ABSITE 2020 Questions And Answers Graded

A
How to monitor esophageal pH? Correct Answer: 1) Wireless probe placed 5 cm above the LES for
48 hr or 2) NG tube with multiple probes for 24 hr (more accurate). Percent time w/pH <4 recorded,
number of episodes, and duration -- semester score is a composite with abnormal being >14.72

Types of esophageal diverticuli (true/false, location) Correct Answer: Pulsion- not true diverticula (do
not contain all layers of the esophageal wall) and occur either proximally at the cricopharygneus
muscle (Zenker's) or distal esophagus
Traction- true diverticuli and occur in the mid-esophagus due to an inflammatory process with LNs
putting traction on the esophagus

Management of rectovaginal fistula Correct Answer: High: transabdominal

Low or mid-low: endorectal advancement
Wait at least 3-6 mo for repair to decrease inflammation.

Location of the splenic artery and vein in relation to the pancreas Correct Answer: Artery: inferior;
Vein: posterior or within the pancreas

Nerve innervation of the external anal sphincter Correct Answer: Rectal branch of the internal
pudendal and the perineal branch of S4. Anal canal lengthens with contraction.

Classification and management of femoral neck fractures Correct Answer: Garden classification
system. I: not a complete fracture, early mobilization under a physical therapist (secondary
dislocation can occur 10-50% of the time leading to additional repair) or screw fixation; II: complete fx
but no dislocation: screw; III: partial dislocation and IV complete dislocation -- both need arthroplasty
(anatomic reduction and fixation)

Major effect of corticosteroids Correct Answer: Block transcription of cytokine gene transcription in
macrophages including: IL-2, TNF, IL-6

Action of factor C Correct Answer: Proteolysis of factor Va and VIIIa

What is the maximal amount of air that can be exhaled? Correct Answer: Vital capacity

Physiologic changes in pregnancy: HR, BP, intravascular volume Correct Answer: HR goes up, BP
goes down, intravascular volume goes up

% of blood loss in a pregnant before signs of shock Correct Answer: 35% of circulating blood volume

Crohn's medications for moderately active Crohn's and helpful with treating persistent perianal
fistulas Correct Answer: Infliximab -- monoclonal chimeric antibody to TNF

Most common locations for glucagonoma, insulinoma, gastrinoma, somatostatinoma, and VIPoma
Correct Answer: Glucagonoma: body and tail; Insulinoma evenly distributed in the pancreas, VIPoma
in the tail, Somatostatinoma in the head, and Gastinoma in the triangle
What is the Cori cycle? Correct Answer: The recycling of lactate and pyruvate for gluconeogenesis by
the liver -- can provide up to 40% of plasma glucose during starvation

What is a klatskin tumor? Correct Answer: Cholangiocarcinoma at the hilum

What is the step-up approach for necrotizing pancreatitis? Correct Answer: First drain (either perc
drain or endoscopic transgastric) and if not improved in 72 hr, look for other places to drain and drain,
and if not improved in another 72 hr: VARDs with postoperative lavage. + Abx of course

Rate of choledocholithiasis in cholecystectomies Correct Answer: 4-11%

Most common artery to be profused by the false lumen in a aortic dissection Correct Answer: the left
renal

What is Petersen's space? Correct Answer: The space btwn the alimentary limb and the transverse
mesocolon at the level of the jj where an internal hernia can occur.

When does collagen amount peak in the wound? What collagen predominates? Correct Answer:
Week 3. Collagen III peaks early but then replaced by type I.

Phases of skin graft healing? Correct Answer: 1) Plasmatic imbibition (24-48 hr) 2) innosculation and
capillary ingrowth 3) revascularizaiton

Standard of care for treatment of stage III rectal cancer Correct Answer: 1) neoadjuvant chemo/rads
2) resection 3) chemo and then surveillance with CEA every 3-6 mo for 2 years then annually for 3
years, colonoscopy within one year and pelvic CT every year for 5 years

Where does esophageal perforation occur in Boerhave syndrome? Correct Answer: In the distal
esophagus on the left

Billroth I vs II vs roux-en-y reconstruction anatomy and pros/cons Correct Answer: I:

gastroduodenostomy with end of duodenum re-anastomosed to distal greater curve after antrectomy;
II: gastrojejunostomy created but no j-j needed because more proximal jejunum -- done if adequate
reach w/o tension of duo for BI; rny: loop of jejunum brought up to the stomach and anastomosis
done to the stomach and then also jj. BI prevents afferent limb syndrome (obstruction). RNY good if
pts can't tolerate BII -- less reflux but can get gastric atony.

Where are Delphian nodes located? Correct Answer: Within the anterior suspensory ligament in the
prelarygneal position in the midline.

Procedures for anal incontinence Correct Answer: Wrap-around sphincteroplasty where the sphincter
is mobilized and reapproximated without tension -- most common. Can do a gracilis transposition with
constant low freq stimulation but that's usually for recurrent/refractory cases

SBP -- organism(s) that cause, treatment, prophylactic treatment?, mortality rate Correct Answer:
Usually one gram neg organism, treat with 3rd gen cephalo or fluoroquinolone, prophylactic treatment
for cirrhotics w/h/o SBP, low protein (<15 g/L) ascites, GI hemorrhage, and mortality is 20-40%

How long is the rectum Correct Answer: 15 cm

Where is procollagen formed? Correct Answer: fibroblasts

Phases of cardiac tamponade Correct Answer: Phase 1: diastolic ventricular filling pressures
decrease but compensatory mechanisms at work to sustain cardiac output (increased filling
pressures, increased HR, increased SVR)
Phase II: first signs of shock
Phase III: ventricular filling pressures approaches intrapericardial pressures

