New York Chicago San Francisco Lisbon London Madrid Mexico City Milan. New Delhi San Juan Seoul Singapore Sydney Toronto. SURGERY · LANGE Q&A. Lange Q&A™: Surgery, 5e. C. Gene Cayten, Max Goldberg, Nanakram Agrawal, Simon Wapnick. Search Textbook Autosuggest Results. The e-chapter logo. major issues in internal medicine by presenting a wide variety of typical examination questions Lange Q &a Lange Q & A. USMLE Step 3.

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Lange Q&A Surgery 5th Edition. The comprehensive review of surgery that students need to pass the USMLE Step 2 and the surgery shelf exam. A Doody's . [UPDATED] lange SURGERY MCQs pdf free download for freshers experienced students objective books interview questions mcqs lab viva. LANGE Q & A SURGERY 5th Edition PDF Board Exam, Surgery, Pdf, Medical Tumor board review 2nd Edition PDF Board Exam, Assessment, Medicine, Pdf.

In this. B A history of bleeding should alert the clini- cian to evaluate the underlying cause. Prerenal Intrinsic Renal Failures Failures 8. Prolongation of failure versus those observed in intrinsic renal the PT may be attributed to decreased absorption failure acute tubular necrosis.

B Oliguria may be prerenal or renal. Renal insufficiency that of plasma. A The composition of small intestinal fluid is sodium. They are as follows: In the presence from combined acidosis. B repre- CNS symptoms due to increased intracranial sents normal saline 0. D Sodium deficit is estimated by multiplying imbalance. Muscle twitching and increased tendon saline 0. On rare occasions.

D Respiratory acidosis in the immediate post. Treatment consists of include hypogonadism. The ability to tone in the skin and in the renal and splanchnic excrete potassium is impaired in high-output circulation.

In the heart. There is no conclu- 7. In all other types seen in zinc deficiency. Copper defi. The oxyhemoglobin dis. Skin lesions similar to enterohep. C Neurogenic shock not to be confused with sociation curve is shifted to left.

The additional increase in pH is due to meta. Other manifestations of shock. The measured pH is 7. B Villous adenoma of colon can result in watery Eosinopenia rather than eosinophilia is more likely to be There is a by prompt intubation and ventilatory support. The changes are mediated significant release of intracellular potassium. Adequate ventilation needs to be restored cates an adverse prognosis in shock.

D5W and D5W and 0. E Zinc is one of the metalloenzymes involved extremities. A PCO2 of 30 mm Hg.. Neurogenic shock is clinically man- in lipid. C Initial resuscitation of a trauma patient is change in pH from 7.

Use of crystalloid Hypokalemia can be sudden and severe. Lactic acid accumulation indi- tion. A Alkalosis is associated with hypokalemia. C The fall in cardiac output results in a rela- diarrhea and hypokalemia. There is a switch from aerobic to anaer- operative period is due to inadequate ventila. It is solutions also aids in the resuscitation of the related to a intracellular shift of potassium in interstitial compartment.

Spironolactone is a potassium. Massive tissue injury tively larger proportion of blood to be distrib- producing myoglobinemia is associated with uted to the heart.

There is Massive blood transfusion results in release increased arteriolar and precapillary sphincter of large amounts of potassium. Drainage procedures include pyloroplasty. If the condition is treated appro- until moderate hydration has been achieved. Ammonium chlo- bolic alkalosis includes administration of isotonic ride would make the acidosis worse. B Spontaneous bleeding occurs when factor II subtotal gastrectomy with gastrojejunal anas. For severe does not preclude a diagnosis of high-output lesions.

In severe metabolic alkalosis. In minor lesions. DES especially in patients with hepatic insufficiency. Normal saline is 2 weeks. D Potassium should not be given initially hypernatremia. Once serious tomosis. Ammonium chloride solution has also occurs during infancy.

In patients refractory to stan. Although mortality figures are high. Hypokalemia if the patient survives the postoperative period. The mechanism is based in part on hand behind and the other in front of the left prior ischemia to the nephron structure of the abdomen and rib cage and rocking the patient kidneys. D Initial management of hypochloremic meta. Potassium sodium chloride solution with replacement of has to be monitored carefully. Phosphorous and mag- most likely causes of pyloric obstruction in nesium levels may be increased.

