Clinical Scenarios for the ABSITE, etc.

[SLUser11]

Prowler's thread about ABSITE question banks brought up an interesting idea in my mind. Since we've established that there isn't a wonderful resource for ABSITE style questions, I am curious if there's enough interest here on SDN to create a thread consisting of classic ABSITE clinical scenarios/questions.

Contributors to the thread could range from interns to attendings, with a larger contribution from the poor SDN souls that have suffered through up to seven ABSITES in the past. The thread could also act as a springboard to in-depth clinical discussions.

I know the concept is nerdy, and the thread will get less views than one focusing on scrub tops or the 80 hour work week, but I think it would be beneficial, and possibly sort of fun.

The accuracy of answers would be easy to maintain since there's such a big group of people here who are reading constantly. The only rules would be that no copyrighted questions could be shared, and absolutely no questions directly from the ABSITE or ABS exam.

Let me know what you think. I will start.


1. Which of the following is the most common cause of hypercalcemia in breast cancer?
a) Tumor secretion of calcitriol
b) Parathyroid Hormone Related Peptide (PTHrP)
c) Bony metastases
d) Chemotherapy toxicity

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[mosfet]

Is it C??

 

[SLUser11]

Is it C??

No.

1. Which of the following is the most common cause of hypercalcemia in breast cancer?
a) Tumor secretion of calcitriol
b) Parathyroid Hormone Related Peptide (PTHrP)
c) Bony metastases
d) Chemotherapy toxicity

PTHrP is the main cause of hypercalcemia associated with breast cancer. Bony metastases is the main cause of hypercalcemia associated with prostate cancer. Hypercalcemic patients with PTHrP will have increased urinary cAMP, while hematogenous cancers that invade bone will have decreased urinary cAMP.

 

[SLUser11]

2. A 45 year old patient with a long-standing history of Crohn's Disease presents to the hospital with gastric outlet obstruction secondary to a duodenal stricture. Which of the following would be the best treatment?
a) Duodenal stricturoplasty
b) Endoscopic stent placement
c) resection with primary anastomosis
d) Gastrojejunostomy

 

[45408]

I'm inclined to go with A) duodenal stricturoplasty. If it were anyone other than a Crohn's patient, I'd say D) gastrojej, but I know that the CD patients need all the GI tract length they can get, which is also why I wouldn't pick C). I think B) would be a pretty temporary solution.

 

[thedrjojo]

I mean, in reality this is not an answerable question based on the information given, considering you need to know the length of the stricture to know whether a stricturoplasty is possible or applicable or if a primary resection and reanastomosis is needed to overcome it. Regardless, I think the answer you are probably looking for is stricturoplasty and what I would probably put.

 

[SLUser11]

I'm inclined to go with A) duodenal stricturoplasty. If it were anyone other than a Crohn's patient, I'd say D) gastrojej, but I know that the CD patients need all the GI tract length they can get, which is also why I wouldn't pick C). I think B) would be a pretty temporary solution.

I mean, in reality this is not an answerable question based on the information given, considering you need to know the length of the stricture to know whether a stricturoplasty is possible or applicable or if a primary resection and reanastomosis is needed to overcome it. Regardless, I think the answer you are probably looking for is stricturoplasty and what I would probably put.

The ABSITE is full of "unanswerable" questions. I agree with you that the question is sort of unfair, and that may or may not be intentional.

2. A 45 year old patient with a long-standing history of Crohn's Disease presents to the hospital with gastric outlet obstruction secondary to a duodenal stricture. Which of the following would be the best treatment?
a) Duodenal stricturoplasty
b) Endoscopic stent placement
c) resection with primary anastomosis
d) Gastrojejunostomy

Stricturoplasty of the duodenum would be very technically difficult, and you could injure important structures along the way. Stricturoplasty is an excellent treatment for fibrotic crohn's strictures of the small bowel. It is not to be used for inflammatory strictures or large bowel strictures, which are better treated by resection.

Duodenal stents are of questionable benefit, and the only literature I've read on them is for palliation for malignant gastric outlet obstruction. I guess the fear would be stent migration and duodenal perforation, but I bet they'll have a bigger role in the future. Still, not the right answer yet.

Duodenal resection has a very high morbidity, and would require a more complex reconstruction.

The anwer is gastrojejunostomy without any resections. Bypass the diseased segment.


This is exactly why I think an ABSITE question thread is a good idea.