Why was the vertical banded gastroplasty abandoned? Correct Answer: Due to weight regain

Contraindication(s) to meperidine and reasoning Correct Answer: Pts with hepatic or renal
dysfunction b/c meperidine forms a toxic metabolic normeperidine, with a longer half life than
meperidine, -- can cause difficult to control life-threatening seizures

Grades of internal hemorrhoids Correct Answer: 1) bleeding w/o prolapse, 2) prolapse that
spontaneously reduces, 3) prolapse that needs to be manually put back in, 4) irreducible (1 & 2 &
most 3s can be treated with measures to reduce constipation)

Contraindications to ketamine Correct Answer: 1) increased ICP (increases cerebral blood flow), 2)
open eye injuries (increases IOP), 3) as sole anesthetic for pts w/ischemic heart dz (increases
myocardial O2 consumption due to HTN and tachycardia), 4) intrathecal or epidural administration
(neurotoxic preservative)

Types/location of gastric ulcers Correct Answer: 1) lesser curve 2) two ulcers -- one at lesser curve
and one duodenum 3) prepyloric 4) cardia 5) from NSAIDs (2 &3 from high acid)

Leriche syndrome Correct Answer: Bilateral buttock claudication, impotence, and absent femoral
pulse seen with aortic-iliac atherosclerotic dz

Size at which to intervene for popliteal aneurysm Correct Answer: 2 cm -- ligate and bypass

Should radial scars undergo excision? Correct Answer: According to truelearn if > 6mm

Where are mucinous cystic neoplasms usually found? Correct Answer: the body and tail of the
pancreas

Treatment for fibromuscular dysplasia Correct Answer: just angioplasty (unlike RAS, which is treated
with angioplasty and stenting)

MoA of doxorubicin Correct Answer: Inhibits DNA synthesis by inhibition of topoisomerase II

What is a modified Hanley approach? Correct Answer: Drainage of horseshoe abscess with seton
from anal verge extending laterally on either side.

What lung cancers are related to the following paraneoplastic syndromes: ACTH, ADH, and PTH?
Correct Answer: ACTH and ADH are small cell and PTH is squamous

Pathophysiology of ischemic colitis Correct Answer: Arterioles of the colon are affected and can be
due to hypercoagulable states, infection, embolic phenomenon, vasculitis, or cocaine
Solitary rectal ulcer syndrome (SRUS) Correct Answer: Benign disorder marked by rectal bleeding,
copious mucus discharge, anorectal pain, and difficulty passing stool. Misnomer b/c may have one
ulcer, multiple, or none. Conservative therapy/lifestyle modification should be done first for treatment
but can operate if prolapse or can resect and pull through if conservative management not adequate.

Approach for repair of subclavian artery repair (to obtain proximal and distal control) Correct Answer:
Left: anterior thoracotomy at third intercostal space for proximal control and infraclavicular and
supraclavicular incisions for distal control and repair
Right: median sternotomy and infraclavicular and supraclavicular incisions

Surgery for resectable gallbladder cancer Correct Answer: Resection of gallbladder and segments 4b
and 5 of the liver

What is the common arrhythmia that complicates post-pneumonectomy patients, and it what is used
for prophylaxis? Correct Answer: Afib; diltizem

What is roux syndrome and what is the treatment? Correct Answer: Delayed gastric emptying after
RNYGB without mechanical obstruction. Promotility agents should be used first. If that is ineffective
than decrease the size of the gastric pouch, and if that doesn't work: total gastrectomy with resection
of roux limb.

Neurovascular injuries associated with posterior knee dislocation and anterior shoulder dislocation
Correct Answer: Popliteal artery and axillary nerve respectively

Anatomical landmark for division of the left and right hepatic lobes Correct Answer: Middle hepatic
vein

Management of hydatid liver cysts Correct Answer: Albendazole for a period of weeks and then
surgical excision

Management of pyogenic liver abscess Correct Answer: IV antibiotics and perc drainage

What patient populations are at higher risk for OPSI? Correct Answer: Children less than 5 are at
highest risk, and patients with hematologic illnesses or malignancies are at higher risk.

Amount of initial weight loss for vertical gastric band and reason for it falling out of favor Correct
Answer: 55-60% body weight loss; fallen out of favor due to regaining of weight since patient's will go
back to bad eating habits (shakes that will go thru easier).

Most common cause of acute paronychia Correct Answer: S. aureus

Natural history of ASDs Correct Answer: Usually present in adulthood with CHF. If children are
symptomatic they should have repaired or by age 5 to prevent CHF.

Obligate glycolytic cells Correct Answer: RBCs, renal medulla, polymorph neutrophils

Treatment for hepatitis D virus Correct Answer: Only current treatment is alpha interferon
Effects of vitamin E deficiency Correct Answer: hemolytic anemia, peripheral
neuropathy/neuromuscular issues, retinopathy

What does vitamin K do for coag factors? Correct Answer: Carboxylates them so they can bind to
calcium on the phospholipid membrane

What is another name for factor I? Correct Answer: fibrinogen

Operative approaches for type A and type B aortic dissections Correct Answer: Type A: median
sternotomy and can modify with a cervical, supraclavicular, or trapdoor incision to gain exposure to
the brachiocephalic and thoracic aorta; Type B: pt should be positioned in the right lateral decubitus
and incision is a posterolateral thoracotomy in the fourth intercostal space but could also do a
thoracoabdominal incision if need abdominal exposure.

