What are the characteristics of a breast abscess?
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Generalized hypersensitivity, edema and erythema, palpable mass, soft tissue infection, and Staphylococcus origin.
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What are the characteristics of a breast abscess?
Generalized hypersensitivity, edema and erythema, palpable mass, soft tissue infection, and Staphylococcus origin.
What symptoms may be present in infections of deep surgical wounds?
Fever and/or leukocytosis, sclero-tegumentary jaundice, rectorrhagia, dysphagia, odynophagia.
What is required for osteomyelitis in infections of the foot?
Long-term antibiotic therapy and excisional debridement.
What occurs in an Amyand hernia?
The herniac sac contains the cecal appendix.
How long may antibiotic therapy be extended in cardiac surgery?
48 hours.
What is the first step in open CBD exploration?
Mobilization of the liver through the Kocher maneuver.
What symptoms do patients with angiocholitis typically present?
Jaundice, abdominal pain in the left hypochondrium, Charcot’s triad, and fulminant fever.
Which statement about ventral hernias is true?
Ventral hernias are primary hernias, associated with an anterior incision of the abdominal wall.
When should preoperative antibiotics be administered for optimal concentration?
One hour before the incision.
Which statement about hernias in women is true?
Women rarely have indirect inguinal hernias.
What is identified during open CBD exploration?
The bile duct.
What directly affects the rate of catheter-associated urinary tract infections?
Duration of use for urinary catheter.
What vessels ensure the vascularization of the central abdominal wall?
Superior and inferior epigastric vessels.
Which of the following represents a patient's right?
a) confidentiality, c) informed consent, d) full disclosure of information.
What are the alternative names for sportsman hernia?
Inguinodynia, athletic pubalgia, Gilmore’s groin, or hockey groin.
What are the main characteristics of disseminated intravascular coagulation (CID)?
Diffuse thrombosis, diffuse hemorrhages due to coagulation factors consumption, fibrino-platelet thrombi systemic deposition causing diffuse tissue damage, and may be precipitated by infection or shock.
What is true regarding the TEP procedure?
It does not involve entry into the peritoneal cavity.
For how many days is antibiotic therapy usually sufficient for patients with ventilator-associated pneumonia?
7 days.
What are the four types of hernias clinically?
Asymptomatic, symptomatic, subacute, and acute.
What is a potential outcome of postpartum thyroiditis?
It may cause hypothyroidism.
What type of incision is made in the bile duct during open CBD exploration?
A longitudinal incision.
What may sometimes be required for parastomal hernias?
Relocation of the stoma.
What usually causes a sportsman hernia?
Tension in the adductor muscles that is inserted on the pubis.
What are the characteristics of necrotizing soft tissue infections?
Pathogens invasion, tissue necrosis, and systemic signs of sepsis.
What must a patient demonstrate to be considered competent?
a) not be diagnosed as presently psychotic or intoxicated, b) have an understanding of his/her medical condition, e) be able to make decisions that are in agreement with their present values.
What can precipitate disseminated intravascular coagulation (CID)?
Infection or shock.
What are potential gateways for pathogens?
Peritoneal drain, surgical sutures, urinary catheters, venous catheters.
What can wound infection in surgical treatment of hernias lead to?
Defective healing.
In which situations is the evaluation of the preoperative serum ionogram recommended?
In patients with chronic pathology, long-term anticoagulant therapy, long-term diuretic therapy, persistent vomiting, and young patients at high risk of fluid or electrolyte disorder.
What is the highest risk factor for the development of a urinary tract infection?
The presence of a urinary catheter.
What do the right and left hepatic ducts join to form?
The common hepatic duct.
What is a common symptom of an obturator hernia?
The patient may have paresthesias or intense antero-medial thigh pain.
Which statement about postpartum thyroiditis is true regarding antibody positivity?
Antibody positivity brings with it a high chance of evolution towards transient hypothyroidism.
What is done to the CBD lumen during the procedure?
Irrigation of CBD lumen with saline.
What is the prognosis of a sportsman hernia?
It is a hernia with a severe prognosis.
What happens to the organs around a stoma in parastomal hernias?
They may herniate.
What is a Do-Not-Resuscitate Order (DNR)?
A type of advanced directive document that details care in cases of severe illness, allowing refusal of specific therapies.
What can result from delayed diagnosis and treatment of necrotizing soft tissue infections?
Death and extensive tissue loss.
