surgery NBME 2

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MudPhud20XX

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Hi all, I would really appreciate if anyone could help me with these q.

Following a high speed car accident, a 23 y/o male brought to the ER who was the unrestrained driver. bp is 150/90. He has retrosternal and interscapular chest pain, dyspnea, and hoarseness. X-ray show fractures of the sternum and Lt. 1st rib, widening of the superior mediastinum, and caudal desplacement of the Lt. main bronchus. Which of the following is the most likely dx?

A. flail sternum
B. pulmonary contusion
C. rupture of the esophagus
D. rupture of the intrathoracic trachea
E. rupture of the thoracic aorta
--> So widening superior mediastinum points me toward like aortic rupture, but his bp is fine. Is it still E? Or I am also debating D could be the better answer.

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I would go with rupture aorta (probably contained putting pressure elsewhere). Rupture trachea seems unusual and would probably expect crepitus.

Willing to hear other opinions though
 
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Hi all, I would really appreciate if anyone could help me with these q.

Following a high speed car accident, a 23 y/o male brought to the ER who was the unrestrained driver. bp is 150/90. He has retrosternal and interscapular chest pain, dyspnea, and hoarseness. X-ray show fractures of the sternum and Lt. 1st rib, widening of the superior mediastinum, and caudal desplacement of the Lt. main bronchus. Which of the following is the most likely dx?

A. flail sternum
B. pulmonary contusion
C. rupture of the esophagus
D. rupture of the intrathoracic trachea
E. rupture of the thoracic aorta
--> So widening superior mediastinum points me toward like aortic rupture, but his bp is fine. Is it still E? Or I am also debating D could be the better answer.


It's E. Per Pestana, you have to have a high suspicion for aortic rupture in any significant mechanism of injury, like a high-speed car crash. Most aortic ruptures will exsanguinate on the spot and be DOA, but if he's maintaining a blood pressure that could mean the rupture is contained within the adventitia. Widened mediastinum on CXR would be expected.
 
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Here are some more qs:

1. Immediately after birth, a 900 g new baby has difficulty breathing and needs intubation/ventilation.
Born at 30 wk gestation to a 15 y/o mom, pregnancy/delivery were uncomplicated. exam shows harsh murmur with PDA, pharmacologic manipulation is recommended to close PDA. indomethacin is given and murmur then disappears. which is the most likely explanation for the pt's response indomethacin?

A. cortisol inhibition with dec norepinephrine release
B. cyclo oxygenase inhibition with increased norepinephrine release
C. dec arterial oxygen tension flowing through the ductus
D. IL-2 receptor blockade to promote ductal closure
E. secretion of surfactant by pulmonary alveolar cells

So I am leaning toward B, but i though blocking COX was related to increased prostaglandin release not norepi, any thoughts?

2. a healthy 42 y/o male comes with 2 day hx of Rt. knee pain and an inability to extend the Rt. knee. The sx began when he was getting up from a low chair. His temp is 37C, exam shows knee tenderness to palpation along with medial joint line and a joint effusion. ligament stability is normal. range of motion is from 15 to 110 degree. X-ray of the knee is normal. what is dx?

A. ACL injury
B. bursitis
C. chondromalacia
D. collateral ligament injury
E. patellar dislocation
F. patellar tendon rupture
G. post. cruciate ligament injury
H. torn meniscus
 
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1. Thought exactly the same as you. Would choose B but not sure how the norepi relates (should be dec pg). C works as a general mechanism but I don't see how it relates to indomethacin (if tension of 02 is concentration then the concentration should stay the same).

2. torn meniscus in light of medial joint line tenderness and effusion. I think it can affect extension too. Ligament stability rules out ligaments. I'm not sure what the normal range of motion for knee is but it says in the stem theres a problem with extension.
 
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A previously healthy 19-year old woman is brought to the E.D. because of a 4-hour history of constant severe abdominal pain. Her symptoms began 3 weeks ago as intermittent, colicky pain; examination 1 week ago showed a 5-cm right ovarian cyst. Abdomianl examination now shows tenderness with rebound and guarding in the right lower quadrant. There is a palpable, tender, 10-cm right adnexal mass. X-rays of the chest and abdomen show no abnormalities. Pelvic ultrasonography confirms a complex, cystic mass. Her leukocyte count is 12,000/mm3. Urinalysis shows no abnormalities. A pregnancy test is negative. Which of the following is the most appropriate next step in management?

