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ABSITE Correct Questions &
Answers(RATED A)
Which nutrient is poorly absorbed in achlorhydria? a.) Vitamin D b.) Vitamin B c.) Bile salts d.) Proteins e.) Fats - ANSWER(b) Vitamin B Hypophosphatemia has been associated with all of the following EXCEPT: a.) impaired diaphragmatic contractility b.) treated diabetic ketoacidosis c.) malabsorption coupled with carbohydrate refeeding d.) chronic alcoholism e.) respiratory muscle hyperresponsiveness - ANSWER(e) It is seen in patients with chronic alcoholism, diabetic ketoacidosis, sepsis, and severe malnutrition after carbohydrate refeeding. It can also be seen in surgical patients who are not receiving enough phosphate repletion from parenteral nutrition. Hypophosphatemia causes muscle weakness, and probably affects the diaphragm more than other muscles, therefore leading to respiratory failure. Studies have shown lower contractility of the diaphragm Phosphorus deficiency may lead to insulin resistance as well What is the main nutrient for colonocytes? a.) Glutamine b.) Alanine c.) Short chain fatty acids d.) Glucose - ANSWER(c) Short chain fatty acids (Note: the primary fuel source though for enterocytes is glutamine) What chemotherapy agent leads to pulmonary fibrosis? a.) Doxorubicin b.) Methotrexate c.) Bleomycin d.) Vincristine
e.) Cyclophosphamide - ANSWER(c) What is the most useful serum marker for cancer screening? a.) PSA b.) CEA c.) AFP d.) CA 19- e.) CA 15-3 - ANSWER(a) All others are used for follow-up or diagnosis What is the embryologic origin of the inferior parathyroid gland? a.) 4th arch b.) 4th pouch c.) 3rd arch d.) 3rd pouch - ANSWER(d) Derivatives of the 3rd pouch include the inferior parathyroid glands and the thymus. The main nerve supply is the glossopharyngeal nerve. Superior parathyroids come from the 4th pouch What is the cause of hypotension and decreased EtCO2 during laparoscopic surgery a.) Tension pneumothorax b.) Inferior vena cava compression c.) CO2 embolus d.) Anesthetic overdose - ANSWER(c) Increased levels of glutamine are associated with all of the following EXCEPT: a.) decreased incidence of clinical infections in patients receiving bone marrow transplantation b.) vitro suppression of hepatoma growth c.) alleviation of depletion of muscle glutamine stores d.) decreased glutathione levels in tumor cells during radiation therapy or chemotherapy e.) increased tumor growth in patients with advanced malignant disease - ANSWER(e) Glutamine, the most abundant amino acid in the body, can be trapped by a growing tumor, depleting the body's glutamine stores and producing cachexia. A prospective, randomized, double-blind trial demonstrated that patients undergoing bone marrow transplantation had significantly decreased clinical infections when they received supplemental glutamine. Glutamine also reduced the glutathione levels in tumor cells of patients undergoing chemotherapy or radiation therapy. The concern that administering glutamine would promote tumor growth has proven unfounded.
(a) LAR (b) More chemo/radiation (c) APR (d) Sigmoid colectomy - ANSWER(c) In cases followed up with surveillance bipsies, if positive can undergo salvage APR (abdomino-perineal resection) Most common groin hernia in women? a.) Direct inguinal b.) Femoral c.) Indirect inguinal d.) Obturator - ANSWER(c) Indirect inguinal hernia is still the most common, even in women What is the most common visceral arterial aneurysm? a.) SMA b.) Splenic c.) GDA d.) Celiac - ANSWER(b) Splenic artery aneurysm, fix when > 2.5cm or symptomatic Gastroschisis a.) Is usually associated with hepatomegaly b.) Is associated with chromosomal disorders c.) Is located on the left side of the umbilical cord d.) Repair is followed by prolonged ileus due to intestinal atresia - ANSWER(d) Gastroschisis represents a congenital defect characterized by a defect in the anterior abdominal wall through which the abdominal contents freely protrude. There is NO overlying sac and the size of the defect is usually less than 4 cm. The abdominal wall defect is located at the junction of the umbilicus and normal skin, and is almost always to the RIGHT of the umbilicus. Associated with intrauterine rupture of umbilical cord. The cremaster muscle is derived from what structure? a.) External oblique b.) Internal oblique c.) Transversalis d.) Rectus sheath - ANSWER(b)
