SHELF / USMLE Step 2 Practice Questions > Surgery
Q1) A 15-year-old male cut his arm while climbing a chain link fence. No foreign bodies are found in the cut anf the wound is thoroughly cleaned. The patient was never immunized against tetanus toxoid. Which of the following represents appropriate management?
a) The patient may be given a toxoid booster.Q2) A 64 year patient who has been on IV heparin for 3 days for a DVT begins to have hematemesis from a bleeding GI ulcer. What is the appropriate management?
b) The patient may be immunized in three separate doses.
c) The patient may be treated with penicillin as prophylaxis against Clostridia tetani.
d) Passive immunization with tetanus immunoglobulin is recommended.
e) The wound should not be sutured.
a) Decrease the heparin dose & administer blood products as needed.
b) Switch to Coumadin.
c) Stop heparin and observe for 3 day to see if the DVT resolves.
d) Stop the systemic heparin and administer thrombolytics directly to the femoral vein.
e) Stop the systemic heparin and place an IVC filter.
Q3) A 43 y/o male presents to the ED with abdominal pain and 3 days of emesis. On 1st assessment he has a temp of 103.2, a bp of 72/40 and a rigid abdomen. Which of the following diagnostic studies would most likely reveal the diagnosis?
a) a CBC with diff.
b) an abdominal flat plate
d) an obstruction series
e) an upper GI
A1) b - The patient may be immunized in three separate doses as long as the wound is clean.
A2) e - Stop the systemic heparin and place an IVC filter. PE must be prevented, however anticoagulants cannot be given in the setting of a bleed.
A3) d - an obstruction series will demonstrate free air (peritonitis, perforated viscus) on the CXR.
Must have book on your surgery rotation: Surgical Recall