surgery4 - multivit

[ArchivalUser]

19. A 72-year-old man develops acute abdominal pain of
sudden onset. He is brought to the emergency department
within 30 minutes from the onset of the pain. He
describes the pain as diffusely periumbilical, constant,
and extremely severe, and indeed his appearance is that
of someone in great distress. However, the physical
examination of his abdomen shows only very mild tenderness
and seems to be out of proportion with the
severity of his pain. Other findings include a grossly
irregular pulse of 105/min and 4+ occult blood in the
stool. He is afebrile and has a leukocyte count of
9800/mm3. Chest x-ray and plain x-rays of the abdomen
are noncontributory. Further diagnostic studies should
focus on establishing which of the following?
(A) Evidence of retroperitoneal bleeding
(B) The patency of his colonic lumen
© The patency of his coronary vessels
(D) The presence of perforation in his gastrointestinal
tract
21. An 8-year-old boy is involved in an automobile accident.
He was riding in the back seat and was wearing a seat
belt. When evaluated in the emergency department he
complains of mild abdominal tenderness, particularly
on the left upper quadrant. He does not have guarding
or rebound. His vital signs are stable, as is his hematocrit.
A CT scan of the abdomen shows the presence of a
small amount of blood free in the peritoneal cavity. The
study also shows fractures of the ninth and tenth ribs on
the left, and a laceration in the spleen. The laceration is
1.5 cm deep, and it does not involve trabecular vessels.
Which of the following is the most appropriate next step
in management?
(A) Arteriogram and embolization
(B) Bedrest and close in-hospital observation
© Discharge home
(D) Exploratory laparotomy and splenectomy
(E) Exploratory laparotomy and splenorrhaphy

[ArchivalUser]

On the fourth postoperative day after a gastrectomy for
cancer, a 73-year-old man complains of severe chest
pain of sudden onset. He is short of breath, perspiring,
and tachycardic. His neck veins are not distended, and
auscultation of his chest is unremarkable. A 12-lead
electrocardiogram shows occasional premature ventricular
contractions, but there is no elevation of the ST
segment. CK-MB enzyme levels are normal, and there
are high levels of Troponin-T. Blood gases show PO2 of
94 mm Hg and PCO2 of 42 mm Hg.Which of the following
is the most likely explanation for the pain?
(A) Anxiety
(B) Fat embolism
© Myocardial infarction
(D) Pulmonary embolus
(E) Tension pneumothorax
more frequent. When pressed for details, he explains
that when he wakes up he is œchoking and that fragments
of undigested food come up when he coughs and
tries to œclear up his tracheobronchial tree. From time
to time he also finds bits of undigested but putrid food
on his pillow when he wakes up in the morning. Lately
he also has had occasional dysphagia, which he locates
to the lower neck. Which of the following is the most
appropriate diagnostic study?
(A) Barium swallow
(B) Bronchoscopy
© Esophageal manometry
(D) Esophageal x-rays with water-soluble contrast
material
(E) Upper gastrointestinal endoscopy

[ArchivalUser]

A 24-year-old woman is extricated from a wrecked car
and brought to the emergency department by helicopter.
She is the only survivor of four occupants in a car that
crashed against a bridge abutment. She is conscious but
moaning with pain, which she locates to her abdomen.
She is also cold, pale, shivering, anxious, and thirsty. Her
blood pressure is 75/55 mm Hg, with a feeble pulse of
130/min. Quick evaluation in the emergency department
shows abdominal tenderness and abdominal distention,
with no signs of pelvic fracture or femur fractures. She
has no signs of rib fractures, and has bilateral breath
sounds. Both arms have multiple closed fractures, and
she also has facial lacerations. A central venous line is
placed and reads a central venous pressure of zero.
Which of the following is the most likely reason for her
state of shock?
(A) Intraabdominal bleeding
(B) Intracranial bleeding
© Neurogenic shock
(D) Pericardial tamponade
(E) Tension pneumothorax
29. A 19-year-old man is stabbed in the right chest with a
5-cm switchblade. He arrives at the hospital short of
breath, with a blood pressure of 95/70 mm Hg and a
pulse of 100/min. The entrance wound is just lateral to
the right nipple, right under the lower edge of the fifth
rib. He has no breath sounds on the right hemithorax,
which sounds dull to percussion. Chest x-ray shows diffuse
opacity over the entire right hemithorax. A chest
tube placed on the right recovers 1200 cc of bright red
blood, and drains another 250 cc over the ensuing 10
minutes. He is taken to the operating room for prompt
thoracotomy. The surgeons should expect to find that
which of the following is the source of bleeding?
(A) An intercostal vessel
(B) The lung parenchyma
© The right ventricle
(D) The skin and subcutaneous tissue
(E) The thoracic aorta
30. A 62-year-old man has been involved in a major accident