A complication that enteral and parenteral feeding have in common is a.) Increased incidence of sepsis b.) Intestinal villous atrophy c.) Elevated liver transaminases d.) Hyperosmolar Nonketotic coma e.) Diarrhea - ANSWER(d) A patient on POD1 has a fever of 104F and grey wound drainage. What is the most likely organism? a.) Strep b.) Staph c.) E. Coli d.) C. Perfringens e.) C. Difficile - ANSWER(d) Clostridium perfringens (Gram +, spore forming rod) A hemodynamic effect of CO2 pneumoperitoneum is a.) ↓ Cardiac Index b.) ↓ in the SVR c.) ↓ in the MAP d.) ↑ inflammatory response e.) ↑ Cardiac index - ANSWER(a) In the diabetic foot a.) Atherosclerosis often involves the pedal arteries b.) Foot sepsis is often polymicrobial c.) ABI correctly measure the degree of ischemia d.) Diabetic neuropathy only involves the peripheral nerves - ANSWER(b) In contrast to adults, fetal wound healing biochemistry is characterized by which of the following? a.) ↑ inflmmatory phase b.) ↑ content of type III collagen c.) ↑ level of transforming growth factor-B d.) ↓ hyaluronic acid synthesis - ANSWER(a) Death from postoperative renal failure is most commonly due to? a.) Myocardial infarction b.) Bleeding c.) Sepsis d.) Liver failure - ANSWER(c)
The treatment of malignant hyperthermia involves administration of all of the following EXCEPT: a.) Oxygen. b.) Mannitol. c.) Potassium supplementation. d.) Bicarbonate. e.) Dantrolene. - ANSWER(a) Potassium salts may actually trigger susceptible patients. In addition, serum potassium levels are usually increased due to acidosis. Additionally, renal dysfunction may develop leading to elevated potassium levels. Fluid administration and mannitol administration should take place to ensure brisk diuresis. The most common presentation of blunt myocardial injury a.) Atrioventciular block b.) Atrial flutter c.) PVCs d.) PACs e.) Atrial fibrillation - ANSWER(c) The most common injured nerve during general anesthesia is a.) Radial b.) Brachiocephalic c.) Ulnar d.) Spinal e.) Brachial plexus - ANSWER(c) Six hundred seventy (16% of 4,183) claims were for anesthesia-related nerve injury. The most frequent sites of injury were the ulnar nerve (28%), brachial plexus (20%), lumbosacral nerve root (16%), and spinal cord (13%). Ulnar nerve (85%) injuries were more likely to have occurred in association with general anesthesia Which of the following contributes to the arterial supply of the thoracic esophagus? a.) Right gastric artery b.) Bronchial artery c.) Pulmonary artery d.) Innominate artery - ANSWER(b) The left bronchial arteries (superior & inferior) usually arise directly from the thoracic aorta. The single right bronchial artery usually arises from the thoracic aorta but may vary more. Each bronchial artery also has a branch that supplies the esophagus.
The most common cardiac defect in adults is? a.) ASD b.) VSD c.) PDA d.) Endocardial cushion defect - ANSWER(a) ASD in Adults VSD in children Which one of the following is true regarding respiratory depression from epidural morphine? a.) Late respiratory depression is more likely with fentanyl than with morphine. b.) Respiratory depression from epidural morphine is biphasic. c.) Caudal spread of epidural morphine is responsible for respiratory depression. d.) Respiratory depression from epidural narcotics is difficult to treat once recognized. e.) Respiratory depression from epidural narcotics is not potentiated by intravenous sedation and analgesia. - ANSWER(b) The respiratory depression from epidural morphine is biphasic. The first phase is caused by intravenous absorption of morphine, whereas the second or late phase is due to cephalad spread of epidural morphine. Spread is cephalad A femoral hernia often causes strangulation. What is the lateral boundary of the femoral canal? a.) inguinal ligament b.) lacunar ligament c.) femoral vein d.) iliacus and psoas tendons e.) fascia of pectineus - ANSWER(c)
- superior -- inguinal ligament
- medial -- lacunar ligament
- lateral -- femoral vein
