ABSITE TRUELEARN QUESTIONS AND ANSWERS ACTUAL COMPLETE EXAM SOLUTION THAT COVERS 2024/2025, Exams of Nursing

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COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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Very high vitamin D levels can cause what? - CORRECT ANSWERS increased mortality and ACS Monosaccharide glucose and galactose are transported by what mechanism? - CORRECT ANSWERS Sodium dependent secondary transport Monosaccharide fructose transported by what mechanism? - CORRECT ANSWERS Na independent facilitated diffusion Kidneys use what to perform gluconeogenesis? - CORRECT ANSWERS glutamine and glutamate Most common etiology for ESRD requiring transplant? - CORRECT ANSWERS DM then HTN Vitamin deficiency 4-6 weeks after bariatric surgery with peripheral neuropathy? - CORRECT ANSWERS Vit B1, thiamine. peripheral neuropathy Recommended protein intake per day? - CORRECT ANSWERS 0.8 g/kg/day Daily nitrogen requirement - CORRECT ANSWERS protein/6. Can you do bolus feeds through J tube? - CORRECT ANSWERS No, only gastric Primary fuel of large bowel - CORRECT ANSWERS short chain fatty acids Magnesium toxicity - CORRECT ANSWERS confusion, loss of deep tendon reflexes, flaccid paralysis, hypotension, respiratory failure, cardiac arrhythmia, cardiac arrest Copper Deficiency - CORRECT ANSWERS pancytopenia, neuropathy with ataxia

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When can chemotherapy for breast cancer be given in pregnancy? - CORRECT ANSWERS second trimester Chylous ascites - CORRECT ANSWERS triglycerides > 110, most common cause in developed world: lymphoma, most common cause in undeveloped world: infectious Highly selective vagotomy - CORRECT ANSWERS preserves Latarget's nerves (pylorus), posterior vagus (small intestine and pancreas) and anterior vagus (liver and gallbladder) Sudden rise in end tidal CO2 during operation - CORRECT ANSWERS increase tidal volume, most likely atelectasis. Rare but concerning cause would be malignant hyperthermia Congenital lobar emphysema - CORRECT ANSWERS Can cause severe respiratory distress, looks like pneumothorax, Chest tube makes it worse. If severe, requires lobectomy EGD surveillance for various pathologies - CORRECT ANSWERS Family polyposis: 1-2 years esophageal varices s/p intervention: 6 weeks gastric and esophageal ulcer: 6 weeks until healed Barretts: low risk every 2 years, medium risk every year, high risk every 6 months SVC syndrome initial treatment - CORRECT ANSWERS balloon angioplasty Increased risk for hemangiosarcoma - CORRECT ANSWERS vinyl chloride, thorotrast, arsenic approach to distal trachea injury - CORRECT ANSWERS R posterolateral thoracotomy TTP - CORRECT ANSWERS thrombocytopenic purpura, neurologic manifestations, hematuria, hemolytic anemia, fever

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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CEAP classification - CORRECT ANSWERS Clinical Etiology Anatomy Pathophysiology Lifethreatening side effect from protamine - CORRECT ANSWERS hypotension What happens to non absorbed saccharides in the digestive tract? - CORRECT ANSWERS Digested by intestinal bacteria to form short chain fatty acids Resuscitation in patient's younger than 2 - CORRECT ANSWERS LR with 5% dextrose for the first 24 hours. Titrate to 1 cc/kg/hr Most common benign neoplasm of spleen - CORRECT ANSWERS hemangioma complications from silvadene - CORRECT ANSWERS neutropenia, hypersensitivity reactions branched amino acids - CORRECT ANSWERS leucine, isoleucine, valine Expected excess weight loss after 2 years post lap gastric band? - CORRECT ANSWERS 50- 60% During APR, do dissect the levator ani muscles, what is the guide through the perineum? - CORRECT ANSWERS coccyx to avoid neurovascular bundles Most common side effect of mycophenalate? - CORRECT ANSWERS leukopenia (1/3 of patients)

