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In which of the following cases is a preoperative nutritional assessment necessary?
A. 70 year old man, BMI 19.
B. 54-year-old man, unplanned weight loss from 80 to 74 kg in the last year.
C. 35 year old woman, albumin levels 3.3.
D. A 57-year-old woman, a decrease in eating of 40% of the usual diet in the last week.
|
A
|
What is the imaging of choice for assessing body mass before surgery?
A. DXA mapping (Dual Emission X-ray Absorptiometry).
B. US muscles.
C. CT.
D. MRI.
|
A
|
A patient with severe inflammation of the pancreas, in shock, is being treated with amine drugs in the intensive care unit. What is the recommended nutritional administration?
A. TPN.
B. Nasogastric feeding.
C. Post pyloric nasogastric feeding.
D. Feeding Jejunostomy.
|
A,C
|
Which of the following dietary recommendations is recommended for a critically ill hospitalized patient in intensive care?
A. Determine the amount of secretion in the nasogastric tube and calculate the volume of the oral economy according to this.
B. Start oral feeding within 24-48 hours and increase the amount up to the feeding goals within a week.
C. Immediate start of intravenous feeding.
D. Avoid administering prokinetic drugs in treating a patient in the intensive care unit.
|
B
|
A street dweller is brought to the hospital after being attacked. Upon examination, he appears to be in a very poor nutritional state. What is the electrolyte disorder that may develop when he starts feeding it?
A. Hyponatremia.
B. Hypernatremia.
C. Hypophosphatemia.
D. Hyperkalemia.
|
C
|
Which patient is at risk for short bowel syndrome?
A. 25 years old, after a car accident, he underwent right colon resection and segments of small intestine. The remaining length of the small intestine is 90 cm.
B. 62 years old, after an acute mesenteric event in which a small intestine was resected. The length of the remaining small intestine is 80 cm.
C. 75 years old after Total Proctocolectomy.
D. 35-year-old Crohn's disease patient who underwent surgery to remove a 120 cm jejunostomy from the Treitz.
|
A
|
A patient who underwent sleeve surgery develops nutritional deficiencies. Which condition is the most common?
A. Hypothyroidism.
B. Megaloblastic anemia.
C. Lactic acidosis.
D. Zinc deficiency.
|
B
|
A patient underwent Heller myotomy surgery. A few days later he was diagnosed with a perforation and rushed to surgery. Which of the options is most suitable for starting enteral feeding as early as possible?
A. Nasogastric.
B. Nasoduodenal.
C. Gastrostomy.
D. Jejunostomy.
|
D
|
A patient with severe carotid stenosis and recurrent TIA events despite treatment with aspirin
is a candidate for carotid endarterectomy. What is the patient's ASA rating?
A. 2 ASA.
B. 3 ASA.
C. 4 ASA.
D. 5 ASA.
|
B,C
|
A patient with an inguinal hernia that bothers him when playing golf asks for advice on the best time for surgery. A month ago, due to a positive stress test, he underwent catheterization, and due to severe stenosis, angioplasty was performed, and a drug-eluting stent was inserted. He is currently being treated with aspirin and Pelvis. What is the desired date for surgery?
A. A month and a half since the catheterization.
B. 3 months after the catheterization.
C. 6 months from the catheterization.
D. A year since the catheterization.
|
D
|
What is not included in Fried frailty phenotype?
A. Weight loss.
B. Memory loss.
C. Weakness in grip.
D. Slow walk.
|
B
|
What is the main risk factor for postoperative delirium?
A. Trauma.
B. Dementia.
C. History of past surgeries.
D. Diabetes.
|
B
|
Where does the hindgut end?
A. In the upper third of the rectum.
B. In the middle third of the rectum.
C. In the lower third of the rectum.
D. In the anal canal.
|
D
|
What is the disadvantage of mechanical preparation of the colon before colon resection surgery?
A. Excessive risk of wound infection.
B. Excessive risk of leak.
C. Excessive risk of electrolyte disturbances.
D. Excessive risk of thromboembolic events.
|
C
|
A patient, after surgery, develops an active infection with Clostridium difficile that does not respond to antibiotic treatment. It was decided to treat with Fecal Microbiota Transplant. What is the most effective approach to providing this treatment?