A) Admission for observation
B) Antibiotic therapy
C) Colposcopy
D) CT scan-guided drainage
E) Exploratory operation

So for this one, I would choose E, elevated white count should and presence of cyst should prompt you to do exploratory operation right?
 
A previously healthy 19-year old woman is brought to the E.D. because of a 4-hour history of constant severe abdominal pain. Her symptoms began 3 weeks ago as intermittent, colicky pain; examination 1 week ago showed a 5-cm right ovarian cyst. Abdomianl examination now shows tenderness with rebound and guarding in the right lower quadrant. There is a palpable, tender, 10-cm right adnexal mass. X-rays of the chest and abdomen show no abnormalities. Pelvic ultrasonography confirms a complex, cystic mass. Her leukocyte count is 12,000/mm3. Urinalysis shows no abnormalities. A pregnancy test is negative. Which of the following is the most appropriate next step in management?

A) Admission for observation
B) Antibiotic therapy
C) Colposcopy
D) CT scan-guided drainage
E) Exploratory operation

So for this one, I would choose E, elevated white count should and presence of cyst should prompt you to do exploratory operation right?

Acute abd pain in a female with known ovarian mass is torsion until proven otherwise. Plus she has peritoneal signs. So yes E for both of those reasons.
 
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here is another one.

42 y/o male has 4 by 4 cm painless ulcer over the Rt. medial malleoulus for 6 months. has a hx of DVT that occurred while hospitalized for a femur fracture 20 yrs ago. pedal pulses are palpable. there is 2+ edema of the Rt. lower extremity. Lt. lower extremity is normal. which of the following is the cause of this ulcer?

A. cellulitis
B. lymphedema
C. peripheral arterial vascular dz
D. previous fracture and soft tissue injury
E. venous valvular insufficiency

So I am leaning toward E, but does E cause ulcer? I don't think it's C since pulses are strong and he has no complaint of pain. Any thoughts?
 
here is another one.

42 y/o male has 4 by 4 cm painless ulcer over the Rt. medial malleoulus for 6 months. has a hx of DVT that occurred while hospitalized for a femur fracture 20 yrs ago. pedal pulses are palpable. there is 2+ edema of the Rt. lower extremity. Lt. lower extremity is normal. which of the following is the cause of this ulcer?

A. cellulitis
B. lymphedema
C. peripheral arterial vascular dz
D. previous fracture and soft tissue injury
E. venous valvular insufficiency

So I am leaning toward E, but does E cause ulcer? I don't think it's C since pulses are strong and he has no complaint of pain. Any thoughts?

It's a venous stasis ulcer
 
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37 y/o female primigravid at 26 wk, visits for a routine exam. She has 12 month hx of pain of the Lt. wrist with occasional numbness of the palm. she uses computer keyboard every day at work and at home. her symptoms were alleviated with regular breaks from keyboard use and use of NSAIDs but have become more difficult to control during the pregnancy which is uncomplicated. exam reveals positive for tingling of theindex and middle fingers of the Lt. hand with percussion of the volar wrist. which is the most likely to confirm dx?

A. x-ray of the hands/wrists
B. electromyography
C. MRI
D. arthroscopy
E. nerve conduction studies

So this is Carpel then which is better B or E???
 
37 y/o female primigravid at 26 wk, visits for a routine exam. She has 12 month hx of pain of the Lt. wrist with occasional numbness of the palm. she uses computer keyboard every day at work and at home. her symptoms were alleviated with regular breaks from keyboard use and use of NSAIDs but have become more difficult to control during the pregnancy which is uncomplicated. exam reveals positive for tingling of theindex and middle fingers of the Lt. hand with percussion of the volar wrist. which is the most likely to confirm dx?

A. x-ray of the hands/wrists
B. electromyography
C. MRI
D. arthroscopy
E. nerve conduction studies

So this is Carpel then which is better B or E???
E
 
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it would be nice if you could confirm that these are in fact the correct answers that are disccused
 
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Any thoughts on these?