Indications for repair of chronic aortic dissection Correct Answer: Impending or actual rupture,
malperfusion, sx related to dissection such as CHF/AR/angina/stroke/pain, aortic expansion of >1 cm
per year or size ≥ 5.5 cm for type A and ≥ 6.5 in type B

Stimulants and inhibitors of glucagon Correct Answer: Stimulants: epinephrine, CCK, pituitary ACAP,
gastrin, GLP-2, urocortin III, vasopressin, GIP; Inhibitors: insulin, glucose, GABA

Most common cause of necrotizing soft tissue infection Correct Answer: Polymicrobial; most common
mono is group A hemolytic strep

Treatment for neuroblastomas Correct Answer: stage I-IIB with low risk classification can be treated
with surgery alone

Early and late dumping syndrome Correct Answer: Both occur after pyloroplasty, pyloromyotomy, or
distal gastrectomy. Early is about 30 min after a meal and due to high osmotic load hitting the
duodenum. Late is 2-3 hr after a meal due to hypoglycemia from large insulin release.

Trocar placement for lap appy in a pregnant pt Correct Answer: First trimester: same spots; second:
10 umbilicus, 5 RLQ, 5 LLQ; third: 10 umbilicus, 5 in RU and RL

Where do electrical burns cause the most injury? Correct Answer: Deep tissue: muscle and bone

What are the types and frequencies of true cysts of the spleen, and how do you treat them. Correct
Answer: Most are parasitic -- hydatid disease (Echinococcus). These are treated with partial or
complete splenectomy, but of note, they can be sterilized with injection of 3% NaCl, AgNO3, and
EtOH. Congenital cysts occur at a freq of 10% and usually involute on their own if <4 cm.

What are the high risk features of intraductual papillary mucinous neoplasm? Correct Answer: Main
duct has the highest risk of malignant degeneration at 30-50%. High risk features for BD-IPMN are
size > 3 cm, thickened enhancing wall, main duct 5-9 mm, non-enhancing mural nodule, changing
caliber of main pancreatic duct with distal atrophy, and LAD

Cushing disease vs syndrome Correct Answer: Disease: high ACTH vs syndrome is high cortisol

Which is preferred in renal disease, LMWH or UH? Correct Answer: UH

Why can bradycardia occur with insufflation? Correct Answer: Due to vagal response from stretching
the peritoneum too quickly

First line treatment for breast abscess Correct Answer: Aspiration first and second, only I&D if
refractory to repeated aspiration or overlying skin compromised

Difference between internal and external hemorrhoids: origin, presentation, and treatment Correct
Answer: Origin: superior hemorrhoidal plexus are internal and inferior hemorrhoidal plexus is
external. Presentation for external is usually is thrombosis with treatment being incisional
decompression if presenting within 24 hr or supportive care if already reabsorbing. Presentation with
internal usually with bleeding and prolapse. Treat according to grade. Grade I & II injection
sclerotherapy and infrared coagulation. Grade II & III rubber band ligation, and operative III & IV.
Grade I: prolapse in anal canal, II: spontaneous prolapse outside canal, III: can be manually reduced,
IV: can't

Treatment of anal squamous cancer cell Correct Answer: Chemoradiation with 5-FU and mitomycin C
and APR if no effect in 6 mo or recurrence

What type of suture should be used to repair esophageal and tracheal injuries? Correct Answer: Both
absorbable

Criteria for liver transplant Correct Answer: Acute (<28 days) liver failure without recovery, MELD
≥15, MELD ≤ 15 with portal hypertension, HCC

How is the patient positioned in an ERCP and where is the ampulla, panc duct, and CBD located?
Correct Answer: Patient positioned in left lateral decubitus and then switched to prone when in
second portion of the duodenum. The ampulla is located int he 12-1 o'clock positions, the panc in the
ampulla at 1 o'clock and CBD at 11 o'clock. Use a side viewing endoscope for ERCP.

Management of a femoral pseudoaneurysm Correct Answer: Surgical decompression and repair is

required if infection, hemodynamic instability, expanding pulsatile mass (especially if cellulitis or skin
necrosis), neurologic deficit (from femoral compression), size > 5 cm, wide neck, failure of ultrasound
techniques. However, if none of the above, try ultrasound compression, and then thrombin injection.

Hard signs of vascular injury Correct Answer: Arterial bleeding, distal ischemia, palpable thrill or
audible bruit, ongoing hemorrhage with shock, pulsatile or expanding hematoma, loss of distal pulses

treatment of hidradenitis suppurativa Correct Answer: Conservative measures can be done but if
intractable wide local excision with healing by secondary intention or skin graft. There is less
recurrence perianally so localized resection could be attempted here.

What induces secretion of bicarb from the pancreas? Correct Answer: Secretin stimulates secretion
of bicarb. High flow rates increases bicarb conc and decreases Cl secretion. Secretin stimulates
cystic fibrosis transmembrane exchanger of Cl-/HCO3

What stimulates the secretion of secretin and CCK? Correct Answer: Secretin is stimulated by acid in
the lumen of the duodenum and CCK is stimulated by luminal digestion products of fat and protein
Location of carotid body tumors and from what cells are they derived Correct Answer: They are
located at the bifurcation of the common carotid artery in the posterior medial adventita, and they're
derived from neural crest cells.

