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DEPARTMENT OF SURGERY
PRINCIPLES OF SURGERY EXAM
EXAMINATION INSTRUCTIONS
1.
Please write and code your name on the Computer Answer Sheet left side.
2.
3.
4.
5.
Questions marked with an asterisk are optional for residents in the ENT and OBGYN programs.
Page 2 of 34
*1.
A 19 year old man suffers a stab wound to the mid-abdomen. On arrival in the
Emergency Room his blood pressure is 80/50. Following rapid infusion of 4 liters
of normal saline, his blood pressure is 110/80. Blood gasses taken at this time are:
ph
7.20
pO2
95
PCO2 25
HCO3 15
This patients metabolic acidosis would be best treated with?
2.
3.
a)
b)
c)
hyperventilation
d)
immediate laparotomy
b)
normal saline 150 cc/h until the serum sodium returns to normal
c)
d)
hypotension
b)
lactic acidosis
c)
d)
Page 3 of 34
4.
5.
6.
7.
The following four factors affect the rate of flow of blood through a stenotic artery.
Which is the most important?
a)
diameter of stenosis
b)
length of stenosis
c)
blood viscosity
d)
cigarette smoking
b)
c)
d)
oral contraceptives
Which of the following clinical conditions are indicated by the presence of serum
antibodies against hepatitis B surface antigen (anti-HBs) and hepatitis B core
antigen (anti-HBc) in the absence of HBs AG?
a)
b)
c)
d)
A 70 year old man has known cirrhosis of the liver complicated by portal
hypertension and ascites. He is admitted to hospital because of increasing
encephalopathy and low grade fever. Which of the follow statements about this
situation is correct?
a)
b)
c)
d)
Page 4 of 34
8.
9.
*10.
All the following proteins are primarily synthesized in the liver, EXCEPT?
a)
albumin
b)
fibrinogen
c)
Factor VII
d)
b)
c)
d)
Primary blast injury is caused by the blast pressure wave as it propagates through
air or water. Common injuries of this type include all of the following EXCEPT?
a)
myocardial contusion
b)
pulmonary contusion
c)
hollow-viscous perforation
d)
perforated eardrum
11. A 34 year old woman, know to use crack cocaine, is brought to the Emergency Room
following a fall of approximately 20 feet. She has an obvious left tibia-fibula
fracture and an open left humeral fracture. She is extremely agitated and
uncooperative. Blood pressure is 180/120 and the heart rate is 130. Further
investigation and management of this patient will require sedation. This is best
accomplished by?
a)
IM Haloperidol 5 mgs
b)
c)
d)
Page 5 of 34
12. A 35 year old man is injured in a high speed motor vehicle crash. When he is brought
to the Emergency Room, his blood pressure is 90/50, heart rate 120, GSC 3. The
anaesthesia resident can mask-bag the patient achieving an O2 saturation of 95, but
cannot intubate the patient with a laryngoscope. The next step in management of
the airway should be?
a)
b)
c)
surgical airway
d)
b)
c)
d)
14. A 55 year old man underwent successful kidney transplantation two years ago. He is
taking Mycophenolate, prednisone, and tacrolimus to prevent rejection. He presents
in the Emergency Room with generalized peritonitis secondary to a perforated
viscus and undergoes emergency surgery. In order to prevent organ rejection in the
perioperative period, the surgeon should?
a)
only provide stress-steroid coverage until the patient can resume oral
intake
b)
c)
continue oral intake with his usual meds in the expectation that his GI tract
will be able to absorb most of the medication
d)
Page 6 of 34
15. A 70 year old man is found to have a bulky mid-rectal adenocarcinoma without
metastatic disease. He undergoes neoadjuvant chemo-radio therapy. On flexible
sigmoidoscopy six weeks after completion of therapy, he is seen to have only a 2
cm residual tumour, 12 cms from the anal verge. At this point, the surgeon should?
*16.
*17.
