Este test está cronometrado.
Tienes 30 minutos para completar 60 preguntas de este test.
1. Which of the following statements regarding hand hygiene is NOT correct?
Health care workers (HCWs) should clean their hands with an antiseptic-containing agent before and after each contact with a patient
The use of soap and water for hand washing is required when hands are visibly soiled with blood or bodily fluids
Alcohol-based hand rubs are inferior to antimicrobial soaps for hand decontamination
Vancomycin-resistant enterococci are frequently isolated from the hands of HCWs
Please rate your level of confidence regarding your answer for the previous question (1 = least confidence, 7 = greatest confidence)
1
2
3
4
5
6
7
2. Out of the following four indicators, the best clinical sign of successful fluid resuscitation and end-organ perfusion in a patient with hemorrhagic shock is:
An increase in blood pressure
An increase in urine output
An increase in arterial oxygenation
A decrease in tachycardia
3. Technical errors during surgical procedures are MOST likely to occur:
During routine procedures in complex patients
In high-complexity operations
Due to surgical inexperience
Due to inadequate resident supervision
4. In the AD DAVID system for writing post-op orders, the “I” is an abbreviation for 3 things. Of the following, what does the “I” NOT stand for?
Investigations
IV
“Ins and outs” (intake and output)
Irrigation
5. The risk of developing a surgical site infection is dependent on all of the following factors, EXCEPT:
Hyperthermia
Immunosuppression
Diabetes mellitus
Length of operation
6. Of the following, what is NOT considered a phase of normal wound healing?
Proliferation
Remodeling
Exfoliation
Hemostasis and inflammation
7. Please choose the CORRECT statement regarding wound healing and closure.
Wound healing via secondary intention leads to improved scar formation and superior cosmetic outcome
A contaminated wound from an open fracture should be immediately closed via primary intention
Wound healing via primary intention requires manual approximation of wound edges and healing through the normal stages of wound healing
Wound healing via tertiary intention is reserved for simple, uncomplicated lacerations
8. With regards to the fundamental principles of antibiotic prophylaxis in surgery, which of the following are INCORRECT?
The antibiotic of choice should be active against organisms usually found at the site of surgery
During surgeries that go longer than expected, the antibiotic should be re-dosed to ensure adequate levels
The antibiotic should be given 30 minutes prior to the incision
The antibiotic should be continued for 7 days post surgery to prevent antibiotic resistance
9. What is NOT a benefit of laparoscopic surgery versus open surgery?
Decreased trauma to the abdominal wall and decreased post-operative scarring
Shorter recovery time
Decreased post-operative pain
Improved tactile sensation of tissues
10. Which of the following is NOT a physiological consequence of routine laparoscopic surgery?
Hypercarbia due to absorption of CO2 used to create a pneumoperitoneum
Decreased blood return from the lower body back to the heart
Decreased systemic blood pressure
Decreased lung volume and residual functional capacity
11. You are preparing to make an abdominal incision for a laparotomy as you suspect your patient has complex perforated appendectomy. What is the correct order of the layers you will cut through, starting with the most superficial layer?
Skin, superficial fascia (Camper’s and Scarpa’s), external oblique, internal oblique, transversus abdominis, transversalis fascia, extraperitoneal fascia, parietal peritoneum
Skin, extraperitoneal fascia, superficial fascia (Camper’s and Scarpa’s), external oblique, internal oblique, transversus abdominis, parietal peritoneum
Skin, superficial fascia (Camper’s and Scarpa’s), extraperitoneal fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, parietal peritoneum
Skin, extraperitoneal fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, superficial fascia (Camper’s and Scarpa’s), parietal peritoneum
