ABSITE 2021 EXAM QUESTIONS
AND ANSWERS
What is the vascular supply and configuration of the CBD? - Answer-Blood supply is
segmental coming from branches of the cystic, hepatic, and gastroduodenal arteries,
which meet to form collaterals that run in the 3 and 9 o'clock positions
When do you increase the frequency of a medication? The amount? - Answer-When the
trough is low, and when the peak is low respectively
What are the first muscles to become paralyzed with paralytics? What is the first to
recover? - Answer-Facial muscles and diaphragm respectively
Positive DPL criteria - Answer-1) aspirate 10 ml frank blood 2) 100,000 RBCs/ml in
infusate, 3) 500 WBCs/ml in infusate 3) Bacteria on lab exam of infusate 4) elevated
amylase 5) enteric contents
Most common organism cultured from septic thrombophlebitis 2/2 contiguous severe
pharyngitis or peritonsillar abscess - Answer-Fusibacterium necrophorum (gram
negative rod -- gram negative rods or polymicrobial infections are most common cause
of septic thrombophlebitis from secondary, contiguous source
Blood supply of the peritoneum - Answer-Viscera peritoneum is supplied by the
splanchnic vessels while the parietal is supplied by the intercostal, lumbar, and iliac
vessels
UOP desired for adequate resuscitation in adult and pediatric burn pts - Answer-Adults:
0.5-1 cc/kg, and peds: 1-1.5 cc/kg
Most common polypoid lesion of the gallbladder - Answer-Cholesterolosis = cholesterol
laden macrophages in the gallbladder lamina propria, often multiple. Not considered
premalignant
Premalignant lesions of the gallbladder - Answer-Adenomas are the only known ones
What is bleeding typically in the first 24 hr after hemorrhoidectomy? At 5 days? -
Answer-Technical error, needs to go back to OR for exploration vs 5 day eschar
sloughing
, ROTEM, when do transfuse what? - Answer-Long clot time: FFP or PCC; MCF
(maximal clotting factor = clotting strength) if abnormal analyze FIBTEM and if normal
then plts. If FIBTEM abnormal, fibrin problem and give cryo. High lysis index indicates
shows need TXA (Inhibits plasmin)
Essential fatty acids - Answer-linoleic acid and linolenic acid
Inguinal nodes obtained for melanoma - Answer-Can stop at SLN if not clinically
positive and do u/s surveillance q4 mo. But if clinically positive or can't do surveillance:
superficial first with superficial inguinal and superficial femoral but if those positive
extend to deep femoral, obturator, and iliac nodes
Treatment of hyponatremia - Answer-If severe (<120) and acute, treat with bolus of
hypertonic saline (3%) with goal to increase by 4-6 mEq in a couple hours. If mild-
moderate chronic, then fluid restriction, can also employ fluid restriction if asymptomatic.
Alvimopan - Answer-Mu receptor antagonist
Rate of malignancy in main duct IPMN, side duct IPMN, and mucinous cystic neoplasm
- Answer-60% and 25% for side duct if >3 cm and mural nodules, MCN is <15% but 0%
if no mural nodules and <4 cm
Which vitamin has been shown to help wound healing in patients on steroids? - Answer-
A
Enterochromaffin-like cells secrete what? - Answer-Histamine
Most common location for small bowel lymphoma - Answer-Ileum
Where is the hernia sac most often located in an indirect inguinal hernia? - Answer-
Deep to the cremaster muscle, and anterior and superior to the spermatic cord
structures
Initial management of severe ulcerative colitis - Answer-Resuscitation, NG
decompression, systemic steroids (either IV methylpred 20 mg q8 or hydrocortisone 100
mg q8), and +/- IV antibiotics (if fulminant colitis, toxic megacolon, peritoneal signs,
and/or signs of systemic toxicity). Only operate if perforation, life threatening bleeding,
toxic megacolon, fulminant colitis refractory to medical treatment
Types of choledochal cysts and their treatment - Answer-1) Fusiform dilation of the CBD
(90%) -- treat with cyst excision and roux-y hepaticojejunostomy; 2) CBD diverticulum --
treat with cyst excision and closure of the choledochotomy; 3) CBD cyst within the
duodenal -- transduodenal marsupialization or cyst excision; 4) multiple extrahepatic
cyst +/- intrahepatic cysts (b); 5) Caroli's disease
