SHELF / USMLE Step 2 Practice Questions > Surgery (set #1)

SHELF / USMLE Step 2 Practice Questions > Surgery

Q1) You have been asked to perform a preoperative consultation on a 65-year-old male who will be undergoing a testicular hernia repair. Of the following findings, which is of most concern in predicting a cardiac complication in this patient undergoing noncardiac surgery?

a) Age over 60
b) History of myocardial infarction 3.5 years ago
c) Harsh systolic crescendo-decrescendo murmur radiating to the carotids
d) ECG and subsequent telemetry showing up to five PVCs per minute
e) Serum creatinine 2.0 mg/dL

Q2) A right hemicolectomy is performed on a 57-year-old woman with adenocarcinoma who had a preoperative elevation of carcinoembryonic antigen (CEA) to 144. After falling to normal levels postoperatively, her most recent (24-month) follow-up level was 86. Correct statements regarding CEA and colorectal tumors include which of the following?

a) elevated CEA is indicative of a tumor of gastrointestinal origin
b) a low CEA level after resection of a colon tumor is a poor marker of disease control
c) 90% of colorectal tumors produce CEA
d) there is a high likelihood of liver involvement if the CEA level is high (greater than 100 ng/mL)
e) CEA levels are unusually low in cigarette smokers

Q3) A 63-year-old man is seen 3-days post-op and shows signs of fever, abdominal pain, nausea, and anorexia. His urine output is 100 ml over the last 24 hrs. His blood pressure is 84/62, and his pulse is 138. His response to this physiologic state includes which of the following?

a) Increase in sodium and water excretion
b) Increase in renal perfusion
c) Decrease in cortisol levels
d) Hyperkalemia
e) Hypoglycemia

A1) c - harsh systolic crescendo-decrescendo murmur radiating to the carotids
A2) d - here is a high likelihood of liver involvement if the CEA level is high (greater than 100 ng/mL)
A3) d - hyperkalemia

Must have book on your surgery rotation: Surgical Recall