18.
a)
continue to follow the patient to see if the tumour will regress completely
b)
c)
proceed to surgery to remove only the portion of the rectum containing the
residual tumour
d)
proceed with surgery to remove almost all of the rectum as if the patient
had not had any adjuvant therapy
b)
c)
d)
The following treatments for hypotension due to acute blood loss are
contraindicated, EXCEPT?
a)
albumin-containing IV solutions
b)
vasopressors
c)
Trendelenburg positioning
d)
ulnar nerve
b)
femoral nerve
c)
brachial plexus
d)
sciatic nerve
Page 7 of 34
19. A 79 year old man undergoes left hemicolectomy for an obstructing colon cancer. On
post-operative day five he developed peritonitis and undergoes relaparotomy and
exteriorization of his anastomotic leak. Following this procedure, he develops acute
renal failure despite aggressive treatment in the ICU. NG feeds are initiated. His
physician should aim for a protein intake of?
a)
0.3 grams/protein/kg/day
b)
0.8 grams/protein/kg/day
c)
1.4 grams/protein/kg/day
d)
feed only with glucose and lipids because of his acute renal failure
20. A 45 year old man is severely injured in a motor vehicle crash. He undergoes
laparotomy with splenectomy, repair liver laceration, and bowel resection. The
abdomen is closed primarily. An open fracture of the left tibia is treated with an
external fixator. The following morning, his vitals are:
heart rate
120
BP 88/50
CVP 11 mm/Hg
His urine output is 5 cc/h. Peek airway pressures have increased from 32 to
50 cc/H2O. His abdomen is distended and firm. Bladder pressure is 30 mmHg.
The next step in his treatment should be?
a)
b)
c)
inotropic therapy
d)
immediate laparotomy
Page 8 of 34
*21.
A 25 year old woman was an unbelted passenger in a high speed vehicle crash. She
is intubated and a C spine collar is in place. Her GCS is 3T. She has a right
pulmonary contusion and multiple lower extremity fractures. The diagnostic
procedure of choice for radiologic clearance of her cervical spine is?
a)
b)
c)
CT cervical spine
d)
MR cervical spine
22. A 68 year old man sustains multiple injuries in a motor vehicle crash including a
closed head injury with small frontal contusions, and interparenchymal hemorrhage
on CT scan. He has been on coumadin 4 mgs a day for chronic atrial fibrillation for
three years. His admission INR is 2.8. The most rapid method of reversing the
anticoagulant effect of coumadin is?
a)
b)
c)
vitamin K1
d)
octoplex
Page 9 of 34
*23.
A 45 year old man is brought to the Emergency room after a high speed motor
vehicle crash. There was no loss of consciousness. He received 2000 ccs of normal
saline en route to hospital. On arrival in the Emergency Room, his vitals are:
Heart Rate
140
Blood pressure
60 systolic
Respiratory Rate
24
GCS
14
b)
c)
diagnostic laparoscopy
d)
laparotomy
24. A 66 year old woman with long-standing rheumatoid arthritis requires emergency
surgery for perforated sigmoid colon diverticulitis. She has been receiving
prednisone 10 mgs a day for at least the last five years. The recommended
management of perioperative parenteral corticosteroids for this patient should be?
a)
b)
c)
d)
Page 10 of 34
25. Three days after knee arthroscopy, a 35 year old man presents with mild dyspnea on
exertion. His temperature is 38 degrees centigrade. His chest is clear to
auscultation except for right lower lobe rales. Minimal knee swelling is noted at the
arthroscopy site. His white blood cell count is 12,400 and D-dimer level is normal.
A chest x-ray shows that the right hemi-diaphragm is obscured. The next diagnostic
test should be?
a)
b)
c)
d)
sputum culture
b)
low molecular weight heparins share the ability to accelerate the activity
of factor 10a
c)
d)
27. A 70 year old diabetic man with Childs C cirrhosis undergoes operative repair of an
incarcerated umbilical hernia. On post-operative day one, the patient develops upper
GI bleeding and requires four units of packed red cells. On the fifth post-operative
day, the wound is noted to be painful and erythematous. All of the following are
risk factors for developing a surgical site infection in this patient, EXCEPT?
a)
intra-operative hyperglycemia
b)
post-operative transfusion
c)
cirrhosis
d)
age
Page 11 of 34
28. Risk factors for clostridium difficile associated diarrhea include all of the
following EXCEPT?