Components of the Gail model Correct Answer: (All poor prognosticators) 1st degree relative, early
menarche, nulliparity or older age at first birth, number of breast biopsies, number of breast biopsies
showing atypical hyperplasia, race/ethnicity

Classification of bile duct injuries Correct Answer: Strasberg A: cystic duct stump or duct of Lushka;
B: ligation of aberrant right hepatic duct; C: transection of aberrant right hepatic duct; D: lateral injury
to a major duct; E (same as Bismuth) -- 1: just prox to confluence of right and left hepatic ducts, 2: at
the confluence, 3a: main duct and extends to right hepatic, 3b: main and extends to left, 4: both sides

For seminoma and non-seminoma, which has a high AFP? Which is responsive to radiation? Correct
Answer: Seminoma is responsive to radiation and non-seminomas have high AFP

For a lung section, what should be the DLCO, FEV1, FVC, VO2, and which is most important. Correct
Answer: DLCO ≥40%, FEV1 ≥ 0.8, FVC > 1.5 L, VO2 (exercise tolerance) 10-12 mL/min/kg

Anatomic location/landmark of the right hepatic artery Correct Answer: 85% have their right hepatic
artery pass posterior to the common hepatic duct, 15% anterior, and 15% will have replaced/aberrant,
which is posterior to the cystic duct

Structures in the hepatogastric ligament Correct Answer: left gastric artery and vein, hepatic division
of the left vagal trunk, can have an aberrant left hepatic artery (in 25% of ppl)

Antidote for cyanide toxicity and sodium nitroprusside toxicity Correct Answer: Both sodium
thiosulfate

Reversal agent for neuromuscular blockers rocuronium and vecuronium Correct Answer:
Sugammadex

How was the jejenoileal bypass performed, and why has it fallen out of favor? Correct Answer: It was
performed by anastomosing the most proximal 35 cm of jejunum to the most distal 10 cm of ileum. It
has fallen out of favor due to it causing liver and kidney failure.

What is the length of the common channel in the biliopancreatic diversion and the roux limb in a
rnygb? Correct Answer: 100 cm and 150 cm respectively

Most common other cancer in FAP Correct Answer: duodenal -- start getting EGDs at 20-25 or when
start getting colonic polyps

Candidates for primary surgery (w/o neoadjuvant for rectal cancer) Correct Answer: T1 or T2
(invasion of submucosa and muscularis propria respectively) without lymphadenopathy

Surgery that can be done for rectal cancers and indications Correct Answer: LAR can only be done if
in the upper or mid-rectum, not the lower third at ≤ 2 cm from the anal verge. Only T1 can undergo
transanal excision. If can't have the above two, then APR.
Mechanism of action of amrinone Correct Answer: Phosphodiesterase inhibitor that blocks the cAMP
and facilitates an increase in the calcium uptake of the sarcoplasmic reticulum of the heart,
enhancing contractility. It also is a vasodilator by relaxing smooth muscle cells in the vasculature.

What can be done if the J pouch is under tension? Correct Answer: superficial incision of the
mesentery along the course of the SMA

Most common nerve injured during laparoscopic inguinal hernia repair? open? Correct Answer:
laparoscopic: lateral femoral cutaneous, genitofemoral; open: genital branch of the genitofemoral,
ilioinguinal, iliohypogastric

Most common posterior mediastinal tumor Correct Answer: neurogenic

Treatment of small bowel hemangiomas Correct Answer: Resection

What are the primary bile acids? How are they conjugated? And what's their path after conjugation?
Correct Answer: Primary bile acids are cholate and chenodeoxycholate. They are conjugated in the
hepatocytes with taurine and glycine. They are secreted in the intestines and 80% are reabsorbed in
the terminal ileum. Remainder are deconjugated by bacteria in the colon to deoxycholate and
lithocholate. 5% are excreted in the stool.

Cause and treatment of emphysetamous cholecystitis Correct Answer: Cause: C. perfringes and
emergent chole should be done (+ IV abx of course)

Definition of metabolic syndrome Correct Answer: Waist circumference >35 in in women and >40 cm
in men + 2 of the following: fasting BG >100/or dx DM, SBP >135 or DBP >85, TG > 150, HDL < 40 in
males or < 50 for females,

What is the gold std surgical management of atrial fibrillation Correct Answer: Cox-Maze III
Procedure = myriad of surgical incisions in the atrium to stop fibrillation

Type of surgery most likely to have delirium Correct Answer: Cardiothoracic is #1, ortho 2nd

Fibrinogen level associated with an increased risk of bleeding Correct Answer: < 150 mg/dL --
fibrinogen conversion to fibrin by thrombin last step in the coagulation pathway (normal levels 200-
400)

How should the anastomosis be made of a cystgastrostomy Correct Answer: Interrupted, full-
thickness sutures

Most common non-iatrogenic cause of esophageal perforation Correct Answer: Boerhaave syndrome

How to make the dx of chylothorax Correct Answer: Presence of chylomicrons and TG level >110
mg/dL

Most likely cause of hypocalcemia with ESRD Correct Answer: Vitamin D deficiency -- prevents
absorption from the gut

Most common cause of pyogenic liver abscess Correct Answer: Cholangitis from obstructing stone or
malignancy -- usually E. coli, Klebsiella, or Proteus
After abdominal surgery, how long does it take for the stomach, SB, and LB to regain function?
Correct Answer: 3 days, 24 hr, 5 days respectively

Cytokine responsible for asthma and allergic reactions Correct Answer: IL-4

Lymph drainage of the esophagus Correct Answer: Cervical: internal jugular and upper trachael;
Anterior thoracic: tracheal superiorly and subcarinal and paraesophageal inferiorly; abdominal: cardia
and celiac into cisterna chyli or thoracic duct

What are the EKG changes of hypermagnesium and what is the first steps in treatment? Correct
Answer: Similar to hyperkalemia on EKG and treat similarly with calcium first to antagonize the effect
of Mg on neuromuscular function

Another name for epidermoid cell carcinoma Correct Answer: SCC

Component of the gram negative bacterial cell wall responsible for the inflammatory response Correct
Answer: Lipid A, which is the active part of the LPS cell wall

What criteria is used to determine the prognosis of thyroid cancer? And what is the best
prognosticator? Correct Answer: AMES criteria, and the variables include age, metastasis, extent of
involvement, and size. Age is the best prognosticator

Dosing of lidocaine and marcaine (bupivacaine) with and w/o epi Correct Answer: Lidocaine with is 7
mg/kg, without 5 mg/kg; marcaine is 3 mg/kg with and 2 mg/kg w/o

Recommended surveillance for Barrett's Correct Answer: Low grade dysplasia: endoscopy every 6-
12 mo with biopsies; high grade: endoscopy with biopsies every 3 mo

Order of ligations for left hepatectomy Correct Answer: 1) left hepatic artery 2) left hepatic vein 3) left
portal vein

Best non-invasive diagnostic for esophageal varicies Correct Answer: Spleno-portal index = (doppler
used) splenic index (transverse diameter-longitudinal diameter of the spleen in cm) divided by the
mean portal vein velocity. Cut-off of 3 cm used for a sensitivity and specificity of 92% and 93%
respectively.