 

[SLUser11]

3. After a 4 hour gynecologic procedure in lithotomy stirrups, a 39 year old female complains of severe calf pain and tightness. She is diagnosed with compartment syndrome, and undergoes 4-compartment fasciotomy. Several days later, the physical therapist notes the patient has unilateral deficiencies in foot eversion. Which nerve was likely injured?
a) Superficial peroneal nerve
b) deep peroneal nerve
c) common peroneal nerve
d) sural nerve

 

[Rollo]

Oh, I know this one. It's A, isn't it?

 

[SLUser11]

Oh, I know this one. It's A, isn't it?

3. After a 4 hour gynecologic procedure in lithotomy stirrups, a 39 year old female complains of severe calf pain and tightness. She is diagnosed with compartment syndrome, and undergoes 4-compartment fasciotomy. Several days later, the physical therapist notes the patient has unilateral deficiencies in foot eversion. Which nerve was likely injured?
a) Superficial peroneal nerve
b) deep peroneal nerve
c) common peroneal nerve
d) sural nerve


Correct. The superficial peroneal nerve runs in the lateral compartment, and can be injured during fasciotomy, which will manifest (in theory) as decreased foot eversion.

The deep peroneal nerve runs in the anterior compartment, and can be injured as a result of the compartment syndrome itself. This will manifest (once again in theory) as foot drop.

The sural nerve runs posterior to the lateral malleolus, and in my opinion, is purely for show. It's used for mostly fruitless nerve biopsies, and can be used for nerve grafts as well. It's usually a distractor in these types of questions.

The common peroneal nerve branches laterally off the tibial nerve at the popliteal fossa. Injury is uncommon, but I believe usually secondary to leg trauma or surgical misadventure, and manifests as foot drop and decreased sensation on the dorsum of the foot.


This question isn't particularly hard, but these nerves are common on the ABSITE, and I think it's easy to confuse them. I occasionally go to M and M conference at one of the prestigious Texas Medical Center hospitals, and I recently witnessed the attending incorrectly pimping the residents on this topic...but she had an unparalleled level of confidence in her wrong answer, so those residents are all going to get the question wrong this year.


Hopefully some other SDNers will chime in.....come on, WS, I know you have some tough breast questions to share.

 

[Winged Scapula]

Hopefully some other SDNers will chime in.....come on, WS, I know you have some tough breast questions to share.

LOL...you already posted the most infamous one in your first post here.

Ok, well I have blocked most of the ABSITE/ABS stuff from my mind, but perhaps now that I've nearly gotten all my Thanksgiving shopping done and the struggle to find room for all my new patients on my schedule is being fixed, I can think this over. I'll see what I can come up with.

 

[45408]

Stricturoplasty of the duodenum would be very technically difficult, and you could injure important structures along the way. Stricturoplasty is an excellent treatment for fibrotic crohn's strictures of the small bowel. It is not to be used for inflammatory strictures or large bowel strictures, which are better treated by resection.

Does the location matter? Could you do a Heineke-Mikulicz style repair on D1 at least?

 

[SLUser11]

Does the location matter? Could you do a Heineke-Mikulicz style repair on D1 at least?

Stricturoplasty is an option with duodenal crohn's disease, but I've never done it...it's just not the best option. My understanding is that compared to gastro-j, there is increased risk of complications requiring reoperation, including restenosis and leak.

On a similar note, I remember from an old SESAP question that when patients have long-standing duodenitis/PUD and have a burnt-out duodenal stricture, the best treatment is balloon dilation plus or minus stent. However, I've never done that. As a resident, I would do Vagotomy/antrectomy with B-II for bad PUD with GOO (B-II because of the amount of inflammation). As a colorectal fellow, I officially never have to do that again, although those cases are pretty fun.

 

[dpmd]

The common peroneal nerve branches laterally off the tibial nerve at the popliteal fossa. Injury is uncommon, but I believe usually secondary to leg trauma or surgical misadventure, and manifests as foot drop and decreased sensation on the dorsum of the foot.

I don't know why common peroneal nerve injury would be uncommon since it is superficial at the level of the fibular head and is therefore at risk while crossing the legs, with short leg casts/SCD's/certain kinds of stirrups, or other means of direct compression. The sensory deficit should be lateral calf as well as dorsum of foot.

 

[SLUser11]

I don't know why common peroneal nerve injury would be uncommon since it is superficial at the level of the fibular head and is therefore at risk while crossing the legs, with short leg casts/SCD's/certain kinds of stirrups, or other means of direct compression. The sensory deficit should be lateral calf as well as dorsum of foot.