a)
advanced age
b)
immunosuppressive agents
c)
d)
naso-gastric intubation
29. A 60 year old woman with a 40 year history of smoking presents with a painless 2
cm nodule just anterior to the sternomastoid muscle and inferior to the angle of the
mandible. The most appropriate means to obtaining a tissue diagnosis is?
a)
b)
c)
d)
30. Bupivacaine (marcaine) injection for local analgesia may be associated with all of
the following adverse affects, EXCEPT?
a)
seizure
b)
hypotension
c)
heart block
d)
methemoglobinemia
31. The intravenous anesthetic induction agent with the LEAST effect on the
cardiovascular system is?
a)
propofol
b)
ketamine
c)
etomidate
d)
thiopental
Page 12 of 34
32. During an elective laparoscopic cholecystectomy, a 35 year old woman develops a
sudden onset of hypotension, tachycardia, cyanosis, flushed warm skin and
increasing end-tidal CO2 levels. Which of the following statements about this
condition is NOT true?
a)
b)
c)
d)
33. Prior to making the incision for an emergency open appendectomy, administering
0.5% bupivacaine without epinephrine into the area of the wound (including deep
tissues) will?
a)
b)
c)
d)
34. Treatment of wounds with negative-pressure wound dressing (VAC dressings) may
result in all of the following, EXCEPT?
a)
increased apoptosis
b)
c)
d)
35. A physician punctures her finger with a suture needle while securing a drain tube in
a patient with AIDS. The most appropriate therapy for the physician will be?
a)
Zidovudine
b)
c)
d)
Page 13 of 34
36. Which of the following statements about the use of antibiotics for the prevention of
surgical site infection is NOT true?
a)
b)
c)
d)
actinomycosis
b)
mucormycosis
c)
stenotrophomonas maltophilia
d)
nocardia asteroides
38. A 50 year old man requires amputation of his left arm for necrotizing fasciitis.
Wound cultures grew clostridium septicum. Which of the following should be
recommended after the patient recovers from the amputation?
a)
upper GI endoscopy
b)
colonoscopy
c)
d)
39. A 55 year old alcoholic male is admitted to hospital with cellulitis of the lower left
leg. Despite appropriate antibiotic therapy, the cellulitis progresses and the patient
becomes febrile and hypotenisve. Incision of the skin under local anaesthesia
reveals necrotic subcutaneous fat. The next step should be?
a)
b)
c)
above-knee amputation
d)
Page 14 of 34
40. A 30 year old woman undergoes emergency Caesarian section for fetal distress. On
post-operative day four, her wound dehisces and she is taken back to the operating
room for resuturing of her wound. The following day, her abdomen is not distended
but no bowel sounds are heard. Her physician is concerned about her nutritional
state. The preferred route for nutritional intake in this patient is?
a)
b)
NG tube feeding
c)
d)
41. During starvation, the liver maintains serum glucose levels near normal by
synthesizing glucose from all the following molecules EXCEPT?
a)
lactate
b)
glycerol
c)
alanine
d)
arginine
Page 15 of 34
42. A 70 year old man undergoes emergency aortic grafting because of a ruptured
abdominal aortic aneurysm. In the ICU immediately post-operatively he is on a
ventilator and his IV is normal saline at 150 ccs/hr. His vitals and initial blood work
are:
Blood pressure
140/80
pH
7.2
Heart rate
95
pCO2
59
Urine output
120 mls/hr
pO2
110
Hgb
85
HCO3
15
WBC
14.9
Platelets
79,000
b)
c)
d)
Page 16 of 34
43. An 80 year old woman undergoes laparotomy and ileostomy because of an
obstructing unresectable carcinoma of her colon. Post-operatively she does well.
