SURGERY EOR EXAM PA EASY FINAL EXAM 2024
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During a pre-surgical workup, a patient reports that she had received
Desmopressin following
... [Show More] 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 - answer-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 - answer-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 - answer-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 - answer-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. [Show Less]