Soal Bedah Thoraks & Vaskuler

1.A 55-year-old woman gives a history of tiredness, aching, and a feeling of heaviness in the left lower leg for the past 3 months. These symptoms are relieved by leg elevation. She is also awakened frequently by calf and foot cramping, which is relieved by leg elevation, walking, or massage. On physical examination there are superficial varicosities, nonpitting edema, and a slightly painful, 2 cm. diameter superficial ulcer 5 cm. above and behind the left medial malleolus. What is the most appropriate diagnosis? A. Isolated symptomatic varicose veins. B. Superficial lymphatic obstruction. C. Deep venous insufficiency. D. Arterial insufficiency. E. Incompetent perforating veins. 2. The best treatment plan for the patient described in the preceding question should include: A. Varicose vein ligation and stripping as soon as possible. B. Ulcer dbridement, vein stripping, and skin grafting. C. Ligation of the medial perforating veins. D. Transposition of saphenous vein valve. E. Leg elevation, external Unna boot support, and ambulation without standing. 3. In patients who develop a documented episode of deep venous thrombosis (DVT) the most significant long-term sequela is: A. Claudication. B. Recurrent foot infections. C. Development of stasis ulcer. D. Pulmonary embolization. E. Diminished arterial perfusion. 4. A 28-year-old woman developed a painful thrombosis of a superficial varix in the left upper calf 2 days previously. After spending the 2 days in bed with her leg elevated, she felt better and the tenderness resolved; however, when out of bed she developed a twinge of right-sided chest pain when walking and a feeling of heaviness in the calf. Which treatment is most appropriate? A. Check for leg swelling, tenderness, and Homan's sign, and obtain a Doppler ultrasound study. B. Begin antibiotics for a probable secondary bacterial infection. C. Order emergency venography, and if it is abnormal, begin heparin administration. D. Begin ambulation and discontinue bed rest that probably caused muscle pain by hyperextension of the knee. E. If there is no pain on dorsiflexion of the left foot reassure her, since a negative Homan's sign precludes the diagnosis of DVT.

5. In a 55-year-old grocery store cashier with an 8-month history of leg edema increasing over the course of a work day, associated with moderate to severe lower leg bursting pain, the most appropriate investigative study or studies are: A. Doppler duplex ultrasound. B. Brodie-Trendelenburg test. C. Ascending and descending phlebography. D. Measurement of ambulatory and resting foot venous pressure. E. Venous reflux plethysmography 6. Which of the following statements are true of pulmonary embolism? A. Most cases occur postoperatively. B. In the majority of patients pulmonary emboli are ultimately lysed in situ without the administration of pharmacologic agents. C. The preferred therapy for most patients is intravenous heparin. D. It is generally safe to give thrombolytic agents as early as 48 hours postoperatively. 7. Which of the following can cause a radioactive pulmonary perfusion scan to demonstrate an appearance similar to that of acute pulmonary embolism? A. Atelectasis. B. Pneumonitis. C. Pleural fluid. D. Emphysematous bullae. 8. In an otherwise healthy male with previously normal pulmonary and cardiac function, how much of the pulmonary vascular bed must usually be occluded to produce an unstable cardiovascular state (shock)? A. 10%. B. 20%. C. 40%. D. More than 50%. 9. Lytic therapy in pulmonary embolism: A. Should precede anticoagulation. B. Can be considered for all patients. C. Can be considered for hemodynamically unstable patients. D. Is indicated for the majority of patients with documented pulmonary embolism. 10. The single most important indication for emergency pulmonary embolectomy is: A. The likelihood of another episode of embolism. B. The inability to determine whether the problem is acute pulmonary embolism or acute myocardial infarction. C. The presence of persistent and intractable hypotension.

D. Pulmonary emphysema. 11. In prevention of the fat emboli syndrome the primary therapy can be accomplished by which of the following? A. Systemic anticoagulation achieving a partial thromboplastin time greater than 50 seconds. B. Intravenous administration of alcohol. C. Prophylactic administration of methyl prednisolone. D. Maintaining a serum albumin value greater than 3 gm. per 100 ml. in the days immediately following injury.

12.Which of the following statements about acute arterial occlusion today is/are not true? A. Most arterial emboli originate in the heart as a result of underlying cardiac disease. B. It can be treated under local anesthesia. C. It is usually due to atherosclerotic disease. D. Surgical treatment can usually be avoided if the lesion is diagnosed early. 13.Which of the following is/are not true of the embolectomy catheter technique? A. The balloon should be inflated by the same person who withdraws the catheter. B. Distal exploration should be carried out in all major branches of the affected extremity. C. The balloon is designed to dilate as it traverses areas of luminal narrowing. D. Removal of adherent thrombus requires alternate catheter-based therapy in addition to balloon exploration. 14.Flexible bronchoscopy is preferred over rigid bronchoscopy for all of the following except: A. Patients with cervical spine injuries requiring intubation. B. The evaluation of a smoke inhalation injury. C. Transcarinal needle aspiration of an enlarged subcarinal lymph node. D. The removal of a bronchus intermedius foreign body from an infant. E. A cost-effective evaluation of mild hemoptysis. 15. Which of the following approaches is/are currently acceptable for the management of spontaneous pneumothorax? A. Chest tube replacement alone for the patient with a first episode. B. Operation on presentation for any patient with a first episode. C. Video-assisted thoracic surgery (VATS) bleb excision and pleurodesis for recurrent pneumothorax on the same side. D. Thoracotomy with bleb excision and pleurodesis for unilateral recurrent pneumothorax. E. Operation after a first episode in an airline pilot. 16.Which of the following statements are true? A. Pyogenic lung abscess occurs most frequently in the lower lobe of the left lung. B. Anaerobic bacteria are commonly present in pyogenic lung abscess.

C. Operation is usually required to eradicate a pyogenic lung abscess. D. Penicillin is the treatment of choice for lung abscess. 17.Which of the following statements are true? A. The pleural space does not extend into the neck. B. Positive intrapleural pressures as high as 40 cm. H 2O and negative pressures as low as -40 cm. H 2O are possible. C. The pleural cavities cannot absorb more than 500 ml. of fluid per day. D. All pleural effusions are of clinical significance and should be investigated. 18. Which of the following statements are true? A. Chylothorax, or chyle in the pleural cavity, usually is not a serious condition. B. Chyle is easily identified by its milky appearance, which looks like no other kind of pleural effusion. C. The commonest causes of chylothorax are trauma and tumor. D. The thoracic duct can be ligated with impunity. 19.Which of the following statements about spontaneous pneumothorax (PSP) is/are correct? A. The risk of recurrence after resolution of the first episode of PSP or secondary spontaneous pneumothorax (SSP) is 35% to 45%. B. Patients with PSP are typically tall, thin, young adult males with a history of smoking. C. Secondary spontaneous pneumothorax is associated with family history in 10% of cases. D. For bleb resection and pleurodesis thoracoscopic thoracotomy and open thoracotomy provide similar cure rates for patients with primary spontaneous pneumothorax. E. Causes of secondary pneumothorax include trauma and iatrogenic needle puncture. 20.Which of the following would not be acceptable sequences of preoperative studies in a patient being prepared for lingulectomy for bronchiectasis? A. CT alone. B. CT, bronchoscopy, bronchography. C. Bronchoscopy alone. D. Bronchoscopy, bronchography. 21.All of the following may be acceptable operative approaches to management of the thoracic outlet syndrome except: A. Scalenectomy. B. Excision of a cervical rib. C. Thoracoplasty. D. First rib resection. E. Division of anomalous fibromuscular bands.

22.A 24-year-old male has new onset of chest pain. Chest films demonstrate a large anterosuperior mass. Appropriate evaluation should include: A. CT of the chest. B. Measurement of serum alpha-fetoprotein and betahuman chorionic gonadotropin. C. A barium swallow. D. A myelogram. 23.Which of the following would be the least appropriate in the management of acute suppurative mediastinitis? A. Wide dbridement. B. Irrigation under pressure. C. Topical antibacterials. D. Long-term systemic antibacterials. E. Closure with muscle flaps. 24. Each of the following is appropriate for managing acute suppurative mediastinitis except: A. Alloplastic material and skin flaps. B. Rectus abdominis muscle flaps. C. Omentum. D. Pectoralis major muscle flaps. E. Rigid internal fixation. 25.Clinical features suggestive of myasthenia gravis include all of the following except: A. Proximal muscle weakness. B. Diplopia. C. Sensory deficits of the extremities. D. Dysphagia.