Surgery Final 6th yr

Old-Q. Surgery

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This flashcard set covers advanced surgical procedures and treatments at the university level, focusing on topics like pain management, limb ischemia, lung cancer, and aortic stenosis. It delves into critical procedures such as pancreas and lung transplants, treatments for acute lower limb ischemia, and the classification of chronic limb ischemia. The flashcards are particularly useful for medical students and professionals preparing for surgery exams, as they provide detailed insights into complex surgical scenarios and patient care.

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Utilisateurs

Langue

Anglais

Catégorie

Médecine/Pharmacie

Niveau

Université

Créé / Mis à jour

28.01.2017 / 04.06.2022

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Cartes-fiches

1) In pharmacological treatment in patients after traumatic brain injury, the following should not be used:

a) steroids

b) Furosemide

c) Carbamazepine

d) Mannitol

e) Propofol

2) Which of the following statements describing thoracic acute aortic dissection is true:

Hint: about two thirds of people with aortic dissection, pulses in the arms and legs are diminished or absent.

a) treatment with medications that raise blood pressure should be conducted

b) Chest x-ray is essential in diagnostics, as mediastinal widening can be detected

c) routine diagnostics do not require ECG, as myocardial infarction gives completely different symptoms

d) during an Initial physical examination, we will most likely find hypotension

e) the patient complains of sharp, ripping chest pain and/or interscapular pain

3) The symptoms of increased intracranial pressure are:

1/ nausea
2/ headache
3/ increased blood pressure
4/ bradycardia
5/ deteriorating of consciousness

The correct answer is:

HINT:

Cushing triad: irregular breathing, widening pulse pressure (HTN), and bradycardia
TX: Mannitol, Hypertonic saline (Steroids only if ICP 2ndary to neoplams/infection; CI in TBI)

a) all of the above

b) 1 and 2

c) 3 and 4

d) only 4

e) none of the above answers

4) A 67-year-old man with intermittent claudication after 10-20 meters of pain free walking, with symptoms definitely worsened since several weeks. The patient has been conservatively treated for several years, including the use of anti-aggregation drugs. What should be suggested to such a person?

a) continuation of conservative treatment has that been ordered so far

b) continuation of conservative treatment, including increasing the dose of mediations that have been taken so far

c) lower limb amputation without an attempt to improve the limb blood flow

d) urgent admission to the hospital and arterial embolectomy in lower limbs

e) elective admission to the hospital, angio-CT and/or lower-extremity arteriography, possibly an operation preceded by on these tests.

5) Acute lower limb ischemia can be caused by:

a) arterial embolism

b) injury to the artery

c) arterial thrombosis

d) acute dissection of the artery

e) all of the above

6) Chemical pleurodesis procedure is performed in patients:

a) with pleural empyema

b) young with pneumothorax

c) with pleural hemorrhage

d) with recurrent cancer pleural effusion

e) who are not qualified to radical surgery of lung cancer

7) The unconscious patient who does not open his eyes to pain, reacts in this situation defensively (flexion/withdrawal movements) and makes incomprehensible sounds, on the GCS scale will be assessed as score:

Hint:

motor: command > localize pain > withdrawel from pain (w/ flexion) > decorticated (abnormal flexion to pain) > decerebrated (extension to pain) > nothing

a) 1

b) 6

c) 7

d) 8

e) 9

8) The consequences of a chest trauma which is not directly life threatening:

HINT:

Flail chest describes a situation in which a portion of the rib cage is separated from the rest of the chest wall, usually due to a severe blunt trauma, such as a serious fall or a car accident.

a) transverse sternal fracture without bones displacement

b) tension pneumothorax

c) pleural hemorrhage > 200 mL

d) flail chest

e) bilateral pneumothorax

9) Following diagnostic tests are crucial to validate Endocarditis:

Extracardiac manifestations are typically caused by septic microemboli and/or immune complex precipitation
i.e. Roth spots, Janeway lesions, Osler Nodes, splinter hemorrhages

a) echo, blood culture test

b) ECG, X-ray, Echo

c) CT, MRI

d) Dental examination

e) no tests are needed to diagnose Endocarditis

10) The main reason of primary spontaneous pneumothorax is:

HINT:

tobacco and cannabis smoking, emphysema (aka COPD), and other lung conditions can lead to the development of blebs and bullae.
blebs are especially prevalent in damaged lung tissue.

a) COPD

b) subpleural blebs rupture

c) pneumoconiosis

d) rib fracture

e) pleural effusion

11) A patient with persistent atrial fibrillation felt a violent pain in his leg. The doctor found that the right lower limb was pale and cold. The patient had limited limb mobility and sensation. There was no pulse on a foot. The doctor called an ambulance. Before the patient was in the hospital, the most important for his treatment before admission was:

a) positioning the limb on soft pillows

b) administration of heparin

c) administration of vasodilators

d) administration of painkillers

e) warming up the affected limb

12) Untreated intracranial displacements caused by pathological intracranial mass ultimately leads to:

a) cerebral ischemia in the area of posterior cerebral artery

b) hemiparesis

c) facial nerve paralysis

d) death

e) vision impairment

13) The rest pain in the Fontaine Classification for chronic limb ischemia, means:

HINT:

The Fontaine classification specifies exactly the distance at which the pain occurs
Rutherford classification is similar - but rest pain is stage IV

a) stage I

b) stage IIa

c) stage IIb

d) stage III

e) stage IV

14) In a patient with atherosclerotic peripheral artery disease and intermittent claudication after 400 meters of pain free walking, the ...

a) pharmacological treatment and exercise therapy

b) limb amputation

c) arterial reconstructive surgery

d) lumbar sympathectomy

e) patient immobilization

15) Asymptomatic abdominal aortic aneurysm with a diameter of 4.5 cm was detected in the abdominal ultrasound examination. The…..will be:

a) elective open surgical repair of the abdominal aortic aneurysm

b) elective endovascular aortic aneurysm repair (stent-graft implantation)

c) angio-CT scan objectifying the diameter and morphology of the aneurysm

d) conservative treatment, including observation of the size of the aneurysm

e) answers C and D are correct

16) Increased of blood pressure, irregular breathing and bradycardia, due to persistent increase of intracranial pressure (ICP) is called….

HINT:

- rather "___ triad"

a) plantar reflex (Babinski sign)

b) cushing reflex

c) Kernig’s sign

d) Lasegue’s sign

e) Rossolimo’s sign

17) The etiology factor of aortic (valve?) stenosis is:

a) Endocarditis

b) Rheumatic disease

c) calcification degeneration

d) Bioprosthesis degeneration

e) Answers A, B, C and D are correct

18) The indication for liver transplantation is not

a) liver cirrhosis after HCV

b) biliary cirrhosis

c) Wilson’s disease

d) alcoholic liver cirrhosis

e) hepatocellular carcinoma (HCC) with metastases

19) Complication of myocardial infarction requiring surgical treatment is not

a) free wall perforation

b) mitral insufficiency

c) aortic dissection

e) ventricular septum defect

e) left ventricular aneurysm

20) The routine exams before planned lung cancer resection include:

a) chest CT

b) whole abdomen ultrasonography

c) bronchofiberscopy

d) spirometry

e) all of the above

21) Pulmonary embolism is a possible complication of:

HINT:

May-Thurner syndrome - is caused when the left iliac vein is compressed by the right iliac artery, which increases the risk of deep vein thrombosis (DVT) in the left extremity.
acute iliofemoral DVT requires Catheter-directed thrombolysis or thrombectomy

a) lower limb artery thrombosis

b) portal vein thrombosis

c) splenic vein thrombosis

d) iliac vein thrombosis

e) varicose veins of lower extremities

22) The gold standard in surgical treatment of non-small cell lung cancer with curative intent consists of:

a) anatomical resection of lung parenchyma

b) tumor thermoablation

c) tumor enucleation

d) wedge resection

e) wedge resection with min. 1 cm of free resection margin

23) In the case of brain death, the absolute contraindication for organ donation is:

1/ the evidence that the deceased person before his death expressed his objection for organ donation
2/ no family consent
3/ gallbladder cancer
4/ death as a result of a murder
5/ death as a result of suicide

The correct answer is:

a) 1 and 3

b) 2 and 3

c) 1, 3 and 4

d) 1, 3 and 5

e) 1, 2, 3, 4, and 5

24) The most common valvular heart disease is:

a) Mitral stenosis

b) Aortic stenosis

c) Aortic insufficiency

d) Mitral insufficiency

e) Tricuspid insufficiency

25) The 75-year-old man suddenly has grown weak. He is pale and sweaty, heart rate 130/min, blood pressure 80/40 mmHg. He complains of pain in the epigastric region and in the lumbar region. The first thing to do is:

a) coronarography

b) MRI of the lumbar spine

c) complete blood counts as well as ultrasound scan and/or CT angiography of the abdomen

c) colonoscopy

e) urinalysis and urography

26) Antithrombotic prophylaxis in patients after surgery means:

a) low-molecular-weight heparin administration

b) compression bandaging of the lower limbs

c) early post-operative mobilization

d) all of the above answers

e) none of the above

27) The best treatment of patient with acute lower limb ischemia, with concomitant atrial fibrillation, with no history of limb blood flow disturbances in the past, will be:

a) intra-arterial administration of vasodilators

b) intra-arterial administration of heparin

c) intra-arterial streptokinase administration

d) intra-arterial administration of tissue plasminogen activator

e) arterial embolectomy in lower limbs

28) Significant coronary artery stenosis is the narrowing of the vessel diameter:

a) >/= 50%

b) >60%

c) > 30-40%

d) >/= 90%

e) All the answers are incorrect

29) The best elective surgical method of 85 mm diameter abdominal aortic aneurysm ending above the aortic bifurcation in an 80-year-old patient with an ejection fraction of 30%, is:

a) open surgical repair with implantation of a straight vascular prosthesis

b) open surgical repair with implantation of a bifurcated vascular prosthesis

c) endovascular aortic aneurism repair (stent graft implantation)

d) 85 mm diameter abdominal aortic aneurysm is not an indication for surgery

e) 30% ventricular ejection fraction is a contraindication to any surgery

30) Pancreas transplantation procedures are most often performed together with the transplantation procedure of:

a) kidney

b) liver

c) heart

d) lung

e) bone marrow

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