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SURGERY – AMBOSS COMPLETE EXAM QUESTIONS WITH 100% VERIFIED ANSWERS
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SURGERY – AMBOSS COMPLETE EXAM QUESTIONS WITH 100% VERIFIED ANSWERS...
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SURGERY – AMBOSS COMPLETE EXAMQUESTIONS WITH 100% VERIFIED
ANSWERS
How treat new sclerotic lesion at L5 vertebral body in pt w bilateral orchiectomy after
prostate cancer dx - ANSWER local radiation
Pt has RUQ abdominal pain plus XR showing air in biliary tree and dilated transverse
colon - dx - ANSWER cholecystoenteric fistula
Pt has hoarse voice, sore throat, difficulty opening mouth. Swelling of R tonsillar
pillar w uvula deviation to L - dx, tx - ANSWER Peritonsillar abscess
- treat with incision and drainage w IV ampicillin-sulbactam
After stab wound, pt has hypotension, muffled heart sounds, JVD. Dx, what other
exam findings will see - ANSWER cardiac tamponade
- also see pulsus paradoxus (drop in SBP by 10 mmHg during inspiration)
40 yo pt has watery diarrhea, episodic crampy abdominal pain, WL, episodic
cutaneous flushing, asthma, systolic murmur at LSB 4th intercostal - dx? What at risk
for, why - ANSWER carcinoid syndrome
- at risk for dementia from pellagra (dermatitis, diarrhea, glossitis) from niacin
deficiency from decreased tryptophan
Pt has enlarged bluish veins above dentate line, mass that prolapses but reduces
when breathes normally. Dx? what tx - ANSWER internal hemorrhoids; docusate
therapy
How dx Zenker diverticulum - ANSWER barium esophagram w continuous
fluoroscopy
Pt has retrosternal chest pain, single punched out ulcer seen on endoscopy w
normal mucosa at GE junction. Takes a bunch of meds including insulin, amlodipine,
ASA, metformin, beclomethasone, albuterol, alendronate. Dx. What next step? -
ANSWER Drug induced esophagitis, discontinue alendronate
Why discontinue alendronate in pt w drug induced esophagitis - ANSWER
Alendronate can cause drug-induced esophagitis
- other meds that can cause it include abx, NSAIDs, KCl
After ORIF of LS femur fracture after MVA, pt has pain and paresthesia in arm. Has
decreased brachial and radial pulses, pale and cold skin. Platelets are 60k, PTT is
55s. Doppler shows occlusion of R brachial artery. Dx? - ANSWER arterial
thrombosis from HIT
,Pt has fever, chills, plus indurated tender, warm, erythematous skin lesion w sharply
demarcated margins. Also has toe web intertrigo. Dx? what do - ANSWER
Erysipelas; treat w IV cefazolin
3 yo has cough, SOB for 12 hrs. Repeat asthma exacerbations. Decreased breath
sounds, expiratory wheezing, hyperlucency of R lung field w decreased pulm
markings. What do, why - ANSWER Bronchoscopy to remove foreign body
37 yo male has itching in genitals for 7 days, atrophic white papules on glans and
prepuce w erythema. Narrowed, sclerotic urinary meatus. Dx, what do - ANSWER
biopsy lesion; lichen sclerosus but may become SCC
7 mo boy has palpable testicle in R hemiscrotum w palpable mass in L inguinal
canal. What do, why - ANSWER Orchidopexy - spontaneous descent is unlikely as
boy is already 4-6 mo of age
By when do you want to perform orchidopexy - ANSWER before 1 year of age
After AAA repaid, pt has absent bowel sounds, TTP in 4 quads. Dx - ANSWER
ischemic colitis
Homeless pt, IVDU has warmth, erythema neck pain. Palpation causes pain.
inflammation on MRI. Dx, what do, why - ANSWER osteomyelitis
- must cover for MRSA, strep, gram negatives (Pseudomonas)
- give vancomycin and fluoroquinolone (cipro) or cephalosporin (cefepime)
Pt has diarrhea for 2 weeks, urge to defecate 15 min after meal plus palpitations,
sweating after eating. Had distal gastrectomy performed. What do, dx - ANSWER
dietary modifications - early dumping syndrome
4 week old girl has yellowing of eyes, skin for 2 weeks. Can palpate liver 2 cm below
margin. Has very high direct bilirubin and alkaline phosphatase. Dx? - ANSWER
biliary atresia
What are signs of biliary atresia - ANSWER elevated direct hyperbilirubinemia, ALP
levels w post-hepatic jaundice
22 yo has pain of L knee. L tibia is displaced posteriorly when force applied to
proximal tibia after flexing knee. Dx - ANSWER PCL injury
42 yo has 2 episodes of LoC, SOB, palpitations, chest tightness, JVD, pitting edema.
From India. Has diastolic murmur in 5th L intercostal space at midclavicular line. Dx?