Because of excessive ileostomy output she is kept on clear fluids by mouth. She
receives IV 2/3-1/3 saline of 20 mol/l HCL/l at 100 cc/h. On post-operative day
four, her electrolytes are:
Na
122
4.8
HCO2
22
Cr
140
Bun
2.5
b)
cigarette smoking
c)
diabetes mellitus
d)
intra-operative hypothermia
Page 17 of 34
45. An 85 year old woman with a bleeding gastric ulcer receives 2 units of packed cells
over two hours. One hour after her transfusion, she becomes severely dyspnic and
is transferred to the ICU. Her physician suspects transfusion-related acute lung
injury (TRALI) is responsible for her dyspnea. Which of the following data,
obtained in the ICU, rules OUT TRALI?
a)
b)
c)
d)
46. A 65 year diabetic man presents to the Emergency room with septic shock
secondary to infected necrosis of his left foot and lower leg. Blood work
demonstrates coagulopathy:
INR
1.7
(n<1.2)
PTT
50
(n<30)
Platelet Count
30,000
(n>75,000)
D-dimer
770
(n<230mg/ml)
b)
8 units cryoprecipitate
c)
d)
47. A 72 year old man with chronic renal failure on hemodialysis requires surgery to
remove an infected hip prosthesis. The surgeon is worried about abnormal bleeding
due to the patients uremia. All the following treatments will improve platelet
functioning in uremic patients, EXCEPT:
a)
b)
c)
d)
Page 18 of 34
48. A 58 year old woman undergoes total hysterectomy, bilateral salpingoophorectomy
and omentectomy for ovarian carcinoma. Post-operatively she receives an
intravenous of 2/3-1/3 of 20 mmol of KCL/l at 100 ccs/h. On post operative day
two, routine blood work records:
Hg
98
Na
127
6.3
Cl
115
(previously 125)
Glucose 23.2
Creatinine 75
She has no history of diabetes or renal disease. The next step in her management
should be?
a)
b)
c)
d)
49. A 65 year old man is scheduled to have a left total knee replacement. He has a
mechanical aortic valve and is permanently anticoagulated with coumadin. The
most appropriate management of his anticoagulation pre-operatively is?
a)
continue coumadin until the day prior to surgery. Administer two units of
fresh frozen plasma at the beginning of the surgery
b)
continue coumadin until the day prior to the surgery. Administer 10 units
of Factor VIIa at the beginning of the surgery
c)
d)
hold coumadin 5 days prior to surgery, admit the patient to hospital and
treat with IV unfractionated heparin. Hold the heparin two hours prior to
the surgery
Page 19 of 34
50. A 64 year old man has shortness of breath and documented hypoxemia 2 days after
right hemicolectomy for cancer. His chest x-ray is unremarkable. His ECG and
serum troponin are normal. The next diagnostic test should be?
a)
thoracic CT scan
b)
ventilation-perfusion scan
c)
D-dimer assay
d)
51. A 45 year old woman has right sided chest pain and a nonproductive cough seven
days after modified radical mastectomy for breast cancer. Her vitals are:
Heart rate
110
Blood pressure
120/70
Respiratory rate
24
Her ECG is normal. A thoracic CT scan shows a saddle embolus to the main
pulmonary artery extending into both left and right main pulmonary arteries.
Blood flow is not completely obstructed to either lung. The most appropriate
treatment would be?
a)
b)
c)
d)
52. A 70 year old man develops a 2 cm nodule in the right lung two years after right
hemicolectomy for colon cancer. Which of the following is the BEST predictor of
the risk of pulmonary complications after lung resection for this patient?
a)
b)
c)
d)
Page 20 of 34
53. Which of the following statements about acute rejection of a transplanted kidney is
NOT true?
a)
it is T-cell mediated
b)
c)
d)
hepatitis C
b)
c)
alcohol-induced cirrhosis
d)
55-57. For each of the three statements below, fill in the most appropriate answer.
a)
enteral nutrition
b)
parenteral nutrition
c)
both
d)
neither
55.
56.
57.
Page 21 of 34
58.
59.
A 58 year old man has chronic duodenal ulcer disease because of noncompliance
with medications. Over the past two weeks he has had increasing nausea and
vomiting with weight loss. In the Emergency room he appears dehydrated with a
serum creatinine of 170. All of the following metabolic abnormalities are expected,
EXCEPT?
a)
elevated pH
b)
c)
d)
b)
c)
d)
3% hypertonic saline
60. Severe closed head injury often results in increased intra-cranial pressure. Which of
the following treatments would NOT help relieve intracranial hypertension?
a)
b)
c)
d)
mannitol bolus IV
Page 22 of 34
61.
A 24 year old woman comes to the Emergency Room because of left leg pain.
Twelve hours previously she noticed a small puncture wound on the sole of her
foot. Over the last six hours, her foot and lower leg have become erythematous,
swollen and very tender. She also complains of feeling febrile, with chills and
malaise. On examination, her lower leg is edematous and the skin erythematous.
No areas of fluctuance are noted. The leg below the knee is extremely tender.
Blood work demonstrates a WBC of 25,000. A plain x-ray of the leg does not show
any subcutaneous emphysema. The most appropriate treatment of this would be?
a)
oral Keflex and pain meds and return to the Emergency Room in am for
reassessment
b)
c)
admit to hospital. Treat with broad spectrum antibiotics and explore under
general anaesthestia if she develops signs or symptoms of compartment
syndrome
d)
*63.
a)
HIV transmission
b)
Hepatitis C
c)
ABO incompatibility
d)
Bacterial contamination
A 17 year old man driving a snowmobile runs into a tree at high speed. There is no
loss of consciousness. He is taken to the local hospital. On clinical examination he
has multiple right rib fractures. Abdominal examination is unremarkable. The
blood pressure was 130/80 on admission to the Emergency Room and 30 minutes
later drops suddenly to 80/40. The most likely cause of this hypotension is?
a)
myocardial contusion
b)
c)
intraabdominal bleed
d)
Page 23 of 34
*64.
65.
A 60 year old male unbelted driver is involved in a high speed motor crash. When
evaluated in the Trauma Centre, he is found to be suffering from a significant left
epidural hematoma, a false aneurysm in his thoracic aorta, severe lung contusions, a
grade II liver laceration, and an open fracture of the left tibia and fibula. Which
operation should be carried out first?
a)
b)
c)
d)
Which of the following urinary findings is NOT consistent with the diagnosis of
acute renal failure secondary to tubular necrosis?
a)
b)
c)
d)
66. A patient with acute adrenal insufficiency would be expected to show each of the
following, EXCEPT?
67.
a)
hypotension
b)
hyperglycemia
c)
hyperkalemia
d)
hyponatremia
A 75 year old man suffers a pulmonary embolus after a bowel resection for cancer.
He is treated with an IV infusion of unfractionated heparin. Two weeks later he is
still on his heparin infusion and his platelets drop from 350,000 to 75,000 in two
days. Which of the following is a risk factor for the development of heparin
induced thrombocytopenia?
a)
b)
c)
d)
Page 24 of 34
*68.
A 26 year old man was involved in a motor vehicle crash and suffers a closed
fracture of his left femur. This is treated surgically with an IM nail. The following
day he is found to be confused. His vitals are:
Temperature
39.2
Heart rate
130
Blood pressure
130/80
Respiratory rate
32
69.
70.
a)
blood culture
b)
MR head
c)
d)
A 64 year old woman presents with sudden onset of a painful swollen left leg two
days after stepping on a nail in a farm yard. She is hypotenisve (90/50) and febrile
with a temperature of 395. Crepitus is noted in the lower left leg. This infection
could be caused by all of the following organisms, EXCEPT
a)
bacteroides fragilis
b)
streptococcus A
c)
clostridium perfringens
d)
staphylococcus aureus
Which of the following treatments has been shown to reduce mortality for patients
with severe sepsis?
a)
activated protein C
b)
high-dose corticosteroids
c)
anti-endotoxin antibody
d)
Erythropoietin
Page 25 of 34
71.
72.
73.
hypomagnesemia
b)
hypochloremia
c)
hypoglycemia
d)
hyperphosphatemia
A 23 year old man has a subdural hematoma after a motor vehicle crash. This
requires craniotomy shortly after his admission to hospital. He remains intubated
and comatose in the ICU. On the fourth post-operative day, he develops an
increased oxygen requirement and a CT thorax shows a pulmonary embolus. This
should be treated with?
a)
b)
c)
d)
A 60 year old man is scheduled for a low anterior resection of rectal cancer. He has
hypertension controlled with an angiotension-coverting enzyme inhibitor. He does
not smoke and is able to walk up two flights of stairs without difficulty. Preoperative evaluation and management should include?
a)
b)
c)
d)
Page 26 of 34
74.
