PLE Category: Surgery

PLE-8326

A 45-year-old male crashed his car into another vehicle and was brought to the ER. On physical examination, the patient has multiple bruises over the chest. The chest X-ray showed multiple rib fractures, no pneumohemothorax, and clear lung parenchyma. After two days in the ER, however, the patient started having respiratory distress. A repeat CXR showed a white out of bilateral lungs. Which of the following steps is most important?

PLE-8327

What is considered to be the most effective treatment for a 50-year-old man who presents with a year-long history of heartburn and chest pain, unrelated to food intake? A few weeks prior to the consultation, he developed intermittent dysphagia to both solids and liquids, resulting in weight loss. A barium swallow was performed, revealing a dilated esophagus that tapers smoothly to a beak-like narrowing at the gastroesophageal junction.

PLE-8324

How long should one stop taking aspirin prior to surgery if they are a 48-year-old female with known gallstone disease, obesity, hypertension, and diabetes, and are being maintained on aspirin by their internist to reduce the risk of cardiovascular events?

PLE-8321

A 77-year-old woman is brought to the emergency department after collapsing at home. Six hours ago, she had the sudden onset of massive bright red rectal bleeding. On arrival, her blood pressure is 90/60 mm Hg, and pulse is 120/min. Abdominal examination shows no abnormalities. Insertion of a nasogastric tube yields clear aspirate. Her hematocrit is 28%. What is the most likely diagnosis?

PLE-8322

A previously healthy 85-year-old man has had abdominal distention, decreased caliber of stools, and decreased appetite over the past 2 weeks, and a 9-kg (20-lb) weight loss over the past 3 months. On sigmoidoscopy, he is found to have a constricting adenocarcinoma of the sigmoid colon. Imaging studies show three 1-cm metastases to the liver. Which of the following is the most appropriate next step in management?

PLE-8323

A 32-year-old man is brought to the emergency department 30 minutes after being involved in a motor vehicle collision. He was the restrained driver. On arrival, he is alert and has shortness of breath. His blood pressure is 80/50 mm Hg, pulse is 130/min, and respirations are 30/min. Examination shows jugular venous distention and abrasions over the left hemithorax. The trachea is deviated to the right. Breath sounds are absent on the left. What is the most likely cause of the hypotension?

PLE-8318

Six weeks after spontaneous drainage of an anal abscess, a 32-year-old man has persistent blood-stained purulent fluid on his underwear. He has not had significant anal pain since drainage of the boil. Bowel movements are normal. What is the most likely diagnosis?

PLE-8319

A 32-year-old woman has had a lump in her neck for 6 months. She has a 1.2-cm solitary left thyroid nodule. Fine-needle aspiration cytology of the mass is consistent with a low-grade papillary malignancy. What is the most appropriate next step in management?

PLE-8320

A 75-year-old man has had hypertension for 25 years. There is an unusually prominent pulsation of the abdominal aorta in the upper mid abdomen, and a systolic bruit is heard at this site. Femoral, popliteal, and pedal pulses are present. Which of the following is the most appropriate initial diagnostic study?