View Answer

D

The patient continues to bleed and requires transfusion.

32. What further treatment should be undertaken?

A Observation in the intensive care unit

B Right hepatic artery ligation

C Right hepatic lobectomy

D Angiographic embolization of hepatic artery

E CT portogram

View Answer

D

33. A 45-year-old man presents to the emergency room with 24 hours of left lower quadrant abdominal pain. Examination reveals fever and focal tenderness in the left lower quadrant but no generalized peritoneal signs. CT scan reveals a collection containing air and fluid. Optimal management of this patient includes which of the following?

A Admission for intravenous antibiotics and serial abdominal exams

B Urgent operation with resection of diseased bowel and primary anastomosis

C Urgent operation with resection of diseased bowel and diverting colostomy

D Colonoscopy to rule out the possibility of a perforated cancer followed by CT-guided drainage

E CT-guided drainage followed by bowel resection once the patient has fully recovered

View Answer

E

Questions 34–36

A 52-year-old alcoholic man with known cirrhosis presents to the emergency department with hematemesis.

34. After resuscitation and stabilization, which procedure should take place?

A Arteriography

B Upper gastrointestinal series

C Endoscopy

D Tagged red cell scan

E Liver biopsy

View Answer

C

Work-up reveals acutely bleeding esophageal varices.

35. What should the next treatment be?

A Transjugular intrahepatic portosystemic shunt

B Emergency portacaval shunt

C Splenectomy

D Sclerotherapy

E Gastroesophageal devascularization

View Answer

D

After appropriate therapy, the bleeding ceases and the patient stabilizes. He is found to be a Child's C alcoholic cirrhotic who has been abstinent for 1 year. Evaluation for an orthotopic liver transplant has begun.

36. If his variceal bleeding recurs, it could be managed by all except which of the following?

A Portacaval shunt

B Mesocaval shunt

C Sclerotherapy

D Transjugular intrahepatic portosystemic shunt

E Selective Warren shunt

View Answer

A

37. A 73-year-old previously healthy man presents to the emergency room with several days of jaundice followed by 12 hours of right upper quadrant pain and fever. He is mildly hypotensive. CT scan of the abdomen reveals dilatation of the biliary tree. The next step in management includes which of the following?

A Laparoscopic cholecystectomy

B Open cholecystectomy and T tube placement

C Open cholecystectomy and choledochojejunostomy

D Fluid resuscitation, antibiotics, and endoscopic retrograde cholangiopancreatography (ERCP)

E Fluid resuscitation and hepatitis serologies

View Answer

D

Questions 38–39

A 33-year-old man with no significant past medical history presents to the emergency room with abdominal pain and nausea. He is afebrile, and laboratory studies reveal a serum amylase level of 1200 U/L.

38. Which of the following would not be part of initial management?

A Intravenous hydration

B Nasogastric decompression

C Abdominal imaging with ultrasound and/or CT scan

D ERCP to evaluate pancreatic duct anatomy

E Intravenous narcotic pain medicine