PACKRAT Surgery Exam Questions and Answers All Correct.docx

PACKRAT Surgery Exam Questions and Answers All C An 18-year-old patient has a tibia/fibula fracture following a motorcycle crash. Twelve hours later the patient presents with increased pain despite adequate doses of analgesics and immobilization. Which of the following is the most likely diagnosis? A. avascular necrosis B. myositis ossificans C. compartment syndrome D. reflex sympathetic dystrophy - Answer-EXPLANATIONS: (u) A. Avascular necrosis occurs primarily in muscles post-traumatically and may not arise for several months after an injury. (u) B. Myositis ossificans is a late complication of fracture resulting from disruption of the blood supply to the bone. (c) C. Compartment syndrome is characterized by a pathological increase of pressure within a closed space and results from edema or bleeding within the compartment. It may occur as an early local complication of fracture. (u) D. Reflex sympathetic dystrophy is characterized by painful wasting of the hand muscles that may be secondary to injury and could occur as a late complication. A patient presents to the Emergency Department with complaints of increasing pain in the right lower extremity. He has a history of a non-displaced proximal tibial fracture treated with application of a long leg cast 2 days prior. On exam there is marked swelling of the toes and the patient refuses to move them secondary to pain. An injection of meperidine fails to relieve the patient's pain. Clinical intervention is needed to prevent what complication? A.osteomyelitis B.traumatic arthritis C.Volkmann's contracture D.malunion of fracture fragments - Answer-EXPLANATIONS: (u) A. Osteomyelitis results from a source of infection that may include an open fracture, but not a closedfracture. (u) B. Traumatic arthritis only occurs as a result of fractures that involve the articular surface. (c) C. This patient has classic findings of acute compartment syndrome. Volkmann's contracture may occur from an untreated compartment syndrome or an arterial injury. (u) D. Malunion of the fracture fragments occur when there is poor reduction of the fracture fragments. Non-displaced fractures do not require reduction. A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive range of motion of the toes the patient "yells" in agony. The patient also states that the top of his foot has decreased sensation. On physical examination the physician assistant notes that the leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing should be done? A. X-ray of the lower leg and ankle. B. Doppler studies. C. Bone scan. D. Compartment pressure - Answer-Explanations (u) A. X-rays of the lower leg and ankle will only determine bone placement. (u) B. Doppler studies will confirm the presence of a decreased pulse. (u) C. A bone scan is not indicated in the evaluation of compartment syndrome. (c) D. Compartmental pressures should be obtained as soon as possible. If they are elevated this is a surgical emergency. A 35 year-old male placed in a thumb spica cast for a scaphoid fracture presents complaining of forearm and hand pain that is not relieved with pain medication and elevation. Which of the following is the earliest physical exam sign for his current condition? A.Slow capillary refill B.Loss of two-point discrimination C. Absent peripheral pulses D. Pain with passive stretch. - Answer-(c) B. Loss of two-point discrimination can be the earliest sign of compartment syndrome. (u) C. Peripheral pulses are poor indicators of compartment syndrome as they remain intact until late. (a) D. Pain with passive stretch is a subjective finding early and must be differentiated from pain of the original injury. Although a reliable finding it may be difficult to reproduce in the cast. 25 year-old male presents to the ED with left calf pain and cramping, as well as nausea and vomiting. He admits to "partying with cocaine all night". He describes his urine as a dark brown color. Serum creatinine kinase (CK) is 1325 IU/L (Normal Range 32-267 IU/L). Which of the following is the initial mainstay of therapy for this condition? A. IV rehydration B. Fasciotomy C. Toradol (Ketorlac) D. Hydrotherapy - Answer-Explanations (c) A. IV rehydration with crystalloids for 24 to 72 hours is the mainstay of therapy for rhabdomyolysis. (u) B. Fasciotomy is indicated for compartment syndrome. (h) C. NSAIDS, such as Toradol (Ketorlac), should not be used due to the vasoconstrictive effects on the kidneys. (u) D. Hydrotherapy is not useful or indicated for Rhabdomyolysis A 42 year-old male presents complaining of a sudden onset of a severe intermittent pain originating in the flank and radiating into the right testicle. He also complains of nausea and vomiting. On examination the patient is afebrile, but restless. Examination of the abdomen reveals tenderness to palpation along the right flank