoneal bladder injuries Right Ans - Most can be
managed non-operatively with foley drainage
When should a crossmatch of blood be repeated Right Ans - After
transfusion of 8-10 units
Treatment for locally recurrent anal cancer Right Ans - APR with inguinal
lymph node dissection if positive
Treatment of anal cancer per stage Right Ans - I (T1N0, T2N0): wide local
excision with 1 cm margins ( if no sphincter involvement); T2 advanced CRT
(5-FU and cisplatin); T3 and T4 or LN positive: CRT and if inguinal LN
positive: radiation to pelvis
Criteria for transanal excision of anal cancer Right Ans - 1) < 30% circum
2) < 8 cm from the anal verge 3) < 3 cm in diameter 4) clear margins > 3mm
5) mobile not fixed 6) T1 (invades submucosa only) 7) no lymphovascular or
perineurial invasion 8) well to moderately differentiated
, Treatment for anal melanoma Right Ans - local excision, chemo and
radiation don't work well. Often anal melanoma when already advanced and
metastatic, so often local excision is done for palliative measures
Parotid tumor that can be bilateral, associated with smoking Right Ans -
Warthin's tumor, aka papillary cystadenoma lymphomatosum
Types of choledochal cysts Right Ans - I: saccular or fusiform dilation of a
portion or entire cBD with normal intrahepatic duct
II: isolated diverticulum protruding from the CBD
III: (choledochocele) dilation of duodenal portion of CBD or where pancreatic
duct meets; IVa: multiple dilations of the intrahepatic and extra hepatic duct
trees
IVb: multiple dilations involving only the extra hepatic ducts
V: (aka Caroli's disease): cystic dilation of intrahepatic biliary ducts
How does hypomagnesium decrease Ca level? Right Ans - Decreases end
organ's responsiveness to PTH and severe levels suppress PTH release. Of
note, high levels of Mg can bind to the calcium-sensing receptor on the
parathyroid gland imitating hypercalcemia
Growth factor that is a major contributor of smooth muscle cell proliferation
Right Ans - Platelet derived growth factor
What is in the lipid core and what is in the fibrous cap? Right Ans - Lipid
core: LDL, proteins, inflammatory cells; Fibrous cap: smooth muscle cells and
connective tissue
Dumping syndrome Right Ans - Affects 5-10% of patients that undergo
pyloroplasty, pyloromyotomy, or distal gastrectomy. Sx include
lightheadedness, tachycardia, diaphoresis, weakness. Early dumping
syndrome occurs 30 min after eating and is due to hyperosmotic load being
delivered to the duodenum in the absence of a pylorus causing a fluid shift.
Late dumping syndrome occurs 2-3 hours after a meal and is due to a large
insulin release when a large bolus hits the duodenum.
kcal of energy for lipids, proteins, dextrose, and carbs Right Ans - lipids= 9
kcal/g, proteins 4 kcal/g, dextrose 3.4 kcal/g, carbs 4 kcal/g
