Surgery & Ophthalmology, Otolaryngology and Rhinology Samplex Test 5

A 24 y/o man presents with a 1-2 day history of right eye redness, purulent discharge, mild blurring of vision and mild pain. PE reveals a visual acuity of 20/25 right and 20/20 left, right conjunctival edema, injection, a clear cornea, and copious creamy purulent discharge. Which of the following would be inappropriate in the management?

Mr. Bugoy Tigas, 20 y/o male, is stabbed in the left side of his chest, medial to the nipple. Upon examination, his blood pressure is 90/60 mmHg and his pulse is 130/min. His jugular venous pulse increases on inspiration, whereas his peripheral pulse and blood pressure decreased on inspiration. Breath sounds are normal bilaterally. The patient’s chest x-ray film is unremarkable. After receiving 2 L of isotonic saline, his blood pressure remains low, whereas his central venous pressure rises to 32 cmH2O. Which of the following is the most appropriate next step in the most appropriate next step in the management of this patient?

A grossly underweight 52 y/o woman with chronic malnutrition is due to undergo major surgery. It is decided to start total parenteral nutrition (TPN) as part of the initial therapy. While introducing a central venous catheter into the right subclavian vein, the patient develops sudden dyspnea. Which of the following is the most likely diagnosis?

A 60 y/o alcoholic male presents with severe chest pain after repeated vomiting. A chest X-ray shows a small left pleural effusion. The next step in management is:

Three months after accidental ingestion of muriatic acid, a 30 y/o female consults for dysphagia. Barium swallow shows a 10cm structured segment of distal thoracic esophagus and normal-looking stomach. What is the preferred treatment for this patient?

The criteria for diagnosis of Primary Sclerosing Cholangitis are the following; except,

Statement/s true about metabolic changes in injured patients;

The most common organism associated with OPSI is:

A 68 y/o man presents at the ED because of such severe abdominal pain. He tells the triage nurse that he hadn’t been feeling well for the past couple of months, primarily because he had been having abdominal pain about 30 minutes after eating and as a consequence lost almost 10 pounds, but last night he suddenly developed severe stomach ache. He also has been vomiting and has had several episodes of bloody diarrhea. Upon PE, the physician notes hypotension and confirms the abdominal pain and notices abdominal distention. However, bowel sounds are absent, and there is no rebound tenderness present or other relevant findings upon abdominal examination. Laboratory

data reveal an absolute neutrophilic leukocytosis and left shift plus lactic acidosis, and elevation of the serum amylase level.

Which of the following is the most likely diagnosis?

Ten years ago, a 79 y/o female with a 25-year history of type 2 diabetes was diagnosed with diabetic nephropathy. At this time, she is overweight but not obese and she smokes about three packs of cigarettes per week. Despite being diagnosed with diabetic nephropathy, she had not stopped smoking and in general had not tightly controlled her blood glucose levels; consequently, her renal function has steadily deteriorated and her physician now believes she has ESRD. He arranges for her to undergo hemodialysis. Before undergoing hemodialysis, it was also recommended that she have an operation. Which of the following choices describes the surgical procedure most likely recommended?

A 65-yr-old man w/ a history of chronic alcohol abuse has been experiencing epigastric & periumbilical pain associated w/ nonbilious vomiting for 1 day. He denies any melena or hematemesis. In the past he has had several episodes of similar pain that sometimes radiated to the back and was hospitalized for several days 2 months prior. No previous surgery or medical problems. P/E: BP 120/80, HR 110 bpm, dry mucous membranes. Abdomen not distended, no surgical scars. Diminished bowel sounds. Soft abdomen, exhibits voluntary guarding of epigastrium. Serum amylase level is 550 units/100 ml. What is the most reasonable initial step in management of this patient?

The syndrome of multi-organ system failure (MOF):

One of the following is a true diverticulum:

A 35-yr-old woman complains of dysphagia, regurgitation and weight loss. Esophagography shows narrowing of the distal end of esophagus and manometry studies show significant tertiary waveforms. The LES has high residual pressure on swallowing. Which of the following has not been implicated as a possible cause of her disease?

All but one meet the criteria for referral to burn center:

Refeeding syndrome is characterized by which of the following electrolyte abnormalities?

Definitive treatment of a patient with sclerosing cholangitis and biliary cirrhosis involves which of the following?

A 60-yr-old alcoholic man has a 24-hr history of nausea and vomiting, abdominal pain, distention and decreased passage of stool and flatus. He underwent abdominoperineal resection of the rectum for cancer 18 months earlier, along w/ post-op irradiation and chemo. P/E reveals distended, diffusely tender, tympanitic abdomen. Which of the following is the least likely diagnosis?

Radiation delivered to the breast after right lumpectomy and sentinel lymph node biopsy for a 1.2 cm node-neg infiltration ductal carcinoma is likely to be associated with which of the following?

Based on the classification of the American College of Surgeons, the classical features of hypovolemic shock is first noted in: