NPSA 2018 2nd Session

1. A patient with carcinoid tumor becomes hypotensive intraoperatively but does not respond to fluids, phenylephrine, or vasopressin. Which of the following is an appropriate next step?

Ignore the hypotension- it should resolve without intervention

Administer a beta-adrenergic agonist

Give 2 units of packed red blood cells, as the hypotension must be secondary to blood loss

Keep administering phenylephrine until there is a response

2. A 60 year old patient presents with a left sided pheochromocytoma. They would like to know if their tumor can be removed laparoscopically. They have no prior history of abdominal surgery. What percent of patients are able to undergo a laparoscopic adrenal

60%

70%

90%

100%

3. A patient undergoes sentinel node biopsy of an axillary node for melanoma and presents on their post op visit with a slightly tender 5 cm swelling under the incision without bruising/cellulitis. US.shows smooth fluid collection. The most likely dx is:

Seroma

Hematoma

Abscess

Lympocele

4. Which sociodemographic variable was reported less than 50% of the time in prospective research studies examined?

Age

Education Level

Sex

Race

5. A patient has a CT demonstrating mid-jejunal mass consistent with small bowel adenocarcinoma and peritoneal nodules concerning for peritoneal carcinomatosis. What is the median overall survival (OS) you would quote when discussing CRS/HIPEC for treatment?

Median OS less than 10 months

Median OS between 10-20 months

Median OS between 20-30 months

Median OS beyond 30 months

6. A 69 year old woman with non-metastatic carcinoid tumor of the terminal ileum is undergoing a right hemicolectomy for definitive treatment of her carcinoid and becomes hypotensive intraoperatively. Which pressor is the most appropriate first choice?

Epinephrine

Ephedrine

Dobutamine

Phenylephrine