with no rebound or direct testicular tenderness. Urinalysis reveals a pH of 5.4 and microscopic hematuria, but is otherwise unremarkable. Which of the following is the most likely diagnosis? A. Bladder cancer B. Nephrolithiasis C. Acute appendicitis D. Acute epididymitis - Answer-Explanations (u) A. While bladder cancer may have associated microscopic hematuria, it presents with painless hematuria orirritative voiding symptoms. (c) B. A sudden onset of severe colicky flank pain associated with nausea and vomiting as well as the absence of rebound or direct testicular tenderness makes nephrolithiasis the most likely diagnosis. This is further supported by the presence of hematuria on the urinalysis. (u) C. While an acute abdomen, such as acute appendicitis, is in the differential diagnosis, the absence of fever and peritoneal signs makes this diagnosis less likely. (u) D. The absence of fever as well as non-tenderness to palpation of the testes suggests a renal rather than gonadal cause of the patient's symptoms. Which of the following pathophysiological processes is believed to initiate acute appendicitis? A. Obstruction B. Perforation C. Hemorrhage D. Vascular compromise - Answer-Explanations (c) A. Obstruction of the appendiceal lumen by lymphoid hyperplasia, a fecalith or foreign body initiates most cases of appendicitis. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. What is the term for blue discoloration about the umbilicus? A. Cullen's sign B. Murphy's sign C. Rovsing's sign D. Turner sign - Answer-Explanations (c) A. Cullen's sign is a blue discoloration about the umbilicus and can occur in hemorrhagic pancreatitis and results from hemoperitoneum. (u) B. Murphy's sign is seen in liver and gallbladder disease by which the patient abruptly halts deep inspiration due to pain in the right upper quadrant while the examiner's hand is keeping stable pressure to the area. (u) C. Rovsing's sign is positive when the patient experiences right sided abdominal pain with palpation to the left side. This is generally seen in those with appendicitis. (u) D. Turner sign is also seen in severe, acute pancreatitis but is represented by a green-brown discoloration of bilateral flanks A patient presents with abdominal pain in the right lower quadrant, examination reveals increased pain in the right lower quadrant on deep palpation of the left lower quadrant. This commonly known as which of the following? A.Psoas sign B.Murphy's sign C.Rovsing's sign D.Obturator sign - Answer-Explanations (u) A. Psoas sign is right lower quadrant pain with right leg extension. (u) B. Murphy's sign is seen in liver and gallbladder disease in which the patient abruptly halts deep inspiration due to discomfort as the examiners hand applies pressure to the right upper quadrant. (c) C. A positive Rovsing's sign can be elicited in a patient with appendicitis when increased pain occurs in the right lower quadrant upon palpation of the left lower quadrant. (u) D. Obturator sign is right lower quadrant pain with internal rotation of the hip. A 25 year-old female presents with right lower quadrant pain, right flank pain, nausea, and vomiting. Her temperature is 39.6 degrees C. There is right CVA tenderness and RLQ tenderness. Pelvic exam is unremarkable. Urinalysis reveals pH 7.0, trace protein, negative glucose, negative ketones, positive blood, and positive nitrates. Specific gravity is 1.022. Microscopic shows 102 RBCs/HPF, 50-75 WBCs/HPF, rare epithelial cells, and WBC casts. The most likely diagnosis is A.acute salpingitis. B.nephrolithiasis. C.acute pyelonephritis. D.appendicitis. - Answer-Explanations (u) A. Acute salpingitis would be suggested if pelvic exam abnormalities were present. (u) B. Nephrolithiasis does not usually present with fever or casts. Urinalysis will have RBCs present. (c) C. Acute pyelonephritis presents with flank pain, fever, and generalized muscle tenderness. Urinalysis shows pyuria with leukocyte casts. (u) D. This scenario is consistent with acute pyelonephritis, not acute appendicitis. A 26 year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the following is the most likely diagnosis? A. Ectopic pregnancy B. Appendicitis C. Crohn's disease D. Pelvic inflammatory disease - Answer-Explanations (c) A. High suspicion for ectopic pregnancy should be maintained when any possible pregnant woman presents with vaginal bleeding or abdominal pain. (u) B. Appendicitis presents with nausea, vomiting and periumbilical pain that moves to the right lower quadrant of the abdomen. (u) C. Crohn's disease is more common in women and may present with an acute abdomen. However, pelvic examination would be normal. (u) D. In pelvic inflammatory disease the temperature is usually above 38 degrees C and pelvic pain usually follows onset of cessation of menses A 22 year-old male presents to the clinic complaining of scrotal pain that radiates into