77 year old resident of skilled nursing care facility is brought to the emergency department because of fever vomiting for the past 2days. She is alert but unable to give history.She asks repeatedly for a drink of water.her temp 101.5F, BP 100/ 60.Examination shows distended non tender abdomen with sparse high pitched bowel sounds.A supine X ray of abdomen shows multiple dilated loops of small bowel and gas within small bowel lumen and within liver. Which of the following is the most likely cause of these findings?
A) Bacterial cholangitis caused by kleibsella
B) Cholecystoduodenal fistula with an an impacted gall stone
C) Emphysematuos cholecystitis with intrahepatic perforation
D) Perforated duedenal ulcer with subhepatic abscess
E) Pyelephlebitis caused by sigmoid diverticulitis


80yr women h/o atherosclerosis and chr afib has had sever mid abd pain for 4 hrs. mild abd tenderness and absent bowel sounds no mass r signs of peritoneal irritation, test for occult blood is positive, leukocyte 28340 65% seg neutrophile, 20% bands and 15%lymphocytes. ABG PH 7.18 pco2 35 po2 62. Abd x ray shows non specific gas pattern. Next step?
Colonoscopy
Exp celiotomy
Gastroscopy
Laproscopy
Peritoneal lavage


A 42 year old woman comes to the physician because of a 2 day history of right upper abdominal pain and generalized itching. During the past 2 months, she has had three episodes of similar symptoms associated with nausea. She has not had fever or vomiting. She has no history of serous illness and takes no medications. Her current temperature is 37.3C(99.1F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Examnination shows scleral icterus. A mildly tender mass is palpated in the right upper qudrant of the abdomen. There are no peritoneal signs. Her leukocyte count is 10,000/mm3, and serum total bilirubin concentration is 6 mg/dL with a direct component of 5 mg/dL. Ultrasonography of the right upper quadrant of the abdomen shows mild distension of the gallblaader with no gallstones. A CT scan of the abdomen shows a 5cm cystic structure medial to the gallbladder with moderate dilation ot the proximal intrahepatic ducts. Which of the follwing is the most appropriate next step in management?
A. Cholescintigraphy
B. Cholecystectomy with exploration of the common bile duct
C. Endoscopic sphincterotomy
D. Roux-en-Y cytojejunostomy
E. Surgical excision of the cyst

A 75-year-old man is scheduled to undergo elective repair of an abdominal aortic aneurysm. He has a history of hypertension controlled with drug therapy Examination shows no abnormalities except for a palpable, 6-cm aortic aneurysm. An ECG shows normal findings Which of the following studies is most appropriate to predict this patient's risk for perioperative myocardial infarction?
A) Measurement of serum cholesterol concentration
B) 24-Hour ambulatory ECG monitoring
C) Coronary angiography
D) Surface echocardiography
E) Radionuclide scan with thallium and dipyridamole
--> this one, I am debating btw C or E. any thoughts?
 
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Any thoughts on these?

77 year old resident of skilled nursing care facility is brought to the emergency department because of fever vomiting for the past 2days. She is alert but unable to give history.She asks repeatedly for a drink of water.her temp 101.5F, BP 100/ 60.Examination shows distended non tender abdomen with sparse high pitched bowel sounds.A supine X ray of abdomen shows multiple dilated loops of small bowel and gas within small bowel lumen and within liver. Which of the following is the most likely cause of these findings?
A) Bacterial cholangitis caused by kleibsella
B) Cholecystoduodenal fistula with an an impacted gall stone
C) Emphysematuos cholecystitis with intrahepatic perforation
D) Perforated duedenal ulcer with subhepatic abscess
E) Pyelephlebitis caused by sigmoid diverticulitis


80yr women h/o atherosclerosis and chr afib has had sever mid abd pain for 4 hrs. mild abd tenderness and absent bowel sounds no mass r signs of peritoneal irritation, test for occult blood is positive, leukocyte 28340 65% seg neutrophile, 20% bands and 15%lymphocytes. ABG PH 7.18 pco2 35 po2 62. Abd x ray shows non specific gas pattern. Next step?
Colonoscopy
Exp celiotomy
Gastroscopy
Laproscopy
Peritoneal lavage


