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ABSITE EXAM WITH COMPLETE SOLUTIONS 100% CORRECT LATEST UPDATE
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ABSITE EXAM WITH COMPLETE SOLUTIONS 100%CORRECT LATEST UPDATE
T-Tube s/p cholecystectomy - ANSWER T-tubes are commonly inserted whenever there
is a concern for retained gallstones after a CBD exploration to decompress the biliary
tree. Usually a T-tube cholangiography is done 2 weeks post-operatively to evaluate any
retained stones and for possible removal of the T-tube. A minimum of 4-6 weeks should
pass before any instrumentation is performed to allow for the tract to mature.
Neck Zones - ANSWER Zone I is located from the clavicle to the cricoid. Injuries to this
zone may involve lung apex, trachea, brachiocephalic or subclavian artery and veins,
nerve roots and esophagus. Zone II is located from the cricoid to the angle of the
mandible. Injury in this location may involve the carotid or vertebral arteries, the jugular
veins, esophagus or trachea. Zone III is located from the angle of the mandible to the
skull base. Injury to this zone may result in external or internal carotid injury, jugular
injury, cranial nerve injury or hypopharyngeal injury. Those patients that are
hemodynamically unstable require operative intervention, regardless of zone. Other
indications for operative intervention include hard signs of vascular injury (bruit, thrill,
expanding or pulsatile hematoma) or tracheal injury (subcutaneous air or bubbling from
the wound).
Breast cancer in males - ANSWER Tamoxifen confers a survival benefit for males with
hormone receptor positive breast cancer. Orchiectomy is a second line hormonal
manipulation in males with estrogen receptor positive, metastatic breast cancer. In the
above case orchiectomy is not indicated because the patient does not have evidence of
metastatic disease
Causes of pseudohyponatremia - ANSWER Causes of pseudohyponatremia may lead to
treatment that is not directed at the correction of sodium levels, such as in
hyperglycemia, mannitol administration, or radiologic contrast medium.
Cause of isotonic hyponatremia - ANSWER Isotonic hyponatremia can occur due to lab
testing and is most commonly due to high blood triglyceride levels
,Hyponatremia - ANSWER Treatment of asymptomatic, euvolemic or hypervolemic
hyponatremia is free water restriction and observation of sodium levels. Hypovolemic
hyponatremia is treated with volume resuscitation with either lactated ringer's solution
or normal saline solution. If the patient were symptomatic, treatment would be
correction with hypertonic saline solution.
Treatment of Hypervolemic hyponatremia - ANSWER The patient now presents with
acute, symptomatic, hypervolemic, hyponatremia due to excessive water intake. The
appropriate treatment is correction of the sodium deficit with hypertonic saline. Sodium
deficit is calculated based upon actual and desired sodium level and total body water.
The appropriate rate of sodium correction in this setting is 0.5 mEq/L/hour.
Central pontine myelinolysis - ANSWER Brain adaptations that reduce the risk of
cerebral edema in chronic hyponatremia make the brain vulnerable to injury if the
hyponatremia is too rapidly corrected. The neurologic manifestations associated with
overly rapid correction have been called the osmotic demyelination syndrome (ODS,
formerly called central pontine myelinolysis or CPM). This syndrome is caused by rapid
correction of sodium deficit at greater than the appropriate rate of 0.5 mEq/L/hour. The
risk is greatest for patients who have had a low sodium level for greater than 48 hours.
Cerebral edema with brainstem herniation is seen with rapid correction of
hypernatremia
Paronychia - ANSWER Minor skin break down is the most common predisposing factor
for acute paronychia; therefore, people with occupations that are associated with
increased risk of such minor traumas have higher risk of developing acute paronychia.
Staph aureus is the most common pathogen. Other possible organisms are
streptococcus, enterococci and pseudomonas. Paronychia is the most common hand
soft tissue infection. It represents 35% of all hand infections
Thoracic duct - ANSWER The thoracic duct is the main lymphatic channel for the
abdomen and chest. Chylomicrons and long-chained fatty acids enter into this lymphatic
system, whereas short and medium-chained fatty acids are transported in the portal
system. It originates at the cisterna chyli at L1-L2 and courses superiorly through the
aortic hiatus. It runs along right of midline until crossing to the left at T4-T5. The duct
then empties in to the left subclavian vein at the junction with the internal jugular vein.
