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Old 06-04-2016
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Default Surgery: Clinical Mastery Series Form 3 (Please Help)

If anyone knows the answers to the following questions, I'd really appreciate your help. Thanks in advance.

1. Six hours after sigmoid colectomy and colostomy for perforated diverticulitis, a 62yo woman has had a total post-op urine output of 65mL through a Foley. Preoperatively, pt had a serum urea nitrogen of 45 mg/dL and Cr of 2 mg/dL. She has been receiving 1/2NS at 90 mL/h since the operation. BMI is 24. Pulse 95, BP 130/90, normal electrolytes, urine specific gravity is 1.028. What is the next step in management?

A. Measure Cr clearance
B. IV pyelography
C. Renal perfusion scan
D. Rapid administration of 500mL NS
E. Administration of IV fluids to replace insensible fluid losses only
F. Administration of IV fluids to replace urine output only

10. A 26yo woman with chronic alcoholism comes to the ED because of hematemesis x4 during the past 2 hours. She vomited clear material before vomiting blood. Appears unkempt and tremulous. Pulse 124, BP 92/68. Exam shows dry, blood-caked oral mucous membranes. No skin signs of chronic hepatic disease. Liver and spleen non-palpable. No evidence of ascites or peripheral edema. What is the next step in management?

A. Measure ABG
B. IV fluids
C. IV ADH (vasopressin)
D. NG tube
E. Upper gastroduodenal endoscopy

22. A 24yo woman comes to ED because of diffuse pain after she fell asleep for 4hrs sunbathing. Exam shows diffuse erythema and tenderness over 48% of body. What is the next step in management?

A. Observation
B. Application of porcine xenografting
C. Calcium gluconate therapy
D. Topical silver sulfadiazine therapy
E. Excision and skin grafting

25. 24hrs after AAA repair, 77yo man has mild confusion. Urine output has been 10mL/h over the past 3hrs. Diaphoretic. Oriented to person, but not place or time. Temp is 100.8, pulse 110, RR 20, BP 80/60. Upper and lower extremities are cold and clammy. Pulmonary artery catheterization shows PCWP of 23. Which of the following is the most likely explanation?

A. Inadequate volume replacement
B. Intra-abdominal hemorrhage
C. MI
D. PE
E. Sepsis

36. Healthy 27yo woman is brought to the ED after a single gunshot wound to the right mid thigh. AO x3. She has pain in her right thigh. Pulse 100, RR 24, BP 120/80. Exam shows a single entry wound with swelling. Right popliteal, PT, DP pulses are absent. Administration of O2 and IV NS is begun. X-ray of RLE shows a comminuted fracture of the femur. After reduction and immobilization, what is the next step in management?

A. Measure ABI
B. Duplex US of RLE
C. CT scan of pelvis
D. MRI of right thigh
E. Surgical exploration of right femoral artery

39. 57yo man with 3mo history of pain in calves while walking. Pain resolves after rest, but returns with walking. 40 pack year smoking history. 10 year history of hypertension well controlled with HCTZ and atenolol. Temp 98.6, pulse 84, RR 12, BP 140/85. Popliteal, DP, PT pulses are slightly decreased. Femoral pulses are normal. ABI is 0.8. In addition to smoking cessation counseling, what is the next step in management?

A. Recommend a walking program
B. CT of lumbar
C. MRI of calf
D. Aspirin
E. Aortic angiography

48. 3wk female newborn has a 18 day history of jaundice. Born at term to a 24yr woman, gravida 2, para 2, uncomplicated pregnancy and delivery. Weight was 7lb. Exclusively breast-fed. Today, she is 7lb6oz. Exam shows scleral icterus and jaundice. Her serum total bilirubin is 15 (direct is 13). What is the diagnosis?

A. ABO incompatibility
B. Biliary atresia
C. Breast milk jaundice
D. Gilbert
E. Hereditary spherocytosis
F. Physiologic jaundice
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  #2  
Old 06-05-2016
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Quote:
Originally Posted by MedStudentJY View Post
If anyone knows the answers to the following questions, I'd really appreciate your help. Thanks in advance.