A 42 year old woman comes to the physician because of a 2 day history of right upper abdominal pain and generalized itching. During the past 2 months, she has had three episodes of similar symptoms associated with nausea. She has not had fever or vomiting. She has no history of serous illness and takes no medications. Her current temperature is 37.3C(99.1F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Examnination shows scleral icterus. A mildly tender mass is palpated in the right upper qudrant of the abdomen. There are no peritoneal signs. Her leukocyte count is 10,000/mm3, and serum total bilirubin concentration is 6 mg/dL with a direct component of 5 mg/dL. Ultrasonography of the right upper quadrant of the abdomen shows mild distension of the gallblaader with no gallstones. A CT scan of the abdomen shows a 5cm cystic structure medial to the gallbladder with moderate dilation ot the proximal intrahepatic ducts. Which of the follwing is the most appropriate next step in management?
A. Cholescintigraphy
B. Cholecystectomy with exploration of the common bile duct
C. Endoscopic sphincterotomy
D. Roux-en-Y cytojejunostomy
E. Surgical excision of the cyst

A 75-year-old man is scheduled to undergo elective repair of an abdominal aortic aneurysm. He has a history of hypertension controlled with drug therapy Examination shows no abnormalities except for a palpable, 6-cm aortic aneurysm. An ECG shows normal findings Which of the following studies is most appropriate to predict this patient's risk for perioperative myocardial infarction?
A) Measurement of serum cholesterol concentration
B) 24-Hour ambulatory ECG monitoring
C) Coronary angiography
D) Surface echocardiography
E) Radionuclide scan with thallium and dipyridamole
--> this one, I am debating btw C or E. any thoughts?
Anyone please? I am about to submit my answers.
 
1. Thought exactly the same as you. Would choose B but not sure how the norepi relates (should be dec pg). C works as a general mechanism but I don't see how it relates to indomethacin (if tension of 02 is concentration then the concentration should stay the same).

2. torn meniscus in light of medial joint line tenderness and effusion. I think it can affect extension too. Ligament stability rules out ligaments. I'm not sure what the normal range of motion for knee is but it says in the stem theres a problem with extension.
--> just submitted the answer and for 1 I chose C and got it wrong, so the answer may be B although I have no clue about norepi, for #2 yes torn meniscus was the answer. Thanks!
 
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Any thoughts on these?

77 year old resident of skilled nursing care facility is brought to the emergency department because of fever vomiting for the past 2days. She is alert but unable to give history.She asks repeatedly for a drink of water.her temp 101.5F, BP 100/ 60.Examination shows distended non tender abdomen with sparse high pitched bowel sounds.A supine X ray of abdomen shows multiple dilated loops of small bowel and gas within small bowel lumen and within liver. Which of the following is the most likely cause of these findings?
A) Bacterial cholangitis caused by kleibsella
B) Cholecystoduodenal fistula with an an impacted gall stone
C) Emphysematuos cholecystitis with intrahepatic perforation
D) Perforated duedenal ulcer with subhepatic abscess
E) Pyelephlebitis caused by sigmoid diverticulitis


80yr women h/o atherosclerosis and chr afib has had sever mid abd pain for 4 hrs. mild abd tenderness and absent bowel sounds no mass r signs of peritoneal irritation, test for occult blood is positive, leukocyte 28340 65% seg neutrophile, 20% bands and 15%lymphocytes. ABG PH 7.18 pco2 35 po2 62. Abd x ray shows non specific gas pattern. Next step?
Colonoscopy
Exp celiotomy
Gastroscopy
Laproscopy
Peritoneal lavage


A 42 year old woman comes to the physician because of a 2 day history of right upper abdominal pain and generalized itching. During the past 2 months, she has had three episodes of similar symptoms associated with nausea. She has not had fever or vomiting. She has no history of serous illness and takes no medications. Her current temperature is 37.3C(99.1F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Examnination shows scleral icterus. A mildly tender mass is palpated in the right upper qudrant of the abdomen. There are no peritoneal signs. Her leukocyte count is 10,000/mm3, and serum total bilirubin concentration is 6 mg/dL with a direct component of 5 mg/dL. Ultrasonography of the right upper quadrant of the abdomen shows mild distension of the gallblaader with no gallstones. A CT scan of the abdomen shows a 5cm cystic structure medial to the gallbladder with moderate dilation ot the proximal intrahepatic ducts. Which of the follwing is the most appropriate next step in management?
A. Cholescintigraphy
B. Cholecystectomy with exploration of the common bile duct
C. Endoscopic sphincterotomy
D. Roux-en-Y cytojejunostomy
E. Surgical excision of the cyst