What blood pressure must be maintained for renoprotection in diabetic nephropathy?
Blood pressure must be maintained <130/80 mmHg.
What are systemic risk factors that increase surgical infection incidence?
Systemically disseminated local infection, obesity, contamination, diabetes mellitus, old age.
Which factors can be incriminated in the etiology of CID?
Release of tissue debris, extensive endothelial damage, and some types of interventions involving the prostate, lung, or malignant tumors.
Which statement about postoperative recurrence in hernias is true?
All hernias have the potential for post-herniorraphy recurrence.
Which neoplasms may cause glomerulonephritis?
Hodgkin’s lymphoma, Malignant melanoma, Leukemia, Kaposi’s sarcoma.
Which substance may induce defects in the synthesis of thyroid hormones?
a) interferon
What cardiovascular responses occur due to surgical stress?
Increased catecholamine levels, increased myocardial oxygen demand, suppression of the fibrinolytic system, suppression of the coagulation cascade, and decreased risk of myocardial ischemia.
What type of tumor is thyroid medullary carcinoma?
A neuroendocrine tumor of C cells.
Where do most gallstones form?
In the gallbladder.
What occurs in a Hernia Littre?
The herniac sac contains a Meckel’s diverticulum.
Which clinical feature cannot be said about hypothyroidism in children?
Children may develop early puberty.
What type of incision is NOT typically made in the bile duct during open CBD exploration?
A transverse incision.
How can the rate of surgical wound infections be significantly reduced?
By reducing the duration of surgical intervention, blood glucose regulation, maintaining body temperature, and oxygen administration.
What can incarcerated hernias lead to?
Intestinal obstruction and ischemia.
What are the major glomerular clinical syndromes?
Acute glomerulonephritis, asymptomatic hematuria, proteinuria, nephrotic syndrome, renal dysfunction syndrome, and rapidly progressive glomerulonephritis.
What is required for necrotizing soft tissue infections?
Wide surgical debridement of the necrotic tissue.
What is true regarding preoperative evaluation in diabetes patients requiring surgery?
Preoperative evaluation of metabolic control and associated complications is necessary.
Under what circumstances may doctors eliminate respiratory assistance?
When the family believes that the elimination of care is consistent with what the patient would like.
What is a key requirement for surgical techniques in ventral hernias?
Must minimize the risk of postoperative recurrence.
What is a key diagnostic criterion for CID?
Hypofibrinogenemia and thrombocytopenia.
What is true about the Lichtenstein alloplastic procedure?
It is an anterior approach operation, performed with a mesh.
What can modify the podocytic cytoskeleton?
Abnormalities of cytoskeletal proteins, capillary loop abnormalities, lesions of slit diaphragm proteins, mesangial proliferation, direct injury by viral infection or drugs.
What is a durable power of attorney?
A legal document that designates a second party as a surrogate decision maker for medical issues.
With which condition is thyroid medullary carcinoma often associated?
MEN 2.
What is the most common cause of hypothyroidism?
c) atrophic hypothyroidism
When is cardiac ultrasound or stress test evaluation indicated?
In patients with low or undetermined cardiac function, high cardiovascular risk, and arterial hypertension.
What are the three types of pigment stones?
Black, brown, and reddish.
What are common symptoms of hypothyroidism?
Puffy eyes, dry skin, and loss of eyebrows.
What is a key characteristic of nephrotic syndrome?
Massive proteinuria (> 3.5 g/day).
What does mixed nephrotic and nephritic syndrome involve?
It involves mesangial cells, the endothelium, glomerular basement membrane, podocytes, and lysosomal damage.
What is a manifestation of tetanus?
Stiffness of the masseter muscle.
What is required within 4-6 hours of incarceration of a hernia?
Surgical intervention to avoid complications.
What are important indicators for surgical reoperation in postoperative intra-abdominal infection?
Fever, leukocytosis, diffuse abdominal pain, abdominal guarding, rigidity, and rebound tenderness.
What condition is more common in diabetic patients and caused by diabetic microangiopathy?
Gastroparesis.
What does orchitis suggest in the treatment of inguinal hernias?
The presence of a swollen and sensitive testicle.
What conditions may render organs unsuitable for donation?
a) neoplasm with loco-regional dissemination, b) sepsis, c) organ-specific infection or disease.
What are the methods for preoperative assessment of bleeding and coagulation disorders?
