ABSITE 2020 Questions And Answers Graded
A
How to monitor esophageal pH? Correct Answer: 1) Wireless probe placed 5 cm above the LES for
48 hr or 2) NG tube with multiple probes for 24 hr (more accurate). Percent time w/pH <4 recorded,
number of episodes, and duration -- semester score is a composite with abnormal being >14.72
Types of esophageal diverticuli (true/false, location) Correct Answer: Pulsion- not true diverticula (do
not contain all layers of the esophageal wall) and occur either proximally at the cricopharygneus
muscle (Zenker's) or distal esophagus
Traction- true diverticuli and occur in the mid-esophagus due to an inflammatory process with LNs
putting traction on the esophagus
Management of rectovaginal fistula Correct Answer: High: transabdominal
Low or mid-low: endorectal advancement
Wait at least 3-6 mo for repair to decrease inflammation.
Location of the splenic artery and vein in relation to the pancreas Correct Answer: Artery: inferior;
Vein: posterior or within the pancreas
Nerve innervation of the external anal sphincter Correct Answer: Rectal branch of the internal
pudendal and the perineal branch of S4. Anal canal lengthens with contraction.
Classification and management of femoral neck fractures Correct Answer: Garden classification
system. I: not a complete fracture, early mobilization under a physical therapist (secondary
dislocation can occur 10-50% of the time leading to additional repair) or screw fixation; II: complete fx
but no dislocation: screw; III: partial dislocation and IV complete dislocation -- both need arthroplasty
(anatomic reduction and fixation)
Major effect of corticosteroids Correct Answer: Block transcription of cytokine gene transcription in
macrophages including: IL-2, TNF, IL-6
Action of factor C Correct Answer: Proteolysis of factor Va and VIIIa
What is the maximal amount of air that can be exhaled? Correct Answer: Vital capacity
Physiologic changes in pregnancy: HR, BP, intravascular volume Correct Answer: HR goes up, BP
goes down, intravascular volume goes up
% of blood loss in a pregnant before signs of shock Correct Answer: 35% of circulating blood volume
Crohn's medications for moderately active Crohn's and helpful with treating persistent perianal
fistulas Correct Answer: Infliximab -- monoclonal chimeric antibody to TNF
Most common locations for glucagonoma, insulinoma, gastrinoma, somatostatinoma, and VIPoma
Correct Answer: Glucagonoma: body and tail; Insulinoma evenly distributed in the pancreas, VIPoma
in the tail, Somatostatinoma in the head, and Gastinoma in the triangle
,What is the Cori cycle? Correct Answer: The recycling of lactate and pyruvate for gluconeogenesis by
the liver -- can provide up to 40% of plasma glucose during starvation
What is a klatskin tumor? Correct Answer: Cholangiocarcinoma at the hilum
What is the step-up approach for necrotizing pancreatitis? Correct Answer: First drain (either perc
drain or endoscopic transgastric) and if not improved in 72 hr, look for other places to drain and drain,
and if not improved in another 72 hr: VARDs with postoperative lavage. + Abx of course
Rate of choledocholithiasis in cholecystectomies Correct Answer: 4-11%
Most common artery to be profused by the false lumen in a aortic dissection Correct Answer: the left
renal
What is Petersen's space? Correct Answer: The space btwn the alimentary limb and the transverse
mesocolon at the level of the jj where an internal hernia can occur.
When does collagen amount peak in the wound? What collagen predominates? Correct Answer:
Week 3. Collagen III peaks early but then replaced by type I.
Phases of skin graft healing? Correct Answer: 1) Plasmatic imbibition (24-48 hr) 2) innosculation and
capillary ingrowth 3) revascularizaiton
Standard of care for treatment of stage III rectal cancer Correct Answer: 1) neoadjuvant chemo/rads
2) resection 3) chemo and then surveillance with CEA every 3-6 mo for 2 years then annually for 3
years, colonoscopy within one year and pelvic CT every year for 5 years
Where does esophageal perforation occur in Boerhave syndrome? Correct Answer: In the distal
esophagus on the left
Billroth I vs II vs roux-en-y reconstruction anatomy and pros/cons Correct Answer: I:
gastroduodenostomy with end of duodenum re-anastomosed to distal greater curve after antrectomy;
II: gastrojejunostomy created but no j-j needed because more proximal jejunum -- done if adequate
reach w/o tension of duo for BI; rny: loop of jejunum brought up to the stomach and anastomosis
done to the stomach and then also jj. BI prevents afferent limb syndrome (obstruction). RNY good if
pts can't tolerate BII -- less reflux but can get gastric atony.
Where are Delphian nodes located? Correct Answer: Within the anterior suspensory ligament in the
prelarygneal position in the midline.
Procedures for anal incontinence Correct Answer: Wrap-around sphincteroplasty where the sphincter
is mobilized and reapproximated without tension -- most common. Can do a gracilis transposition with
constant low freq stimulation but that's usually for recurrent/refractory cases
SBP -- organism(s) that cause, treatment, prophylactic treatment?, mortality rate Correct Answer:
Usually one gram neg organism, treat with 3rd gen cephalo or fluoroquinolone, prophylactic treatment
for cirrhotics w/h/o SBP, low protein (<15 g/L) ascites, GI hemorrhage, and mortality is 20-40%
How long is the rectum Correct Answer: 15 cm
, Where is procollagen formed? Correct Answer: fibroblasts
Phases of cardiac tamponade Correct Answer: Phase 1: diastolic ventricular filling pressures
decrease but compensatory mechanisms at work to sustain cardiac output (increased filling
pressures, increased HR, increased SVR)
Phase II: first signs of shock
Phase III: ventricular filling pressures approaches intrapericardial pressures
Why was the vertical banded gastroplasty abandoned? Correct Answer: Due to weight regain
Contraindication(s) to meperidine and reasoning Correct Answer: Pts with hepatic or renal
dysfunction b/c meperidine forms a toxic metabolic normeperidine, with a longer half life than
meperidine, -- can cause difficult to control life-threatening seizures
Grades of internal hemorrhoids Correct Answer: 1) bleeding w/o prolapse, 2) prolapse that
spontaneously reduces, 3) prolapse that needs to be manually put back in, 4) irreducible (1 & 2 &
most 3s can be treated with measures to reduce constipation)
Contraindications to ketamine Correct Answer: 1) increased ICP (increases cerebral blood flow), 2)
open eye injuries (increases IOP), 3) as sole anesthetic for pts w/ischemic heart dz (increases
myocardial O2 consumption due to HTN and tachycardia), 4) intrathecal or epidural administration
(neurotoxic preservative)
Types/location of gastric ulcers Correct Answer: 1) lesser curve 2) two ulcers -- one at lesser curve
and one duodenum 3) prepyloric 4) cardia 5) from NSAIDs (2 &3 from high acid)
Leriche syndrome Correct Answer: Bilateral buttock claudication, impotence, and absent femoral
pulse seen with aortic-iliac atherosclerotic dz
Size at which to intervene for popliteal aneurysm Correct Answer: 2 cm -- ligate and bypass
Should radial scars undergo excision? Correct Answer: According to truelearn if > 6mm
Where are mucinous cystic neoplasms usually found? Correct Answer: the body and tail of the
pancreas
Treatment for fibromuscular dysplasia Correct Answer: just angioplasty (unlike RAS, which is treated
with angioplasty and stenting)
MoA of doxorubicin Correct Answer: Inhibits DNA synthesis by inhibition of topoisomerase II
What is a modified Hanley approach? Correct Answer: Drainage of horseshoe abscess with seton
from anal verge extending laterally on either side.
What lung cancers are related to the following paraneoplastic syndromes: ACTH, ADH, and PTH?
