Monday, September 29, 2008

33 - surgery cases mcqs - 2

Question 2 :

A 45-year-old man skidded from the road at

high speed and hit a tree. Examples of deceleration

injuries in this patient include:

(A) Aortic valve rupture

(B) Kidney injury

(C) Posterior dislocation of shoulder

(D) Mesenteric avulsion

(E) Stomach rupture


(E) Deceleration injuries occur when the body

is subjected to a sudden stop when traveling at

a high speed (e.g., high-speed automobile hitting

a tree, fall from a height). As the impacting

part of the body comes to a sudden halt, the

organs behind continue to travel forward, thus

causing shearing injuries at the junction of

mobile and fixed parts; such as mesenteric

avulsion. The other choices are possible but

much less common.

32 - surgical cases mcqs - 1

CASE 1 :

Twenty-four hours after colon resection, urine

output in a 70-year-old man is 10 mL/h. Blood

chemistry analysis reveals sodium, 138 mEq/L;

potassium, 6 mEq/L; chloride, 100 mEq/L; bicarbonate,

14 mEq/L. His metabolic abnormality

is characterized by which of the following?

(A) Abdominal distension

(B) Peaked T waves

(C) Narrow QRS complex

(D) Cardiac arrest in systole

(E) J wave or Osborne wave


(B) Hyperkalemia can manifest by GI or

cardiovascular signs. GI symptoms include

nausea, vomiting, intestinal colic, and diarrhea.

Abdominal distension as a result of paralytic

ileus is due to hypokalemia. An ECG is useful

to monitor potassium levels. Hyperkalemia

is characterized by peaked T waves. ECG

changes also include ST-segment depression,

widened QRS complex, and heart block.

Cardiac arrest occurs in diastole with increasing

levels of potassium. Osborne (J) wave is

seen in hypothermia.

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