Undifferentiated spindle cell tumor (malignant fibrous histiocytoma of bone) - ANSWER
Undifferentiated spindle cell tumor (malignant fibrous histiocytoma of bone) is an
,uncommon tumor. The most common site of occurrence is the proximal tibia and distal
metaphyses of the femur. It may also be found in the pelvis, humerus, and scapula.
Radiographic features include loss of normal trabeculation and cortical destruction.
Adjacent soft tissue invasion and mass formation may occur. MRI with contrast is the
imaging study of choice. Pathology commonly shows high-grade lesions (> 90%) and a
tumor showing fibroblasts in a whirling pattern with multinucleated giant cells,
inflammatory cells, and foamy mononuclear giant cells. Neoadjuvant chemotherapy can
be administered in which it can relieve pain and decrease local edema, contracture, and
the size of the soft tissue tumor. Urgent surgical resection is indicated if at high risk for
pathologic fracture. Surgical excision with wide margin is advised whether or not the
patient receives neoadjuvant therapy. Amputation can normally be avoided.
Pneumocytes - ANSWER There are three major cell types in the alveolar wall
(pneumocytes):
Type I (Squamous Alveolar) cells that form the structure of an alveolar wall Type II
(Great Alveolar) cells that secrete pulmonary surfactant to lower the surface tension of
water and allows the membrane to separate, therefore increasing its capability to
exchange gases. Surfactant forms an underlying aqueous protein-containing hypophase
and an overlying phospholipid film. Macrophages that destroy foreign material, such as
bacteria.
Pneumocytes - ANSWER Answer A: Alveoli production continues until approximately 10
years of age.
Answer B: Type II (Great Alveolar) cells secrete pulmonary surfactant between 24 and
28 weeks.
Answer C: Alveoli production begins at 7 months gestation and continues until
approximately 10 years of age.
Answer D: The pores of Kohn are found in alveolar walls and allow communication
, between individual alveoli but do not play a significant role in carbon dioxide delivery.
Answer E: Alveoli are squamous-lined sacs at the terminal ends of the respiratory tract
that are the sites for gas exchange in the lung.
Peri-operative diabetes control - ANSWER The doses of insulin and other hypoglycemic
drugs need to be titrated during the perioperative period. The oral hypoglycemic agents
are withheld on the day of surgery and resumed after the surgery except Metformin. If
there is altered renal action, then Metformin has to be withheld until the renal function
stabilizes due to the risk of lactic acidosis. During this period hyperglycemia is managed
with a short-acting insulin preparation based on blood glucose monitoring. Rapid and
short-acting insulin is withheld when the patient is NPO and covered based on blood
glucose monitoring. Intermediate and long-acting insulin is given at the normal dose the
night before surgery. If there is a morning dose, then half the normal dose on the
morning is given. Some patients use insulin pumps for glucose management. The pumps
have variable delivery rate based on endogenous insulin production. On the day of
surgery, the patient is managed with basal insulin infusion and the pump is used to
correct the glucose level as it is measured.
GIST tumors - ANSWER GIST tumors have the potential to behave malignantly and
metastasize to distant organs. The most prominent indicator of this potential is mitotic
figures and size of the tumor. It is recommended that tumors with > 5 mitoses per high
power field and size > 5 cm be treated with Imatinib postoperatively to marginalize the
malignant potential.
intussusception - ANSWER When the clinical index of suspicion for intussusception is
high, hydrostatic reduction by enema using contrast or air is the diagnostic and
therapeutic procedure of choice. Contraindications to this study include the presence of
peritonitis or hemodynamic instability.
Surgical Management of Intussusception - ANSWER The intussusceptum is delivered
through a transverse incision in the right side of the abdomen and reduced by squeezing
the mass retrograde from distal to proximal until completely reduced. Warm lap pads
may be placed over the bowel and a period of observation may be warranted in cases of
questionable bowel viability. Adhesive bands around the ileocecal junction are divided,
and an appendectomy is then performed. The recurrence rates are very low after
surgical reduction. Invariably, the lymphoid tissue within the ileocecal valve region is
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