You're absolutely right about direct compression with lithotomy stirrups, which I should have mentioned since it's part of the same family of ABSITE questions. It is relatively uncommon, though, occuring in 3/996 patients in this prospective study: Warner DO, Harper CM, et al: Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000; 93:938-942.


I seriously doubt SCDs could cause any significant injury. Leg crossing and casts would cause more of a chronic neuropathy than an acute injury.

Thanks for the input. Feel free to share your own questions that may be beneficial to the junior residents.

 

[SLUser11]

4. A 42 year old male with chronic pancreatitis secondary to alcohol has a known pancreatic pseudocyst of 3 months duration that has grown slowly over time. The patient has increasing abdominal pain, and is arranged for elective cyst-gastrostomy in 2 weeks. He presents to the ER with worsening pain and a syncopal episode, and is found to have a hemoglobin of 7. Contrasted CT of the abdomen is consistent with hemorrhage into the pseudocyst. What is the most appropriate treatment?
a) ICU admission with bowel rest and serial abdominal exams.
b) Emergent laparotomy with pseudocyst excision and oversewing of bleeding vessels.
c) Emergent laparotomy with cyst-gastrostomy and ligation of involved peripancreatic artery.
d) Angiography with embolization of bleeding artery.
e) EGD with trans-gastric stents and ultrasound-guided thrombin injection.

 

[DrNick Riviera]

D?

 

[SLUser11]

D?

Correct.

4. A 42 year old male with chronic pancreatitis secondary to alcohol has a known pancreatic pseudocyst of 3 months duration that has grown slowly over time. The patient has increasing abdominal pain, and is arranged for elective cyst-gastrostomy in 2 weeks. He presents to the ER with worsening pain and a syncopal episode, and is found to have a hemoglobin of 7. Contrasted CT of the abdomen is consistent with hemorrhage into the pseudocyst. What is the most appropriate treatment?
a) ICU admission with bowel rest and serial abdominal exams.
b) Emergent laparotomy with pseudocyst excision and oversewing of bleeding vessels.
c) Emergent laparotomy with cyst-gastrostomy and ligation of involved peripancreatic artery.
d) Angiography with embolization of bleeding artery.
e) EGD with trans-gastric stents and ultrasound-guided thrombin injection.

The patient has a bleeding pseudocyst/pseudoaneurysm, which typically occurs as the pseudocyst expands into a surrounding artery (e.g. pancreaticoduodenals) and the pancreatic enzymes cause wall erosion. They are a surgical emergency.

Pseudocyst management is an hour-long lecture, but the short answer is that cyst-gastrostomy or cyst-jejunostomy are the operations of choice, and endoscopic management with placement of multiple stents through the back wall of the stomach is probably an even better idea.

The patient is bleeding to death, so A is wrong. B is wrong because we generally don't excise pseudocysts. C is wrong because bleeding pseudocysts/pseudoaneurysms typically occur in places of high real estate that are extremely hostile. It's a very difficult technical operation, and angiography is first line.

Ultrasound guided thrombin injection is the treatment of choice for femoral pseudoaneurysms...but who knows, maybe this is the future of bleeding pseudocysts....compression would certainly be more difficult.

 

[DrNick Riviera]

If the pt were stable and presented with only pain, could you argue for initial mgmt w A? Can these erosions/ruptures be self-contained?

 

[SLUser11]

If the pt were stable and presented with only pain, could you argue for initial mgmt w A? Can these erosions/ruptures be self-contained?

I don't know the answer to that. I will defer to any HPB or surg onc specialists on the topic. I've luckily only seen this once, and it was successfully treated with angioembolization. However, I will say that any other time I treated a pseudocyst that was flirting with the nearby vasculature, I was internally freaking out.

My gut feeling is that it should always be addressed. It's a pseudoaneurysm, and is hypothetically subjected to systemic blood pressures, so it's unlikely to tamponade easily. I feel the same way about femoral pseudoaneurysms....no reason to watch them when they carry a risk of hemorrhage or infection, and we have effective therapy available.

On a side note, there's an excellent review article from JACS 2009 on pancreatic pseudocysts. I am a big fan of the review articles in the back of JACS.....they're often quick, easy reads and evidence-based.

 

[45408]

I thought Cameron's had a good chapter on pseudocysts.