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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Margin of resection for gastric adenocarcinomas - CORRECT ANSWERS 5 cm What anesthesia produces muscle fasciulations? - CORRECT ANSWERS depolarizing neuromuscular blocking agents, succinylcholine Parathyroid location - CORRECT ANSWERS posterolateral to the thyroid and above or below the junction of the inferior thyroid artery with the recurrent laryngeal nerve. Most common complication in PACU that leads to admission for outpatient procedures - CORRECT ANSWERS nausea and vomiting Visceral artery aneurysm most common location - CORRECT ANSWERS Splenic artery How to close full thickness graft site - CORRECT ANSWERS primarily Side effects of Trastuzumab - CORRECT ANSWERS increased risk of cardiac events, reversible Side effects of tamoxifen - CORRECT ANSWERS hot flashes, DVTs, stroke and endometrial cancer Maneuver to access supraceliac aorta - CORRECT ANSWERS Maddox (left medial visceral rotation) Maneuver for access to retrohepatic IVC - CORRECT ANSWERS Cattell-Braasch (right medial visceral rotation) During Nissen, how do you avoid spleen injury - CORRECT ANSWERS ligating short gastrics

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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How to surgically treat perforations of upper two thirds of esophagus? - CORRECT ANSWERS R thoracotomy How to surgically treat perforations of lower third of esophagus? - CORRECT ANSWERS L thoracotomy with myotomy Best situations for rigid procto over flex sig - CORRECT ANSWERS rectal foreign objects, anastomotic evaluation and biopsy, measuring low rectal tumor Borders of the inguinal canal - CORRECT ANSWERS inferior: inguinal ligament posterior: conjoint tendon anterior: external oblique superior: external oblique aponeurosis and internal oblique and transversalis muscle aponeuroses Lichtenstein repair - CORRECT ANSWERS inferior edge of mesh: shelving edge of external oblique superior medial edge: conjoint tendon superior lateral: internal oblique and transversalis fascia how to treat acute traumatic carotid thrombosis? - CORRECT ANSWERS emergent surgical repair methemoglobinemia is best treated how? - CORRECT ANSWERS methylene blue What anesthetic agents are known to cause methemoglobinemia - CORRECT ANSWERS lidocaine, benzocaine, tetracaine, cetacaine Innervation of cricothyroid muscle causing pitch control - CORRECT ANSWERS external branch of superior laryngeal nerve

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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velocity of carotid artery that is >70% stenosis - CORRECT ANSWERS > 250 cm/s When should ERCP be used in patients with pancreatic cancer? - CORRECT ANSWERS 1. new jaundice and presumed pancreatic cancer but no mass on CT

2. symptomatic but non jaundiced with no mass
3. patients with chronic pancreatitis with new jaundice location of tubercle of Zuckerkandl - CORRECT ANSWERS located lateral and anterior to recurrent laryngeal nerve Extraintenstinal manifestation of Crohn's that can be fixed with medical treatment - CORRECT ANSWERS erythema nodosum Is proton pump inhibitor therapy effective for marginal ulcers after RYGB? - CORRECT ANSWERS yes up to 90% Hepatoblastoma treatment - CORRECT ANSWERS resection followed by chemotherapy Most common place for benign bile duct tumors - CORRECT ANSWERS periampular region Puestow procedure - CORRECT ANSWERS longitudinal Pancreaticojejunostomy Beger Procedure - CORRECT ANSWERS resection of the pancreatic head with Roux en Y jejunal loop as side to end and side to side pancreatico-jejunostomy Frey procedure - CORRECT ANSWERS coring out of pancreatic head and roux en y pancreatico jejunostomy

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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How much fluid does saliva make a day? - CORRECT ANSWERS 1.5 L how much biliary fluid is made daily - CORRECT ANSWERS 500 mL What do you do in esophagomyotomy for achalasia? - CORRECT ANSWERS incise 6.5 cm of longitudinal then circular muscle fibers in distal esophagus as well as 2.5 cm of gastric muscle What imaging modality do you use to diagnose acalculous cholecystitis? - CORRECT ANSWERS ultrasound, HIDA will not work What is the cardiovascular effect of isoproterenol - CORRECT ANSWERS arrhythmogenesis. It is a beta adrenergic agonist that increases cardiac contractility and peripheral vasodilation First line treatment for PID? - CORRECT ANSWERS ceftriaxone and doxycycline Best first treatment of LGIB with angiography? - CORRECT ANSWERS embolization. Vasopressin is associated with more bleeds and complications Extrinsic clotting pathway - CORRECT ANSWERS Factor I, II, V, VII, X Intrinsic clotting pathway - CORRECT ANSWERS Factor I, II, V, VIII, IX, X, XI, XII Malignant potential of a hepatic adenoma - CORRECT ANSWERS 5% Accepted ACCT level during CABG - CORRECT ANSWERS 400- Can SSRIs decrease the efficacy of Tamoxifen? - CORRECT ANSWERS yes

