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Flashcards in Pre Midterm Deck (19)
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1

46/M suffered 2nd degree burns on the whole anterior trunk and perineal area. How much is the calculated TBSA affected in this patient?

19%

whole anterior trunk: 18%
perineal: 1%

2

If the patient weighs 60kg, what will be the appropriate rate of fluid rescucitation for the patient?

285cc/hr for the first 8 hrs LRS

Parkland= 4cc/kg (x weight) x TBSA

4cc x 60kg x 19% administered in 24 hrs

3

What serum electrolyte level is deranged in Refeeding syndrome?

Phosphate

Refeeding syndrome occurs with rapid and excessive feeding of patients with severe malnutrition, starvation, anorexia nervosa. This is due to a shift in metabolism from fat to CHO substrate which stimulates insulin release and eventually cellular uptake of electrolytes (Phosphate, magnesium, Calcium, Potassium)

4

36/M was stabbed in the right lateral chest area, presented in respiratory distress, decreased breath sounds at the right hemithorax; tachycardic and hypotensive with BP of 70/50. What is likely diagnosis?

Tension pneumothorax

The diagnosis of tension pneumothorax is implied by resp distress and hypotension in combination with any physical signs in patients with chest trauma: tracheal deviation away from the affected side, decreased breath sounds on affected side, subcutaneous emphysema on the affected side.

5

The immediate surgical management for tension pneumothorax:

Needle tube thoracostomy at 2nd ICS MCL

Immediate is needle tube thoracostomy (2nd ICS, MCL). Definitive is CTT (4th-5th ICS, MAL)

6

Test used to confirm the diagnosis of burn wound sepsis.

Wound culture

7

What clinical condition is most often confused with acute appendicitis in pediatric age group?

Acute mesenteric adenitis

Patients usually have a history of URTI, pain is diffuse and not as sharp in acute appendicitis. Voluntary guarding is sometimes present, but true rigidity is rare.

8

Most prevalent congenital anomaly of the GI tract.

Meckel's diverticulum

Meckel's diverticulum contains all layerss-making it a true diverticulum; Gastric mucosa is the most common appearing heterotopic mucosa, 2nd is pancreatc acini; Bleeding is the most common presentation in children, obstruction most common for adults; Meckel's is remnant of omphalomesenteric/vitelline duct.

9

46/F has a painful solitary nodule. which of the following conditions can be considered?
a. Intra thyroidal hemorrhage
b. Thyroiditis
c. Malignancy

All are correct.
a. Intra thyroidal hemorrhage
b. Thyroiditis
c. Malignancy

Solitary thyroid nodule are usually painless. If it presents with pain, consider hemorrhage in to benign thyroid lesion, thyroiditis, or malignancy.

10

What diagnostic imaging of choice is used to differentiate rectus diastasis from a true ventral hernia?

CT scan

Diastasis recti is the clinically evident separation of rectus abdominis muscle pillars resulting to a bulging of the abdominal wall in the epigastrium; it can be congenital, associated with obesity.

11

Positive test for rectus sheath hematoma.

A. Tillaux test
B. Prehn sign
C. Goldflamm's
D. Fothergill sign
E. Cullen's sign

Fothergill sign

Tillaux sign-messenteric mass (a mass which is only movable in the horizontal direction;

Prehn sign- diffferntiate between orchitis/epididimytis (+) vs torsion (-), prehn sign is relief of testicular pain when one elevates the testis;

Goldflamm's (Costovertebral angle tenderness-used for acute pyelonephritis);

Fothergill sign- rectus sheath hematoma (a palpable abdominal mass that remains unchanged with contraction of the rectus muscles);

Cullen's sign-acute pancreatitis

12

Type of thyroid malignancy that has a propensity for hematogenous spread.

Follicular

Papillary: lymphatic

13

Based on Modified johnson classification of gastric ulcer, what type is located near the angular incisure on the lesser curvature and is also the most common?

type I

1- angular incisura location, assoc with decreased or normmal acid secretion, also the most common;
2-same with type 1 + an active/quiscent duodenal ulcer, assoc with normal to increased acid secretion;
3-prepyloric disease with normal to increased gastric acid secretion;
4-ge junction ajd acid secretion is low to normal; V-nsaid induced, anywhere in the stomach.

14

This cytokine is responsible for muscle breakdown and cachexia:
A) Il-1 B) IL-2 C) IL-6
D) IL-8 E) TNF-A

E) TNF-A

IL-1- induces fever through prostaglandins; IL2- promotes lymphocyte prolif, and Ig production, IL-6 mediator of acute phase reactants; IL 8-cheomatractant for neutrophils

15

Which is not included in the four life threatening injuries that must be identified in the primary survey for circulation?
A. Hemothorax of 1200 cc
B. Cardiac tamponade
C. Massive hemoperitoneum
D. Mechanically unstable pelvic fractures
E. All are included.

A. Hemothorax of 1200 cc

It should be massive hemothorax (>1500).

16

The following statements regarding wound care is/are true, except?
A. Lacerated wounds located on the face for more than 24 hours should be immediately closed.
B. Any suture with pus or signs of infection should be removed immediately.
C. Sutures located on the face should be removed within 3-5 days.
D. Sutures should be at least 1 cm from the wound edge to prevent pull through.
E. All statements are correct.

A. Lacerated wounds located on the face for more than 24 hours should be immediately closed.

Wounds located on the extremities (>12hours), wounds on the face(>24 hours), infectio, fever, bite wounds, tendon/nerve/vessel involement. These are the contraindications for wound suturing.

17

A 46 year old female have a strong family history of breast cancer.While doing her regular self breast examination, she noticed a hard, painless, non tender lump on her right breast. Upon consult, it was found out to be invasive ductal CA. What
are the contraindications for breast conservation therapy?
A. Prior radiation therapy
B. Post partum
C. diffuse macrocalci`cations
D. multifocal lesion
E. All of the above

A. Prior radiation therapy

The following are CI to BCT:
1. prior RT, 2. pregnant, 3. Positive margins, 4. multicentric, 5. diffuse microcalcifications.

18

Which of the following is true regarding inguinal hernias?
A. Presence of patent processus vaginalis is a predisposing condition
B. Incidence of hernias are equal among both sexes.
C. Femoral hernias are more common in males.
D. The most common type of inguinal hernia in females is femoral hernia.

A. Presence of patent processus vaginalis is a predisposing condition

Incidence of hernias are more common in males, Femoral hernias are more common in females, the most common type of hernia in females are indirect inguinal hernias.

(direct-through the hesselbac's triangle, indirect-lateral to inferior epigastric vessels, femoral-through the femoral ring)

19

A deffective LES sphincter predisposes a patient to developing GERD and complications relatied to it. Which of the following definitions fits a deffective sphincter.?
A. LES pressure of less than 6 mm Hg
B. Overall sphincter length of <2 cm
C. Intraabdominal length of <1 cm
D. A and B is correct.
E. All of the above

All are correct.

When compared to the general subjects, those with GERD are below 2.5 percentile for each parameter. The most common cause of a defective sphincter is inadequate abdominal length.