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* CMS Surgery Form 3 Questions
 #828453  
  goatmilk - 07/01/16 09:48
 
  2. A 52-year-old woman comes to the physician because of a 1-year history of progressive difficulty swallowing, intermittent vomiting of undigested food, and a cough that is more severe at night. During the past 6 months, she has had an 8-kg weight loss. She has not had pain with swallowing or difficulty speaking. She has no history of serious illness and takes no medications. She states that she has had some anxiety during the past 6 months because of fear of losing her job. She does not smoke cigarettes or drink alcohol. Her temperature is 37C, pulse is 80/min, respirations are 18/min, and blood pressure is 120/84 mmHg. Examination shows no palpable neck masses. The trachea is midline, and there is no thyromegaly. Cardiopulmonary and abdominal examinations show no abnormalities. A chest x-ray shows an air-fluid level in the posterior mediastinum at the level of the cardiac silhouette. Manometry shows normal lower esophageal sphincter pressure and absent lower esophageal sphincter relaxation with swallowing. Which of the following is the most likely diagnosis?
A) Achalasia
B) Diffuse esophageal spasm
C) Globus hystericus
D) Hiatal hernia
E) Systemic sclerosis (scleroderma) (wrong answer)

3. A 65-year-old man has frequent premature ventricular contractions (PVCs) in the recovery room following elective repair of an inguinal hernia under spinal anesthesia. Examination shows a complete T3-4 spinal motor and sensory block. Pulse oximetry shows an oxygen saturation of 95%, unchanged from during the operation. Arterial blood gas analysis shows:
pH 7.25
Pco2 55 mmHg
Po2 75 mmHg
An ECG shows normal sinus rhythm with nonspecific changes and frequent PVCs. Which of the following is the most likely cause?
A) Fluid overload
B) Intraoperative myocardial infarction
C) Metabolic acidosis
D) Total sympathetic blockade (wrong answer)
E) Ventilatory insufficiency

19. A 22-year-old man is brought to the emergency department 1 hour after being involved in a motor vehicle collision. On arrival, his pulse is 120/min, and blood pressure is 100/70 mmHg. He has multiple facial lacerations. Which of the following imaging studies is best used to screen for cervical trauma?
A) CT scan (wrong answer)
B) Lateral x-ray
C) MRI
D) Myelography
E) Tomography

41. A 72-year old man comes to the physician because of a 4-month history of progressive hearing loss and ringing in his right ear and unsteadiness when walking. He has a history of hypercholesterolemia, myocardial infarction, and mitral valve prolapse He sustained a cerebral infarction 33 years ago. Medications are atorvastatin and 81-mg aspirin. His temperature is 37C (98.6F), pulse is 72/min, respirations are 13/min, and blood pressure is 130/82 mm Hg. Physical examination shows decreased movement of the right side of the face. Weber test localizes to the left ear. Rinne test shows air conduction is greater than bone conduction bilaterally. Muscle strength is 5/5 throughout. Deep tendon reflexes and coordination are normal. Sensation to temperature is decreased over right side of the face. His gait is unsteady. An MRI of the brain is the most likely to show which of the following?
A) Acoustic neuroma (vestibular schwannoma)
B) Basilar artery thrombosis
C) Cholesteatoma
D) Pontine hematoma
E) Temporal lobe mass (wrong answer)

49. Six hours after sigmoid colectomy and colostomy for perforated diverticulitis, a 62-year-old woman has had a total postoperative urine output of 65 ml/h through a Foley catheter. Preoperatively, the patient had a serum urea nitrogen concentration of 45 mg/dL and a serum creatinine concentration of 2 mg/dL. She has been receiving 0.45% saline at 90 mL/h since the operation. She is 157 cm (5 ft 2 in) tall and weighs 60 kg (132 lb), BMI is 24 kg/m2. Her pulse is 95/min, and blood pressure is 130/90 mm Hg. Her serum electrolyte concentrations are within the reference range, and urine specific gravity is 1.028. Which of the following is the most appropriate next step in management?
A. Measurement of creatinine clearance (wrong answer)
B. Intravenous pyelography
C. Renal perfusion scan
D. Rapid administration of 500 Ml OF 0.9% saline
E. Administration of intravenous fluids to replace insensible fluid losses only
F. Administration of intravenous fluids to replace urine output only


Please help with the answers and explanations please..thanks!!

2)
3)
19)
41)
49)
 
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* Re:CMS Surgery Form 3 Questions
#3299982
  whatsfordinner - 07/01/16 12:12
 
  2- id go with hiatal hernia - achalasia -increase LES sphincter pressure, globus - just a feeling of soemthing being there, des - episodic spasms - would present like this, sclerosis - shed have other ymptoms involved - hiatal hernia makes sense cuz she is brining up undigested food - hiatal hernia can lead to esophageal carcinoma possibly leading to weight loss???
3 - e vent insuff low o2 high co2 resp acid,
19 - b
41 - i had this question in another neuro cms i think number three - acoustic neuroma - at the cerebelopintine angle involves cn 7 and 8, they may also describe difficulty in tandem walking
49 - D im not too sure.....her preop bun/cr inidactes shes dehydrated, and her urine specific gravity is on the higher side, her electrolytes are fine and she has a folley, id go with giving her some hydration - D
 
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* Re:CMS Surgery Form 3 Questions
#3299985
  whatsfordinner - 07/01/16 12:24
 
  as a complete side note, if a question stem indicates infant is only given goatsmilk - folate def and or vit D  
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* Re:CMS Surgery Form 3 Questions
#3299988
  whatsfordinner - 07/01/16 12:29
 
  im going to do CMS psych soon, ill asnwer those in a couple hrs
 
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* Re:CMS Surgery Form 3 Questions
#3300152
  djkesh2008 - 07/02/16 20:05
 
  2 A
3 E
19 B
41 A
49 D?
Goat milk lacks folate?
 
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* Re:CMS Surgery Form 3 Questions
#3345433
  free3mt21 - 08/09/17 14:40
 
  Urine SG is normal ... WTF are you talking about.
1.025-1.028 is all normal
 
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