Requirements of AAA neck for EVAR Correct Answer: Typically should be > 15 cm and no > 32 cm

Indication for operative management for splenic trauma in peds Correct Answer: transfusion of half of
patient's blood volume, 40 mL/kg

Treatment algorithm for cervical cancer Correct Answer: Surgery if stage I, but radiotherapy and
cisplatin-based chemotherapy if ≥II

What is more effective for rewarming: convection or conduction? Correct Answer: Conduction

Most common location of small bowel lymphoma? And is B or T cell more common? What is T cell
small bowel lymphoma associated with? Correct Answer: Ileum, due to Peyer's patches; B cell is
more common, and T cell SB lymphoma associated with celiac disease
Most common malignant primary tumor of the chest wall Correct Answer: Chondrosarcoma

What are the types of LeFort fractures? Correct Answer: I: horizontal fracture through the maxilla
superior to the maxillary dentition; II: pyramidal fracture outlining the nose and is a fracture thru the
maxilla and orbit; III: complete craniofacial separation -- fracture from the skull thru the facial bones

Pressor support for HCOM Correct Answer: Inotropes should be avoided b/c worsen outlet
obstruction -- should use neo

Elements of the Clinical Pulmonary Infection Score (CPIS) Correct Answer: Temperature, purulent
sputum, CXR infiltrates, WBC count

Treatment of Pancoast tumors Correct Answer: Neoradiation due to involvement of local structures

What nerves cause arm/hand radiculopathy? Correct Answer: C8 and T1

On GI series, "soap bubble" appearance or "paint brush" sign is pathognomonic for what? Correct
Answer: Villous adenoma

Indications for parathyroidectomy for primary hyperparathyroidism Correct Answer: Age < 50 years,
can't participate in surveillance, calcium > 1 mg/dL over normal, sx, renal dysfunction ≥ 30%,
systemic complications of hyperparathyroidism, urinary calcium > 400 mg/24 hr

Bethesda criteria Correct Answer: I: non-diagnostic, II: benign, III: AUS or FLUS, IV: suspicious for
follicular neoplasm, V: suspicious for malignancy, VI: malignant

Parameters in the Ranson score Correct Answer: WBC >16 K, AST > 250, Glucose > 200, LDH >
350, age > 55

Treatment of a entamoeba histolytica liver abscess Correct Answer: flagyl

Hydatid cyst treatment Correct Answer: albendazole

Rutherford acute limb ischemia classifications Correct Answer: I: viable and not immediately
threatened -- no loss of sensory/motor fxn and audible doppler signals. IIa: marginally threatened with
mild-mod sensory sx and minimal motor and often inaudible arterial doppler signals. IIb: immediately
threatened w/sensory and more than toes motor and usually inaudible signals. III: irreversible with
major tissue loss or permanent nerve damage with profound anesthesia and paralysis

Delta pressure used for diagnosis for compartment syndrome Correct Answer: 20-30 mmHg

Secretin test for chronic pancreatitis, end stage pancreatitis, pancreatic cancer, zollinger ellison
syndrome, malnutrition Correct Answer: Chronic pancreatitis: normal enzyme and total vol secretion
and lower bicarb; ES pancreatitis: all the above is low; pancreatic cancer: low total volume and
normal bicarb and enzyme; zollinger ellison: high volume and normal bicarb and enzyme;
malnutrition: low enzyme and normal bicarb and total volume

What is considered large volume hemoptysis? And what is management? Correct Answer: 600
mL/24 hr. Management: rigid bronchoscopy with airway packing
5 most common EGD findings for eosinophilic esophagitis Correct Answer: strictures, linear furrows,
edema, stacked circular rings, exudates

Diseases associated with hyposplenism Correct Answer: chronic graft vs host disease from BMT,
untreated HIV, severe celiac disease

How to calculate the nitrogen balance? Correct Answer: Intake - output: Intake= (protein
consumed)/6.25 -- 6.25 g of protein = 1 g of N. Output = Urinary urea nitrogen (80% of total urinary
nitrogen excretion) + 4

Treatment for pancreatic divisum Correct Answer: ERCP with sphincterotomy and stent placement

Criteria for liver transplant with HCC Correct Answer: Single lesion ≤ 5 cm or 3 separate lesions all ≤
3 cm in size, no distant mets or regional LNs, no evidence of gross vascular invasion

Components of frailty score Correct Answer: Slow walker, low energy expenditure, wt loss > 10 lb,
reported exhaustion, weak grip strength

Brooke formula and Parkland formula Correct Answer: Brooke = 2 cc/kg/BSA & give half during first 8
hr and remainder in next 16 hr and Parkland is 4 cc/kg/BSA

Rate of fluid resuscitation for electrical burns to prevent renal injury Correct Answer: 2 cc/kg/hr

What do Merkel cell tumors stain positively for? Correct Answer: CK-20, which small cell lung cancers
also stain positively for but they also stain for thyroid transcription factor 1 (TTF-1)