 

[SLUser11]

5. A 52 year old man presents to the endoscopy suite for screening colonoscopy. He has no gastrointestinal or anorectal complaints, and his family history is negative for colon cancer. On colonoscopy, 6 separate small polyps (<1cm) are identified in the distal sigmoid colon and proximal rectum, all removed with cold forceps. Pathology determines these polyps to be hyperplastic. Which of the following is the most appropriate next step:
a) Low anterior resection
b) Repeat flexible sigmoidoscopy in 3-6 months
c) Repeat flexible sigmoidoscopy in 6 months, and if negative, repeat colonoscopy in 5 years
d) Repeat colonoscopy in 5 years
e) Repeat colonoscopy in 10 years

 

[mosfet]

d

 

[applesurg]

5. A 52 year old man presents to the endoscopy suite for screening colonoscopy. He has no gastrointestinal or anorectal complaints, and his family history is negative for colon cancer. On colonoscopy, 6 separate small polyps (<1cm) are identified in the distal sigmoid colon and proximal rectum, all removed with cold forceps. Pathology determines these polyps to be hyperplastic. Which of the following is the most appropriate next step:
A) low anterior resection
b) repeat flexible sigmoidoscopy in 3-6 months
c) repeat flexible sigmoidoscopy in 6 months, and if negative, repeat colonoscopy in 5 years
d) repeat colonoscopy in 5 years
e) repeat colonoscopy in 10 years

d

 

[SLUser11]

d

d

You guys aren't going to do an LAR? How do you know that the polyps were completely cleared? Aren't you going to at least check back in a few months to make sure the polyps haven't grown back?




















Just kidding, but those are the tricks I've seen used to talk students or residents out of a right answer. If you think you know it, stick by your initial answer and don't flip-flop. That being said, D is incorrect.

--------------------------------------------------------------------------------

5. A 52 year old man presents to the endoscopy suite for screening colonoscopy. He has no gastrointestinal or anorectal complaints, and his family history is negative for colon cancer. On colonoscopy, 6 separate small polyps (<1cm) are identified in the distal sigmoid colon and proximal rectum, all removed with cold forceps. Pathology determines these polyps to be hyperplastic. Which of the following is the most appropriate next step:
a) Low anterior resection
b) Repeat flexible sigmoidoscopy in 3-6 months
c) Repeat flexible sigmoidoscopy in 6 months, and if negative, repeat colonoscopy in 5 years
d) Repeat colonoscopy in 5 years
e) Repeat colonoscopy in 10 years

Hyperplastic polyps are not pre-malignant, and their presence or absence shouldn't affect screening guidelines. For a patient with no risk factors and a normal colonoscopy, they should be re-scoped in 10 years.

Interestingly, if you look at the AGA guidelines, they will even wait 10 years on adenomatous polyps as long as they are diminutive....I don't know how I feel about that.

 

[applesurg]

I guess I confused hyperplastic with benign adenoma.

 

[SLUser11]

Which of the following extra-intestinal manifestations of ulcerative colitis improve after total proctocolectomy?
a) Uveitis
b) Peripheral Arthritis
c) Primary Sclerosing Cholangitis
d) Ankylosing Spondylitis

 

[Rollo]

A

 

[mosfet]

I thought both A and B improve after a proctocolectomy.

 

[applesurg]

B only

 

[dpmd]

Well, shoot. I thought none of them improved. Have to go look it up now.

 

[SLUser11]

Which of the following extra-intestinal manifestations of ulcerative colitis improve after total proctocolectomy?
a) Uveitis
b) Peripheral Arthritis
c) Primary Sclerosing Cholangitis
d) Ankylosing Spondylitis

Sorry about the delayed response...I was in CA doing robotics with JayDoc, then I've been slammed at work since I got back.

Unfortunately for the patient, PSC does not improve with colectomy, and patients can ultimately require transplant. Uveitis severity does not correlate with disease activity, and it does not reliably improve with colectomy...it can also lead to blindness. Peripheral arthritis does improve, but axial syndromes (spondylitis and sacroiliitis) do not. Pyoderma Gangrenosum does seem to improve with disease remission, but I think it's a cloudy subject, as the steroids used for remission may treat the pyoderma as well.