A 75-year-old man is scheduled to undergo elective repair of an abdominal aortic aneurysm. He has a history of hypertension controlled with drug therapy Examination shows no abnormalities except for a palpable, 6-cm aortic aneurysm. An ECG shows normal findings Which of the following studies is most appropriate to predict this patient's risk for perioperative myocardial infarction?
A) Measurement of serum cholesterol concentration
B) 24-Hour ambulatory ECG monitoring
C) Coronary angiography
D) Surface echocardiography
E) Radionuclide scan with thallium and dipyridamole
--> this one, I am debating btw C or E. any thoughts?
Just out of curiosity was the answer for the 2nd laproscopy, 3rd excision of cyst and 4th maybe echo?
 
I still can't figure out these qs:

1. 67 y/o male comes to physician b/c of 1 wk hx of increasingly severe abdominal pain, fever, vomiting, and dec appetite. 2 yrs ago, he was admitted to the hospital for a similar episode. he had intermittent Lt. lower abdominal pain during the past 5 yrs, temp is 39.6C, pulse is 105, RR 12, bp 150/90. abdominal exam shows Lt. lower quadrant tenderness with rebound. the remainder abdomen is soft and non-tender. no masses are palpated on rectal exam. occult blood test is negative. his leukocyte count is 21,000/mm3 with Lt. shift. x-rays of the abdomen show a nonspecific gas pattern. which one is the most appropraite next step in dx?

A. iv pyelography
B. visceral angiography
C. CT of the abdomen and pelvis
D. colonoscopy
E. exploratory laparotomy
--> presence of gas made me think perforation so I chose E and got it wrong. so is this ischemic bowel dz so C? Any thought?

2.
A 42 year old woman comes to the physician because of a 2 day history of right upper abdominal pain and generalized itching. During the past 2 months, she has had three episodes of similar symptoms associated with nausea. She has not had fever or vomiting. She has no history of serous illness and takes no medications. Her current temperature is 37.3C(99.1F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Examnination shows scleral icterus. A mildly tender mass is palpated in the right upper qudrant of the abdomen. There are no peritoneal signs. Her leukocyte count is 10,000/mm3, and serum total bilirubin concentration is 6 mg/dL with a direct component of 5 mg/dL. Ultrasonography of the right upper quadrant of the abdomen shows mild distension of the gallblaader with no gallstones. A CT scan of the abdomen shows a 5cm cystic structure medial to the gallbladder with moderate dilation ot the proximal intrahepatic ducts. Which of the follwing is the most appropriate next step in management?
A. Cholescintigraphy
B. Cholecystectomy with exploration of the common bile duct
C. Endoscopic sphincterotomy
D. Roux-en-Y cytojejunostomy
E. Surgical excision of the cyst
--> So C was wrong, I am debating btw D or E, any though?
 
I still can't figure out these qs:

1. 67 y/o male comes to physician b/c of 1 wk hx of increasingly severe abdominal pain, fever, vomiting, and dec appetite. 2 yrs ago, he was admitted to the hospital for a similar episode. he had intermittent Lt. lower abdominal pain during the past 5 yrs, temp is 39.6C, pulse is 105, RR 12, bp 150/90. abdominal exam shows Lt. lower quadrant tenderness with rebound. the remainder abdomen is soft and non-tender. no masses are palpated on rectal exam. occult blood test is negative. his leukocyte count is 21,000/mm3 with Lt. shift. x-rays of the abdomen show a nonspecific gas pattern. which one is the most appropraite next step in dx?

A. iv pyelography
B. visceral angiography
C. CT of the abdomen and pelvis
D. colonoscopy
E. exploratory laparotomy
--> presence of gas made me think perforation so I chose E and got it wrong. so is this ischemic bowel dz so C? Any thought?