the groin. Patient admits to being a weightlifter and was lifting 24 hours prior to this pain developing into the scrotum. The patient admits to being sexually active with only his male partner. Examination reveals a reddened scrotum and it is difficult to distinguish the epididymis from the testes on the right side. Elevation of the right testicle brings relief of the pain. This is known as a positive A. Prehn's sign. B. Cullen's sign. C. Rovsing's sign. D. Murphy's sign. - Answer-Explanations (c) A. Prehn's sign is seen in epididymitis when elevation of the scrotum with the affected epididymis to the level of the symphysis pubis brings relief from the pain. (u) B. Cullen's sign is a bluish discoloration of the umbilicus resulting from hematoperitoneum. (u) C. Rovsing's sign is seen in appendicitis when pressure on the left quadrant produces pain in the right lower quadrant. (u) D. Murphy's sign is seen in acute cholecystitis with a sharp increase in tenderness when the gall bladder touches the examining hand causing a stop of the inspiratory effort. Which of the following conditions is most suggestive of an asymptomatic abdominal aortic aneurysm? A. abdominal mass B. hypertension C. chest pain D. syncope - Answer-EXPLANATIONS: (c) A. Symptomatic abdominal aortic aneurysm presents with pulsating upper abdominal mass. (u) B. Hypertension is not suggestive of symptomatic abdominal aortic aneurysm. (u) C. Abdominal aortic aneurysm presents with mid-abdominal or lower back pain. (u) D. Syncope is not common in abdominal aortic aneurysm, unless it ruptures. A 12-year-old boy presents to the office with pain in his legs with activity gradually becoming worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Examination of the heart reveals an ejection click and accentuation of the second heart sound. Femoral pulses are weak and delayed compared to the brachial pulses. Blood pressure obtained in both arms is elevated. Chest x-ray reveals rib notching. Which of the following is the most likely diagnosis? A. abdominal aortic aneurysm B. pheochromocytoma C. coarctation of the aorta D. thoracic outlet syndrome - Answer-EXPLANATIONS: (u) A. Abdominal aortic aneurysm is usually asymptomatic until the patient has dissection or rupture. It is uncommon in a child. (u) B. Pheochromocytoma classically causes paroxysms of hypertension due to catecholamine release from the adrenal medulla, but does not cause variations in blood pressure in the upper and lower extremities. (c) C. Coarctation is a discrete or long segment of narrowing adjacent to the left subclavian artery. As a result of the coarctation, systemic collaterals develop. X-ray findings occur from the dilated and pulsatile intercostal arteries and the "3"is due to the coarctation site with proximal and distal dilations. (u) D. Thoracic outlet syndrome occurs when the brachial plexus, subclavian artery, or subclavian vein becomes compressed in the region of the thoracic outlet. It is the most common cause of acute arterial occlusion in the upper extremity of adults under 40 years old. A 19 year-old female presents with complaint of palpitations. On examination you note the patient to have particularly long arms and fingers and a pectus excavatum. She has a history of joint dislocation and a recent ophthalmologic examination revealed ectopic lentis. Which of the following echocardiogram findings would be most consistent with this patient's physical features? A. right atrial enlargement B. aortic root dilation C. pulmonic stenosis D. ventricular septal defect - Answer-Explanations (u) A. Patients with Marfan's syndrome commonly have mitral valve prolapse and possibly aortic regurgitation (high frequency diastolic murmur at the third right intercostal space). Right atrial enlargement, pulmonic stenosis and ventricular septal defect are not commonly seen. (c) B. This patient has the signs and symptoms consistent with Marfan's syndrome. Ectopia lentis, aortic root dilation and aortic dissection are major criteria for the diagnosis of the disease. (u) C. See A for explanation. (u) D. See A for explanation A 56 year-old male presents to the office with a history of abdominal aortic aneurysm. He was told that he will need on going evaluation to assess whether the aneurysm is expanding. What is the recommended study to utilize in this situation? A. plain film of the abdomen B. serial abdominal exam C. ultrasound of the abdomen D. angiography of the abdominal aorta - Answer-Explanations (u) A. Although some abdominal aortic aneurysms are calcified, abdominal radiography may demonstrate the calcified outline of the aneurysm. However, about 25% of aneurysms are not calcified and cannot be visualized by plain x-ray. (u) B. Serial abdominal exams are not sensitive in detecting progression of abdominal aortic aneurysms. (c) C. An abdominal ultrasound can delineate the transverse and longitudinal