 

[Rollo]

More Q's whenever you're free SLUser

 

[SLUser11]

More Q's whenever you're free SLUser

7. A 35 year old female presents to the office with anal bleeding, and is foundon exam to have an ulcerated, dark, pigmented lesion at the anal verge. Punch biopsy reveal malignant melanoma with a depth of 5mm. CT of the chest, abdomen, and pelvis are negative for metastases, but PET scan shows increased metabolic activity in the right groin and perirectal fat. Which of the following is the most appropriate initial treatment?
a. Chemotherapy and radiation.
b. Abdominoperineal Resection
c. Wide local excision with 2 cm margins and right inguinal lymph node dissection
d. Wide local excision with 2 cm margins.
e. Systemic infusion of 6B-FP.

 

[Rollo]

C because you want to spare sphincter and tumor is too aggressive to be treated alone with chemo/radio?

 

[SLUser11]

C because you want to spare sphincter and tumor is too aggressive to be treated alone with chemo/radio?

You're not going to do the APR? The patient is only 35, and she has two young kids at home. Based on the PET, she likely has positive perirectal nodes.






















7. A 35 year old female presents to the office with anal bleeding, and is foundon exam to have an ulcerated, dark, pigmented lesion at the anal verge. Punch biopsy reveal malignant melanoma with a depth of 5mm. CT of the chest, abdomen, and pelvis are negative for metastases, but PET scan shows increased metabolic activity in the right groin and perirectal fat. Which of the following is the most appropriate initial treatment?
a. Chemotherapy and radiation.
b. Abdominoperineal Resection
c. Wide local excision with 2 cm margins and right inguinal lymph node dissection
d. Wide local excision with 2 cm margins.
e. Systemic infusion of 6B-FP.


This question usually comes in a more simple form on the ABSITE, but I wanted to use it to spark a discussion...of course, traffic on this thread is light, so no such discussion is likely to occur. The take home one-liner is WLE only is the treatment for anal melanoma, not APR.

Here's a good review article I found with google. Let me know if it doesn't link and I'll attach it.

The truth is that arguments can be made for all of the answers (except A, which was a distractor for people confusing squamous cell and melanoma). However, the literature shows that anal melanoma is a very bad player, and radical resection has not shown to provide a survival benefit. For stage III+ disease, there are almost no long-term survivors. The best published 5 year survival I've ever seen for patients with regional disease is <10%.

For this patient, she is young so it's sad, but with perirectal and inguinal nodes, the horse is out of the barn. WLE is the only indicated surgical procedure. I have to admit that I'd personally be tempted to do an inguinal lymphadenectomy, but the morbidity would be high and the benefit would be hypothetical.

As for E, that's a common chemo joke among surgeons, and it stands for Fishing Pole and a 6 pack of beer. Like I said, an argument could be made for this treatment.

 

[45408]

Anal melanomaI, now that would be awful. Is that from too much time spent naked in a tanning bed?

 

[lavodnas]

You're not going to do the APR? The patient is only 35, and she has two young kids at home. Based on the PET, she likely has positive perirectal nodes.





















7. A 35 year old female presents to the office with anal bleeding, and is foundon exam to have an ulcerated, dark, pigmented lesion at the anal verge. Punch biopsy reveal malignant melanoma with a depth of 5mm. CT of the chest, abdomen, and pelvis are negative for metastases, but PET scan shows increased metabolic activity in the right groin and perirectal fat. Which of the following is the most appropriate initial treatment?
a. Chemotherapy and radiation.
b. Abdominoperineal Resection
c. Wide local excision with 2 cm margins and right inguinal lymph node dissection
d. Wide local excision with 2 cm margins.
e. Systemic infusion of 6B-FP.


This question usually comes in a more simple form on the ABSITE, but I wanted to use it to spark a discussion...of course, traffic on this thread is light, so no such discussion is likely to occur. The take home one-liner is WLE only is the treatment for anal melanoma, not APR.

Here's a good review article I found with google. Let me know if it doesn't link and I'll attach it.

The truth is that arguments can be made for all of the answers (except A, which was a distractor for people confusing squamous cell and melanoma). However, the literature shows that anal melanoma is a very bad player, and radical resection has not shown to provide a survival benefit. For stage III+ disease, there are almost no long-term survivors. The best published 5 year survival I've ever seen for patients with regional disease is <10%.

For this patient, she is young so it's sad, but with perirectal and inguinal nodes, the horse is out of the barn. WLE is the only indicated surgical procedure. I have to admit that I'd personally be tempted to do an inguinal lymphadenectomy, but the morbidity would be high and the benefit would be hypothetical.

As for E, that's a common chemo joke among surgeons, and it stands for Fishing Pole and a 6 pack of beer. Like I said, an argument could be made for this treatment.

