Surgery EOR UWORLD exam with
correct answers
In an orbital floor fracture, what inferior nerve is most commonly affected and what does
damage to the nerve produce? - ANSWERS✔✔ The infraorbital nerve:
- Numbness and paresthesia of the upper cheek, upper lip and upper gingiva.
What medications reduce prostate volume (decrease size)? - ANSWERS✔✔ 5-alpha-
reductase inhibitors:
- Finasteride
- Dutasteride
*effectiveness may take 6-12 months, helps the fixed component (structural effects of the
enlarged prostate)
What is the MOA of 5-alpha reductase inhibitors? - ANSWERS✔✔ Blocks the conversion of
testosterone to dihydrotestosterone in the prostate
What medications are first line for BPH dynamic component sxs? - ANSWERS✔✔ Alpha-
adrenergic antagonists:
- Terazosin
- Tamsulosin
*relaxes smooth muscle in bladder neck, prostate capsule and prostatic urethra.
If a pt has heparin induced thrombocytopenia, what medications should be used after
cessation of heparin product? - ANSWERS✔✔ Nonheparin agents:
- Argatroban
- Fondaparinux
,Why not use Warfarin initially after HIT? - ANSWERS✔✔ Initial tx with warfarin is c/i in
pts with HIT b/c it rapidly lowers protein C levels, which may transiently increase the risk of
thrombus.
- Warfarin is used as anticoag maintenance in HIT after they have received another anticoag
and platelet count is > 150,000
For orthopedic surgeries such as a total hip arthroplasty, what should be given prior to
surgery for VTE ppx? - ANSWERS✔✔ LMWH (enoxaparin)
What is tx for a 36 YO pt with intermittent episodes of rectal bleeding over the past 2
months, with bright red blood after defecating? Anoscopy shows purplish mucosal bulges. -
ANSWERS✔✔ High-fiber diet and f/u for Internal Hemorrhoids
What is the PE finding when a pts knees are bent due to abdominal pain, and the pt reports
worsening pain when hips are extended? - ANSWERS✔✔ Psoas sign (highly specific for
acute appy)
What might a UA show in acute appy show? why? - ANSWERS✔✔ Microscopic hemturia
(1+ blood), most likely due to proximity of right ureter to appendiceal inflammation
When should solitary pulmonary nodules be biopsied or resected? - ANSWERS✔✔ Nodules
> 0.8 cm
and based on:
- pt Age, > 65
- Smoking hx
- Fam hx
60 YO pt has an emergent lap appendectomy and vomits during rapid sequence induction
and requires repeat mouth and trachea suctioning. Surgery is tolerated well, but ~4 hours
after the surgery, he is tachypneic and hypoxemic. Pulmonary exam reveals bilateral
, crackles. ABG shows PO2 of 67mmHg on an FiO2 of 90%. CXR reveals bilateral infiltrates.
What is the most likely mechanism of this pt's lung injury? - ANSWERS✔✔ Inflammatory
reaction to aspirated gastric acid (Pneumonitis)
57 YO pt presents with several episodes of gross hematuria over the last 3 month, followed
by spontaneous clearing. Pt has no fever, dysuria, back pain or weight loss. He has a 20-pack
year h/o smoking. Vitals are normal. Exam shows a left-sided varicocele that fails to reduct
when the pt is recumbent. Rest of exam is normal. Labs are significant for Hgb 18g/dL,
leukocytoes 7,400, platelets 580,000, and UA > 10 rbcs/high-power field. What is the most
appropriate diagnostic procedure for this pt? - ANSWERS✔✔ CT scan (Renal cell
carcinoma: hematuria, left-sided varicocele and polycythemia)
*Left-sided varicocele should always raise suspicion for obstructing mass
52 YO pt is brought to ED after being hit by a car. Initial workup does not reveal any
fractures but shows bruising to extremities, right chest and upper abdomen. 8 hours after
accident, the pt develops right-sided chest discomfort and SOB. Pulse ox is 90% on room air.
PE shows bronchial breath sound at the right lung base and normal S1 and S2 heart sounds.
The abdomen is soft and nontender. CXR shows infiltrate at lower right lung base. What is
most likely dx? - ANSWERS✔✔ Pulmonary contusion
46 YO M presents with progressive urinary frequency, urgency, and hesitancy for past
several months. Pt also has new-onset lower abdominal pain and perineal pain during
ejaculation. HE has no dysuria or hematuria. Exam of external genitalia is normal and rectal
exam shows a smooth, slightly enlarged prostate. UA shows many leukocytes and no
erythrocytes. Urine culture grows no organisms. Serum prostate-specific antigen is normal.
What is most likely cause of pt's condition? - ANSWERS✔✔ Noninfectious chronic prostate
inflammation (chronic prostatitis)
What hernia originates lateral to the inferior epigastric vessels and may extend into the
scrotum? What is pathophys? - ANSWERS✔✔ Indirect inguinal: patent processus vaginalis
What hernia protrudes medial to the inferior epigastric vessels into Hesselbach's triangle
and has no direct route to the scrotum? What is pathophys? - ANSWERS✔✔ Direct inguinal:
weakness of transversalis fascia
correct answers
In an orbital floor fracture, what inferior nerve is most commonly affected and what does
damage to the nerve produce? - ANSWERS✔✔ The infraorbital nerve:
- Numbness and paresthesia of the upper cheek, upper lip and upper gingiva.
