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Surgery EOR Exam PA Easy
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Surgery EOR Exam PA Easy
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Surgery EOR Exam PA EasyA 54-year-old man presents to the emergency department with crampy
abdominal pain, nausea, and vomiting. The patient has not passed gas or
had a bowel movement for at least 10 hours. On examination, the abdomen
is distended and there are high-pitched bowel sounds with rushes. A plain
radiograph of the abdomen reveals cecal distension to 12 cm. What is the
most appropriate definitive management for this patient?
A
Intravenous fluids
B
Nasogastric suction
C
Observation
D
Surgical exploration - -The Correct Answer is: D
Massive distention of the cecum, as detected on plain radiograph, is typically
seen in "closed loop" obstructions where the ileocecal valve is competent.
When distention approaches 12 cm, there is an increased risk of perforation
and/or gangrene. Expedient surgical intervention is indicated. Although
observation with intravenous fluids and nasogastric decompression are
important adjuncts to management, surgical exploration is the only way to
rapidly address this emergent situation.
-When a bone is fractured, there are the 3 stages of healing. What is the
proper order in which the healing occurs?
A
Inflammatory, Remodeling, Reparative
B
Inflammatory, Reparative, Remodeling
C
Remodeling, Inflammatory, Reparative
D
Remodeling, Reparative, Inflammatory
E
Reparative, Inflammatory, Remodeling - -The Correct Answer is: B
Inflammatory changes happen after fractures and this is followed by a
reparative phase and ultimately, a remodeling phase. The healing from acute
injuries generally starts with inflammation,. Once the integrity of the bone
has been restored on the macro level, bone remodeling continues until full
healing has occurred.
-What is the most common embolic source of acute arterial occlusion in the
lower extremities?
A
, Atrial fibrillation
B
Aortic aneurysm
C
Myocardial infarction
D
Prosthetic cardiac valve
E
Iliac artery thrombus - -The Correct Answer is: A
The heart accounts for 80% of all emboli, with atrial fibrillation making up
70% of that. Aortic aneurysms are frequently lined with thrombus but
infrequently embolize; aneurysmal disease only accounts for 6% of all acute
arterial occlusion. Acute myocardial infarction (especially those associated
with left ventricular thrombus) accounts for 25% of cardioembolism, with
peripheral embolization often the first sign of a previously "silent" MI.
Prosthetic cardiac valves make up a still small but increasingly prevalent
source of emboli. Peripheral arterial thrombi account for only 3% of acute
occlusion.
-Following emergent appendectomy, a 58-year-old obese male develops a
temperature of 102.4˚F, 18 hours postoperatively. His respiratory rate is 26
and his pulse is 116bpm. A physical exam reveals scattered fine rales. What
is the most likely diagnosis?
A
Atelectasis
B
Aspiration pneumonitis
C
Pleural effusion
D
Pneumonia
E
Pulmonary embolus - -The Correct Answer is: A
Pulmonary alveoli collapse, also known as atelectasis, occurs during
operative procedures for a variety of reasons, including decreased clearance
of secretions and decreased intra-alveolar pressure. Postoperatively, often
due to pain, patients may not mobilize secretions appropriately, also
contributing to atelectasis. Atelectasis is the most common postoperative
pulmonary complication, and is often associated with emergent and
prolonged surgeries, especially those of the thorax and abdomen. Atelectasis
is associated with fever, an increased respiratory rate, an increased pulse,
and lung exam findings ranging from normal to rales and decreased breath
sounds. Symptoms usually present within the first 48 hours postoperatively.
Pulmonary aspiration pneumonitis, although possible, is less likely due to
appropriate preoperative and intraoperative measures being utilized to
decrease risk. Pneumonia is also a common postoperative complication, due
,to the same contributing factors as atelectasis. Physical exam findings may
also be similar. However, postoperative pneumonia is likely to become
evident between 24 and 96 hours postoperatively.
-During a pre-surgical workup, a patient reports that she had received
Desmopressin following the birth of her son. Her CBC is within normal range,
as well as her PT and aPTT. What is the most likely cause of her needing this
medication?
A
Allo immunization following vaginal delivery
B
Hemolytic anemia
C
Iron deficiency anemia
D
Thalassemia
E
Von Willebrand's disease - -The Correct Answer is: E
Desmopressin is the mainstay of therapy for people with von Willebrand's
disease. Hemolytic anemia, iron deficiency anemia, and thalassemia would
all have abnormal findings on the CBC. Allo immunization does not require
desmopressin therapy.
-What absolute tissue pressure generally is used as a guideline for
diagnosing compartment syndrome?
A
10 mm Hg
B
20 mm Hg
C
30 mm Hg
D
40 mm Hg
E
50 mm Hg - -The Correct Answer is: C
Many trauma surgery services use an absolute tissue pressure of
approximately 30 mm Hg as the threshold for diagnosing compartment
syndrome. Based on the entire clinical picture, patients with numbers in that
range or higher will likely require surgical decompression with a fasciotomy,
while lower numbers will probably be managed with a more conservative
approach.
-What is the most common site of an acute arterial occlusion due to embolic
disease?
A
Iliac artery
, B
Aortic bifurcation
C
Mesenteric arteries
D
Femoral artery
E
Popliteal artery - -The Correct Answer is: D
The most common site for an acute embolic occlusion is the femoral artery.
Other common sites include the axillary, popliteal, and iliac arteries as well
as the aortic bifurcation and mesenteric vessels. The majority (80%) of
arterial embolic originate in the heart in patients with atrial fibrillation or
from mural thrombi in the left ventricle from an akinetic or dyskinetic portion
of the myocardium following a myocardial infarction.
-A 64-year-old man has been experiencing signs and symptoms compatible
with diverticular disease for the past 3 weeks. He now presents to the
emergency department malnourished with severe left-sided lower abdominal
pain. After appropriate workup and hydration, he is taken to the operating
room where a perforated sigmoid colon is discovered with gross
contamination. What is the most appropriate surgical intervention at this
time?
A
Left colectomy with primary anastomosis
B
Hartmann procedure
C
Proctocolectomy
D
Abdominoperineal resection
E
Low anterior resection - -The Correct Answer is: B
This vignette is consistent with an emergent resection in an unprepared
patient. The most appropriate therapy for an acute perforation is a Hartmann
procedure, which includes resection of the affected portion of the bowel, a
temporary diverting colostomy, and oversewing of the distal rectal stump;
the second stage of the procedure will involve taking down the colostomy
with anastomosis to the rectal stump. A colectomy with a primary
anastomosis should not be done when the bowel is unprepared due to the
significant risk of infection and leakage of the bowel at the site of the
anastomosis. Abdominoperineal resection is used in the treatment of
malignant disease of the lower rectum. In this procedure, a permanent
colostomy is created and the entire rectum, anal canal, and anus are
removed. In the management of benign disease of the lower rectum, a
proctocolectomy is appropriate to preserve anal function.
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