ABSITE 2020 Questions And Answers Graded A

How to monitor esophageal pH? Correct Answer: 1) Wireless probe placed 5 cm above the LES for 48 hr or 2) NG tube with multiple probes for 24 hr (more accurate). Percent time w/pH 4 recorded, number of episodes, and duration -- semester score is a composite with abnormal being 14.72 Types of esophageal diverticuli (true/false, location) Correct Answer: Pulsion- not true diverticula (do not contain all layers of the esophageal wall) and occur either proximally at the cricopharygneus muscle (Zenker's) or distal esophagus Traction- true diverticuli and occur in the mid-esophagus due to an inflammatory process with LNs putting traction on the esophagus Management of rectovaginal fistula Correct Answer: High: transabdominal Low or mid-low: endorectal advancement Wait at least 3-6 mo for repair to decrease inflammation. Location of the splenic artery and vein in relation to the pancreas Correct Answer: Artery: inferior; Vein: posterior or within the pancreas Nerve innervation of the external anal sphincter Correct Answer: Rectal branch of the internal pudendal and the perineal branch of S4. Anal canal lengthens with contraction. Classification and management of femoral neck fractures Correct Answer: Garden classification system. I: not a complete fracture, early mobilization under a physical therapist (secondary dislocation can occur 10-50% of the time leading to additional repair) or screw fixation; II: complete fx but no dislocation: screw; III: partial dislocation and IV complete dislocation -- both need arthroplasty (anatomic reduction and fixation) Major effect of corticosteroids Correct Answer: Block transcription of cytokine gene transcription in macrophages including: IL-2, TNF, IL-6 Action of factor C Correct Answer: Proteolysis of factor Va and VIIIa What is the maximal amount of air that can be exhaled? Correct Answer: Vital capacity Physiologic changes in pregnancy: HR, BP, intravascular volume Correct Answer: HR goes up, BP goes down, intravascular volume goes up % of blood loss in a pregnant before signs of shock Correct Answer: 35% of circulating blood volume Crohn's medications for moderately active Crohn's and helpful with treating persistent perianal fistulas Correct Answer: Infliximab -- monoclonal chimeric antibody to TNF Most common locations for glucagonoma, insulinoma, gastrinoma, somatostatinoma, and VIPoma Correct Answer: Glucagonoma: body and tail; Insulinoma evenly distributed in the pancreas, VIPoma in the tail, Somatostatinoma in the head, and Gastinoma in the triangle What is the Cori cycle? Correct Answer: The recycling of lactate and pyruvate for gluconeogenesis by the liver -- can provide up to 40% of plasma glucose during starvation What is a klatskin tumor? Correct Answer: Cholangiocarcinoma at the hilum What is the step-up approach for necrotizing pancreatitis? Correct Answer: First drain (either perc drain or endoscopic transgastric) and if not improved in 72 hr, look for other places to drain and drain, and if not improved in another 72 hr: VARDs with postoperative lavage. + Abx of course Rate of choledocholithiasis in cholecystectomies Correct Answer: 4-11% Most common artery to be profused by the false lumen in a aortic dissection Correct Answer: the left renal What is Petersen's space? Correct Answer: The space btwn the alimentary limb and the transverse mesocolon at the level of the jj where an internal hernia can occur. When does collagen amount peak in the wound? What collagen predominates? Correct Answer: Week 3. Collagen III peaks early but then replaced by type I. Phases of skin graft healing? Correct Answer: 1) Plasmatic imbibition (24-48 hr) 2) innosculation and capillary ingrowth 3) revascularizaiton Standard of care for treatment of stage III rectal cancer Correct Answer: 1) neoadjuvant chemo/rads 2) resection 3) chemo and then surveillance with CEA every 3-6 mo for 2 years then annually for 3 years, colonoscopy within one year and pelvic CT every year for 5 years Where does esophageal perforation occur in Boerhave syndrome? Correct Answer: In the distal esophagus on the left Billroth I vs II vs roux-en-y reconstruction anatomy and pros/cons Correct Answer: I: gastroduodenostomy with end of duodenum re-anastomosed to distal greater curve after antrectomy; II: gastrojejunostomy created but no j-j needed because more proximal jejunum -- done if adequate reach w/o tension of duo for BI; rny: loop of jejunum brought up to the stomach and anastomosis done to the stomach and then also jj. BI prevents afferent limb syndrome (obstruction). RNY good if pts can't tolerate BII -- less reflux but can get gastric atony. Where are Delphian nodes located? Correct Answer: Within the anterior suspensory ligament in the prelarygneal position in the midline. Procedures for anal incontinence Correct Answer: Wrap-around sphincteroplasty where the sphincter is mobilized and reapproximated without tension -- most common. Can do a gracilis transposition with constant low freq stimulation but that's usually for recurrent/refractory cases SBP -- organism(s) that cause, treatment, prophylactic treatment?, mortality rate Correct Answer: Usually one gram neg organism, treat with 3rd gen cephalo or fluoroquinolone, prophylactic treatment for cirrhotics w/h/o SBP, low protein (15 g/L) ascites, GI hemorrhage, and mortality is 20-40% How long is the rectum Correct Answer: 15 cm CONTINUES...