What medications reduce prostate volume (decrease size)? - ANSWERS✔✔ 5-alpha-
reductase inhibitors:
- Finasteride
- Dutasteride
*effectiveness may take 6-12 months, helps the fixed component (structural effects of the
enlarged prostate)
What is the MOA of 5-alpha reductase inhibitors? - ANSWERS✔✔ Blocks the conversion of
testosterone to dihydrotestosterone in the prostate
What medications are first line for BPH dynamic component sxs? - ANSWERS✔✔ Alpha-
adrenergic antagonists:
- Terazosin
- Tamsulosin
*relaxes smooth muscle in bladder neck, prostate capsule and prostatic urethra.
If a pt has heparin induced thrombocytopenia, what medications should be used after
cessation of heparin product? - ANSWERS✔✔ Nonheparin agents:
- Argatroban
- Fondaparinux
,Why not use Warfarin initially after HIT? - ANSWERS✔✔ Initial tx with warfarin is c/i in
pts with HIT b/c it rapidly lowers protein C levels, which may transiently increase the risk of
thrombus.
- Warfarin is used as anticoag maintenance in HIT after they have received another anticoag
and platelet count is > 150,000
For orthopedic surgeries such as a total hip arthroplasty, what should be given prior to
surgery for VTE ppx? - ANSWERS✔✔ LMWH (enoxaparin)
What is tx for a 36 YO pt with intermittent episodes of rectal bleeding over the past 2
months, with bright red blood after defecating? Anoscopy shows purplish mucosal bulges. -
ANSWERS✔✔ High-fiber diet and f/u for Internal Hemorrhoids
What is the PE finding when a pts knees are bent due to abdominal pain, and the pt reports
worsening pain when hips are extended? - ANSWERS✔✔ Psoas sign (highly specific for
acute appy)
What might a UA show in acute appy show? why? - ANSWERS✔✔ Microscopic hemturia
(1+ blood), most likely due to proximity of right ureter to appendiceal inflammation
When should solitary pulmonary nodules be biopsied or resected? - ANSWERS✔✔ Nodules
> 0.8 cm
and based on:
- pt Age, > 65
- Smoking hx
- Fam hx
60 YO pt has an emergent lap appendectomy and vomits during rapid sequence induction
and requires repeat mouth and trachea suctioning. Surgery is tolerated well, but ~4 hours
after the surgery, he is tachypneic and hypoxemic. Pulmonary exam reveals bilateral
, crackles. ABG shows PO2 of 67mmHg on an FiO2 of 90%. CXR reveals bilateral infiltrates.
What is the most likely mechanism of this pt's lung injury? - ANSWERS✔✔ Inflammatory
reaction to aspirated gastric acid (Pneumonitis)
57 YO pt presents with several episodes of gross hematuria over the last 3 month, followed
by spontaneous clearing. Pt has no fever, dysuria, back pain or weight loss. He has a 20-pack
year h/o smoking. Vitals are normal. Exam shows a left-sided varicocele that fails to reduct
when the pt is recumbent. Rest of exam is normal. Labs are significant for Hgb 18g/dL,
leukocytoes 7,400, platelets 580,000, and UA > 10 rbcs/high-power field. What is the most
appropriate diagnostic procedure for this pt? - ANSWERS✔✔ CT scan (Renal cell
carcinoma: hematuria, left-sided varicocele and polycythemia)
*Left-sided varicocele should always raise suspicion for obstructing mass
52 YO pt is brought to ED after being hit by a car. Initial workup does not reveal any
fractures but shows bruising to extremities, right chest and upper abdomen. 8 hours after
accident, the pt develops right-sided chest discomfort and SOB. Pulse ox is 90% on room air.
PE shows bronchial breath sound at the right lung base and normal S1 and S2 heart sounds.
The abdomen is soft and nontender. CXR shows infiltrate at lower right lung base. What is
most likely dx? - ANSWERS✔✔ Pulmonary contusion
46 YO M presents with progressive urinary frequency, urgency, and hesitancy for past
several months. Pt also has new-onset lower abdominal pain and perineal pain during
ejaculation. HE has no dysuria or hematuria. Exam of external genitalia is normal and rectal
exam shows a smooth, slightly enlarged prostate. UA shows many leukocytes and no
erythrocytes. Urine culture grows no organisms. Serum prostate-specific antigen is normal.
What is most likely cause of pt's condition? - ANSWERS✔✔ Noninfectious chronic prostate
inflammation (chronic prostatitis)
What hernia originates lateral to the inferior epigastric vessels and may extend into the
scrotum? What is pathophys? - ANSWERS✔✔ Indirect inguinal: patent processus vaginalis
What hernia protrudes medial to the inferior epigastric vessels into Hesselbach's triangle
and has no direct route to the scrotum? What is pathophys? - ANSWERS✔✔ Direct inguinal:
weakness of transversalis fascia
