A 33-year-old woman comes to the emergency department because of a 1-hour history of severe pelvic pain and nausea. She was diagnosed with a follicular cyst in the left ovary 3 months ago. The cyst was found incidentally during a fertility evaluation. A pelvic ultrasound with Doppler flow shows an enlarged, edematous left ovary with no blood flow. Laparoscopic evaluation shows necrosis of the left ovary, and a left oophorectomy is performed. During the procedure, blunt dissection of the left infundibulopelvic ligament is performed. Which of the following structures is most at risk of injury during this step of the surgery?
ABladder trigone
BUterine artery
CKidney
DUreter
During the course of investigation of a suspected abdominal aortic aneurysm in a 57-year-old woman, a solid 6 × 5 cm mass is detected in the right kidney. The abdominal aorta reveals no abnormalities. The patient is feeling well and has no history of any serious illness or medication usage. She is a 25-pack-year smoker. Her vital signs are within normal limits. Physical examination reveals no abnormalities. Biopsy of the mass shows renal cell carcinoma. Contrast-enhanced CT scan indicates no abnormalities involving contralateral kidney, lymph nodes, lungs, liver, bone, or brain. Which of the following treatment options is the most appropriate next step in the management of this patient?
ASunitinib
BRadiation
CNephrectomy
DInterferon-ɑ (IFN-ɑ)
EInterleukin 2 (IL-2)
Eight hours after undergoing an open right hemicolectomy and a colostomy for colon cancer, a 52-year-old man has wet and bloody surgical dressings. He has had episodes of blood in his stools during the past 6 months, which led to the detection of colon cancer. He has hypertension and ischemic heart disease. His younger brother died of a bleeding disorder at the age of 16. The patient has smoked one pack of cigarettes daily for 36 years and drinks three to four beers daily. Prior to admission, his medications included aspirin, metoprolol, enalapril, and simvastatin. Aspirin was stopped 7 days prior to the scheduled surgery. He appears uncomfortable. His temperature is 36°C (96.8°F), pulse is 98/min, respirations are 14/min, and blood pressure is 118/72 mm Hg. Examination shows a soft abdomen with a 14-cm midline incision that has severe oozing of blood from its margins. The colostomy bag has some blood collected within. Laboratory studies show: Hemoglobin 12.3 g/dL Leukocyte count 11,200/mm3 Platelet count 210,000/mm3 Bleeding time 4 minutes Prothrombin time 15 seconds (INR=1.1) Activated partial thromboplastin time 36 seconds Serum Urea nitrogen 30 mg/dL Glucose 96 mg/dL Creatinine 1.1 mg/dL AST 48 U/L ALT 34 U/L γ-Glutamyltransferase 70 U/L (N= 5–50 U/L) Which of the following is the most likely cause of this patient's bleeding?
AFactor VIII deficiency
BLiver dysfunction
CErosion of blood vessels
DInsufficient mechanical hemostasis
EPlatelet dysfunction
+ 7 more in the PDF
Browse all chapters