View Answer

E

2. A trauma patient undergoes exploratory laparotomy for severe blunt injury with a positive diagnostic peritoneal lavage. After splenorrhaphy is performed for a splenic laceration, a retroperitoneal hematoma overlying the pancreas is explored. The pancreas is found to be transected overlying the vertebral bodies. What is the optimal management of this injury?

A Sump drainage

B Resection of the distal pancreas

C End-to-end repair of the pancreatic duct

D Whipple resection

E Anastomosis of the jejunum to the severed pancreatic duct

View Answer

B

3. A 21-year-old male is brought to the emergency room after an assualt with a baseball bat. He has suffered obvious head trauma. He opens his eyes spontaneously, does not speak but makes incomprehensible sounds, and localizes to pain. What is his Glasgow Coma Scale (GCS) score?

A 8

B 9

C 10

D 11

E 12

View Answer

D

Questions 4–5

A 50-year-old man is brought to the emergency department immediately after suffering full-thickness burns over the entire surface of both upper extremities and the anterior chest and abdomen. His weight is approximately 155 pounds. Initial fluid resuscitation has been started with lactated Ringer's solution.

4. The initial resuscitation rate should be approximately which of the following?

A 300 mL/hour

B 600 mL/hour

C 900 mL/hour

D 1,200 mL/hour

E 1,500 mL/hour

View Answer

D

The patient responds to treatment.

5. After 8 hours, the fluid rate should be changed to which of the following?

A 300 mL/hour

B 600 mL/hour

C 900 mL/hour

D 1,200 mL/hour

E 1,500 mL/hour

View Answer

A

6. A 22-year-old previously healthy male presents with a 2-month history of fevers, night sweats, and a 20-pound weight loss. On physical examination, he is found to have palpable cervical and inguinal lymphadenopathy. A computed tomography (CT) scan of the chest and abdomen reveals mediastinal and abdominal para-aortic enlarged lymph nodes. Excisional biopsies are performed on a cervical and inguinal lymph node. Both of these biopsies reveal lymphocyte-depleted Hodgkin's disease. What should be the next step in the management of this patient?

A Radiation therapy

B Surgical debulking of the enlarged lymph nodes followed by chemotherapy

C Staging laparotomy to include splenectomy, liver biopsy, and biopsies of intra-abdominal lymph nodes

D Systemic chemotherapy

E Mediastinoscopy

View Answer

D

7. A 55-year-old patient with alcoholism who is still actively drinking presents to the emergency department with hematemesis. The bleeding stops, and he undergoes upper endoscopy. This reveals large varices in the gastric fundus. Physical examination is notable for splenomegaly and the absence of ascites. His prothrombin time is 14 seconds, but his bilirubin and albumin are normal. An ultrasound and Doppler examination of the abdomen reveal a small nodular liver, a large spleen, calcifications throughout the pancreas, a thrombosed splenic vein, and patent superior mesenteric and portal veins with hepatopetal flow. What is the recommended treatment for this patient?

A Orthotopic liver transplant

B Peritoneovenous shunt

C Mesocaval shunt

D Distal splenorenal shunt

E Splenectomy