130
blood pressure
80/40
CVP
2 mm/Hg
urine output
His abdomen is soft and nondistended. His last haematocrit in the OR was 35%. His
low blood pressure should be treated with?
75.
a)
Levophed infusion
b)
blood transfusion
c)
d)
b)
c)
d)
Page 27 of 34
76.
77.
*78.
A 55 year old woman undergoes mitral valve replacement with a St. Jude
mechanical prosthesis. Coumadin therapy is started post-operatively. On post-op
day 5, she develops signs and symptoms of DVT and is started on a unfractionated
heparin infusion. On post-operative day nine she has an acute onset of shortness of
breath and hypoxemia. CT thorax demonstrates multi pulmonary emboli. Her
platelet count is found to have fallen from 300,000 to 50,000. Definitive
management of this problem should be?
a)
b)
c)
d)
A 60 year old man receiving total parenteral nutrition via a right arm PICC line,
suddenly develops fever and malaise. The PICC line is removed and the tip is sent
for culture. Peripheral blood cultures are obtained and the patient is started on
cefazolin 1 gram IV tid. The tip grows >15 colony forming units of staph aureus at
24 hours and peripheral blood cultures are also positive for methicillin sensitive
staph aureus at 48 hours. The patient is currently afebrile. The most appropriate
treatment now would be?
a)
b)
c)
d)
mannitol
b)
furosemide
c)
bicarbonate
d)
volume replacement
Page 28 of 34
*79.
80.
81.
A 20 year old woman was an unrestrained passenger in a high speed motor vehicle
crash. She was found on the road 20 feet ahead of the car. She has no signs of life
when the paramedics arrive but develops a pulseless rhythm during CPR on route to
the Emergency Room. On arrival in the Emergency Room, she again loses her
cardiac rhythm. The best course best of action now should be?
a)
b)
c)
d)
declaration of death
A 75 year old man is brought to the Emergency room because of severe abdominal
pain. Plain films of the abdomen demonstrate free air under both hemidiaphrams.
At laparotomy a perforated duodenal ulcer is repaired with an omental patch. At the
end of the operation, the anesthetist notes that despite fluid resuscitation, the
patients blood pressure is 80/40, core temperature is 33.5, and he is unable to be
extubated because of CO2 retention. This state could be due to any of the following
conditions, EXCEPT?
a)
severe hypothyroidism
b)
c)
diabetic ketoacidosis
d)
severe malnutrition
A 45 year old woman with type I diabetes mellitus is admitted to hospital and
undergoes emergency cholecystectomy for gangrenous cholecystitis. Postoperatively, her serum glucose is difficult to control with an insulin infusion.
Which of the following hormones is NOT a cause of her elevated blood sugar?
a)
epinephrine
b)
cortisol
c)
glucogen
d)
triodothyronine (T3)
Page 29 of 34
82.
83.
84.
A 32 year old man presents to the Emergency Room in septic shock. He was well
until two days ago when he developed a flu like illness. He has rapidly deteriorated
since then. His past medical history is unremarkable except for a splenectomy at
the age of two years. Which of the following organisms is likely to be the cause of
his sepsis?
a)
staphylococcus aureus
a)
escherichia coli
c)
streptococcus pneumoniae
d)
pseudomouas aeruginosa
A 65 year old man is admitted to hospital to undergo right total hip replacement
because of osteoarthritis. In the pre-op hold area an intravenous is started and he is
given 1 gram of cefazolin IV. Two minutes after starting the infusion he developes
hypotension, bronchospasm, cyanosis, and an urticarial skin rash. All of the
following drugs will be useful in treating this condition EXCEPT?
a)
epinephrine
b)
dopamine
c)
solucortef
d)
benadryl
A 60 year old woman is found to have ovarian cancer and requires total
hysterectomy and bilateral salpingo-oophorectomy. She also has severe aortic
stenosis with an aortic valve area of 1 cm2 and a pressure gradient of 60 mm/Hg
across the valve. Which of the following statements about the management of this
patient is TRUE?
a)
b)
she would benefit from after load reduction to maintain cardiac output
c)
d)
Page 30 of 34
85.