It is sex-linked.

Kidney transplantation

An alternative to with a disturbance in copper metabolism. The bicarbonate and a solute-poor urine is excreted. Peristalsis is likely to be is given to avoid development of acidosis. A Potassium should not be given. In pyloric uria. In elderly and cardiac patients. It is important to be certain that a gas.

B The actual surgical treatment for obstruc. D Succussion splash is elicited by placing one renal failure. Metabolic alkalosis results from loss of tremia is likely to occur when fluid is restricted fixed acids from the stomach. Autopsy in content of the blood accompanies the elevation patients dying early shows that the distal in pH. C Marked fluid restriction may result in There may be an initial period of olig- gently between the two hands.

The half-life of factor VIII is 8—12 hours. B Duodenal ulcer and gastric carcinoma are the avoid hyperkalemia. The thrombin time eval- uates fibrinogen to fibrin conversion with an The patient is taken to the OR 24—48 symptoms. A Platelet deficiency is likely to be evident. Calcium chloride stabi- studies. Intravenous administration of with laparotomy packs may offer temporary calcium chloride is indicated in the presence of control.

Hypersplenism occurs ECG changes temporarily. Calcium but tests to exclude other causes of bleeding are chloride should be administered to reverse the indicated. D Symptoms are due to magnesium deficiency. The PT evaluates the extrinsic with parenteral magnesium sulfate or magne- coagulation pathway. D Determination of serum albumin or protein procedure. C Symptomatic hypermagnesemia is seen external source of thrombin and will be normal after early thermal injury.

Magnesium is mainly intracellular. Hypokalemia disorder in massive blood transfusion. Half of the calcium in the blood of coagulopathy. Magnesium Penicillamine is used to inhibit excess copper deficiency occurs in the presence of starvation. Symptoms are charac- If fibrinolysis reflexes. The possibility of defibrinogenation. C Thrombocytopenia is the major hemostatic those seen with hyperkalemia.

Hypocalcemia is may be slightly prolonged after massive blood characterized by hyperactive tendon reflexes.

Management in patients with enlarged spleens. D The clinical picture is suggestive of hemo. B In desperate cases where bleeding persists serum albumin. Bleeding from a vein or artery. There is phosphorus are increased in renal failure. The syndrome of magnesium deficiency reduced.

Fresh-frozen plasma is the source of Hyponatremia is characterized by nervous irri- factors V and VII. Magnesium deficiency is treated IX. The normal bleeding time excludes cap. For every 1 g decrease of The normal PT excludes sium chloride. Stored blood is defi. In the presence of a normal PT. After major surgical procedures. Peritoneal dialysis intravascular coagulopathy. Platelet and hypophosphatemia can cause symptoms transfusion usually is indicated when more than of generalized weakness.

B Administer calcium chloride. Unless there is previous liver cir. ECG changes resemble C Injury to the pituitary stalk in major skull cial because movement beyond the point when fractures involving the base of the skull can result bleeding can recur is limited owing to pain. Diseases tion will lower the serum calcium by dilution transmitted by an autosomal-recessive mode and increased renal excretion.

This process is inhib- result in loss of bicarbonate.

D Hypophosphatemia results in decreased syn. Vigorous resuscitation with salt solu. C The boy has hemophilia. It has autosomal-dominant inheritance. The other conditions listed are associated platelet factor 4. B Patients with hypercalcemia have decreased dominant mode.

Other disorders transmitted extracellular fluid volume due to vomiting and by this mode are hereditary hemorrhagic polyuria. C von Willebrand disease is characterized by membrane instability.

Bed values of sodium. These mias. It is even more reliable lites such as adenosine triphosphate ATP. Symptoms involve the GI. WBC dysfunction. D ADP. Factor VIII true hemophilia and Additional therapy includes administration of factor IX Christmas disease deficiencies are oral or intravenous inorganic phosphates.

Patients can use fluid volume is contracted. D The symptoms are suggestive of hypercal. In contrast. The extracellular required volume is excessive. E Obtaining a detailed history is the most important preoperative information that pre- Furosemide and are factor X. B von Willebrand disease is the most common hemostatic disorder transmitted by autosomal- Hypercalcemia causes polydypsia and polyuria.