dimensions of an abdominal aortic aneurysm and may detect mural thrombus. Abdominal ultrasound is best used to screen patients at risk for the development of this condition. (u) D. Contrast aortography is used commonly for the evaluation of patients with aneurysms before surgery, but it has no role in the serial assessment of patients being followed on a chronic basis. Which of the following is a proven risk factor for the development of abdominal aortic aneurysm? A. Infective endocarditis B. Diabetes mellitus C. Cigarette smoking D. Alcohol abuse - Answer-Explanations (u) A. Infective endocarditis is not associated with the development of abdominal aortic aneurysm. (u) B. Diabetic patients do have a higher rate of atherosclerosis, but there is no clear causal evidence of diabetics being at higher risk for the development of abdominal aortic aneurysm. (c) C. Cigarette smoking is the primary risk factor for the development of aortic aneurysms. (u) D. Alcohol abuse is not related to development of abdominal aortic aneurysm. Postmenopausal patient is diagnosed with grade I breast cancer. The tumor is 0.7 cm in size, estrogen-receptor positive, and axillary nodes are negative. After undergoing a lumpectomy, which of the following adjuvant therapy is indicated for this patient? A. chemotherapy B. tamoxifen C. ovarian ablation D. bisphosphonate therapy - Answer-EXPLANATIONS: (u) A. Chemotherapy is indicated in breast cancer with tumors larger than 1 cm in site. (c) B. Tamoxifen is the adjuvant therapy of choice in post-menopausal estrogen receptor positive axillary node negative breast cancer. (u) C. While ovarian ablation is a form of hormonal therapy, it is not the initial treatment of choice. (u) D. Bisphosphonate therapy is used in breast cancer patients with metastasis disease for the bone. A 28 year-old female with diabetes mellitus type 2 sustains a partial thickness burn to her left upper arm and her chest when hot grease spilled on her at home. The burn to her arm is circumferential and the estimated total body surface burned is 18%. She has no allergies. The most appropriate treatment of this patient would include A. outpatient application of silver sulfadiazine. B. debridement of all intact blisters. C. IV cefazolin (Ancef, Kefzol). D. transfer to a burn center. - Answer-Explanations (u) A. Although treatment may include silver sulfadiazine dressings, this patient should not be treated as an outpatient. Also see D for explanation. (u) B. Debridement of intact blisters remains controversial, however many authorities recommend leaving intact blisters intact and only debride ruptured blisters. (u) C. If used in the care of a burn patient, the antibiotic selected should have activity against Pseudomonas and S. aureus. Cefazolin does not have any antipseudomonal activity. (c) D. Reasons for transfer to a burn center include a partial thickness burn covering greater than 10% of total body surface area. In addition, burns in patients with pre-existing medical conditions, such as diabetes, that could complicate their management, prolong recovery, or affect their outcome, is also a reason for transfer to a burn center. A 72 year-old female is being evaluated for recurrent kidney stones. PE reveals no abnormal findings. Laboratory findings show elevated calcium and decreased phosphate levels. Which of the following is the most likely diagnosis? A. Pheochromocytoma B. Adrenal insufficiency C. Hyperparathyroidism D. Breast cancer - Answer-EXPLANATIONS (u) A. Pheochromocytoma may lead to hypercalcemia but the patient does not have any signs or symptoms suggestive of pheochromocytoma, such as hypertension, headache, profuse sweating,or weight loss. (u) B. Adrenal insufficiency, Addison's disease, would reveal, in addition to the hypercalcemia,anorexia, nausea and vomiting, weight loss, and cutaneous hyperpigmentation, none of which areevident in this patient. (c) C. The majority of patients with hyperparathyroidism are asymptomatic. Recurrent nephrolithiasis may be one of the presentations of primary hyperparathyroidism. Measurement of parathyroid levels would be the initial laboratory test for the evaluation of hypercalcemia. (a) D. Hypercalcemia may be the earliest manifestation of a malignancy and this must be investigated. Most often the signs and symptoms of a malignancy will cause the patient to seek medical care. Malignancy is the second leading cause of hypercalcemia, behind hyperparathyroidism. Nulliparity is a risk factor for breast cancer and the most common presenting sign in a breast mass. A 56 year-old female four days post myocardial infarction presents with a new murmur. On examination the murmur is a grade 3/6 pansystolic murmur radiating to the axilla. She is dyspenic at rest and has rales throughout all her lung fields. Blood pressure is 108/68 mmHg, pulse 70 bpm. Which of the following would be the definitive clinical intervention? A. Intra-aortic balloon counterpulsation B. Mitral valve replacement C. Coronary artery bypass surgery D. Immediate fluid bolus - Answer-Explanations (u) A. Although part of the primary treatment to reduce mitral regurgitation, it is not definitive. (c) B. MVR is the definitive intervention to correct MR caused by papillary muscle rupture. (u) C. CABG may be necessary if significant blockage is found, but it will not correct the mitral regurgitation. (u) D. A fluid bolus is indicated if the patient is hypotensive. 