12. Of the following, what is NOT an indication for chest tube insertion?
Pneumothorax
Pulmonary edema
Hemothorax
Postoperative cardiac surgery
13. Regarding chest tubes, which of the following answers is correct?
If a chest tube needs to be repositioned further into the chest cavity after insertion, simply advance it further as necessary
A chest X-ray should ALWAYS be taken to confirm the location of a chest tube
Routine chest tubes should be placed in the second intercostal space in the anterior axillary line
Prophylactic antibiotics (most commonly cefazolin) are indicated for chest tube insertions to prevent infection
14. A security guard sustains a left thoraco-abdominal stab wound. He is alert, talking, and hemodynamically stable. On examination, his abdomen is soft and non-tender. The most appropriate management would be:
Observation
Diagnostic peritoneal tap
CT thorax, abdomen, and pelvis
Laparotomy
15. A 30-year-old male pedestrian presents with a posterior left knee dislocation after being hit by a car. He has no distal pulses in his left leg. The most appropriate next step in his management would be to:
Take the patient to the operating room
Reduce dislocation in the ER
Obtain an angiogram
Start IV heparin
16. Comparing internal and external fixation, which of the following is true?
Internal fixation is generally preferable for open fractures
External fixation makes access for wound care more difficult
External fixation is useful in very comminuted fractures
Internal fixation is less invasive than external fixation
17. A patient is brought into the trauma bay after a high-speed motor vehicle collision. He has decreased breath sounds on the right with a deviated trachea to the left, a laceration of his left radial artery with pulsatile bleeding, and an obvious deformity of his right thigh with bone protruding through a 7-cm wound. Which of the following is the most important next step in his management?
Chest tube on the left (5th intercostal space, mid-axillary line)
Pressure dressing on the left forearm
Sterile dressing on the right thigh wound, antibiotics, tetanus booster
Needle thoracotomy on the right (2nd intercostal space, mid-clavicular line)
18. Which of the following is true?
Lag screws cause compression, stabilization, and healing mainly through secondary bone healing
External fixation causes compression and healing mainly through primary bone healing
Casting, splinting, and bracing result in callus formation leading to secondary bone healing
Bone plating induces absolutely stability and mainly leads to healing via secondary bone healing
19. A primipara is in labour and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is:
Ease of repair
Lower blood loss
Less dyspareunia
Less extension of the incision
20. A patient sustained a laceration of the perineum during delivery. It involved the muscles of perineal body but not the anal sphincter. Such a laceration would be classified as:
First degree
Second degree
Third degree
Fourth degree
21. Which of the following statements about episiotomy is FALSE?
Episiotomy incisions are repaired anatomically in layers
Mediolateral or lateral episiotomy may be associated with more blood loss than median one
Indications for episiotomy include avoiding an imminent perineal tear, the use of forceps, breech delivery, and the delivery of premature infants.
In general, the earlier the episiotomy is done during delivery, the more beneficial it will be in speeding up the delivery
22. Which is NOT an indication for urethral catheterization?
Chronic obstruction causing hydronephrosis
Acute urinary retention (BPH, blood clots, etc.)
Traumatic injury to the lower urinary tract causing painful urination
Intermittent decompression for neurogenic bladder
23. Urethral strictures also occur away from the ureterointestinal anastomosis. These are most commonly found in the _____ ureter.
Left
Right
Pelvic ureters
Infantile
24. With regard to acute traumatic subdural hematoma, which of the following is true?
Blood products collect between the inner surface of the calvarium and dura
Bleeding usually results from tearing of the bridging veins
Cerebral contusions are infrequently seen
Burr hole drainage is the surgical treatment of choice
25. The most common location for spontaneous intracerebral hemorrhage secondary to hypertension is the:
Cerebellum
Cerebral white matter
Basal ganglia
Brainstem
26. Indications for treatment of an unruptured intracerebral aneurysm include all of the following except:
Size >10 mm
Symptomatic lesion
Two 1st degree relatives with cerebral aneurysms
History of subarachnoid hemorrhage secondary to another treated aneurysm
27. For local excision, what is generally the best shape to use for ease of closure?
S-Shape
Ellipse
Rectangle
Square
28. To minimize scarring, in what orientation should incision lines be placed in reference to the lines of minimal tension?
Circumferential
Cross
Parallel
Perpendicular
29. An 8-year-old girl has a 2.5 cm breast mass that is enlarging just beneath her left nipple-areolar complex. Her mother first noticed this mass 2 months previously. Management may include all of the following, EXCEPT:
In-depth history for a review of systemic symptoms
Ultrasound imaging
Fine-needle aspiration
Excisional biopsy
30. A 62-year-old patient comes to clinic with a suspicious 2.0 cm lesion, which characteristic of the lesion would make you want to avoid investigating with a punch biopsy?
Ulcerated
Pigmented
Rapidly growing
Hard horn present