Fresh-frozen plasma has a low level of factor There is increased urine output that is diluted VIII 0. B Methanol ingestion results in increased pro. In contrast to platelets of normal patients that aggregate when resto- Management con- Deficiency can result in erythrocyte Major causes of hypercalcemia are cancer platelets fail to aggregate in presence of with bony metastasis and hyperparathyroidism.

With chlorambucil treatment. E In the anesthetized patient. Blood must the PT. Following stress. DIC be given at room temperature to such patients.

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The most spe- days after initiation of therapy. D In general. D Patients receiving barbiturates. Serum of the recipient It majority of patients ranges between 25 and must not be given in DIC. The caloric requirements of of transfusion reaction are masked. An alternative formula for calcu- intravascular clotting may occur. The labora- involves the skin of thighs. Secondary agglutinin titer. In patients with vitamin K cholecystectomy should be performed to avoid deficiency or impaired liver function and in those the possible need to perform the operation on with thyrotoxicosis.

Group O is the universal the dose of Coumadin when initiating anticoag. If patients with lymphoma or leukemia. Aminocaproic acid inhibits plasminogen activation to plasmin and In the conscious patient. Management involves serological criteria to show antigen incompati- immediate cessation of Coumadin and admin.

E Acute hemolytic transfusion reaction due to Glucose and amino acids must be infused transfusion of incompatible blood in a patient simultaneously to appropriately utilize nitrogen. E Requires cessation of Coumadin and infu. The sudden humans also varies by amount of activity. It usually occurs 3—10 may be decreased because of DIC. C Patients with polycythemia vera do poorly It is important to adjust tran administration.

Cryoglobulin may be present in fibrinolysis is most commonly seen in DIC. D Fibrinolysis may be primary or acquired. Warfarin Coumadin -induced eralized bleeding due to DIC. D Cross-matching should be done before dex- its anticoagulant effect. D The baseline protein requirements are cal- chills.

C Most patients are elderly. D In metabolic alkalosis. The mortality is higher in this patient population. The overall Escherichia form.

B The patient has tension pneumothorax. The lipid A portion is prob. Endotoxins are lipopolysac. Two or more organisms are found in 4. The most There is a shock. The underlying nitrogen. A Swan-Ganz catheter should be Dopamine will increase BP but is delete- acids and an increase in oleic and palmitoleic rious to the heart.

C Low cardiac output in the presence of ele- nia. One of the real organisms. PCWP is decreased in all the other types of shock. The platelet count remains over in hypochloremic. Immediate management charide complexes. It is immune mediated In addition to the skin changes.

In starvation. C Essential fatty acid deficiency usually inserted for appropriate assessment of hemody- occurs if hyperalimentation is extended for namic status and institution of appropriate ther- more than 1 month and when soybean oil is not apy.

The patient should not be acid. Type II. Increased intrathoracic pressure by respiratory and biliary tract and abdominal interferes with venous return to the heart. D Thrombocytopenia is a common complica- with hypokalemia because of renal conser. The car. The genitourinary and respiratory amount of calories can be provided through a tracts are more common sources for initiating peripheral vein. B Many of the adverse changes can be and can be caused by heparin therapy in any accounted for by endotoxin release.

Lactulose is hypovolemic. It is associated Treat- gram-negative septicemia. Fluid therapy will worsen cardiogenic administered at least twice a week. Gram-positive safflower oils are widely used. This patient has developed ARDS. Insertion of a central venous line of 0. Starvation Stress diastolic BP is usually unchanged. See Answer D The metabolic response to stress is different ulates dopaminergic receptors and increases to that seen following starvation.

It is a b1-receptor ders. Systolic and mean BP are increased. Respiratory quotient 0. B Administration of a depolarizing anesthetic agent such as succinylcholine in quadriplegics. Urine-specific grav- trauma can result in life-threatening hyper. The increase in energy. D Successful weaning from the ventilator is venous access should be achieved by inserting suggested by the presence of two large-bore gauge angiocatheters in the a PaO2 of 70 mm Hg or more with an FiO2 cubital veins. At moderate doses 3—10 in Table 1—2.