Patient history, physical examination, superior endoscopic evaluation, abdominal ultrasound, and laboratory tests (aPTT, PT, bleeding time).
What must surgical techniques in ventral hernias limit?
Potential morbidity.
What are the characteristics of podocytes in HIV-associated nephropathy (HIVAN) under light microscopy?
Increased in volume, hyperplastic, coarsely vacuolated, containing protein absorption droplets.
Is durable power of attorney valid in all US states?
No, it is not valid in New York state.
What laboratory findings are associated with the diagnosis of CID?
Low activated partial thromboplastin time (aPTT), low prothrombin time (PT), hypofibrinogenemia, thrombocytopenia, and positive D-dimers.
What is the main investigation in primary hypothyroidism?
e) TSH
At what age can prophylactic thyroidectomy be performed for patients with mutations within MEN2?
As early as 3 years of age.
When is preoperative chest radiography indicated?
In patients undergoing intrathoracic surgery, those with signs of active lung disease, neoplastic patients, patients with cardiovascular disease, and patients with dysphagia.
What test is recommended for a patient with primary hypothyroidism?
Serum TSH.
What does a distended gallbladder with sclerotegumentary jaundice suggest?
Acute cholecystitis.
Which element is NOT associated with nephrotic syndrome?
Hyperalbuminemia.
What is a key characteristic of nephrotic syndrome?
Proteinuria > 3.5 g/day.
What characterizes IgM nephropathy?
Increased mesangial cellularity in most glomeruli and episodes of hematuria and nephrotic syndrome.
What is a true statement about incarcerated hernias?
They often require emergency surgical intervention.
What types of repair techniques are used for ventral hernias?
Anatomical, alloplastic, and component separation techniques.
Which congenital hemostasis disorders have a risk of bleeding?
Factor V Leiden mutation, Hemophilia A, and Von Willebrand's disease.
What symptom suggests the presence of gastroparesis?
Dysphagia.
What are the most common nosocomial infections?
Pneumonia associated with hospitalization, urinary tract infections, ventilator-associated pneumonia.
What are risk factors for breast abscess?
Smoking, obesity, and pregnancy over age 30.
What are the causes of secondary membranous glomerulonephritis?
Certain medications, pregnancy, infections, autoimmune diseases, neoplasms.
What does a durable power of attorney allow a designated individual to do?
Make decisions consistent with the patient’s values.
Which statement about toxic multinodular goiter is true?
b) Subacute thyroiditis may be accompanied by VSH levels within normal limits.
What is the primary treatment for papillary carcinoma?
Surgical.
Which condition can be an etiological factor of CID?
Severe liver disease.
What are the true statements regarding the ASA classification?
Age is a factor, it includes 6 categories, it was developed to predict operator risk, congestive heart failure is a factor, and the rate of postoperative pulmonary complications increases with ASA class.
Which statement about primary hypothyroidism is true?
Patients with ischemic heart disease will receive initial doses of 25 mcg/day.
What is the initial exploration of choice in patients with biliary disorders?
Computed tomography.
What is a defining feature of rapidly progressive glomerulonephritis?
Rapidly progressive renal failure.
What can massive transfusion isolated from red blood cell mass predispose to?
Bleeding.
What is another characteristic of nephrotic syndrome?
Hypoalbuminemia.
What does Class M1 in the Oxford Histological Classification of IgA nephropathy indicate?
Class M1 means mesangial hypercellularity >0.5.
What are the options for hernia repair?
Anatomical, alloplastic, component separation, and non-invasive techniques.
How does hyperglycemia affect the immune system?
It negatively influences the function of the immune system, especially phagocytic activity.
What are the true statements about Hemophilia A?
Appears only in males, bleeding occurs in mucous membranes and skin, occurs due to reduced or absent factor VIII activity, aPTT is prolonged, and platelet function is normal.
What are the basic principles for the prevention of ventilator-associated pneumonia?
Daily detubing assessment, maintaining physical fitness through early mobilization, and raising the thorax by positioning the bed at 30-45 degrees.
What is indicated in the last trimester of pregnancy for hyperthyroidism?
b) PTU (propylthiouracil)
What do patients with reactive systemic amyloidosis (secondary AA) often present with?
Nephrotic syndrome, chronic kidney disease.
What type of document details a patient’s wishes in specific medical situations?
A written document that outlines wishes regarding resuscitation, ventilation, and extraordinary maintenance of life.