28 year-old male presents with burns sustained from hot grease splashed on his left hand earlier this afternoon. The burn extends from his palm to the volar aspect of his wrist and has an erythematous base, covered by an intact blister. There are a few small scattered blisters over the dorsum of the left hand. Which of the following is the initial intervention of choice? A.Tetanus prophylaxis B.Admission to a burn unit C.Intravenous fluid administration D.Debridement of blisters - Answer-Explanations (c) A. Tetanus prophylaxis should be initially considered in all burn patients. (u) B. Admission to a burn unit is not indicated for adult patients with uncomplicated partial thickness burns covering less than 15 to 20% of total body surface area (TBSA). (u) C. IV fluids are indicated for severe partial thickness burns covering more than 10% TBSA or in burns with complications. (u) D. Debridement of blisters is controversial, however blisters on the palms and soles should remain intact. Which of the following hyperthyroid patients would be the best candidate for radioiodine therapy? A. A 30-year-old patient with toxic adenoma. B. A 50-year-old man with subacute thyroiditis. C. A patient over age 65 with Grave's disease. D. A pregnant woman with Hashimoto's thyroiditis. - Answer-EXPLANATIONS: (u) A. Patients with toxic solitary nodules may be treated with surgery or radioactive iodine. Surgery isrecommended for patients under 40 years of age. (u) B. Subacute thyroiditis is usually self-limited. Thyroid iodine uptake is low in this condition, thus rendering radioactive iodine ineffective. (c) C. Radioactive iodine is the recommended treatment for overactive thyroid tissue in patients without risk for subsequent thyroid cancer, leukemia, or other malignancies. (h) D. Hyperthyroid states are well tolerated during pregnancy. Usual treatment would be small doses of propylthiouracil, which does cross the placenta. Rarely, fetal hypothyroidism may occur; however, this is of much less consequence than using radioiodine therapy A 40-year-old male is hit in the face with a baseball. There is nasal deformity with bleeding. The most appropriate initial management is to A.treat the hematoma with I&D and antibiotics. B.consult with an ENT for immediate reconstructive nasal surgery. C. reduce septal defect using open technique. D. maintain nasal patency and nasal cosmesis. - Answer-EXPLANATIONS: (u) A. Septal hematoma is less likely due to the finding of epistaxis, and is not of highest priority. (u) B. Reconstructive nasal surgery is a delayed procedure. (u) C. Open reduction is not indicated for nasal trauma. (c) D. Maintain nasal patency until closed reduction can be attempted in 1 week Which of the following is the selected method for the prevention of venous thromboembolism in a 38-year-old male undergoing an inguinal hernia repair? A. early ambulation B.elastic stockings C.intermittent pneumatic compression D.low-molecular weight heparin - Answer-EXPLANATIONS: (c) A. Early ambulation is recommended for prophylaxis of venous thromboembolism in low-risk, minor procedures when the patient is under 40 years of age and there are no clinical risk factors. (u) B. Elastic stockings are indicated for patients at moderate risk of venous thromboembolism in ages 40-60 with minor procedures with additional thrombosis risk factor, or major operations for patients under age 40 without additional clinical risk factors. (u) C. Intermittent pneumatic compression is indicated in patients undergoing a major operation plus an increased risk of bleeding. (u) D. Low molecular weight heparin is indicated in patients undergoing orthopedic surgery, neurosurgery, or trauma with an identifiable risk factor for thromboembolism. A 16-year-old male presents with increasing pain and swelling of his right scrotum. The right testicle is extremely tender to palpation on examination. A Doppler ultrasound demonstrates decreased blood flow. Which of the following is the most appropriate intervention? A. oral doxycycline B. emergent surgery C. incision and drainage D. scrotal elevation and ice packs - Answer-EXPLANATIONS: (h) A. Oral doxycycline is the treatment of choice for epididymitis. While epididymitis and testicular torsion present similarly, the Doppler ultrasound in epididymitis would show increased blood flow, not decreased. (c) B. Once