In a trauma patient. D Resting energy expenditure is decreased fol- weight. C Dobutamine is the drug of choice for lality. This pre. Normal creatinine level dence suggests that in addition to safety.

Excess glucose results in increased produc- thesized de novo in skeletal muscle. Sudden cessation of TPN can lead to convenient method to study the affinity of rebound hypoglycemia. The stress of surgery tolerated. It holds on to the oxygen at high catecholamine release secondary to hypo. C Glucose infusion should not exceed reduced septic complications. Glucose is the primary source B Patients on TPN with hypertonic glucose solutions have elevated islet-cell production of All the other choices are directly measured.

C Hyperosmolar-nonketotic coma is a seri- femur. Glutamine is a nonessential amino acid. The increased urine output is be administered when enteral access cannot be secondary to osmolar load from blood glu- obtained. As com. Insulin drives the potassium intracellu- hypermetabolic response to surgery. Weaning from TPN should be done gradually a right or left shift does have a real impact on the over 24—48 hours.

Parenteral nutrition should resistant state. The patient is receiving g of glucose.

In instances where TPN is affinity of hemoglobin for oxygen. Fat has a res- Glutamine is a major fuel for the small intes. Glucose has a respiratory quotient of Low CVP.

Treatment consists of is not a component of presently available reducing glucose load and providing fat calo- TPN solutions because of its lack of stability.

It is readily syn. It is S-shaped. At the peripheral tissues. D It is easy to start and administer nutrient gery and sepsis results in an increased insulin- requirements rapidly. Symptoms are attrbutable to release of oxygen.

C Systemic vascular resistance an approxi- of fuel for the brain. A The oxyhemoglobin dissociation curve is a insulin. Current evi. Management consists of aggressive meability to bacteria and other toxins.

If the S-curve. It patient off ventilator.

Lange Q&A - Surgery (McGraw-Hill, ).pdf

The cause second 10 kg of body weight. Manganese erwise fluid restriction is sufficient. I Zinc deficiency. Vitamin C deficiency B Low molecular weight heparins LMWH matched blood transfusion to alkalinize the are fragments of unfractionated standard urine. Serum sodium level should not be wound healing. Cardiac perforation is certainly a risk zyme involved in protein and nucleic acid anytime a catheter is being placed through metabolism.

D Chromium is an insulin cofactor. D Intravenous protamine sulfate. LMWH has greater bioavailability. D Transient arrhythmias and right bundle agulant effect. C Zinc is one of the metalloenzymes involved tion. They bind to and accelerate massive blood transfusion. A right shift occurs with increase in 2. Besides Zinc is a metalloen- catheter.

Vitamin A complication.. Hourly fluid neutralized by intravenous protamine sulfate. A left shift occurs with a decrease in temperature. Pneumothorax is a risk associated with The antico. Only symptomatic hyponatremia Intravenous sodium bicarbonate is indicated after mis. D The coagulation changes can be reversed increase in hormones cortisol. Mural thrombus is not a known wound strength and healing rates. Defi- requires treatment with hypertonic saline.

D Abnormal hemostasis. This interaction can be corrected by using ity of hemoglobin for oxygen more oxygen is desmopressin or by transfusing cryoprecipitate. Platelet transfusions are necessary to cor. Deficiency results in diminished the heart.

C Daily maintenance fluid requirements are globinemia. The prolonged bleeding in lipid. The excessive breakdown of fibrinogen results in measurable amounts of In pure fibri. C There are two coagulation pathways— Relatively few com- factors XII. Hetastarch binds to amylase and boplastin antecedent.

It results in laxis. H All the coagulation factors except throm. E The patient is suffering from anaphylaxis. Intra-aortic balloon pump advantage of plasma administration.

B The only ECG rhythm. Dobutamine and epinephrine also Factor XII.

This DIC. The amount of ionized calcium required showing. In the extrinsic system. Other manifestations include Large tial step in the coagulation cascade. Copper deficiency Amrinone will inhibit phosphodiesterase and is characterized by microcytic hypochromic result in an increased cyclic AMP level.

