SHELF / USMLE Step 2 Practice Questions > Surgery
Q1) A workup for a patient with frequent and multiple areas of cutaneous ecchymosis discloses a large spleen and evidence of immune (idiopathic) thrombocytopenic purpura (ITP). ITP includes which of the following?
a) A significant enlargement of the spleenQ2) 4. A 27-year-old man undergoes general anesthesia for a hernia repair. As the anesthesia begins, his jaw muscles tense and he becomes generally rigid. He becomes febrile, tachycardic, and tachypnic. Intravenous administration of which of the following agents may be lifesaving?
b) A high reticulocyte count
c) Megakaryocytic elements in the bone marrow
d) An increase in platelet count on cortisone therapy
e) Patient age of less than 5 years
b) Nitrous oxide
Q3) An 80-year-old man is admitted to the hospital complaining of nausea, abdominal pain, distention, and diarrhea. A cautiously performed transanal contrast study reveals an apple core configuration in the rectosigmoid area. Which of the following is the most appropriate management at this time?
a) Colonoscopic decompression and rectal tube placement
b) Saline enemas and digital disimpaction of fecal matter from the rectum
c)Colon resection and proximal colostomy
d)Oral administration of metronidazole and checking a Clostridium difficile titer
e)Evaluation of an electrocardiogram and obtaining an angiogram to evaluate for colonic mesenteric ischemia
A1) d - An increase in platelet count on cortisone therapy (Corticosteroid therapy increases the platelet count in over 75% of cases and provides the best indication that splenectomy will be of lasting benefit.)
A2) d - this is a case of malignant hyperthermia, pts may become severely acidotic and develop rhabdomyolysis. Pathology shows diffuse segmental muscle necrosis. Tx is dantrolene, which prevents release of calcium from the SR, and supportive measures.
A3) c - Colon resection and proximal colostomy. An apple core lesion in the distal colon is diagnostic of colon cancer
Must have book on your surgery rotation: Surgical Recall