AMERICAN BOARD OF SURGERY
QUALIFYING EXAM (ABS QE)
QUESTIONS WITH COMPLETE
ANSWERS
Kaplan-Meier - ANSWER-A statistical technique used to analyze survival (life/death)
data when there are censored observations (observations that are unknown because
a subject has not been in the study long enough for the outcome to be observed). A
method frequently used to study life expectancy or the effects of different treatment
procedures.
Log-rank test - ANSWER-test used to compare survival analysis curves between 2
or more groups
Cox model - ANSWER-Adjustment for con-founders
Pulmonary Status In Aging - ANSWER-Decreased strength of respiratory muscles,
lung volumes (1/2 from 30 to 70 YO)_, compensatory responses to low O2 or high
CO2, decrease cough
Cardiovascular Status in Aging - ANSWER-Myocardium is stiffer, reduces
contractility, increased filling pressures, arteries are stiffer increases MAP and PP,
increased pulse wave velocity, less time to fill, more sensitive to arrhythmia, increase
SNS but decreased receptor affinity
Renal Physiology in Aging - ANSWER-Loss of renal mass, 30% loss by 80 YO,
increased sclerosis, blood flow decreased by 10% per decade (1/2 by 80 YO), GFR
is usually 1/2 by 80, decreased RAS (cannot conserve NA), less thirsty, less
responsive to ADH
Urologic Physiology in Aging - ANSWER-Increased collage in bladder, less
extensible, BPH, incontinence due to less estrogen
Immune System in Aging - ANSWER-Baseline Neutrophils unchanged but marrow
cannot produced, decreased T cell production, cannot respond to new Ag,
persistently elevated cytokines and ACP
What is the most common operation in >65 YO? - ANSWER-Biliary Tract Disease
What is the most common complication/death in >65 YO? - ANSWER-Cardiac
Complications
What is more important, physiologic age or chronological age - ANSWER-
Physiologic Age
,In elderly patients, what is the percentage that fever is absent in serious infections -
ANSWER-1/3
Low Muscle Mass - ANSWER-Lower Cr, a Cr of 1.0 is not necessarily normal in a
80YO
Increased risk for hypothermia - ANSWER-Decreased muscles mass, decreased
metabolism, thinner skin, malnutritionion
Misclassification Bias - ANSWER-A type of bias that occurs when an individual is
classified into the wrong category (ex. classifying an individual as a case when in
actuality he/she is a control and vise versa).
recall bias - ANSWER-Knowledge of presence of disorder alters recall by subjects
information bias - ANSWER-A prejudice in the data that results when either the
respondent or the interviewer has an agenda and is not presenting impartial
questions or responding with truly honest responses, respectively
Ascertainment bias - ANSWER-Bias that occurs due to differences in assessing or
analyzing outcomes by the researcher due to awareness of which participants
received the active versus control interventions.
Follow-up bias - ANSWER-reason for lack of follow up relates to exposure and
differs between groups
social desirability bias - ANSWER-A tendency to give socially approved answers to
questions about oneself.
lead time bias - ANSWER-Bias introduced when screening detects a disease earlier
and thus lengthens the time from diagnosis to death.
Confounding bias - ANSWER-Occurs when factor is related to both exposure and
outcome, but is not the the causal pathway; factor distorts or confuses effect of the
exposure on outcome
Odds Ratio (OR) - ANSWER-The odds that an individual with a prognostic (risk)
factor had an outcome of interest as compared to the odds for an individual without
the prognostic (risk) factor, AD/BC
Bradford Hill Criteria - ANSWER-strength, consistency, specificity, temporality,
biological gradient, plausibility, coherence, experiment, analogy
censoring - ANSWER-Loss of subjects from a follow-up study; the occurrence of the
event of interest (i.e. developing a disease or death) among such subjects is
uncertain after a specified time when it was known that the event of interest had not
occurred; it is not known, however, if or when the event of interest occurred
subsequently. Such subjects are considered censored.
, High risk for malnutrition - ANSWER->10% weight loss or Albumin <2.5, need 7-10
days of nutritional replacement
fraility - ANSWER-Heightened inflammation, altered innate & adaptive systems,
dysregulated cortisol, altered HR and hormonal status
Weakness - ANSWER-Defined by grip strength, gender and BMI
Shrinking - ANSWER-Unintentional weight loss of >10lbs/1 yr
Exhaustion - ANSWER-Measured using 2 questions from 10 item Depression Scale
Low physical activity - ANSWER-Minnesota Leisure Time, assess 2 weeks
Slow Walking - ANSWER-Average of 3 trials of 15 ft at normal pace
delirium - ANSWER-Altered level of consciousness associated with reduced ability to
shift, focus, sustain attention and an acute or fluctuating course, a confused state
Dementia - ANSWER-Loss of intellectual function, diminished memory, thinking and
judgement
What % of patients over 70 YO are expected to have delirium? - ANSWER-15%
What procedures has the highest incidence of delirium in patients over 70 YO? -
ANSWER-Orthopedic, 60%
Mini-Mental State Examination (MMSE) - ANSWER-orientation to time/place,
registration, attention/calculation, recall, language, total 30 pts, >24 is normal
Confusion Assessment Method (CAM) - ANSWER-Points to delirium in the older
adult
FEATURE 1: evidence of acute change in mental status
FEATURE 2: Inattention, difficulty focussing attention, keeping on track
(feature 1 and 2 always present)
**PLUS EITHER**
FEATURE 3: disorganized thinking
OR
FEATURE 4: altered level of consciousness
Metabolic Etiologies for Delirium - ANSWER-Hypoxia, HyperCA, HypoNA, HyperNA,
Hypoglycemia, liver or kidney dysfunction, dehydration
QUALIFYING EXAM (ABS QE)
QUESTIONS WITH COMPLETE
ANSWERS
Kaplan-Meier - ANSWER-A statistical technique used to analyze survival (life/death)
data when there are censored observations (observations that are unknown because
a subject has not been in the study long enough for the outcome to be observed). A
method frequently used to study life expectancy or the effects of different treatment
procedures.