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What is a type I error? - CORRECT ANSWERS detecting an effect that is not present What is a type II error? - CORRECT ANSWERS failing to detect an effect that is present How quickly do different parts of the intestine regain function after surgery? - CORRECT ANSWERS small intestine 1 day stomach 3-4 days large intestine 3-4 days Side effect of mafenide acetate? - CORRECT ANSWERS carbonic anhydrase inhibition causing secondary metabolic acidosis Side effect of Silver Nitrate - CORRECT ANSWERS hyponatremia and methemoglobinemia Side effect of silver sulfadiazine - CORRECT ANSWERS transient neutropenia What is the Cori cycle? - CORRECT ANSWERS lactate created from glycolysis in skeletal muscle is transformed to glucose in the Cori cycle What percentage of cytoreductive surgery is successful in malignant peritoneal mesothelioma? - CORRECT ANSWERS 87% What is severe hypothermia? - CORRECT ANSWERS temp of 70-85F, EKG changes such as prolonged QRS, Osborne waves, patient may become flaccid and comatose. can develop v fib Where should an ostomy be located? - CORRECT ANSWERS through the rectus muscle on the summit of hte intraumbilical fan fold

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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What are good indications for laparoscopic liver resections? - CORRECT ANSWERS tumors < 5 cm, in segments 2,3,4,5, Selenium deficiency symptoms - CORRECT ANSWERS cardiomyopathy, hypothyroidism, and neurologic changes What is the incidence of recurrence of rectal adenocarcinoma after pelvic extent? - CORRECT ANSWERS 5% Where is the best place for an IVC filter? - CORRECT ANSWERS below the renal veins How to treat early gastric MALT lymphoma? - CORRECT ANSWERS H pylori eradication with antibiotics Epidural hematoma CT finding - CORRECT ANSWERS biconvex Epidural clinical course - CORRECT ANSWERS loss of consciousness, lucid interval Most common cause of death in FAP patients s/p colectomy - CORRECT ANSWERS periampullar adenocarcinoma What are the borders of a superficial inguinal lymphadenopathy? - CORRECT ANSWERS lateral: sartorius medial: abductor magnus superior: inguinal ligament Most powerful predictor of outcome in congenital diaphragmatic hernia? - CORRECT ANSWERS presence of cardiac defect

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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Why is the majority of breast cancer in the upper outer quadrant? - CORRECT ANSWERS That is where the most epithelial tissue is Most common site of testicular metastasis? - CORRECT ANSWERS retroperitoneum Most likely intestinal tract injury in blunt trauma pediatric patients? - CORRECT ANSWERS jejunum and ileum What do you do if you see a CBD stone on intraoperative cholangiogram? - CORRECT ANSWERS ask the anesthesia to administer glucagon Should all penetrating renal wounds be explored? - CORRECT ANSWERS yes How to treat SMA syndrome? - CORRECT ANSWERS duodenojejunostomy What is the most common incision for parotid surgery - CORRECT ANSWERS Modified blair incision What types of thyroid cancer are likely to spread to lymph nodes - CORRECT ANSWERS papillary and medullary should all medullary thyroid cancers have central neck lymph node dissection - CORRECT ANSWERS yes How do follicular thyroid cancers spread? - CORRECT ANSWERS hematologically Do you need to do a lymph node dissection with Hurthle cells? - CORRECT ANSWERS Nope