a diagnosis of testicular torsion is suspected, emergent surgery is indicated to have the best possible chance of salvaging the testicle (85-97% chance if less than 6 hours). Any other treatment measures delay the definitive treatment and increase the risk of testicular ischemia and infarction. (h) C. Incision and drainage is indicated for treatment of abscesses, not testicular torsion. (h) D. Scrotal elevation and ice packs are indicated for adjunct treatment of epididymitis, not testicular torsion. Which of the following is the most appropriate intervention for a stage I testicular seminoma? A.Watchful waiting B.Chemotherapy initially C.Orchiectomy and radiation D.Orchiectomy and chemotherapy - Answer-Explanations (u) A. Surveillance is an option in stage I disease of a nonseminoma testicular tumor. (u) B. Patients with stage IIC and stage III are treated with chemotherapy. (c) C. Inguinal orchiectomy followed by retroperitoneal radiation therapy cures about 98% of patients with stage I seminoma. (u) D. Chemotherapy is used for later stage tumors (II/III) and followed by surgery in stage III tumors Which of the following beta-adrenergic blocking agents has cardioselectivity for primarily blocking beta-1 receptors? A. Propranolol (Inderal) B. Timolol (Blocadren) C. Metoprolol (Lopressor) D. Pindolol (Visken) - Answer-Explanations (u) A. Propranolol and timolol are nonselective beta-adrenergic antagonists. (u) B. See A for explanation. (c) C. Metoprolol is selective for beta-1 antagonists (u) D. Pindolol is an antagonist with partial agonist activity. A 55-year-old male presents complaining of episodic substernal chest pain that occurs especially during strenuous exercise. Suspecting coronary artery disease (CAD), an exercise stress test is ordered. The test is considered to be abnormal if which of the following occurs? A.Systolic blood pressure increases during exercise. B.The heart rate reaches maximal value during exercise. C.Random premature ventricular beats occur at peak exercise. D.A 2 mm ST-segment depression is seen on the ECG at peak exercise. - Answer- Explanations (u) A. An increase in systolic blood pressure is an expected normal response during this test. (u) B. Heart rate should reach maximal value during exercise. (u) C. Random premature ventricular beats are not uncommon during peak exercise and do not indicate CAD. (c) D. A 2 mm ST-segment depression is suggestive of cardiac ischemia and is considered to be an abnormal finding. The treatment of choice for a patient with WPW (Wolff-Parkinson-White Syndrome) who has recurrent episodes of supraventricular tachycardia is which of the following? A. IV Verapamil (Calan, Isoptin) B. Digoxin (Lanoxin) C. Surgical ablation of the accessory pathway D. Radiofrequency ablation of bypass tracts - Answer-Explanations (h) A. Caution should be employed when using digitalis or intravenous verapamil in patients with the WPW syndrome and atrial fibrillation, since these drugs can shorten the refractory period of the accessory pathway and can increase the ventricular rate, thereby placing the patient at increased risk for ventricular fibrillation. (h) B. See A for explanation. (u) C. Although surgical ablation is an effective therapy, surgery has been virtually replaced by the advent of radiofrequency catheter ablation. Surgery should be reserved for patients who do not respond to other therapy. (c) D. Catheter ablation of bypass tracts is possible in more than 90% of patients and is the treatment of choice in patients with symptomatic arrhythmias. It is safer, more cost-effective, and just as successful as surgery. A 60 year-old female presents for pre-op evaluation for surgical treatment of a tri- malleolar fracture of the left ankle. Which of the following puts her at an increased risk for infection post-surgery? A.Recent URI B.Diabetes mellitus C. Heart murmur D. Swelling of the ankle - Answer-Explanations (u) A. Recent URI, heart murmur and swelling of the ankle would not put her at risk for an infection post surgery. (c) B. Diabetes mellitus puts her at risk for infection post surgery. (u) C. See A for explanation.(u) D. See A for explanation A patient with renal artery stenosis is unresponsive to medical therapy. Which of the following is the next most appropriate intervention? A. Stenting of the renal artery B. Nephrectomy C. Radioactive iodine D. Lifestyle modifications - Answer-Explanations (c) A. Stenting of the renal artery will dilated the narrowed area interfering with blood supply to the kidney. (u) B. Saving the kidney and not removing the kidney is indicated. (u) C. Radioactive iodine is indicated for multi-nodular goiter and not for renal artery stenosis. (u) D. Lifestyle modifications in patients who are unresponsive to medical therapy prior to stenting will not change the natural course of the disease. This is recommended following stenting or surgery.