Log-rank test - ANSWER-test used to compare survival analysis curves between 2
or more groups
Cox model - ANSWER-Adjustment for con-founders
Pulmonary Status In Aging - ANSWER-Decreased strength of respiratory muscles,
lung volumes (1/2 from 30 to 70 YO)_, compensatory responses to low O2 or high
CO2, decrease cough
Cardiovascular Status in Aging - ANSWER-Myocardium is stiffer, reduces
contractility, increased filling pressures, arteries are stiffer increases MAP and PP,
increased pulse wave velocity, less time to fill, more sensitive to arrhythmia, increase
SNS but decreased receptor affinity
Renal Physiology in Aging - ANSWER-Loss of renal mass, 30% loss by 80 YO,
increased sclerosis, blood flow decreased by 10% per decade (1/2 by 80 YO), GFR
is usually 1/2 by 80, decreased RAS (cannot conserve NA), less thirsty, less
responsive to ADH
Urologic Physiology in Aging - ANSWER-Increased collage in bladder, less
extensible, BPH, incontinence due to less estrogen
Immune System in Aging - ANSWER-Baseline Neutrophils unchanged but marrow
cannot produced, decreased T cell production, cannot respond to new Ag,
persistently elevated cytokines and ACP
What is the most common operation in >65 YO? - ANSWER-Biliary Tract Disease
What is the most common complication/death in >65 YO? - ANSWER-Cardiac
Complications
What is more important, physiologic age or chronological age - ANSWER-
Physiologic Age
,In elderly patients, what is the percentage that fever is absent in serious infections -
ANSWER-1/3
Low Muscle Mass - ANSWER-Lower Cr, a Cr of 1.0 is not necessarily normal in a
80YO
Increased risk for hypothermia - ANSWER-Decreased muscles mass, decreased
metabolism, thinner skin, malnutritionion
Misclassification Bias - ANSWER-A type of bias that occurs when an individual is
classified into the wrong category (ex. classifying an individual as a case when in
actuality he/she is a control and vise versa).
recall bias - ANSWER-Knowledge of presence of disorder alters recall by subjects
information bias - ANSWER-A prejudice in the data that results when either the
respondent or the interviewer has an agenda and is not presenting impartial
questions or responding with truly honest responses, respectively
Ascertainment bias - ANSWER-Bias that occurs due to differences in assessing or
analyzing outcomes by the researcher due to awareness of which participants
received the active versus control interventions.
Follow-up bias - ANSWER-reason for lack of follow up relates to exposure and
differs between groups
social desirability bias - ANSWER-A tendency to give socially approved answers to
questions about oneself.
lead time bias - ANSWER-Bias introduced when screening detects a disease earlier
and thus lengthens the time from diagnosis to death.
Confounding bias - ANSWER-Occurs when factor is related to both exposure and
outcome, but is not the the causal pathway; factor distorts or confuses effect of the
exposure on outcome
Odds Ratio (OR) - ANSWER-The odds that an individual with a prognostic (risk)
factor had an outcome of interest as compared to the odds for an individual without
the prognostic (risk) factor, AD/BC
Bradford Hill Criteria - ANSWER-strength, consistency, specificity, temporality,
biological gradient, plausibility, coherence, experiment, analogy
censoring - ANSWER-Loss of subjects from a follow-up study; the occurrence of the
event of interest (i.e. developing a disease or death) among such subjects is
uncertain after a specified time when it was known that the event of interest had not
occurred; it is not known, however, if or when the event of interest occurred
subsequently. Such subjects are considered censored.
, High risk for malnutrition - ANSWER->10% weight loss or Albumin <2.5, need 7-10
days of nutritional replacement
fraility - ANSWER-Heightened inflammation, altered innate & adaptive systems,
dysregulated cortisol, altered HR and hormonal status
Weakness - ANSWER-Defined by grip strength, gender and BMI
Shrinking - ANSWER-Unintentional weight loss of >10lbs/1 yr
Exhaustion - ANSWER-Measured using 2 questions from 10 item Depression Scale
Low physical activity - ANSWER-Minnesota Leisure Time, assess 2 weeks
Slow Walking - ANSWER-Average of 3 trials of 15 ft at normal pace
delirium - ANSWER-Altered level of consciousness associated with reduced ability to
shift, focus, sustain attention and an acute or fluctuating course, a confused state
Dementia - ANSWER-Loss of intellectual function, diminished memory, thinking and
judgement
What % of patients over 70 YO are expected to have delirium? - ANSWER-15%
What procedures has the highest incidence of delirium in patients over 70 YO? -
ANSWER-Orthopedic, 60%
Mini-Mental State Examination (MMSE) - ANSWER-orientation to time/place,
registration, attention/calculation, recall, language, total 30 pts, >24 is normal
Confusion Assessment Method (CAM) - ANSWER-Points to delirium in the older
adult
FEATURE 1: evidence of acute change in mental status
FEATURE 2: Inattention, difficulty focussing attention, keeping on track
(feature 1 and 2 always present)
**PLUS EITHER**
FEATURE 3: disorganized thinking
OR
FEATURE 4: altered level of consciousness
Metabolic Etiologies for Delirium - ANSWER-Hypoxia, HyperCA, HypoNA, HyperNA,
Hypoglycemia, liver or kidney dysfunction, dehydration