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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How do you repair a large paraesophageal hernia? - CORRECT ANSWERS cruroplasty, biologic mesh, nissen fundoplication Most common nutrition deficiency after RYGB? - CORRECT ANSWERS iron deficiency What to do with simple mesenteric cysts? - CORRECT ANSWERS excise them completely Best indication for component of separations - CORRECT ANSWERS multiple midline hernias with contraindications for mesh Mediator of cachexia - CORRECT ANSWERS TNF alpha What causes keloids? - CORRECT ANSWERS increased IgG Meperidine side effect? - CORRECT ANSWERS seizures What is the largest vessel you can seal with thermal spread? - CORRECT ANSWERS 7 mm how to repair trachea injuries? - CORRECT ANSWERS cervical incision for proximal median for thoracic inlet right thoracotomy for distal trachea What is the percentage of marginal ulcers in lap RYGB? - CORRECT ANSWERS 3-15% What determines when drains can be taken out after pancreas surgery? - CORRECT ANSWERS when drain amylase is less than serum amylase

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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Negative predictive prognosis factors of liver met in colon cancer - CORRECT ANSWERS disease free interval > 12 months node positive primary tumor multiple liver lesions liver lesion > 5cm CEA > What is immuno-positive in merkle cell carcinoma - CORRECT ANSWERS CK 20 and thyroid transcription factor 1 First degree frost bite - CORRECT ANSWERS cold, numb, yellow plaque Second degree frost bite - CORRECT ANSWERS milky blister Which arm should be used for proximal anastomosis of axillary-bifem bypass? - CORRECT ANSWERS the one with the higher BP Should you do biopsies in testicular cancer? - CORRECT ANSWERS no, it may affect lymph drainage anastomotic leak rate for ileocolic anastomoses? - CORRECT ANSWERS 1-3% How to treat non-occlusive mesenteric ischemia? - CORRECT ANSWERS increase O2 delivery Decreased renal function in older adults cause? - CORRECT ANSWERS decreased glomeruli and therefore decreased reserve most common type of melanoma? - CORRECT ANSWERS superficial spreading

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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How to repair traumatic ventricular injury? - CORRECT ANSWERS non pledgeted non absorbable suture What is nodular lymphoid hyperplasia associated with? - CORRECT ANSWERS immunosuppression. lymphoid polyps throughout colon What organism most commonly causes acute lymphangitis? - CORRECT ANSWERS Group A strep First line treatment for acute lymphangitis? - CORRECT ANSWERS amoxicillin Most important factor in O2 content? - CORRECT ANSWERS Hgb What do you do if someone has symptomatic CAD and symptomatic carotid stenosis? - CORRECT ANSWERS combined CABG and carotid endarterectomy First choice of bypass for SMA bypass? - CORRECT ANSWERS R iliac artery After a right hemicolectomy, which artery will supply the remaining transverse colon - CORRECT ANSWERS Marginal artery of Drummond. IN right hemicolectomy the middle colic vessels are sacrificed. The Arc of Riolan is a smaller contributor to the anastomotic network between the middle colic and left colic. What to do if hematoma after parathyroidectomy? - CORRECT ANSWERS Release hematoma then intubate

COMPLETE EXAM SOLUTION THAT COVERS 2024/2025 ALL

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Mut-Y Homolog-Associated polyposis - CORRECT ANSWERS autosomal recessive, 10 or more synchronous adenomas, no APC gene Most common sequelae from hepatic trauma - CORRECT ANSWERS biliary fistula Is it ok to just watch small gastro-gastric fistulas after RYGB? - CORRECT ANSWERS yes Indications for total pancreatectomy - CORRECT ANSWERS patients with small duct pancreatitis minimal change pancreatitis with no history of prior resection or drainage How to treat an acute aortic occlusion? - CORRECT ANSWERS femoral cutdowns and embolectomy Where is the ureter most vulnerable to injury - CORRECT ANSWERS at the pelvic brim where the vessels cross Lichtenstein repair - CORRECT ANSWERS Reduction of hernia sac, placement of flat mesh on transversalis fascia. Mesh is sutured to the inguinal ligament starting inferomedially at the pubic tubercle in a continuous fashion and stopping at the internal ring Few interrupted sutures at the superior edge of mesh to conjoint tendon and anterior rectus facia. Lateral slit in mesh then incorporates the spermatic cord or round ligament. Lower edge of the lateral flaps of mesh are sutured to inguinal ligament GERD procedure for someone with impaired esophageal motility - CORRECT ANSWERS Dor fundoplication- anterior (or toupet). Partial wrap