1. Six hours after sigmoid colectomy and colostomy for perforated diverticulitis, a 62yo woman has had a total post-op urine output of 65mL through a Foley. Preoperatively, pt had a serum urea nitrogen of 45 mg/dL and Cr of 2 mg/dL. She has been receiving 1/2NS at 90 mL/h since the operation. BMI is 24. Pulse 95, BP 130/90, normal electrolytes, urine specific gravity is 1.028. What is the next step in management?

A. Measure Cr clearance
B. IV pyelography
C. Renal perfusion scan
D. Rapid administration of 500mL NS
E. Administration of IV fluids to replace insensible fluid losses only
F. Administration of IV fluids to replace urine output only

10. A 26yo woman with chronic alcoholism comes to the ED because of hematemesis x4 during the past 2 hours. She vomited clear material before vomiting blood. Appears unkempt and tremulous. Pulse 124, BP 92/68. Exam shows dry, blood-caked oral mucous membranes. No skin signs of chronic hepatic disease. Liver and spleen non-palpable. No evidence of ascites or peripheral edema. What is the next step in management?

A. Measure ABG
B. IV fluids
C. IV ADH (vasopressin)
D. NG tube
E. Upper gastroduodenal endoscopy

22. A 24yo woman comes to ED because of diffuse pain after she fell asleep for 4hrs sunbathing. Exam shows diffuse erythema and tenderness over 48% of body. What is the next step in management?

A. Observation
B. Application of porcine xenografting
C. Calcium gluconate therapy
D. Topical silver sulfadiazine therapy
E. Excision and skin grafting

I got this wrong and put D, but I've looked it up and it seems that sunburns don't require any other than A.

25. 24hrs after AAA repair, 77yo man has mild confusion. Urine output has been 10mL/h over the past 3hrs. Diaphoretic. Oriented to person, but not place or time. Temp is 100.8, pulse 110, RR 20, BP 80/60. Upper and lower extremities are cold and clammy. Pulmonary artery catheterization shows PCWP of 23. Which of the following is the most likely explanation?

A. Inadequate volume replacement
B. Intra-abdominal hemorrhage
C. MI
D. PE
E. Sepsis

apparently AAA repair is complicated by MI in up to 5% (according to emedicine). eleveated PCWP was a clue


36. Healthy 27yo woman is brought to the ED after a single gunshot wound to the right mid thigh. AO x3. She has pain in her right thigh. Pulse 100, RR 24, BP 120/80. Exam shows a single entry wound with swelling. Right popliteal, PT, DP pulses are absent. Administration of O2 and IV NS is begun. X-ray of RLE shows a comminuted fracture of the femur. After reduction and immobilization, what is the next step in management?

A. Measure ABI
B. Duplex US of RLE
C. CT scan of pelvis
D. MRI of right thigh
E. Surgical exploration of right femoral artery

we need to fix the pulse issue.

39. 57yo man with 3mo history of pain in calves while walking. Pain resolves after rest, but returns with walking. 40 pack year smoking history. 10 year history of hypertension well controlled with HCTZ and atenolol. Temp 98.6, pulse 84, RR 12, BP 140/85. Popliteal, DP, PT pulses are slightly decreased. Femoral pulses are normal. ABI is 0.8. In addition to smoking cessation counseling, what is the next step in management?

A. Recommend a walking program
B. CT of lumbar
C. MRI of calf
D. Aspirin
E. Aortic angiography

similiar question was in Uworld

48. 3wk female newborn has a 18 day history of jaundice. Born at term to a 24yr woman, gravida 2, para 2, uncomplicated pregnancy and delivery. Weight was 7lb. Exclusively breast-fed. Today, she is 7lb6oz. Exam shows scleral icterus and jaundice. Her serum total bilirubin is 15 (direct is 13). What is the diagnosis?

A. ABO incompatibility
B. Biliary atresia
C. Breast milk jaundice
D. Gilbert
E. Hereditary spherocytosis
F. Physiologic jaundice


think of biliary atresia in a newborn (2 weeks and above) presenting with elevated direct bilirubin (obstructive jaundice)
got all of these correct except the sunburn question. so you can count on them.
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