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SHELF / USMLE Step 2 Practice Questions > Surgery (set #3)

SHELF / USMLE Step 2 Practice Questions > Surgery

Q1) A 75-year-old male undergoes an abdominal CT looking for liver metastases from a known colonic adenoma. On the CT a 4.9 cm abdominal aortic aneurysm(AAA). Which of the following risk factors is NOT a contributor to this pt's AAA?

a) His age.
b) Hypercholesterolemia.
c) Diabetes.
d) Smoking.
e) Hypertension.
Q2) A 64 year old diabetic male with a history of PVD presents to vascular clinic with pain and paresthesias of the L foot. The pain improves with rest but always returns after walking approximately 6 city blocks. Which of the following likely represent this patients test results after and ABI?
a) ABI = 1.1 - 1.4
b) ABI = 0.9 - 1.0
c) ABI = 0.6 - 0.8
d) ABI = 0.4 - 0.5
e) ABI < 0.3

Q3)A 7-year-old girl fell while sledding and suffered a jagged wound to her right eyebrow and forehead. After local anesthesia and thorough cleaning, you plan for primary closure. Which of the following statements is true concerning facial wound repair?

a) Permanent suture material is preferred
c) Sutures should be removed in 2 weeks to minimize infection
d) Sutures should be placed 3 to 4 mm apart and 4 mm from the wound edge
e) Knots should be centered on the wound

A1) c - diabetes. The Aneurysm Detection and Management Veterans Affairs Cooperative Study Group trial (commonly referred to as the ADAM trial) found the following factors to be associated with increased risk for an AAA: advanced age, greater height, coronary artery disease, atherosclerosis, high cholesterol levels, hypertension, and smoking. The risk is lower in women, African Americans, and diabetic patients.

A2) c - ABI = 0.6 - 0.8. An ABI < 0.95 indicates significant narrowing of one or more blood vessels in the legs
ABI < 0.8 indicates pain in the foot, leg, or buttock may occur during exercise (intermittent claudication).
ABI < 0.4, symptoms may occur when at rest.
ABI < 0.3 indicates severe limb-threatening PAD is probably present

A3) a - Permanent suture material is generally preferred for the face. Needle marks can be prevented by removing sutures earlier rather than later. The knot should be brought to one side of the wound, and tension should be adjusted so that the skin edges are opposed without compromising the blood supply. On the face, sutures should be ~3-4 mm apart and be placed 2 mm from the wound edge.

Must have book on your surgery rotation: Surgical Recall