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Flashcards in USMLE 2 Deck (25):
1

If a patient has received a complete (3) set of childhood tetanus vaccinations, what immunization is unnecessary? After ___ years without vaccine, which immunization is required for a high risk wound?

Tetanus Immunoglobulin. Administer Tetanus toxoid if it has been more than 5 years since last vaccination.

2

If a patient has not received a complete (3) set of childhood tetanus vaccinations and they suffer a high risk wound, which immunizations are required if it has been 2 years since their last immunization? 7 years? 12 years?

Tetanus Toxoid and Immunoglobulin. No matter how long it's been.

3

In blunt abdominal trauma, what are the three most commonly injured organs (most to least).

Spleen, Liver, Kidney.

4

If a patient receives an upper endoscopy and then becomes sicker, what has happened? What is the next step in management?

Iatrogenic esophageal perforation. Contrast study of the esophagus.

5

Dumping syndrome? What is this a common complication of? Management? Management of resistant cases?

Rapid emptying leads to stimulation of autonomic reflexes - diaphoresis, light headedness, abdominal cramps and weakness.

Post gastrectomy complication.

Dietary modification. Octreotide.

6

Postoperative fever day 6., blood cultures grow Staph. What is the most likely cause? Which is the most likely location of the offending agent?

Intravenous catheter infection. Femoral > subclavian.

7

When a patient climbs a stair, the contralateral hip drops. What is the name of this sign? What muscle is deficient?

Trendelenberg sign. Gluteus muscle weakness.

8

A patient develops a whistling noise after rhinoplasty?

Nasal septal perforation.

9

Air under the diaphragm? Management?

Perforated viscus. Emergent surgical laparotomy.

10

A patient presents with fractures to the long bones, they are hemodynamically stable. What should be done ASAP.

Gentle traction on the bones to prevent further neurovascular damage.

11

A woman presents with the signs of breast cancer. You preform a biopsy for culturing or histology?

Histology. You would only preform cultures if you thought she had an abscess (a young lactating women).

12

A young patient with no bad habits presents with an immobile, fleshy, large mass on the hard palate of his mouth? Management?

Torus palatinus. Typically no therapy required.

13

Which spinal complications can result from AAA surgery? Which functions are decreased? Which functions are preserved.

Spinal cord ischemia.

Anterolateral structures of the cord - Lower spastic paraplegia, pelvic organ dysfunction, loss of Temp and sensation.

Maintain posterior structures - Proprioception.

14

An elderly patient presents with acute, frank hematochezia?

Acute diverticulitis.

15

Describe a septic knee joint? WBC/mcL? Neutrophil %? Glucose? Culture results? Treatment?

Swollen with limited ROM - green/yellow cloudy fluid. WBC > 2000. Neutrophil > 75%. Glucose < 25mg/dL. Positive culture.

Immediate surgical intervention.

16

A 25 year old woman presents with severe abdominal pain, she is not SHOCKY. What must be ascertained before films are shot?

Is she pregnant. Pregnancy tests precede x-rays.

17

When someone hurts their foot and you hear a crunching sound when walking?

Metatarsal fracture.

18

You are worried about breast cancer in a young woman (large mass with coarse calcifications). Multiple core biopsies reveal foamy macrophages and fat globules? Management?

Fat necrosis. Monthly self exams and regular screening once 40 - they're fine.

19

A 36 year old woman presents with a small rubbery lump in her breast. First step of management?

Mammography (for all women >35 y/o with a lump. It's probably just a fibroadenoma, but you can't be sure from PE alone.

20

A patient presents after a MVC with an elevated left hemidiaphragm on CXR?

Diaphragmatic hernia.

21

Dirty wound, never vaccinated for tetanus?

Tetanus vaccine AND tetanus immunoglobulin

22

Clean wound, never vaccinated for tetanus/uncertain vaccine status/<3 shots?

Tetanus vaccine only

23

Dirty wound, vaccinated for tetanus >5years ago?

tetanus vaccine only

24

Dirty wound, vaccinated for tetanus <5years ago?

No need for vaccine

25

Clean wound, vaccinated for tetanus <10years ago? When do you vaccinate for clean wounds?

No need for vaccine.
When >10years since vaccine, or never vaccinated