Correct Answer: ACTH and ADH are small cell and PTH is squamous
Pathophysiology of ischemic colitis Correct Answer: Arterioles of the colon are affected and can be
due to hypercoagulable states, infection, embolic phenomenon, vasculitis, or cocaine
A
How to monitor esophageal pH? Correct Answer: 1) Wireless probe placed 5 cm above the LES for
48 hr or 2) NG tube with multiple probes for 24 hr (more accurate). Percent time w/pH <4 recorded,
number of episodes, and duration -- semester score is a composite with abnormal being >14.72
Types of esophageal diverticuli (true/false, location) Correct Answer: Pulsion- not true diverticula (do
not contain all layers of the esophageal wall) and occur either proximally at the cricopharygneus
muscle (Zenker's) or distal esophagus
Traction- true diverticuli and occur in the mid-esophagus due to an inflammatory process with LNs
putting traction on the esophagus
Management of rectovaginal fistula Correct Answer: High: transabdominal
Low or mid-low: endorectal advancement
Wait at least 3-6 mo for repair to decrease inflammation.
Location of the splenic artery and vein in relation to the pancreas Correct Answer: Artery: inferior;
Vein: posterior or within the pancreas
Nerve innervation of the external anal sphincter Correct Answer: Rectal branch of the internal
pudendal and the perineal branch of S4. Anal canal lengthens with contraction.
Classification and management of femoral neck fractures Correct Answer: Garden classification
system. I: not a complete fracture, early mobilization under a physical therapist (secondary
dislocation can occur 10-50% of the time leading to additional repair) or screw fixation; II: complete fx
but no dislocation: screw; III: partial dislocation and IV complete dislocation -- both need arthroplasty
(anatomic reduction and fixation)
Major effect of corticosteroids Correct Answer: Block transcription of cytokine gene transcription in
macrophages including: IL-2, TNF, IL-6
Action of factor C Correct Answer: Proteolysis of factor Va and VIIIa
What is the maximal amount of air that can be exhaled? Correct Answer: Vital capacity
Physiologic changes in pregnancy: HR, BP, intravascular volume Correct Answer: HR goes up, BP
goes down, intravascular volume goes up
% of blood loss in a pregnant before signs of shock Correct Answer: 35% of circulating blood volume
Crohn's medications for moderately active Crohn's and helpful with treating persistent perianal
fistulas Correct Answer: Infliximab -- monoclonal chimeric antibody to TNF
Most common locations for glucagonoma, insulinoma, gastrinoma, somatostatinoma, and VIPoma
Correct Answer: Glucagonoma: body and tail; Insulinoma evenly distributed in the pancreas, VIPoma
in the tail, Somatostatinoma in the head, and Gastinoma in the triangle
,What is the Cori cycle? Correct Answer: The recycling of lactate and pyruvate for gluconeogenesis by
the liver -- can provide up to 40% of plasma glucose during starvation
What is a klatskin tumor? Correct Answer: Cholangiocarcinoma at the hilum
What is the step-up approach for necrotizing pancreatitis? Correct Answer: First drain (either perc
drain or endoscopic transgastric) and if not improved in 72 hr, look for other places to drain and drain,
and if not improved in another 72 hr: VARDs with postoperative lavage. + Abx of course
Rate of choledocholithiasis in cholecystectomies Correct Answer: 4-11%
Most common artery to be profused by the false lumen in a aortic dissection Correct Answer: the left
renal
What is Petersen's space? Correct Answer: The space btwn the alimentary limb and the transverse
mesocolon at the level of the jj where an internal hernia can occur.
When does collagen amount peak in the wound? What collagen predominates? Correct Answer:
Week 3. Collagen III peaks early but then replaced by type I.