A. Swallowing frozen capsules.
B. Administration through a nasogastric tube.
C. Colonoscopy administration.
D. There is no difference in effectiveness between the approaches.
|
C,D
|
A patient underwent a colonoscopy and complete excision of a polyp on a stalk. The margins are clean. in pathology Well differentiated adenocarcinoma that involves the entire head of the polyp and also penetrates the submucosa of the stalk. What is the chance of metastases to the lymph nodes?
A. Less than 10%.
B. 15-20%.
C. 35%.
D. Over 40%.
|
A
|
A trauma patient undergoes a laparotomy due to bleeding from the liver. A pulse was felt.
Lateral and right to the common bile duct. What is the blood vessel felt?
A. Common hepatic artery.
B. Hepatic propria artery.
C. Replaced right hepatic artery.
D. Cystic artery.
|
C
|
A 40-year-old woman is diagnosed with asymptomatic gallstones during a US performed for a workup of urinary tract infections. What is the chance that you will need surgery anyway in the next 20 years due to the onset of symptoms?
A. About 1%.
B. About 5%.
C. About 10%.
D. 20-30%.
|
D
|
A 30 year old is admitted through the ER with upper right abdominal pain and evidence of fever and peritonitis in the upper right abdomen. She has had similar events in her past that went away without treatment. US is performed due to suspicion of cholecystitis , demonstrating a non-swollen gallbladder, a thickened wall, and stones inside. The findings are inconclusive. What additional test should be performed to help diagnose cholecystitis?
A. CT with contrast material.
B. CT without contrast material.
C. HIDA scan.
D. MRCP.
|
C
|
What are the typical stones formed de novo in the bile ducts?
A. Black stones.
B. Brown stones.
C. Cholesterol stones.
D. Cholesterol stones with calcium.
|
B
|
A 50 year old is after a successful ERCP for cholecystitis secondary to gallstones. In the image after the catheter balloon has passed, there is no evidence of stones in the bile ducts. The patient wants to understand what is the risk of a repeated complication of gallstones if he does not undergo a gallbladder resection.
A. Less than 10%.
B. 20%.
C. 30%.
D. Over 50%.
|
D
|
A patient was operated on for gallstone ileus. What is the chance of the presence of additional large stones in the intestine?
A. About 10%.
B. About 20%.
C. About 30%.
D. 50% or more.
|
A
|
A post-CABG patient diagnosed with acalculous cholecystitis responds well to percutaneous drainage and antibiotics. Imaging two weeks after recovery shows that there is no evidence of stones in the gallbladder and there is good passage of contrast material to the biliary tract and duodenum. What is the next step in treatment?
A. Pulling out the drain.
B. Pulling out the drain and ordering an elective cholecystectomy 6 weeks after.
C. Elective cholecystectomy along with drainage after 6 weeks.
D. Leaving the drain for supervision for another 3 months.
|
A
|
A 55-year-old patient was diagnosed with a type I choledochal cyst after an episode of cholangitis that responded well to antibiotics. What is the recommended treatment?
A. Resection with Roux-en-Y hepaticojejunostomy.
B. Cyst drainage with Roux-en-Y cystojejunostomy.
C. Sphincterotomy by ERCP.
D. Supervision only.
|
A
|
What is the main cause of bicarbonate secretion from the pancreas?
A. The vagus nerve.
B. Trypsin.
C. Secretin.
D. Cholecystokinin.
|
C
|
What is the best CT scan to assess the extent of pancreatic necrosis in a patient with acute pancreatitis?
A. Before contrast agent injection.
B. In the arterial phase.
C. In the venous phase.
D. In the late review (180-200 seconds after injection).
|
C
|
A 75-year-old man is diagnosed with acute pancreatitis due to gallstones. Blood tests upon admission:
Glucose 140 mg, leukocytes 20,000, LDH IU/L200, and AST IU/L 90. What is the degree of inflammation according to Ranson's criteria?
A. Mild degree.
B. Medium degree.
C. Severe degree.
D. Cannot be calculated.
|
D
|
A 45-year-old underwent an abdominal CT for suspicion of appendicitis, and randomly, one cystic lesion was demonstrated in the body of the pancreas. Among these data, what does not support the diagnosis of mucinous cystic neoplasm?