Difference btwn cutting and coag mode in electrocautery Correct Answer: Cutting is low continuous
(unmodulated) current concentrating heat to smaller surface area for more rapid heating. Coag is
modulated/intermittent high-voltage current concentrating heat in a broader area

What is blend electrocautery? Correct Answer: Combo of coag and cut that produces higher voltage
(more coag) at higher settings

Most common bacterial cause of contiguous septic thrombophlebitis Correct Answer: S. aureus

Mechanism of action of aspirin Correct Answer: Irreversibly acetylates cyclooxygenase inhibiting

prostaglandin metabolism

Karydakis procedure Correct Answer: One of the procedures for pilonidal cyst where cyst is excised
off midline, flattening the gluteal cleft

Cleft lift procedure Correct Answer: Pilonidal cyst procedure where the cyst is excised thru a midline
incision, but it is closed off midline by mobilizing subcu tissue

What does plasmin do? Correct Answer: Degrades factors V and VIII

What does ATIII do? Correct Answer: Binds and inhibits thrombin, inhibits factors IX, X, and XI
(heparin activates ATIII 1000x more than normal)
What does TXA2 do? Correct Answer: Increases plt aggregation thru triggering release of Ca, which
exposes GpIIb/IIIa receptor, vasoconstriction,

What is the ACT level desired for routine anticoagulation? Cardiopulmonary bypass? Correct Answer:
150-200 sec and > 480 sec respectively

vWF action and types of vWD Correct Answer: Links Gp1b receptor on plts to collagen. Type I and II
AD; 1 most common. III: AR, most severe, and won't respond to DDAVP

How does uremia cause bleeding? Correct Answer: Plt dysfxn due to inhibiting release of vWF

MoA of amicar Correct Answer: Inhibits fibrinolysis by inhibiting plasminfA3DNS"?2D1D

How is coagulopathy caused in cardiopulm bypass? Correct Answer: Activation factor XII (Hageman
factor) resulting in consumptive coagulopathy

TRALI pathophys Correct Answer: donor antibodies that react to recipient WBCs and clot in
pulmonary capillaries leading to noncardiogenic pulmonary edema in <6hr (ARDS)

interferon gamma Correct Answer: secreted by T cells and NK cells and activates macrophages

Infections associated with defects in cell mediated immunity Correct Answer: Intracellular pathogens:
viruses, TB

Types of odontoid fractures and management Correct Answer: 1) obliquely oriented thru the upper
portion of the dens 2) base of the dens 3) extend into the C2 vertebral body. 1 & 2 are relatively
stable and can be managed non-operatively. Type II should be managed with rigid cervical collar or
halo vest and may need surgery if posterior displacement and are associated with non-union esp in >
50 yr

Nerve and/or vascular injury associated with mid-shaft humerus fracture Correct Answer: Radial
nerve injury

What type of injury is associated with median nerve injury? Correct Answer: Elbow dislocation or
supracondylar fracture

Nerve and/or vascular injuries associated with anterior and posterior shoulder dislocation Correct
Answer: Anterior: axillary nerve; posterior: axillary artery

What is the anatomy of the epididymis? Correct Answer: Attaches the testis to the vas deferens

Most common non-skin melanoma Correct Answer: Eye melanoma

Where is calcium absorbed in the intestine? Correct Answer: duodenum and jejunum

Medical therapy for hypertrophic cardiomyopathy Correct Answer: Beta blockers and fluids

Sx associated with lap band slippage Correct Answer: Sudden food intolerance or GERD -- surgery
to reduce
Treatment/management of pancreatic fistula Correct Answer: NPO, TPN, skin care for 4-6 weeks b/c
most will close in this time

Grading of urethral injuries Correct Answer: I: urethral contusion, II: urethral stretch, III: partial
disruption, IV and V: complete disruption with < or > 2 cm separation respectively

Grading of kidney injury Correct Answer: I: contusion or subcapsular hematoma, II: laceration < 1 cm
or non-expanding perirenal retroperitoneal hematoma, III: lac > 1 cm renal parenchymal depth w/o
urinary extrav, IV: lac into the medulla, cortex, or collecting system or major vascular injury
w/contained hemorrhage, V: shattered kidney or renal hilum avulsion

What does the anterior and posterior vagus give rise to? Correct Answer: Anterior is the left vagus
that gives rise to the hepatic branch and branch of Laterjet (which innervates the pylorus). The
posterior branch is the right vagus and gives rise to the high-branching criminal nerve of Grassi,
which innervates the cardia and eventually joins the celiac plexus

What cells secrete CCK? Correct Answer: I cells in the duodenum

Watershed areas of the colon and rectum Correct Answer: Griffith's point (splenic flexure -- where
SMA and IMA jxn) and Sudak's point (jxn of superior and middle rectal arteries)

Puborectalis muscle Correct Answer: aka external sphincter

Anterior and posterior rectal fascia Correct Answer: Denonvilliers is anterior and
rectovesicular/prostatic in men and rectovaginal in women. Waldeyer's fascia is posterior and
rectosacral

Percent of villous adenomas with cancer Correct Answer: 50%

Haggitt classification Correct Answer: Level of adenocarcinoma invasion in polyps. 0: in situ -- in the
polyp head and doesn't invade the mucosa; 1: invades thru the mucosa to the submucosa but limited
to the head; 2: invades to the submucosa in the neck; 3: invades the submucosa in the stalk; 4:
invades the submucosa at the base of the polyps. All sessile polyps by definition are level 4.

