View Answer

D

23. Which of these statements is true?

A Brain metastases occur more frequently than primary brain tumors.

B The Cushing's response is the tachycardia and hypertension seen with mass lesions of the pituitary.

C The Cushing's response is bradycardia and hypotension seen with terminal brain herniation.

D The Cushing's response is the maintenance of cerebral perfusion pressure against variations in systemic blood pressure.

E Primary brain tumors are more common than metastatic brain tumors.

View Answer

A

Questions 24–25

A 38-year-old previously healthy female presents with a single partial seizure. Physical examination is unremarkable. A CT head scan shows a lesion that enhances with contrast measuring 1.5 × 1 cm in the tip of the right temporal lobe surrounded by a rim of local edema.

24. What is the best way to proceed?

A Stereotactic needle biopsy

B Open biopsy

C Tumor resection

D Electroencephalography (EEG)

E Brain magnetic resonance imaging (MRI), chest radiograph

View Answer

E

25. If this patient's lesion is resected and it turns out to be a glioblastoma, which of the following is true?

A The patient's median expected survival is 2 years.

B Additional surgery is not meaningful.

C The patient's prognosis is unchanged by radiation therapy.

D Age is an important prognostic factor for this tumor.

E The clinical presentation of the tumor was uncommon for this patient.

View Answer

D

26. Which of the following major joint dislocations constitutes the most dire surgical emergency?

A Hip dislocation

B Knee dislocation

C Shoulder dislocation

D Elbow dislocation

E Subtalar dislocation

View Answer

B

27. A 37-year-old intoxicated man is struck by the bumper of a car while he is crossing the street. He sustains a comminuted closed proximal one-third tibia and fibula fractures. The fractures are stabilized with an external fixator 1 hour after the man arrives at the trauma bay. Approximately 2 hours after surgery, he has a severe pain that is not controlled by intravenous morphine. The physical examination demonstrates 2+ dorsalis pedis and posterior tibial pulses, increased swelling of the leg, decreased sensation and paresthesias of the first web space, and exquisite pain with active and passive motion of the toes. What should be the next step in treatment?

A Four compartment fasciotomies of the leg

B Femoral angiography with runoff

C Elevation of the leg above the heart

D Continued observation

E Repeat plain radiographs of the leg

View Answer

A

28. Which of the following describes the most appropriate treatment regimen for a newly diagnosed primary osteogenic sarcoma of the distal femur?

A Above-knee amputation and chemotherapy

B Radiation therapy

C Limb-salvage surgery with marginal excision

D Neoadjuvant and adjuvant chemotherapy with surgical excision

E A combination of chemotherapy and radiation therapy

View Answer

D

29. A 2,600-g newborn without any obvious anomalies turns blue during her first feeding. An attempt at passing an oral gastric tube to decompress the stomach is unsuccessful. Which of the following statements is correct?

A The most likely form of tracheal esophageal malformation is a blind pouch without a tracheal fistula.

B No further workup for other anomalies is indicated owing to the normal appearance of the patient.

C Because the orogastric tube does not pass, it should be removed to prevent gagging.

D Primary repair can be undertaken if the defect is less than 2 cm in length

E If the lung fields are clear to auscultation after the cyanotic episode, an immediate chest radiograph would not aid in the newborn's management.