82 80 yo male with a history of symptomatic

82. 80 y/o male with a history of symptomatic cholelythiasis presents with signs
and symptoms of small bowel obstruction. which of following would
provide the most help in ascertaining the diagnosis?
A. coffee ground aspirate from stomach
B. pneumobilia
C. WBC count of 40000/ml
D. pH 7.5, pCO2 50 and paradoxically acid urine
E. palpable mass in the pelvis

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83. A 22 y/o female is seen in surgery clinic for a bulge in the right groin. She
denies pain and able to make the bulge disappear by lying down and putting
steady pressure on the bulge. She never experienced nausea or vomiting. on
exam she had reducible hernia below the inguinal ligament. Which of the
following is the most appropriate management of the patient?
A. observation for now and follow up in surgical clinic in 6 months
B. observation for now and follow up in surgical clinic if she develops
further symptoms
C. elective surgical repair of the hernia
D. emergent surgical repair of the hernia
E. emergent surgical repair of the hernia and exploratory laparotomy to
evaluate small bowel.
84. 80 y/o male is admitted to the hospital complaining of nausea, abdominal
pain, distention and diarrhea. a cautiously preformed transnasal contrast
study reveals apple core configuration in the rectosigmoid area. Which of
the following is the most appropriate next step in his management?
A. colonoscopic decompression and rectal tube placement
B. saline enemas and digital disimpaction of fecal matter from the rectum
C. colon resection and proximal colostomy
D. oral administration of metronidazole and Clostridium Difficile titers
E. evaluation of an electrocardiogram and obtaining an angiogram to
evaluate for colonic mesenteric ischemia
85. A 30 y.o p who presents with diarrhea and abdom. Discomfort is found at
colonscopy to have colitis confiend to the transverse and descdnding colon.
A biopsy diagnostic is performed. Wich of the following is a finding
consistent with this patientdiagnostic?
A. The inflamatory process is confined to the mucoasa and submucoasa.
B. The inflamatory reaction is likely to be continuos
C. Superficial as aapposed to linear ulcerationcanpe expected.
D. Nonceatinggranulamos can be expected in up to 50% of patients
E. Microabcesses with crypts are comon.

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86. 54 y.o man complains that his eyes are yellow his bilirubin level is elevated.
His physical exam. Is unremarkabel. a CT Scan of the abdomin shows a
small mass in the head of the pancreas ehcasing the superior mesenteric
arterycytology from ERCP is pozitiv for cancer. Wich of the following is the
most appropiate treat. For this patient?
A. pancreaticoduodenectomy
B. pancreaticoduodenectomy with reconstruction of the superior mesenteric
artery
C. distalpancreatectomy
D. distalpancreatectomy with reconstruction of the superior mesenteric
artery
E. chemoradiation therapy
87. A 28 Y.O woman ppresents with hematochezia she is admitted to the
hospital and undergoes upper endoscopy that is negativ. Colonscopy is
performed and no bleeding sources are identifed, although the
gastroenterelogist notes blood in the right colon and old blood coming from
above the ileocecal valve. Wich of the following the test of choice in this
patient?