2.
A 42 year old woman comes to the physician because of a 2 day history of right upper abdominal pain and generalized itching. During the past 2 months, she has had three episodes of similar symptoms associated with nausea. She has not had fever or vomiting. She has no history of serous illness and takes no medications. Her current temperature is 37.3C(99.1F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Examnination shows scleral icterus. A mildly tender mass is palpated in the right upper qudrant of the abdomen. There are no peritoneal signs. Her leukocyte count is 10,000/mm3, and serum total bilirubin concentration is 6 mg/dL with a direct component of 5 mg/dL. Ultrasonography of the right upper quadrant of the abdomen shows mild distension of the gallblaader with no gallstones. A CT scan of the abdomen shows a 5cm cystic structure medial to the gallbladder with moderate dilation ot the proximal intrahepatic ducts. Which of the follwing is the most appropriate next step in management?
A. Cholescintigraphy
B. Cholecystectomy with exploration of the common bile duct
C. Endoscopic sphincterotomy
D. Roux-en-Y cytojejunostomy
E. Surgical excision of the cyst
--> So C was wrong, I am debating btw D or E, any though?

First one is C. Fever, white count, LLQ, old guy = Diverticulitis

Second one is E
 
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2nd one was exp celiotomy, 3rd one not sure I chose C and got it wrong. the 4th one was E
oh I just looked up what a celiotomy was..wish they could just call it a laparotomy. I've literally never heard anyone use the term celiotomy before

For the last one i read it as highest risk of mortality rather than MI occuring..not sure why. need to read the question more carefully next time i guess
 
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oh I just looked up what a celiotomy was..wish they could just call it a laparotomy. I've literally never heard anyone use the term celiotomy before

For the last one i read it as highest risk of mortality rather than MI occuring..not sure why. need to read the question more carefully next time i guess
yeah typical nasty trick done by NBME and step 2 ck lol thanks man.
 
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77 yo resident of Skilled nursing care with 2d fever and vomting for 2 d. Alert but unable to give a history. Aks for drink of water. T101.5, BP 110/60, Exam shows distened abdomen with high pitched bowel sounds. Supine XRA shows multipl dilated loops of small bowel lumen and within the liever. Dx?

A. bacterial cholangitis caused by K. pneumonia
B. cholecystoduodenal fistula with an impacted gallstone
C. emphysematous cholecystitis with an intrahepatic perforation
D. perforated duodenal ulcer with a subhepatic abscess
E. pylephlebitis caused by sigmoid diverticulitis

--> So with high pitch bowel sound, I am thinking anything that can lead to bowel obstruction, any thoughts on this?
 
77 yo resident of Skilled nursing care with 2d fever and vomting for 2 d. Alert but unable to give a history. Aks for drink of water. T101.5, BP 110/60, Exam shows distened abdomen with high pitched bowel sounds. Supine XRA shows multipl dilated loops of small bowel lumen and within the liever. Dx?

A. bacterial cholangitis caused by K. pneumonia
B. cholecystoduodenal fistula with an impacted gallstone
C. emphysematous cholecystitis with an intrahepatic perforation
D. perforated duodenal ulcer with a subhepatic abscess
E. pylephlebitis caused by sigmoid diverticulitis

--> So with high pitch bowel sound, I am thinking anything that can lead to bowel obstruction, any thoughts on this?

Think what pathology can lead to small bowel obstruction + air within the liver
 
A 24 y/o woman is schedule for surgery for chronic pain. Informed consent was taken four days prior surgery and her husband was present. At the time of operation, she is given narcotics as premedication. Five minutes later, she becomes panicky and states that she is afraid and does not want the operation. Which is an appropiate intervention?

A. Cancel operation
B. Obtain opinion of psychiatist regarding her competence
C. Proceed with the operation after administering a narcotic antagonist
D. Proceed operation as planned
E. Reconfirm with her husban that she was not under the influence of narcotics when pt signed consent, treat panic attack with benzo and proceed with operation.

E is wrong Any ideas?
 
A 24 y/o woman is schedule for surgery for chronic pain. Informed consent was taken four days prior surgery and her husband was present. At the time of operation, she is given narcotics as premedication. Five minutes later, she becomes panicky and states that she is afraid and does not want the operation. Which is an appropiate intervention?

A. Cancel operation
B. Obtain opinion of psychiatist regarding her competence
C. Proceed with the operation after administering a narcotic antagonist
D. Proceed operation as planned
E. Reconfirm with her husban that she was not under the influence of narcotics when pt signed consent, treat panic attack with benzo and proceed with operation.

E is wrong Any ideas?
Correct answer is A. E implies that patients are not able to withdraw consent for surgery after it is given. If the answer said treat her panic attack and then discuss if she wants to proceed with surgery that would be correct. But confirming with the husband whether or not she was under the influence of narcotics is not really relevant.
 
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