I was thinking C also. Thanks SLUser, this thread is great!

 

[SLUser11]

8. A 78 year old male with a history of CAD, COPD, and gastric cancer is POD # 2 from a subtotal gastrectomy. You receive a call that the patient has gone into atrial fibrillation with rapid ventricular response. On bedside examination, the patient is somnolent and pale. Temperature 97 degrees, pulse 175, BP 70/30, and RR 30, Pox100%. Which of the following therapies is the most appropriate next step?
a. IV Digoxin and Magnesium
b. Diltiazem 20mg IV bolus followed by a drip at 10mg/hour
c. Amiodarone 150mg IV bolus followed by a drip at 1mg/hour
d. Immediate synchronized cardioversion
e. Endotracheal intubation

 

[DrNick Riviera]

E

 

[mosfet]

D

 

[45408]

I say cardioversion.

 

[SLUser11]

E

D

I say cardioversion.

8. A 78 year old male with a history of CAD, COPD, and gastric cancer is POD # 2 from a subtotal gastrectomy. You receive a call that the patient has gone into atrial fibrillation with rapid ventricular response. On bedside examination, the patient is somnolent and pale. Temperature 97 degrees, pulse 175, BP 70/30, and RR 30, Pox100%. Which of the following therapies is the most appropriate next step?
a. IV Digoxin and Magnesium
b. Diltiazem 20mg IV bolus followed by a drip at 10mg/hour
c. Amiodarone 150mg IV bolus followed by a drip at 1mg/hour
d. Immediate synchronized cardioversion
e. Endotracheal intubation


This is a common ABSITE question. The key point is that the patient is unstable, so the most appropriate move is immediate cardioversion. B and C are both good options for patients with Afib who are stable.

When this happens in real life, and the cardioversion works, it's extremely rewarding, and you'll spend the rest of the day patting yourself on the back. Of course, I did it once without sedating the patient due to the emergent nature of the situation, and the patient woke up pretty fast, screaming and cursing.

The intubation option is interesting, because there are some ABSITE questions that are meant to simply test your ability to stick to the ABCs. There will be a trauma question where there's lots of info/facts, and lots of appropriate treatment options, but intubation will be the correct answer. This patient does not require intubation based on the scenario.

Merry Christmas, everyone. I'm going to finish rounding and go home....

 

[Guile]

Really great thread. Thanks for getting this going, SLUser.

I have a few to offer. Curious to hear what you guys think. I don't have the "correct" answer for them.

You have a patient with low absolute B cell count. What is he most susceptible to?
A. Staph
B. Streph
C. Hemophilus
D. Influenza

 

[acm1980]

HaemophIlus

 

[SLUser11]

10. Which of the following is not part of a standardized pre-operative time out?
a. Patient name
b. Site and side of surgery
c. Presence or absence of a "hot rod" penis tattoo
d. Antibiotic administration
e. Pertinent x-rays

......okay, this one is sort of a joke, but I would bet the house that there will be a "time out" question on the exam, and it's important to know the different elements.





11. Which of the following is the most appropriate treatment for coagulopathy secondary to uremia?
a. Cryoprecipitate
b. Vitamin K
c. Factor VII
d. DDAVP
e. Protamine

 

[Toennis]

10.
11. Which of the following is the most appropriate treatment for coagulopathy secondary to uremia?
a. Cryoprecipitate
b. Vitamin K
c. Factor VII
d. DDAVP
e. Protamine

a

 

[Rollo]

It's D, Desmopressin.

 

[Guile]

You have a patient with low absolute B cell count. What is he most susceptible to?
A. Staph
B. Streph
C. Hemophilus
D. Influenza

HaemophIlus

This is correct. The key is that it's an encapsulated organism. Repeated infection with encapsulated infections is virtually diagnostic for a B cell disorder.

Here's another:

You have a patient undergoing hepatorrhaphy. He is status post splenectomy. Patient starts crashing, trying to die on you on the table. What do you give?

A. 10 pack platelets
B. 4 units PRBCs
C. 4 units FFP
D. Steroids

 

[Guile]

10. Which of the following is not part of a standardized pre-operative time out?
a. Patient name
b. Site and side of surgery
c. Presence or absence of a "hot rod" penis tattoo
d. Antibiotic administration
e. Pertinent x-rays

This reminds me of another:

What is the #1 cause of medical error?

A. MD prescribing
B. Pharmacist filling
C. RN administering