A. Age of the patient.
B. The gender of the patient.
C. The location of the lesions.
D. Number of lesions.
|
B
|
A 56-year-old man is being investigated for cystic lesions in the pancreas that were randomly discovered in a whole-body CT following a car accident. MRCP demonstrated several cysts in the tail, body, and head of the pancreas with a maximum diameter of one of the cysts located in the body of the pancreas - about 2.2 cm with a thick wall that takes up contrast material enhancement, without Virsong expansion, without a nodule or septum in the contents, without lymphadenopathy No additional aggravating findings were demonstrated in the EUS. What is the further management of the case?
A. Review in a year.
B. EUS or MRI in 3 months.
C. Left pancreatectomy.
D. Complete resection of the pancreas.
|
B
|
A 68-year-old woman is hospitalized for two weeks due to acute inflammation of the pancreas. Due to the worsening of her condition, with a heart rate of 107 and temperature of 38.9, she underwent an abdominal CT, which demonstrated 2 connected collections with a diameter of about 6 cm adjacent to the pancreas. What is the further management of the case?
A. Antibiotic treatment with Imipenem.
B. EUS-guided puncture of the collections for culture.
C. CT-guided percutaneous drainage.
D. Endoscopic Cystogastrostomy.
|
B
|
Which of the following measures is included in the qSOFA SCORE?
A. Heartbeat.
B. Body temperature.
C. Breathing rate.
D. Urine output.
|
C
|
What electrolyte disorder is common in patients with severe burns?
A. Euvolemic hyponatremia.
B. Euvolemic hypernatremia.
C. Hypervolemichyponatremia.
D. Hypervolemic hypernatremia.
|
A
|
A patient with intestinal obstruction and multiple vomiting develops tachycardia. Superficial T waves are observed in the ECG.
As well as U waves. What is the appropriate treatment?
A. IV FUSID.
B. IV KCL.
C. IV NS.
D. IV BISOPROLOL.
|
B
|
Which of the following is the preferred agent for induction of anesthesia in an asthmatic patient?
A. Ketamine.
B. Midazolam.
C. Etomidate.
D. Thiopental.
|
A
|
A 30-year-old is known to have ulcerative colitis and is under biological treatment. He is hospitalized for 5 days due to a flare-up of the disease and is being treated with high-dose fluids and steroids without improvement. Now, his pulse is 110, WBC are 15,000, temperature 38.3, transverse colon on x-ray is 6 cm in diameter, no peritonitis. What is the next step in the management of the case?
A. Immediate colonoscopy to decompress the bowel.
B. Immediate colonoscopy to inject vancomycin antibiotics into the rectal area to treat the condition.
C. Colectomy with ileostomy.
D. Complete resection of the colon and rectum, with ileostomy.
|
C
|
A 73-year-old man with diabetes and heart failure comes to the emergency room with abdominal pain, tenesmus, and bloody diarrhea. As part of the workup, a colonoscopy is performed, which demonstrates an edematous, reddish segment that bleeds easily with ulcers in the mucosa. Note that the uninvolved areas appear normal. What is the most common location to find it?
A. Cecum.
B. The spleen glove.
C. Ascending colon.
D. Rectum.
|
B
|
A 65 year old with diabetes and hypertension comes to the emergency room with right abdominal pain and local sensitivity to the touch, and a temperature of 38.5. A CT is performed, which demonstrates diverticulitis of the ascending colon, 1a Hinchey. What is true about the therapeutic approach in this situation?
A. Excision after the flare-up.
B. Excision in the same hospitalization due to a high chance of perforation and abscess in this location.
Third. If you go for surgery, a total abdominal colectomy should be performed to avoid leaving disease in the sigmoid and left colon as well.
D. The therapeutic approach is similar to sigmoid diverticulitis.
|
D
|
In what situations would we recommend surgery in a patient who responded to conservative treatment for an episode of diverticulitis?
A. In young people.
B. In kidney transplant recipients.
C. In right-sided diverticulitis.
D. After a second episode of diverticulitis.
|
B
|
In which position should the stoma location be marked before surgery?
A. Sitting down.
B. Lying down.
C. Lying down with back and head raised to 30-45 degrees.
D. The position is not important.
|
A
|
A 25 year old has fistulous Crohn's disease involving the terminal ileum. Which organ will be most commonly involved?
A. Ascending colon.
B. Sigma.
C. Urinary bladder.
D. Uterus.
|
B
|
What is the correct abdominal CT protocol when Pancreatic Neuroendocrine Tumor is suspected.
(PNET).
A. Without contrast material.
B. Arterial phase.
C. Portal phase.
D. Late phase.
|
B
|
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