- posterior (floor) -- iliacus and psoas tendons, fascia of pectineus An aldosteronoma is associated with which of the following? a.) HTN, ↓K, ↑ Aldosterone, ↑ Renin b.) HTN, ↑K, ↑ Aldosterone, ↓ Renin c.) HTN, ↑K, ↑ Aldosterone, ↑ Renin d.) HTN, ↓K, ↑ Aldosterone, ↓ Renin - ANSWER(d) This is also known as primary aldosteronism or Conn Syndrome. It is characterized by:
a.) Vincristine b.) Cisplatin c.) Cyclophosphamide d.) 5-FU e.) Cytarabine - ANSWER(e) Cytarabine Which chemotherapy agent causes severe peripheral neuropathy? a.) Vincristine b.) Methotrexate c.) Tamoxifen d.) 5-FU e.) Cisplatin - ANSWER(e) A 43yr old presents with weight loss & watery diarrhea. Investigation reveals hypokalemia with a pancreatic mass. Which of the following would support the diagnosis of a VIPoma? a.) Achlorhydria b.) Hypoglycaemia c.) Increased Pancreatic polypeptide d.) Migratory erythema e.) Pellagra - ANSWER(a) 1.) Watery diarrhea 2.) ↓Cl 3.) Acidosis 4.) ↓K Which of the following does NOT form part of the somatostatinoma syndrome? a.) Hypoglycemia b.) Gallbladder disease c.) Diarrhea d.) Steatorrhea e.) None of the above - ANSWER(a)
- Diabetes 2) Diarrhea 3) Gallstones An inhibitor of platelet aggregation is a.) Prostacyclin I b.) Thromboxane A c.) Adenosine Diphosphate d.) Serotonin e.) vWF - ANSWER(a)
It counters the action of Thromboxane A2 which is a potent vasoconstrictor and platelet aggregator PGI (prostacyclin): platelet inhibition, vasodilation and bronchodilation The most common cause of GI bleeding in children is a.) Meckels diverticulum b.) Anal fissure c.) Intussusception d.) Upper GI bleed - ANSWER(b) Anal fissure (Note: the most common MASSIVE GI bleeding is from Meckels) Which motility prokinetic drug and its mechanism of action is correct? a.) Cisapride -- Anticholinergic b.) Erythromycin -- Motilin receptor agonist c.) Metoclopramide -- Serotonin agonist d.) Domperidone -- Serotonin agonist e.) All are correct - ANSWER(b) Metoclopramide/Domperidone have unknown mechanisms of action. Cisapride is a serotonin agonist. A 60yr old patient presents with vague abdominal pain, weight loss, recent onset diabetes, and a patchy erythematous rash in the pelvic region as well as around the mouth and anus. The most likely diagnosis is? a.) VIPoma b.) Syphilis c.) Glucagonoma d.) Gastrinoma e.) Insulinoma - ANSWER(c) Patients with glucagonoma usually have mild diabetes and a severe dermatitis (necrolytic migratory erythema). These patients may also demonstrate malnutrition, anemia, glossitis, and venous thrombosis. The majority of patients have metastatic disease at the time of diagnosis. The most common intra-abdominal tumor in children is a.) Leukemia b.) Nephroblastoma c.) Neuroblastoma d.) Sarcoma - ANSWER(c)
b.) Strep c.) E. Coli d.) Staph aureus - ANSWER(a) staph epidermidis Which of the following statements about chronic mesenteric ischemia due to atherosclerosis is/are correct? a.) Postprandial pain is due to gastric hyperacidity and is relieved with H2 blockers. b.) Men are more often affected than women. c.) Mesenteric endarterectomy is the surgical treatment of choice, since long-term patency rates are superior to mesenteric bypass. d.) Arteriography is no longer necessary since noninvasive diagnosis can be established using duplex ultrasound. e.) Surgical treatment is indicated to prevent intestinal infarction in symptomatic patients. - ANSWER(e) The precise cause of postprandial pain in patients with chronic mesenteric ischemia is unknown. Hyperacidity has been observed in some patients with this disease, but no medical therapy, including H2 blockers, has provided symptomatic relief. Unlike most syndromes of ischemia due to atherosclerosis (coronary, cerebrovascular, etc), chronic mesenteric ischemia occurs more frequently in women. The long-term success rates for bypass and endarterectomy are equivalent; either technique is acceptable. While duplex scanning is a useful noninvasive screening technique in these cases, arteriography is required for definitive diagnosis and to plan revascularization. Elective surgical revascularization is indicated in symptomatic patients with severe mesenteric arterial occlusive disease. What is the treatment of DVT in pregnancy? a.) IV heparin alone b.) IV heparin with Coumadin for 6 months c.) IV heparin with therapeutic Lovenox shots d.) SQ heparin alone e.) SQ therapeutic Lovenox alone - ANSWER(c) Generally should start IV heparin then bridge to LMWH (Lovenox) SQ with a therapeutic dose until term (Remember Warfarin crosses the placenta) Most accurate method to diagnose traumatic aortic arch injury is a.) Upright chest XR b.) Chest CT angiogram c.) MRI d.) TEE - ANSWER(b)