Most common cause of acute lymphangitis Correct Answer: Group A strep

What to do if Barretts? Barretts with low grade dysplasia? High grade? Correct Answer: Surveillance
in 3-5 years with bx; surveillance every 6-12 mo with bx; endoscopic excision and RFA

Time limit for tranexamic acid in a bleeding pt Correct Answer: 3 hr

Signs associated with a traumatic AVF in the groin Correct Answer: Palpable mass with thrill, LE
swelling, CHF

Order of structures in the thoracic outlet (anterior to posterior) Correct Answer: Subclavian vein,
phrenic nerve, anterior scalene, subclavian artery, brachial plexus, middle scalene, first rib

Recurrent laryngeal nerve loops around what on each side Correct Answer: Right: subclavian artery;
Left: arch of the aorta
Where does the recurrent laryngeal nerve enter the larynx? Correct Answer: At the typical location of
the superior parathyroid gland

Management of thoracic outlet syndrome: neurogenic, venous, arterial Correct Answer: Neurogenic:
PT, then surgery with first rib removal and scalenectomy if fail medical management; Venous:
catheter-directed thrombolysis and first rib resection during the same hospitalization; Arterial (rarest):
revascularization with either thrombectomy or often artery is compromised so need to do a graft and
then rib resection during that hospitalization

actions of leukotrienes Correct Answer: Stimulate macrophages, bronchoconstriction, release platelet

aggregating factor, mucous production, leukocyte chemoattraction and adhesion, cap permeability

Positive DPL Correct Answer: 10 cc of blood, 100,000 RBCs/cc, > 500 WBC/cc, return of food
particles, bile, bacteria

Cushing's triad Correct Answer: Sx of increased ICP: bradycardia, hypertension, and low respiratory
rate

Cause of coagulopathy with TBI Correct Answer: Release of tissue thromboplastin

Jefferson fracture Correct Answer: C1 burst fracture from axial compression/loading, treat with rigid
collar

Hangman's fracture Correct Answer: C2 fracture, caused by distraction and extension, treat with
traction and halo

Compression fractures vs burst fractures of the spine Correct Answer: Compression fractures usually
anterior column only and stable (Tx with TLSO for example) vs burst fractures usually unstable
(anterior and middle columns) and require spinal fusion

Most common cause of facial nerve injury in trauma Correct Answer: Temporal bone fracture (at the
geniculate ganglion)

Approach for thoracotomy for chest trauma Correct Answer: Anterolateral on side of injury or right
side if proximal left mainstem or trachea

An indication for clamping chest tube for chest trauma Correct Answer: Tracheobronchial injury

When to repair tracheobronchial injury Correct Answer: Large air leak with respiratory compromise, if
injury > 1/3 diameter of trachea, can't get lung up, 2 weeks of persistent air leak

Approach to repair diaphragm injuries Correct Answer: Abdominal if < 1 week and thru the chest if >1
week b/c need to take down chest adhesions. May need PTFE (Gore-tex) mesh

Signs on CXR of aorta injury Correct Answer: Apical capping, widened mediastinum, trachea
deviation to the right, 1st &/or 2nd rib fx, loss of aortopulmonary window, left hemothorax, loss of
aortic contour

Borders of cardiac box injury Correct Answer: clavicle, nipples, xiphoid, and midclavicular line
Most common injury associated with pelvic injury Correct Answer: head injury

Structures in the anterior, lateral, superficial posterior, deep posterior compartments of the leg
Correct Answer: Anterior: tibialis anterior, extensor digitorum longus and hallucis longus, anterior
tibial artery and vein, deep peroneal; Lateral: peroneus longus and breves, superficial peroneal
nerve; Superficial posterior: gastroc, soleus, plantaris, sural nerve; Deep posterior: flexor digitorum
and hallucis longus, tibialis posterior, posterior tibial vessels, tibial nerve

Factors that determine oxygenation on ventilation Correct Answer: FiO2, PEEP, mean airway
pressure

Minute ventilation Correct Answer: RR x TV

Peak pressure vs plateau pressure Correct Answer: Plateau pressure is a better evaluation of your
alveoli b/c has a chance to equilibrate but peak pressure is a better evaluation of large airways

How to check NIF Correct Answer: Expiratory pause

Requirements in a day of: calories and protein for normal person and with burns Correct Answer:
Normal calories is 25 kcal/kg, normal protein 1 g/kg. Burns add 30 kcal per percent burn and protein
1-1.5 g/kg + 3 g x % burn

Half life of albumin and pre-approval albumin Correct Answer: 18 d and 2 d

Safest to most dangerous access sites for arterial lines Correct Answer: Radial, axillary, femoral,
brachial (most limb threatening)

Obligate O2 users Correct Answer: Rbcs, adrenal medulla, wbcs, peripheral nerves

Kwashiorkor vs. Marasmus Correct Answer: Protein deficiency vs starvation

Primary ammonia donor in the urea cycle Correct Answer: Glutamine

Essential fatty acids Correct Answer: linoleic acid and linolenic acid

Anatomic landmarks for the division of the anterior and posterior sectors of the right liver and the
medial and lateral sectors of the left lobe Correct Answer: The right portal vein and the round
ligament at the umbilical fissure respectively

Most common organism in burn wound infection Correct Answer: Pseudomonas

Types of choledochal cysts and treatments Correct Answer: 1) most common type -- fusiform dilation
of the CBD, treat with primary cyst excision and RnY hepaticoj. 2) Diverticulum extending from CBD,
treat with excision and primary closure. 3) dilation of duodenal portion of CBD or where pancreatic
duct meets -- treat with transduodenal approach w/either excision of cyst or marsupilization. 4a)
cystic dilation of intra and extrahepatic ducts. 4b) only extrahepatic duct dilation. 5) Caroli disease --
hepatic resection of involved segments.or tx for 4 and 5