Factor XII is the ini. Factors II. Calcium is required for nearly all of the enzyme reactions in both the intrinsic and extrinsic sys. The intravascular hypovolemia ical hypocalcemia itself is not a cause of abnor. D The prone positioning reduces the dispar- centration of fibrin degradation products in ity in mechanics between the dependent plasma.

D Dopamine activates b1-receptors and this hypogonadism. All the and platelet count are deranged. E Hetastarch is a synthetic colloid that is extrinsic and intrinsic. Fibrin split products are not part with the vasodilation. The only choice plasma. B The Glasgow Coma Score scale is made up D In anaphylactic shock. Sepsis is a major factor that can trigger and nondependent regions of the lungs. B Disseminated intravascular coagulation is Epinephrine IM has been shown to be more characterized by diffuse intravascular coagu.

The major dis. Castriota et al.

Pelvic inflammatory disease

Castriota, F. Gabrio Secco et al. A23—A28, View at Google Scholar T. Brott, J. Halperin, S. Abbara et al. Tendera, V. Aboyans, M. View at Google Scholar S. Smith Jr. Benjamin, R. Bonow et al. View at Google Scholar M. Roffi, C. Patrono, J. Collet et al. View at Google Scholar P. Steg, S. James, D. Atar et al. View at Google Scholar A. Cremonesi, S. Gieowarsingh, B.

Spagnolo et al. This important step is Bone marrow suppression. Go back and consider each choice individually. A year-old woman complains of lower 5. If a choice is partially correct, tentatively consider it to be abdominal pain and vaginal discharge due to incorrect. This step will help you lessen your choices and gonorrhea. Consider the remaining choices and select the one you think is the answer.

At this point, you may want to quickly scan the Table 2 lists strategies for answering one-best- stem to be sure you understand the question and your answer. Select the appropriate answer.

Even if you do not know the answer, you should at least guess. Your score is based on the number of correct answers, so do not skip any questions. TABLE 2.

The actual examination is timed for an average of 50 seconds per question.

Remember that the lettered choices are followed by the num- bered questions. Consider covering this section first in the beginning of the test, These questions are usually accompanied by the fol- youll likely be less rushed and thus the probability of answer- lowing general directions. For each numbered item, select the appropriate lettered option.

We encourage you to use this section as more realistic to take the Practice Test after you have a basis for further study and understanding. This If you choose the correct answer to a question, will probably give you a more realistic type of test- you can then read the explanation: a for reinforce- ing situation, because very few of us sit down to a ment; and b to add to your knowledge about the test without study.


In this case, you will have done subject matter. If you choose the wrong answer to a some reviewing from superficial to in-depth , and question, you can read the explanation for an your Practice Test will reflect this study time. If, instructional review of the material in the question. We call them Plan A and Plan B.

This will be a good indicator of your ini- son must be either officially enrolled in or a gradu- tial knowledge of the subject and will help to iden- ate of a U. You by the Liaison Committee on Medical Education can now use the first 13 chapters of the book to help LCME ; officially enrolled in or a graduate of a you improve your relative weak points.

US osteopathic medical school accredited by the In Plan B, you go through Chapters 1 through 13 American Osteopathic Association AOA ; or offi- checking off your answers, and then comparing cially enrolled in or a graduate of a foreign medical your choices with the answers and discussions in the school and eligible for examination by the book.

It is not nec- you are. If you still have a major weakness, it should essary to complete any particular year of medical be apparent in time for you to take remedial action. You may find that you have a good command of the material, indicating that SCORING perhaps only a cursory review of the first 13 chap- ters is necessary.

This, of course, would be good to Because there is no penalty for guessing, you should know early in your examination preparation. On answer every question. Do not skip any questions. In this case, you could focus on point, and partial credit may be given to partially these areas in your reviewnot just with this book, correct answers. A year-old man is admitted with systolic blood pressure BP of 60 mm Hg and a heart rate HR of bpm following a gunshot wound to the liver Fig.

What is the effect on the kidneys?Castriota, P. It is important to adjust tran administration. Treatment consists of include hypogonadism. She should breast cancer? The most appropriate management of this E Vitamin A deficiency patient is the administration of which of the F Vitamin D deficiency following? Kenneth A. The amount of ionized calcium required showing. After major surgical procedures.

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