AND ANSWERS
What is the vascular supply and configuration of the CBD? - Answer-Blood supply is
segmental coming from branches of the cystic, hepatic, and gastroduodenal arteries,
which meet to form collaterals that run in the 3 and 9 o'clock positions
When do you increase the frequency of a medication? The amount? - Answer-When the
trough is low, and when the peak is low respectively
What are the first muscles to become paralyzed with paralytics? What is the first to
recover? - Answer-Facial muscles and diaphragm respectively
Positive DPL criteria - Answer-1) aspirate 10 ml frank blood 2) 100,000 RBCs/ml in
infusate, 3) 500 WBCs/ml in infusate 3) Bacteria on lab exam of infusate 4) elevated
amylase 5) enteric contents
Most common organism cultured from septic thrombophlebitis 2/2 contiguous severe
pharyngitis or peritonsillar abscess - Answer-Fusibacterium necrophorum (gram
negative rod -- gram negative rods or polymicrobial infections are most common cause
of septic thrombophlebitis from secondary, contiguous source
Blood supply of the peritoneum - Answer-Viscera peritoneum is supplied by the
splanchnic vessels while the parietal is supplied by the intercostal, lumbar, and iliac
vessels
UOP desired for adequate resuscitation in adult and pediatric burn pts - Answer-Adults:
0.5-1 cc/kg, and peds: 1-1.5 cc/kg
Most common polypoid lesion of the gallbladder - Answer-Cholesterolosis = cholesterol
laden macrophages in the gallbladder lamina propria, often multiple. Not considered
premalignant
Premalignant lesions of the gallbladder - Answer-Adenomas are the only known ones
What is bleeding typically in the first 24 hr after hemorrhoidectomy? At 5 days? -
Answer-Technical error, needs to go back to OR for exploration vs 5 day eschar
sloughing
, ROTEM, when do transfuse what? - Answer-Long clot time: FFP or PCC; MCF
(maximal clotting factor = clotting strength) if abnormal analyze FIBTEM and if normal
then plts. If FIBTEM abnormal, fibrin problem and give cryo. High lysis index indicates
shows need TXA (Inhibits plasmin)
Essential fatty acids - Answer-linoleic acid and linolenic acid
Inguinal nodes obtained for melanoma - Answer-Can stop at SLN if not clinically
positive and do u/s surveillance q4 mo. But if clinically positive or can't do surveillance:
superficial first with superficial inguinal and superficial femoral but if those positive
extend to deep femoral, obturator, and iliac nodes
Treatment of hyponatremia - Answer-If severe (<120) and acute, treat with bolus of
hypertonic saline (3%) with goal to increase by 4-6 mEq in a couple hours. If mild-
moderate chronic, then fluid restriction, can also employ fluid restriction if asymptomatic.
Alvimopan - Answer-Mu receptor antagonist
Rate of malignancy in main duct IPMN, side duct IPMN, and mucinous cystic neoplasm
- Answer-60% and 25% for side duct if >3 cm and mural nodules, MCN is <15% but 0%
if no mural nodules and <4 cm
Which vitamin has been shown to help wound healing in patients on steroids? - Answer-
A
Enterochromaffin-like cells secrete what? - Answer-Histamine
Most common location for small bowel lymphoma - Answer-Ileum
Where is the hernia sac most often located in an indirect inguinal hernia? - Answer-
Deep to the cremaster muscle, and anterior and superior to the spermatic cord
structures
Initial management of severe ulcerative colitis - Answer-Resuscitation, NG
decompression, systemic steroids (either IV methylpred 20 mg q8 or hydrocortisone 100
mg q8), and +/- IV antibiotics (if fulminant colitis, toxic megacolon, peritoneal signs,
and/or signs of systemic toxicity). Only operate if perforation, life threatening bleeding,
toxic megacolon, fulminant colitis refractory to medical treatment
Types of choledochal cysts and their treatment - Answer-1) Fusiform dilation of the CBD
(90%) -- treat with cyst excision and roux-y hepaticojejunostomy; 2) CBD diverticulum --
treat with cyst excision and closure of the choledochotomy; 3) CBD cyst within the
duodenal -- transduodenal marsupialization or cyst excision; 4) multiple extrahepatic
cyst +/- intrahepatic cysts (b); 5) Caroli's disease