Most common reason for AV graft for dialysis loss Correct Answer: venous intimal hyperplasia
What is May-Thurner Syndrome? Correct Answer: Compression of the left iliac vein by the left iliac
artery increasing the risk of DVT

Best inhalation anesthetic for kids Correct Answer: Sevoflurane

Side effects of halothane Correct Answer: Hepatitis, elevated lfts, arrhythmigenic and/or cardiac
depression

Inhalation agent with greatest potency(lowest MAC) Correct Answer: Nitrous oxide but don't use if
enclosed path like pnx or sbo

Sequence of RSI Correct Answer: Preoxygenate, rapid induction agent (I.e. etomidate), paralytic (I.e.
succ), cricoid pressure, intubate

Hoffman Elimination Correct Answer: Not metabolized in the kidney or liver

Classification of aortic dissections Correct Answer: Stanford class A and B for ascending and
descending respectively. DeBakey I: both, II: ascending, III: descending

Most common cause of AAA Correct Answer: atherosclerosis

Belsey-Mark IV procedure Correct Answer: Intrathoracic PEH which involves an anterior 240 degree
wrap that covers 4 cm of intraabdominal esophagus and diaphragmatic crura buttress. Good for
multiple previous failed attempts and shortened esophagus

Hill esophagogastropexy Correct Answer: Used when not enough fundus for fundoplication. Plication
of the lesser curve around the right side of the esophagus and a esophagopexy to the median
arcuate ligament

Most common atherosclerotic occlusion in LE Correct Answer: Hunter's canal -- distal superficial
femoral artery exits here and sartorius muscle covers canal

Management of isolated iliac lesions Correct Answer:

Arterial O2 content Correct Answer: =Hb x 1.34 x SaO2 + (PaO2*0.003)

Size of vessels that can sealed with a bipolar device Correct Answer: ≤ 7 mm

Most appropriate management strategy for cirrhotic ascites Correct Answer: First sodium restriction,
and if that doesn't work diuretics (simultaneous lasix and spironolactone)

Characteristics of mesh that increase bacterial clearance Correct Answer: Macroporous,

monofilament, uncoated. Barrier meshes with anti-microbial and anti-adhesive properties actually
decrease bacterial clearance.

Variable associated with increased incisional hernia recurrence and morbidity Correct Answer: Hernia
width

Petit hernia and Grynfeltt hernia Correct Answer: Lumbar hernias. Grynfeltt is superior btwn the 12th
rib superiorly, quadratus lumborum medially, internal oblique laterally, transversalis fascia at the floor,
and the external oblique at the roof. Petit is inferior with inferior border the iliac crest, internal oblique
at the floor, anterior external oblique, and posterior latissmus dorsi

Criteria for referral to burn center Correct Answer: 1) third degree burn 2) inhalation injury 3) electrical
burns (including lightening), partial thickness burn >10% TBSA, burns w/concomitant trauma, burn
with comorbidities

Approach to repair the trachea Correct Answer: At thoracic inlet: median sternotomy with lateral
retraction of the innominate artery and left carotid; distal trachea: right thoracotomy

Main complication of IO Correct Answer: Compartment syndrome

Grading of pancreatic trauma Correct Answer: 1) minor hematoma or superficial laceration not
involving duct; 2) major hematoma or laceration not involving the duct; 3) distal transection of the
duct; 4) proximal transection of the duct or parenchymal injury including the ampulla; 5) massive head
disruption

Management of traumatic injury to the facial nerve Correct Answer: If lateral to the lateral canthus,
repair within 72 hr. If medial, then can be managed non-operatively due to arborization of the nerve

Staging of NHL of the GI tract Correct Answer: IE1: involves mucosa or submucoa, IE2: extends to
muscularis propria, IIE1: regional nodes, IIE2: distant nodes, (no III), IV mediastinal involvement

Problems associated with selenium deficiency Correct Answer: Cardiomyopathy, hypothyroidism,

neurologic changes

Problems associated with chromium deficiency Correct Answer: Peripheral neuropathy,

hyperglycemia, confusion

Problems associated with copper deficiency Correct Answer: Pancytopenia, myelopathy (neuropathy
w/ataxia)

Tumors with elevated inhibin A Correct Answer: Epithelial stroma tumors such as mucinous or
endometrioid carcinoma and sex cord stromal tumors like granulosa cell and Sertoli-Leydig

Radical neck dissection vs. modified and indications Correct Answer: MRND=removal of LNs from
levels I-V, omohyoid, submandibular gland, cervical sensory nerves C2-C5, cervical branch of the
facial nerve, ipsilateral thyroid. Radical=includes the above and takes the SCM, accessory nerve,
internal jugular resection (rarely done anymore). MRND for tumors > 4 cm, clinically positive nodes,
bone invasion

Treatment for oral cavity cancer Correct Answer: WLE with 1 cm margins, MRND if > 4 cm, bone
invasion, clinically positive nodes, XRT if above as well

Oropharyngeal and hypopharyngeal cancer treatment Correct Answer: If < 4cm and no nodal or bony
invasion: XRT. If not, excision, MRND, XRT

What nodes do oropharyngeal and hypopharyngeal cancers go to? Correct Answer: Oropharyngeal
go to posterior cervical and hypopharyngeal goes to anterior cervical
Treatment for laryngeal cancer Correct Answer: XRT if vocal cord only or chemo-XRT if beyond vocal
cord but MRND if clinically positive nodes

Most common malignant tumor of the salivary glands and second most common and treatment(s)
Correct Answer: Mucoepidermoid carcinoma is most common and adenoid cystic is second.
Treatment for both is resection with the parotid gland trying to spare the facial nerve, prophylactic
MRND and XRT

Most common salivary gland tumor in kids Correct Answer: hemangioma