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Gen Surg Rosh review pt 2 with 100- correct answers.
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Gen Surg Rosh review pt 2 with 100- correct answers.
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Gen Surg Rosh review pt 2with 100% correct answers
B. Ataxia
Wernicke encephalopathy is characterized by the classic
triad of confusion, ataxia, and ophthalmoplegia. Most cases of Wernicke
encephalopathy result from thiamine deficiency due to chronic alcohol
use. Korsakoff psychosis is a chronic neurological condition resulting from
unresolved Wernicke encephalopathy characterized
by anterograde and retrograde amnesia and confabulation.
56-year-old woman with a history of chronic alcohol use disorder presents
via EMS with altered mentation. Vital signs are within normal limits. On
exam, she is noted to have nystagmus leading to conjugate gaze palsy
with extraocular movement. Laboratory studies are unremarkable. Brain
MRI demonstrates signal abnormality within the mammillary bodies.
Which of the following additional physical findings would you expect in
this patient?
A. Anterograde amnesia
B. Ataxia
C. Confabulation
D. Retrograde amnesia
Korsakoff psychosis
a chronic neurological condition resulting from unresolved Wernicke
encephalopathy characterized by anterograde and retrograde
amnesia and confabulation.
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Wernicke encephalopathy
Patients present with altered mentation (manifesting as profound
disorientation, indifference, and inattentiveness), gait
disturbances (ranging from wide-based gait and slow, short-spaced steps
to inability to walk), and ophthalmoplegia (characterized by nystagmus,
lateral rectus palsy, and conjugate gaze palsies).
Brain MRI demonstrates signal abnormality within the mammillary bodies.
iv thiamine
tx for wernickes encephalopathy
wernickes encephalopathy
Associated with chronic alcohol use
Ataxia and confusion
PE will show nystagmus, lateral rectus palsy
Most commonly caused by thiamine (B1) deficiency
Treatment is aggressive thiamine repletion
Replace thiamine BEFORE glucose
Korsakoff (irreversible memory loss)
D Electrocardiogram
Electrocardiogram is the best test for identifying serious cardiac disorders
precipitating syncope, including long and short QT
syndromes and Brugada syndrome (a sodium channelopathy).
Electrocardiogram is the best test for identifying serious cardiac disorders
precipitating syncope, including long and short QT
syndromes and Brugada syndrome (a sodium channelopathy)
24-year-old man presents after passing out 20 minutes prior to arrival. He
was playing football during the day and was asymptomatic. On a break, he
sat down, suddenly felt nauseated, and then passed out for three seconds.
Witnesses did not observe any convulsive activity. On examination, the
patient is well appearing with normal vital signs and a normal physical
exam. CBC and electrolytes are within normal limits. Which of the
following is the best next test?
,A CT head without contrast
B Dix-Hallpike test
C Echocardiogram
D Electrocardiogram
ulcerative colitis
Abdominal X-ray demonstrates colonic dilation and mucosal thickening
that appears as “thumbprinting.” Colonoscopy may reveal ulceration in
the rectum or colon, sandpaper appearance, and pseudopolyps and can
assess the extent of the disease and the presence of complications (such
as strictures, colon cancer, or hemorrhage)
A Colorectal carcinoma
The barium enema in the image above shows the apple core sign in the
ascending colon and is indicative of colorectal carcinoma. Most colorectal
carcinomas are adenocarcinomas and occur in patients older than 50
years. A colonoscopy with biopsy is the first-line diagnostic test for
colorectal carcinoma
62-year-old man presents to his primary care provider with fatigue and
dark red stools for the past 6 months. His vital signs are within normal
limits. His barium enema is shown in the image above. Which of the
following is the most likely diagnosis?
A Colorectal carcinoma
B Large bowel obstruction
C Sigmoid volvulus
D Toxic megacolon
A By bypassing most of the stomach, duodenum, and proximal jejunum
The Roux-en-Y procedure is one of the most common types of bariatric
surgery performed in the US. This creates a bypass of a large portion of
the stomach, duodenum, and proximal jejunum. The procedure reduces
the size of the stomach while creating a short biliopancreatic tract.
Patients without asthma or bradycardia can be administered labetalol
(B) for blood pressure control, however, because the patient in the
, vignette above has a history of asthma, esmolol is a safer initial
medication because it has a shorter half-life.
By what mechanism does a Roux-en-Y procedure promote weight loss?
A By bypassing most of the stomach, duodenum, and proximal jejunum
B By creating three small bowel limbs to induce malabsorption
C By partitioning the stomach into a small proximal pouch
D By removing a majority of the greater curvature of the stomach
B Compression stockings
Venous insufficiency is caused by incompetent venous valves. This can be
secondary to scarring or thickening of the valve, caused by previous deep
venous thrombosis. It can also happen over time and is associated
with obesity, sedentary lifestyle, smoking, pregnancy, and advanced age.
Patients report increased edema, itching of the skin, and a dull ache after
prolonged standing in the lower extremities. Physical exam may
reveal dilated varicose veins, taut skin, or hyperpigmentation. The skin of
the ankle area may appear to have a brownish pigmentation. Stasis
dermatitis may develop and is typically located at the medial aspect of the
ankles. Compression stockings are the mainstay of treatment for venous
insufficiency.
57-year-old woman who is obese presents with concerns of bilateral lower
extremity edema that has been worsening over the last few months. She
reports itching, particularly in the medial aspects of the ankles. Physical
exam reveals hyperpigmentation of the ankles with +1 pitting edema.
There is no tenderness to palpation or ulcerations noted. A venous duplex
ultrasound is negative for deep vein thrombosis. Which of the following is
the most appropriate intervention?
A Antibiotic prescription
B Compression stockings
C Referral for venous stenting
D Unna boot application
Compression stockings
what are the mainstay of treatment for venous insufficiency.
venous insufficiency
Risk factors: obesity, pregnancy, advancing age, prolonged standing,
family history of venous insufficiency
Sx: leg swelling
PE: skin changes, ulceration, edema, varicose veins
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