86.
87.
A 60 year old woman develops oliguria one day after total abdominal hysterectomy
and bilateral salpingo-oophorectomy for uterine cancer. She is known to have
systemic lupus eythrematosis with renal involvement. The diagnostic test that most
accurately distinguishes pre-renal versus renal etiology of the oliguria is?
a)
b)
c)
d)
An 86 year old man with colon cancer with widespread hepatic metastases is
admitted to hospital because of dehydration. He has been receiving feedings
through a previously placed jejunal tube. He has an advanced directive stating that
feeding and intravenous fluids should be discontinued if his condition worsens. The
day after admission, he becomes comatose. Which of the following statements is
TRUE?
a)
a metabolic work up is necessary and will likely discover a cause for the
patients coma
b)
c)
d)
the patients son may override the patients wishes and have the J-tube
feedings increased
b)
weve got a lot to do, so lets be sure were all on the same page
c)
d)
Page 31 of 34
88.
89.
90.
Which of the following statements about the use of opioid analgesics in surgical
patients is TRUE?
a)
b)
c)
d)
Many cancers are now known to be caused by genetic defects. Which of the
following statements concerning genetic testing for hereditary nonpolyposis
colorectal cancer is TRUE?
a)
b)
c)
d)
cyclosporine
b)
tacrolimus
c)
mycophenolate mofetil
d)
daclizumab
Page 32 of 34
91.
92.
93.
94.
An 80 year old woman with advanced Alzheimers disease has been ill for four days
and is transferred from the nursing home with fever, hypotension, and abdominal
distention. CT scan reveals a superior mesenteric artery thrombosis and bowel
ischemia with pneumatosis of the small bowel wall. She is acidotic and in acute
renal failure. Which of the following statements about this patients care is TRUE?
a)
b)
the decision for future care should be left solely with the family
c)
operation is the only chance for cure of the bowel ischemia and should be
performed
d)
b)
c)
both
d)
neither
b)
c)
both
d)
neither
A 57 year old hypertensive man develops torsades de pointes arrhythmia four days
after 4-vessel coronary artery bypass grafting for severe coronary artery disease
associated with a recent anterior myocardial infarction. Which of the following
electrolytes disturbances is likely contributing to the etiology of his arrhythmia?
a)
hyperkalemia
b)
hypermagnesium
c)
hypomagnesium
Page 33 of 34
d)
95.
96.
97.
hypocalcemia
All of the following are involved in the control of aldosterone secretion, EXCEPT?
a)
angiotensin
b)
cortisol
c)
serum potassium
d)
serum sodium
An 86 year old hypertensive man has left calf intermittent claudication after waking
two blocks. His physician ordered an arteriogram. The patients creatinine is 240.
Which of the following statements concerning contrast-induced nephropathy is
TRUE?
a)
b)
c)
d)
the risk of renal failure from intra-arterial contrast is too high in this
patient and alternative imaging should be considered
Which of the following practices help promote a culture of safety in the Operating
Room environment?
a)
b)
c)
d)
Page 34 of 34
98.
*99.
100.
b)
c)
d)
A 25 year old male falls 15 feet from a ladder and is brought to the Emergency
room. He has a GSC of 3 with reactive pupils. There are no other injuries. CT head
shows evidence of diffuse axonal injury. He is taken to the Operating Room for
placement of a ventriculostomy. In the ICU post-operatively he has a mean arterial
blood pressure of 65 mm/Hg and and ICP of 32 mm/Hg. He is ventilated and his
pupils are still reactive. Appropriate management of this situation includes all of
the following, EXCEPT?
a)
chemical paralysis
b)
c)
d)
administration of mannitol
b)
c)
d)
transfer the patient to a ward bed with an appropriate analgesic orders and
a DNR on the chart