What is the prognosis for medullary carcinoma?
Often familial behavior, local metastases, good prognosis.
What does ultrasound provide high sensitivity for in biliary tract disorders?
Detection of biliary dilatations.
Which element may be missing in rapidly progressive glomerulonephritis?
Crescents.
How can shock affect consumption coagulopathy?
It can aggravate it.
What is true about the investigation of glomerular disease?
C3 and C4 levels may be low, antinuclear antibodies are present in systemic lupus erythematosus, and cryoglobulins are elevated in cryoglobulinemia.
What are the main targets in the perioperative management of patients with BCR or IRA?
Maintenance of renal volemia and perfusion.
What symptom is commonly associated with nephrotic syndrome?
Edema.
What are common postoperative complications?
Seroma, wound infection, hernia recurrence, and postoperative neuropathies.
When is surgical intervention recommended for pregnant patients?
In the second trimester.
How can von Willebrand disease be identified?
Through reduced factor VIII activity and reduced von Willebrand factor activity, normal platelet function, and it occurs in both sexes.
What is a common manifestation of acute lung injury in the context of transfusion?
Laryngospasm.
What is a characteristic of autoimmune hypothyroidism?
Lymphoid infiltration of the thyroid.
What is the most common cancer of the biliary tract?
Gallbladder cancer.
What conditions may be associated with AL amyloidosis?
Multiple myeloma, systemic lupus erythematosus, chronic granulocytic leukemia, macroglobulinemia Waldenström, non-Hodgkin's lymphoma.
When is confidentiality not mandated for a patient?
When the patient is considered to be suicidal or homicidal.
What causes proteinuria in kidney disorders?
Structural damage to the glomerular barrier.
What is true about the majority of patients with gallstones?
They are symptomatic.
What is the incidence of thyroid carcinoma in the U.S. per year?
b) 30,000 cases/year
What can acute blood transfusion reactions cause?
Disseminated intravascular coagulation (CID).
Why is arterial hypotension significant in renal management?
It may prevent renal malfunction.
What lipid abnormality is associated with nephrotic syndrome?
Dyslipidemia.
In which condition are nasogastric tubes most commonly used?
Patients with ileus or occlusion.
What are the causes of acquired hemostasis disorders associated with bleeding?
Advanced liver diseases, uremia, and anticoagulant therapy.
When do acute lung injuries most frequently occur during transfusions?
During transfusions containing plasma.
What is the role of ultrasound in diagnosing acute cholecystitis?
Ultrasound is very useful for establishing the definitive diagnosis.
What type of antibodies are commonly found in autoimmune thyroid conditions?
Serum antibodies to the thyroid.
From which cells does medullary carcinoma arise?
Thyroid epithelium cells.
What is the most common risk factor for gallbladder cancer?
Gallstones.
What does a relative risk (RR) value greater than 1 suggest?
A positive relationship between exposure and disease.
What is the initial imaging investigation of choice in patients with choledocholithiasis and cholangitis?
Ultrasound.
Which component does NOT contribute to structural damage leading to proteinuria?
Efferent arteriole.
What should be considered in the differential diagnosis of acute cholecystitis?
Acute hepatitis, acute pancreatitis, perforated ulcer, and acute appendicitis.
What occurs when a patient is under general anesthesia in relation to CID?
No other manifestations occur until generalized bleeding as a result of CID.
What is a histological variant of focal and segmental glomerulosclerosis?
The primary variant.
Why are nonsteroidal anti-inflammatory drugs generally contraindicated in patients with renal issues?
Due to nephrotoxic effects.
What factors predict the need for a massive blood transfusion?
Positive FAST ultrasound, presence of a penetrating wound, craniocerebral trauma, heart rate over 120 beats/minute, and systolic pressure below 90 mmHg.
Which of the following is a urethro-bladder probe?
Foley catheter.
What is the first step in managing minor transfusion reactions?
Immediate cessation of transfusion.
What initial treatments are recommended for acute cholecystitis?
Stopping oral food intake, intravenous administration of fluids, and antibiotic therapy.
What is the role of levothyroxine in papillary and follicular carcinomas?
It reduces the risk of relapse.
When is prophylactic cholecystectomy generally recommended?
For any finding of gallbladder wall calcification on imaging studies.
What is a false-negative finding?
Occurs in patients with a disease and a negative test, approximated by (1 - specificity).