Phases of skin graft healing? Correct Answer: 1) Plasmatic imbibition (24-48 hr) 2) innosculation and
capillary ingrowth 3) revascularizaiton
Standard of care for treatment of stage III rectal cancer Correct Answer: 1) neoadjuvant chemo/rads
2) resection 3) chemo and then surveillance with CEA every 3-6 mo for 2 years then annually for 3
years, colonoscopy within one year and pelvic CT every year for 5 years
Where does esophageal perforation occur in Boerhave syndrome? Correct Answer: In the distal
esophagus on the left
Billroth I vs II vs roux-en-y reconstruction anatomy and pros/cons Correct Answer: I:
gastroduodenostomy with end of duodenum re-anastomosed to distal greater curve after antrectomy;
II: gastrojejunostomy created but no j-j needed because more proximal jejunum -- done if adequate
reach w/o tension of duo for BI; rny: loop of jejunum brought up to the stomach and anastomosis
done to the stomach and then also jj. BI prevents afferent limb syndrome (obstruction). RNY good if
pts can't tolerate BII -- less reflux but can get gastric atony.
Where are Delphian nodes located? Correct Answer: Within the anterior suspensory ligament in the
prelarygneal position in the midline.
Procedures for anal incontinence Correct Answer: Wrap-around sphincteroplasty where the sphincter
is mobilized and reapproximated without tension -- most common. Can do a gracilis transposition with
constant low freq stimulation but that's usually for recurrent/refractory cases
SBP -- organism(s) that cause, treatment, prophylactic treatment?, mortality rate Correct Answer:
Usually one gram neg organism, treat with 3rd gen cephalo or fluoroquinolone, prophylactic treatment
for cirrhotics w/h/o SBP, low protein (<15 g/L) ascites, GI hemorrhage, and mortality is 20-40%
How long is the rectum Correct Answer: 15 cm
, Where is procollagen formed? Correct Answer: fibroblasts
Phases of cardiac tamponade Correct Answer: Phase 1: diastolic ventricular filling pressures
decrease but compensatory mechanisms at work to sustain cardiac output (increased filling
pressures, increased HR, increased SVR)
Phase II: first signs of shock
Phase III: ventricular filling pressures approaches intrapericardial pressures
Why was the vertical banded gastroplasty abandoned? Correct Answer: Due to weight regain
Contraindication(s) to meperidine and reasoning Correct Answer: Pts with hepatic or renal
dysfunction b/c meperidine forms a toxic metabolic normeperidine, with a longer half life than
meperidine, -- can cause difficult to control life-threatening seizures
Grades of internal hemorrhoids Correct Answer: 1) bleeding w/o prolapse, 2) prolapse that
spontaneously reduces, 3) prolapse that needs to be manually put back in, 4) irreducible (1 & 2 &
most 3s can be treated with measures to reduce constipation)
Contraindications to ketamine Correct Answer: 1) increased ICP (increases cerebral blood flow), 2)
open eye injuries (increases IOP), 3) as sole anesthetic for pts w/ischemic heart dz (increases
myocardial O2 consumption due to HTN and tachycardia), 4) intrathecal or epidural administration
(neurotoxic preservative)
Types/location of gastric ulcers Correct Answer: 1) lesser curve 2) two ulcers -- one at lesser curve
and one duodenum 3) prepyloric 4) cardia 5) from NSAIDs (2 &3 from high acid)
Leriche syndrome Correct Answer: Bilateral buttock claudication, impotence, and absent femoral
pulse seen with aortic-iliac atherosclerotic dz
Size at which to intervene for popliteal aneurysm Correct Answer: 2 cm -- ligate and bypass
Should radial scars undergo excision? Correct Answer: According to truelearn if > 6mm
Where are mucinous cystic neoplasms usually found? Correct Answer: the body and tail of the
pancreas
Treatment for fibromuscular dysplasia Correct Answer: just angioplasty (unlike RAS, which is treated
with angioplasty and stenting)
MoA of doxorubicin Correct Answer: Inhibits DNA synthesis by inhibition of topoisomerase II
What is a modified Hanley approach? Correct Answer: Drainage of horseshoe abscess with seton
from anal verge extending laterally on either side.
What lung cancers are related to the following paraneoplastic syndromes: ACTH, ADH, and PTH?
Correct Answer: ACTH and ADH are small cell and PTH is squamous
Pathophysiology of ischemic colitis Correct Answer: Arterioles of the colon are affected and can be
due to hypercoagulable states, infection, embolic phenomenon, vasculitis, or cocaine