Diagnosis is made with aortogram (which is the gold standard but invasive & operator dependent) or CT angiogram. TEE has a limited role in screening for TAI Lung resection is contraindicated based on which of the following pre operative testing values? a.) Resting pO2 = 60mmHg b.) Resting pCO2 = 50mmHg c.) FEV1 = 1L d.) FEV1/FVC = 75% e.) A vital capacity 75% of predicted value - ANSWER(b) preop resting pCO2 > 45 (or pO2 < 50) pneumonectomy FEV > 2L lobectomy FEV1 > 1L wedge resection FEV > 0.6L Need predicted postop FEV1 > 0.8L Most common cause of SBO during pregnancy is a.) Volvulus b.) Compression from the uterus c.) Adhesions d.) Appendicitis e.) Diverticular disease - ANSWER(a) A contraindication to the use of ketamine is which of the following? a.) Hypotension b.) Head injury c.) Asthma d.) Hypoventilation - ANSWER(b) Regarding the anatomy of the esophagus a.) The cervical esophagus lies to the right of the midline b.) The thoracic esophagus is anterior to the aortic arch c.) The cervical portion is supplied by the inferior thyroid artery d.) The abdominal portion is supplied by the right gastric artery e.) The left vagus nerve passes posterior to the esophagus - ANSWER(c) The abdominal portion is supplied by the left gastric artery. The thoracic by the bronchial branches which come off of the aorta. The most common anterior mediastinal tumor is a.) Thymoma b.) Retrosternal goiter
A tracheostomy related TI fistula is best managed by which of the following? a.) Division of the innominate artery and ligation of the ends b.) Division of the innominate artery and vein graft c.) Division of the innominate artery and polytetrafluoroetylene graft d.) Primary repair of the innominate artery - ANSWER(a) division of innominate and ligation of both ends The calorie-nitrogen ratio for an infant should be maintained at: a.) 75:1. b.) 100:1. c.) 50:1. d.) 150:1. e.) 25:1. - ANSWER(d) In an adult the range is about 100-150 : 1. Higher for the infant Direct & indirect physiologic stimuli for the secretion of aldosterone include all of the following EXCEPT: a.) ACTH. b.) Hypokalemia. c.) Hyponatremia. d.) Renin e.) Angiotensin II. - ANSWER(b) Aldosterone stimulates Na resorption / K excretion in distal renal tubules and is driven by the Renin-Angiotensin system, in particular A2. Renin secretion is stimulated by hyperkalemia, not hypokalemia, and also low potassium is directly inhibitory for aldosterone secretion. The catecholamine cause of HTN in extra-adrenal pheochromocytoma? a.) Epi + Norepi b.) Epi alone c.) Norepi alone d.) Dopamine - ANSWER(c) pure norepipherine Highest location of HCO3 secretion in the body? a.) Saliva b.) Colon c.) Stomach d.) Bile
e.) Pancreas - ANSWER(e) Pancreatic secretions. The highest concentration of potassium in its secretions is the colon Using the Parkland formula calculate the fluid requirements for a patient who is 50 kg with a 40% full thickness BSA burn, which occurred 4 hours ago. a.) Ringer's Lactate 500cc/hr x 8 hours then 250cc/hr x 16 hours b.) Ringer's Lactate 250cc/hr x 4 hours then 125cc/hr x 16 hours c.) Ringer's Lactate 1000cc/hr x 4 hours then 250cc/hr x 16 hours d.) Ringer's Lactate 250cc/hr x 16 hours then 125cc/hr x 8 hours - ANSWER(c) 4 x % burn x weight(kg) = 1st 1/2 in 8hours, 2nd 1/2 in 16 hours Half of this is given in the first 8 hours after a burn. As 4 hours has passed, then give this half in the next 4 hours. Thus, 1,000mls/hr for 4 hours Second half given over next 16 hours. So give (4000/16) = 250mls/hr for next 16 hours. Note that fluids need to be adjusted based on urine output (aim for 1ml/kg/hour) and frequent clinical assessment. The surface M protein is a virulence factor associated with: a.) Streptococcus pyogenes. b.) Peptostreptococcus sp. c.) Enterococcus faecalis. d.) Clostridium perfringens. e.) Staphylococcus aureus. - ANSWER(a) The M protein coat of streptococci appears to provide relative protection against phagocytosis. A 33yr old patient develops bloody nipple discharge. There is no family history of breast cancer. The patient denies any trauma, recent pregnancy, prior similar episodes, pain, or fevers. On examination, both breasts are normal in appearance. There are no palpable masses in either breast. A very small amount of blood can be expressed from the right nipple. Which of the following is the most likely diagnosis? a.) Breast abscess b.) Cystosarcoma phyllodes c.) Fibroadenoma d.) Intraductal papilloma e.) Mammary dysplasia - ANSWER(d)