Which studies are best to define the specific site and source of bile duct obstruction?
MRCP, ERCP, or PTC.
What symptoms of an incompatible blood transfusion can occur in patients under general anesthesia?
Agitation and back pain, representing the installation of CID.
What is an example of secondary glomerular impairment?
Systemic lupus erythematosus.
Which variant of focal and segmental glomerulosclerosis is characterized by lesions at the glomerular tip?
Variant with lesion of the glomerular tip.
What must be adjusted according to the degree of renal damage?
Drug dosage.
What is used in the preoperative management of thrombocytopenia?
Administration of l-Desamino-8-D-arginine-vasopressin (DDAVP).
Which bacteria are commonly associated with acute cholecystitis?
Staphylococcus aureus, Enterococcus Faecalis, Clostridium Difficile.
What should be done with the blood unit after a minor transfusion reaction?
Return it to the transfusion center to repeat compatibility.
What is the positive predictive value (PPV)?
The probability that a patient with a positive test has a disease.
What is the most common symptom of gallbladder cancer?
Weight loss.
What is a disadvantage of ERCP?
It cannot extract stones despite establishing the diagnosis of lithiasis.
Which condition is NOT considered secondary glomerular impairment?
Congenital nephrotic syndrome.
How is severe bleeding from wounds defined?
Bleeding that requires at least 10 units of red blood cell mass in the first 5 hours.
What is Fabry Disease?
A lysosomal storage disease caused by a deficiency of the enzyme α-galactosidase.
What is a significant risk when administering opioids to patients with BCR?
High risk of respiratory depression.
Can cholecystectomy be performed laparoscopically?
Yes, but the classic approach may be needed due to bleeding or difficulty establishing anatomical landmarks.
What causes trauma-induced coagulopathy?
Excessive consumption of coagulation factors.
What is the performance of acceptable screening tests typically in terms of sensitivity?
Typically >80% sensitive.
What is another risk factor for gallbladder cancer?
Porcelain gallbladder.
What is the first stage of diabetic nephropathy?
Isolated thickening of the glomerular basement membrane with mesangial expansion.
What is usually increased in patients with cholangitis?
The number of leukocytes.
What are essential measures to take in case of bleeding?
Early control of bleeding during transport.
What accumulates in Fabry Disease?
Glycosphingolipids.
What is the purpose of a gastrostomy?
Used for feeding or drainage.
What is the most common form of symptomatic vesicular lithiasis?
Chronic cholecystitis.
What is true about primary fibrinolysis?
It consists of activating the fibrinolysis cascade with inhibition of plasmin production.
What symptom may be present in gallbladder cancer?
Jaundice.
Which stage of diabetic nephropathy involves advanced glomerulosclerosis?
Stage V.
What is the role of tranexamic acid?
Inhibits fibrinolysis and clot dissolution, with a hemostatic role.
Is renal function normal in Fabry Disease?
No, renal function is not normal.
What may be required if the bile duct cannot be cleared of stones by laparoscopic exploration?
Open bile duct exploration or postoperative ERCP and sphincterotomy.
How can a gastrostomy be placed?
Surgically or endoscopically.
What is the initial investigation of choice for chronic cholecystitis?
Ultrasonography.
What can cause primary fibrinolysis?
Congenital disorders of coagulation cascade inhibitors.
What is the 5-year survival rate for gallbladder cancer?
It is not good (> 80% at 5 years).
In what situation is tranexamic acid recommended?
For patients with severe trauma and massive bleeding.
What skin condition is associated with Fabry Disease?
Cutaneous angiokeratomas.
Is acute suppurative cholangitis a chronic condition?
No, it is not a chronic condition.
What are thoracic drainage tubes used for?
Air, blood, or fluid drainage from the pleural cavity.
What is true about hypercoagulability states in patients with liver disease?
They may have bleeding, hypercoagulability, or both at the same time.
What percentage of patients with gallstones may tolerate dissolution therapy?
15%.
What is a common symptom of bile duct injuries in the early postoperative period?
Severe abdominal pain.
What can lead to an increased risk of postoperative bleeding?
Inadequate control of hemostasis during the intervention.
What is the initial management for acute suppurative cholangitis?
Cholecystectomy.
What does the MELD score take into account?
INR, Bilirubin, Transaminases, Albumin, and Creatinine.
How does aging affect hemostasis processes?
Aging brings major changes in hemostasis processes.
