Free Bachelor of Medicine & Bachelor of Surgery Questions and Answers — Questions and Answers
Question 1: You are seeing a patient in the emergency department who banged his head after falling while skiing. He lost consciousness, according to his buddies who were with him, and they brought him to the lodge while dialing for an ambulance. He "woke up" on the ambulance ride to the hospital and briefly appeared to be fine, but he is now unconscious once more. Which vessel is typically at fault given the diagnosis you suspect?
- Middle meningeal artery (Correct answer)
- Basilar artery
- Posterior meningeal artery
- Anterior meningeal artery
Correct answer: Middle meningeal artery
The patient's presentation of initial loss of consciousness, a lucid interval, and subsequent re-loss of consciousness is a classic sign of an epidural hematoma. This type of intracranial hemorrhage is most commonly caused by trauma to the temporal bone, which can rupture the middle meningeal artery. The arterial bleeding rapidly accumulates between the dura mater and the skull, leading to increasing intracranial pressure and neurological deterioration.
Question 2: A 70-year-old man arrives at the hospital after falling while hanging Christmas lights on his roof. He claims to be experiencing right-side chest pain and shortness of breath. His right breath sounds have significantly decreased, according to a physical examination. The moment you insert a chest tube on the right, 850ml of blood start to flow back. Which course of action in his management is best?
- OR for operative exploration
- Keep tube to suction, watch pressures and output (Correct answer)
- Remove chest tube and place dressing
- Suction then remove and seal chest tube site
Correct answer: Keep tube to suction, watch pressures and output
The patient's symptoms and the significant blood return from the chest tube indicate a hemothorax. While 850ml of blood is a considerable amount, the initial management for a hemothorax is to continue chest tube drainage, monitor the patient's vital signs, and assess the rate of ongoing blood loss. Operative exploration is typically reserved for persistent, massive bleeding (e.g., >1500ml initially or >200ml/hour for several hours), which is not yet indicated here.
Question 3: You are looking at a 34-year-old, 100-pound patient who has just been admitted. Both of her arms and her entire back, from the neck to the buttocks, are burned. What IV fluids will be prescribed in your entrance orders?
- 10.8 Liters of fluid, with 5.4L replaced in the first 8 hours from the time of burn and 5.4 over the next 16 hours (Correct answer)
- 5.4 Liters of fluid, with 2.7L replaced in first 12 hours from now and 2.7L over the next 12 hours
- 10.8 Liters of fluid, with 5.4L replaced in first 8 hours from now and 5.4 over the next 24 hours
- 10.8 Liters of fluid, with 5.4L replaced in first 8 hours from now and 5.4 over the next 16 hours
Correct answer: 10.8 Liters of fluid, with 5.4L replaced in the first 8 hours from the time of burn and 5.4 over the next 16 hours
The Parkland formula for fluid resuscitation in burn patients is 4 mL x patient weight (kg) x % Total Body Surface Area (TBSA) burned. Half of the calculated fluid is administered in the first 8 hours from the time of the burn, and the remaining half over the subsequent 16 hours. Assuming a total body surface area (TBSA) burn of 60% for a 100-pound (approximately 45 kg) patient, the total fluid needed would be 4 mL x 45 kg x 60% = 10,800 mL (10.8 Liters). Therefore, 5.4 Liters would be administered in the first 8 hours, and the remaining 5.4 Liters over the subsequent 16 hours.
Question 4: You are visiting a patient in the SICU whose attempt to wean off the ventilator has been unsuccessful for the previous three days. The patient has a history of trauma, is tube-fed, and has been on a ventilator for ten days. To determine a respiratory quotient (RQ), you choose to order a metabolic cart. This patient has an RQ of 1.45. You tell the dietician that the patient requires:
- increased amount of tube feeds overall
- reduced amount of fat in tube feeds
- reduced amount of protein in tube feeds
- reduced amount of tube feeds overall (Correct answer)
Correct answer: reduced amount of tube feeds overall
A respiratory quotient (RQ) of 1.45 is significantly elevated, indicating that the patient is being overfed, particularly with carbohydrates. Excess carbohydrate metabolism leads to increased carbon dioxide production, which places an additional burden on the respiratory system and can hinder successful ventilator weaning. Therefore, reducing the overall amount of tube feeds is necessary to decrease the metabolic load and CO2 production, facilitating the weaning process.
Question 5: Your patient's end-tidal CO2 after anesthesia induction is observed to be noticeably elevated despite enhanced minute ventilation. What do you do if your diagnosis is as suspected?
- Give bolus of something
- Give dantrolene and abort case (Correct answer)
- Suction airway
- Increase tidal volume
Correct answer: Give dantrolene and abort case
A sudden and noticeably elevated end-tidal CO2 despite increased minute ventilation during anesthesia induction is a hallmark sign of malignant hyperthermia (MH). MH is a rare, life-threatening genetic disorder characterized by a hypermetabolic state in skeletal muscles. The immediate and critical management involves administering dantrolene, a specific muscle relaxant, and aborting the surgical case to prevent further complications and stabilize the patient.
Question 6: The inhaled anesthetic you intend to employ has an extremely high MAC. High minimum alveolar concentration (MAC) anesthetics typically:
- Less lipid soluble (Correct answer)
- Very slow onset
- Little of it is needed for adequate anesthesia
- More potent
Correct answer: Less lipid soluble
Minimum Alveolar Concentration (MAC) is inversely related to anesthetic potency; a high MAC indicates that a large concentration of the anesthetic is required to produce its effect, meaning it is less potent. Anesthetics with high MAC (low potency) are typically less lipid soluble. Lipid solubility is a key determinant of an anesthetic's potency, as it dictates how readily the drug can cross cell membranes and exert its effects within the central nervous system.
Question 7: Treatment for a 38-year-old woman with primary Raynaud's syndrome included calcium channel blockers and cold avoidance. She still has significant, refractory symptoms though. The distal second, third, and fourth digits of her left upper extremity were critically ischemic and ulcerated when she was recently admitted. With a wrist-brachial index of 1.03, the palmar arch, radial, and ulnar pulses were all present. She had intravenous prostaglandin therapy, topical nitrates, and a heparin infusion as treatment. She gradually advanced, nevertheless, to the point where her second and third digits lost all of their tissue, necessitating a distal amputation. Which of the following approaches to this patient would be reasonable?
- Implanted catheter for continuous nitrate infusion
- Upper extremity bypass graft
- Cervical sympathectomy (Correct answer)
- Upper extremity angiogram with radial and ulnar stenting
Correct answer: Cervical sympathectomy
The patient's severe, refractory Raynaud's syndrome with critical ischemia and tissue loss, despite comprehensive medical management, indicates a need for more aggressive intervention. Cervical sympathectomy is a surgical option considered for severe, limb-threatening Raynaud's that has failed conservative and pharmacological treatments. By interrupting the sympathetic nerve supply to the upper extremity, it promotes vasodilation and improves blood flow to the affected digits, aiming to prevent further tissue damage and aid healing.
Free Bachelor of Medicine & Bachelor of Surgery Questions and Answers
You are seeing a patient in the emergency department who banged his head after falling while skiing.
He lost consciousness, according to his buddies who were with him, and they brought him to the lodge while dialing for an ambulance.
He "woke up" on the ambulance ride to the hospital and briefly appeared to be fine, but he is now unconscious once more.
Which vessel is typically at fault given the diagnosis you suspect?