Within the MIR initiative http://emilienko.blogspot.com/ 2.0 I have reviewed the exam and I chose 17 questions from surgery or that may be related with it, there are several gastroenterology or oncology that hopefully meet other students.
all the answers are already surgery on this link or Wikisanidad 2.0 MIR project
all the answers are already surgery on this link or Wikisanidad 2.0 MIR project
Question 1 Women 83 years with a history of diabetes mellitus, hiatus hernia, duodenal ulcer and inguinal hernia. Follow standard treatment with metformin, omeprazole, and iron anemia for months. Go to the emergency department with nausea, abdominal cramping, vomiting and constipation than 48 hours of onset. Physical examination diffusely distended and painful abdomen without signs of peritoneal irritation. Decreased bowel sounds. No palpable masses. Laboratory tests: Hb 8.5 g / dl, MCV 80, Palquetas 240000/uL, 10.200/ul leukocytes (81% granulocytes), pH 7.31, HCO3 17 mmol / L, amylase 150U / L (28-100), LDH 252 U / L, Creatinine 1.1 mg / dL. Normal rest. Radiology of the abdomen: see image1. His tentative diagnosis is:
1. Constipation secondary to iron therapy
2. Acute Pancreatitis
3. acute Gastristis
4. Ileus secondary to ionic alterations.
5. Mechanical intestinal obstruction at the distal ileum and cecum.
I think the answer is 5 think there is no doubt that the Rx shows a dilated distal small bowel with no gas in the colonic frame, if we add the absence of previous surgery, the operation is hernorrafia extraperitoneal and gives no adhesions. Anemia at 83 focuses on gastrointestinal tumor colon probably has no right under the VCM treatment with iron. I think it's a question easily resolved because there are other possible answers.
Question 2.
linked to the image Question # 1. The most appropriate initial clinical management for the patient would be:
1. NPO, nasogastric suction probe and fluid therapy with KCl. Request emergency abdominal CT.
2. Enemas until complete resolution. Repeat Rx control.
3. Fluid therapy with bicarbonate 1 / 6 M, NaCl and KCl intravenously.
4. NPO 8h. tolerance test and discharged via lactulose and oral domperidone.
5. Analgesia and omeprazole intravensoso. If not better assess urgent gastroscopy.
I think the answer is 1. Aspiration and the volume and electrolyte replacement is the mainstay of treatment of mechanical intestinal obstruction. CT is necessary to objectify the cause of obstruction without surgery prior to surgical indication in this case is indicated. The acidosis is treated with volume expansion and intervention to resolve the case, there may be intestinal necrosis. The second most likely answer is 3 but without the aspiration and does not refer to the TC, is the trap of bicarbonate and probably have been answered as correct by many, see the official response.
Question 3.
72 year old with no medical or surgical history of interest because of dyspnea at rest and fatigue from a month earlier. Does not mention changes in bowel habits. On arrival to the emergency room is hemodynamically stable. Analytical requested that presents in her blood count, Hb 7.6 g / dl, MCV 72, and Htco% to 26%. The patient was admitted for tests. Image 2 shows an axial section of CT scan of the patient. "In relation to radiological test carried out which of the following statements is true?
1.Se eccentric wall thickening observed at the ascending colon consistent with adenocarcinoma.
2.Presencia minimum of colon wall thickening with diffuse mucosal hyperemia compatible with ulcerative colitis.
3, has been identified a fluid collection with air-fluid level compatible with perforated diverticulitis.
fecaloma 4.Se see a bulky proximal colonic obstruction.
5.Presenta minimal physiological strain of intestinal apparatus compatible with normal aging.
I think the answer is 1. Do not think it is a question with response options.
Question 4.
linked to the image Question No. 2.
earlier in the patient which would be the steps to follow below:
1.Colocación nasogastric tube.
2.Drenaje PCI.
3.Antibioterapia broad spectrum.
4.Colocación rectal probe.
5.Pancolonoscopia biopsy
I think the answer is 5. The patient has no symptoms of intestinal blockage and if the correct diagnosis of the above is adenocarcinoma of the colon, the correct answer to this is the colonocospia with biopsy and subsequent surgical treatment. If the patient showed symptoms occlusive appropriate response would be 1 because the surgery is urgent and no preoperative biopsy was performed. The piece serves as a biopsy right hemicolectomy and definitive treatment.
Question No. 31:
In a patient with liver trauma by CT, the most important criteria for suspending the conservative treatment and proceed to surgery is:
1 . That there are changes in the radiological control procedures.
2.What are evident pain, ileus and abdominal distension. 3.What
occur hemodynamic instability.
4.Presencia of leukocytosis.
5.Presencia hematocrit less than 30%
I think the correct answer is 3 manuals in all trauma is clear that response, the rest of the symptoms, signs and radiological images are not related to the failure of conservative treatment.
Question No 32
In laparoscopic surgery what is the most widely used gas for the creation of pneumoperitoneum?
1.Oxígeno
2.Argón.
3.Oxido nitrous.
4.Helio.
5-carbon dioxide.
There is no doubt that the answer is 5. is the only gas that is explosive and it is expelled through breathing.
Question No 33
In relation to the indications of surgery for inflammatory bowel disease indicate the wrong answer:
1.Muchos patients with Crohn's disease are require surgery at some point in its evolution.
2.The surgical indications Crohn's disease limited to complications.
3.La toxic megacolon usual solution is surgery.
4.In the surgical treatment of ulcerative colitis resection should be limited to the segment of colon. 5.The
extraintestinal complications of the lower limbs usually resolve after resection of affected intestine, with the exception of spondylitis and liver complications. Ceo
the correct answer is 4 the rest of the answers to all true, the surgery of ulcerative colitis is total resection of the colon. Mucosal resection of colon cures the disease it produces effects. There are techniques for sphincter preservation surgery but at least should be a subtotal colectomy and we must remember that almost all patients with ulcerative proctitis have while working.
Question No 36
A 87 year old patient with a history of chronic bronchitis and heart failure, has been diagnosed with acute gallstone cholecystitis. After four days of treatment with oral intake, serum therapy and piperaciliana / tazobactam, the patient continued with fever, persistent abdominal pain and leukocytosis.
The proper attitude at this point would be:
1.Tratamiento surgery (cholecystectomy urgent)
2-biliary drainage by percutaneous cholecystostomy.
3.Sustituir the piperaciliana / tazobactam and cefotaxime + metronidazole.
4.Sustituir the piperaciliana / tazobactam and amikacin + clindamycin.
5.Add gentamicin.
I think the answer is 2 although the treatment of acute cholecystitis is cholecystectomy, this requires that the patient is a surgical candidate, in this case is an elderly patient with pre-existing conditions that increase surgical risk ASA IV would be a fig a urgent intervention. In these cases, cholecystectomy cholecystitis can heal, and after recovery, to assess the elective surgery as the patient's situation
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