Which of the following statements about the sentinel lymph node in breast cancer is NOT true? a.) Sentinal lymph node biopsy is most useful for outer quadrant lesions of the breast b.) Isosulfan blue dye or radioactive material is injected around the tumor to follow the drainage pathway of the marker c.) A negative sentinal node is predictive of a negative axillary dissection d.) Immunohistochemistry enhances the sensitivity of detecting nodal metastases e.) Successful lymphatic mapping and detection of the sentinel node requires a palpable breast mass - ANSWER(e) The main side effect of Isosulfan blue is cardiac arrhythmias What is the main side effect of adriamycin (doxorubacin)? a.) Neuromuscular blockade b.) Cardiomyopathy c.) Peripheral neuropathy d.) Neutropenic enterocolitis e.) Pulmonary fibrosis - ANSWER(b) cardiomyopathy The following are true of inflammatory breast carcinoma EXCEPT a.) It is characterised by tumor emboli within dermal lymphatics b.) It is bilateral in over 10% of cases c.) Treatment includes neoadjuvant chemo then MRM d.) If untreated the median survival time is less than a year - ANSWER(c) 1.) neoadjuvant chemo 2.) modified radical mastectomy 3.) XRT The carotid body a.) Is a pressure receptor b.) Is an osmoreceptor c.) Is a subintimal structure d.) Is located in the media of the vessel e.) Is located in the adventitia - ANSWER(e) The carotid body (carotid glomus or glomus caroticum) is a small cluster of chemoreceptors that detects changes in the composition of arterial blood flowing through it, mainly the partial pressure of oxygen, but also of carbon dioxide. Furthermore, it is also sensitive to changes in pH and temperature.
A 48yr old female originally presented for evaluation of a suspicious nonpalpable lesion in her right breast that was seen on her annual mammogram. A stereotactic core biopsy shows the presence of DCIS. Which of the following is NOT true? a.) Typically occurs in premenopausal women b.) May appear as a palpable mass or a mammographic abnormality c.) Associated with an increased risk of invasive breast cancer in the affected breast d.) May be treated with lumpectomy and adjuvant radiotherapy e.) May be treated with total mastectomy - ANSWER(a) Ductal carcinoma in situ typically occurs in the postmenopausal (and not the premenopausal) woman. It often is initially appreciated as microcalcifications on mammogram, and can be treated with either total mastcectomy or lumpectomy with radiotherapy. Usually the axillary lymph nodes are not removed because of the low risk of nodal involvement. Which of the following regarding LCIS is NOT true? a.) Tamoxifen increases the risk of invasive cancer b.) Resection with negative margins is required c.) It is more common in premenopausal women d.) Calcifications are usually absent e.) There is an increased risk for bilateral cancer - ANSWER(b) Which of the following is appropriate treatment option for LCIS? a.) Bilateral simple mastectomies b.) Random biopsy of the contralateral side and resection of all areas of LCIS c.) Modified radical mastectomy d.) Lumpectomy with axillary node dissection e.) Lumpectomy with axillary node dissection followed by radiation therapy - ANSWER(a) Options include
- observation 2) tamoxifen 3) bilateral subcutaneous mastectomy; never need ALND Initial management of T4 invasive lobular breast carcinoma is a.) Tamoxifen b.) Modified radical mastectomy c.) Radiation therapy to the breast and ipsilateral axilla d.) Neoadjuvant chemotherapy - ANSWER(d) All of the following are associated with an increased risk in the development of cancer EXCEPT a.) Atypical ductal hyperplasia