What is mechanism of findings? - ANSWER Increased LA pressure from mitral
stenosis (rheumatic fever)
68 yo M has sclerotic lesions in thoracic and lumbar vertebra. Normal DRE. Dx? -
ANSWER prostate cancer mets
- can have normal prostate exam
,Describe lesions that occur from prostate cancer v RCC - ANSWER osteoblastic
bone mets (sclerotic lesions)
- not osteolytic lesions (RCC)
Pt has pulsatile abdominal mass w severe abdominal pain radiating to flank for 30
min. Low BP, high pulse. What do - ANSWER ruptured AAA - open emergency
surgery
19 yo M has blood-speckled stools, protruding rectal mass w 4 cm pedunculated
polyp w superficial excoriations. Colonoscopy shows 14 polyps dx as
hamartomatous polyps. What dx, what associated with - ANSWER Peutz-Jeghers
syndrome - increased risk of pancreatic, breast, ovarian cancer
How treat communicating hydrocele in 6 mo old baby - ANSWER reassurance -
should resolve within 1 year
79 yo W has non-productive cough, fatigue, WL. Worked as seamstress in textile
factory plus smoked for 47 years. Has exudative pleural effusion w nodular pleural
lesions on R side. Dx - ANSWER Mesothelioma
23 yo W has R adnexal tenderness after N/V develop suddenly after sex. Dx, what
findings - ANSWER ovarian torsion - see decreased ovarian blood flow on doppler
68 yo W loses control of bladder when walking or standing. Failed Kegel exercises,
continence pessary. What tx - ANSWER urethral sling - 1st line for stress
incontinence if Kegel, pessary, lifestyle changes fail
52 yo M has 3 mo of upper abdominal pain after eating w improvement w eating.
Dark stools. Epigastric tenderness. Normal vitals. How prevent further cx of disease -
ANSWER Triple therapy for H pylori - amoxicillin, clarithromycin, omeprazole
Pt scheduled for cholecystectomy tomorrow but has elevated K+ of 6.1. How
manage, why - ANSWER administer IV saline w furosemide - not emergency
What are ways to decrease potassium emergently - ANSWER IV calcium gluconate,
hemodialysis, insulin and glucose
What is best prognostic factor for pancreatitis, why - ANSWER hematocrit -
determines if third space volume loss is present
Pt has severe pain over R groin after MVA. R leg is shortened, flexed, adducted, and
internally rotated. Dx? - ANSWER posterior hip dislocation
Compare posterior v anterior hip dislocation - ANSWER Posterior: most common,
often during MVA
- affected leg is shortened, mildly flexed, internally rotated, and adducted
Anterior: less common in MVA
- hip is externally rotated, mildly abducted
, Pregnant pt has breast cancer, positive for HER2 and ER. No mets. How treat? -
ANSWER Surgical resection and chemotherapy (can give after first trimester) bc
high risk
Why no trastuzumab to treat pregnant pt w BC - ANSWER No trastuzumab in
pregnancy
Pt has 1cm mass in head of pancreas w elevated direct bili, alk phos, AST, ALT,
GGT - dx, what do to treat - ANSWER pancreatic cancer
- perform pancreaticoduodenectomy (Whipple)
What happens in Whipple procedure, when performed - ANSWER treatment for non-
metastatic pancreatic head carcinoma
- resect pancreatic head and duodenum
Describe pH, Na+, K+, Cl- in 1 mo old w pyloric stenosis - ANSWER pH: alkalosis
Na+: hyponatremia
K+: hypokalemia
Cl-: low
metabolic alkalosis w hyponatremia and hypokalemia
Pt in MVA has crepitation on palpation of thorax, decreased BS on R, crunching
synchronous w heartbeat over precordium, dullness on percussion on R hemithorax.
Bluish discoloration of lips, tongue. Dx? why - ANSWER Bronchial rupture - can
present w Hamman sign (A crunching, rasping sound in sync with the heartbeat that
is caused by the heart beating against air-filled tissues) which can cause hemothorax
What is Hamman sign - ANSWER A crunching, rasping sound in sync with the
heartbeat that is caused by the heart beating against air-filled tissues.
What injuries are Hamman's sign associated w - ANSWER Associated with
pneumomediastinum, pneumopericardium, and tracheobronchial injury
Pt has 1 wk of back pain, dyspnea, pressure in chest. From Ecuador. Has lower
pressure in L arm than R. CT shows huge ascending aortic aneurysm. What is
cause? - ANSWER Cystic medial necrosis
What is cystic medial necrosis, what causes - ANSWER A degeneration of large
blood vessels such as the aorta.
- causes aortic aneurysm
Newborn has asymmetry of legs. Abduction of R hip after cupping the pelvis and
flexing R hip and knee causes palpable clunk. US of hip shows 50 degree angle
between acetabulum and ilium. What dx, what do next - ANSWER Pt has
developmental dysplasia of the hip (DDH)
- treat with a harness
What is developmental dysplasia of the hip, what results in - ANSWER aka
congenital hip dislocation
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