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A 26-year-old man is undergoing a nerve block for an outpatient orthopedic procedure on his left ankle. Dur¬ing injection of the superficial fibular nerve with lidocaine, he complains of tingling around his mouth and lips. What is the next symptom you would expect in the progression of lidocaine toxicity?
- Cardiac arrest
- Hallucinations
- Seizures
- Nausea and vomiting - ANSWER-B. Hallucinations
An 82-year-old man presents to your clinic for follow up 6 weeks after discharge from the hospital following abdominal aortic aneurysm (AAA) repair. His recovery was complicated by loss of the left femoral pulse, requiring thombectomy. You would like to evaluate his vascular graft for blood flow and to rule out stenosis and false aneurysm. Which of the following imaging modalities is the best test for this?
- B-mode ultrasonography
- Color-flow duplex ultrasonography 1 / 4
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- Digital subtraction arteriography
- CT
- Magnetic resonance angiography (MRA) - ANSWER-B. Color-flow
duplex ultrasonography
A 64-year-old postmenopausal women with estrogen receptor +, stage IIB breast cancer presents following lumpectomy and radiation therapy and therapy with tamoxifen. She asks about the risks of tamoxifen therapy. You tell her that
- tamoxifen increases bone resorption, increasing risk of long bone and
- tamoxifen is associated with a modest, but signifi¬cant increase in the
- tamoxifen has been linked to an increased risk of developing
- tamoxifen increases the likelihood of developing breast cancer in the
pelvic fractures due to osteoporosis
risk of cardiovascular events seen in postmenopausal women with coronary artery disease
endometrial adenocarcinoma and uterine sarcoma
contralateral breast - ANSWER-C. tamoxifen has been linked to an increased risk of developing endometrial adenocarcinoma and uterine sarcoma
Workup for vomiting In a 46-year-old woman with Crohn disease reveals a stricture in the second portion ofthe duodenum. What is the best surgical manage¬ment of this problem?
- Heineke-Mikulicz strictureplasty
- Resection of the affected segment with primary astamosis 2 / 4
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- Side-to-side retrocolic gastrojejunostomy
- Roux-en-Y duodenojejunostomy - ANSWER-A. Heineke-Mikulicz
strictureplasty
A 17-year-old boy presents to the emergency depart¬ment after a right shoulder injury sustained while play¬ing football. Plain radiographs reveal the humeral head displaced medial to the glenoid fossa. Which nerve is most likely injured In this type of dislocation?
- Suprascapular nerve
- Median nerve
- Radial nerve
- Axillary nerve - ANSWER-D. Axillary nerve
An obese woman who underwent a transabdominal hysterectomy 10 years ago presents for an elective ventral hernia repair. She undergoes hernia repair via a laparoscopic approach, to which she responds well initially. However, she develops a recurrent bulge 2 months later. What is the most common reason for recurrence after laparoscopic ventral hernia repair?
- Unrecognized defect
- Failure of suture material or tacks
- Separation of the mesh from the abdominal wall
- Seroma
- Inadequate dissection of the fascial defect - ANSWER-C. Separation
of the mesh from the abdominal wall 3 / 4
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What is the most common cause of late death after heart transplant?
- Acute graft rejection
- Accelerated atherosclerosis
- Cytomegalovirus infection
- Fungal infection - ANSWER-B. Accelerated atherosclerosis
A 43-year-old man presents with persistent peptic ulcers that have been refractory to proton-pump inhibitors. His workup includes a positive
secretin stimulation test. His underlying tumor is:
- associated with Whipple's triad
- associated with hypoglycemia
- frequently located in the tail of the pancreas
- associated with multiple endocrine neoplasia (MEN)-2a
- likely to be sporadic - ANSWER-E. likely to be sporadic
A 38-year-old man presents to the emergency department after attempted suicide via ingestion of oven cleaner. Upon rigid esophagoscopy, you observe erythematous, edematous mucosa with partially circumferential white ulcerations In the mid-esophagus. What is the degree of these lesions?
- Grade I
- Grade IIA
- Grade IIB
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