UWorld Questions Flashcards
(129 cards)
0
Q
Early dumping syndrome
A
50% w/ partial gastrectomy experience it.
Rapid emptying of hypertonic gastric content into duodenum and small intestine –> fluid shift from Intravascular space to sm. int., release of vasoactive polypeptides, and stimulation of autonomic reflexes –> Tx = dietary changes (octreotide in rx cases)
1
Q
What is most important goal in management of rib fx w/ dec. respiratory movements on that side?
A
Adequate analgesia –> allows proper ventilation and prevents atelectasis and pna
2
Q
Newborn hydrocele –> Management?
A
Observe –> most resolve in 12 months
3
Q
MCC of acute mesenteric ischemia?
A
Emboli from the heart (Afib)
4
Q
Pain associated w/ PVD?
A
Exercise-induced
5
Q
Post-op fever, GO!
A
Days 1-2 = Pna, atelectasis
Days 3-5 = UTI
Days 4-6 = DVT, catheters (femoral > subclavian)
Days 5-7 = Wound infection (SSI)
> 7 days = Meds (drug fever) –> Anticonvulsants, TMP/SMX
6
Q
Anterior Cord Syndrome
A
Associated w/ burst fx of vertebra + total loss of motor function below the lesion w/ loss of temperature and pain bilaterally
7
Q
Hypoparathyroid signs/sx
A
- May be asx at initial presentation (incidental finding)
- Fatigue, anxiety, depression
- Tetany (lips, face, extremities) and sz in severe hypocalcemia
8
Q
ECG finding associated w/ hypocalcemia?
A
QT prolongation
9
Q
MC complication of thyroidectomy?
A
Post-op hypoparathyroidism –> hypocalcemia
10
Q
1st step in management of suspected urethral injury?
A
Retrograde urethrogram. Foley predisposes to abscess formation
11
Q
Classic presentation of intraductal papilloma?
A
Intermittent bloody d/c from one nipple (benign). Masses generally not appreciated
12
Q
MC situation to see acalculous cholecystitis?
A
Chronically hospitalized ICU pts w/: multiorgan failure, severe trauma, surgery, burns, sepsis or prolonged TPN
Most likely due to cholestasis and GB ischemia leading to infection, edema, and necrosis
13
Q
Pt develops whistling during respiration following rhinoplasty
A
Nasal septal perforation from septal hematoma
14
Q
Scaphoid fx management
A
Initial XR, Thumb spica w/ f/u radiography in 7-10 days
15
Q
Classic location of venous HTN in legs (stasis dermatitis)
A
Medial leg superior to medial malleolus
16
Q
Solitary Pulmonary Nodule algorithm
A
SPN on CXR –> Chest CT –> Benign –> serial CT
17
Q
Lower GI bleed algorithm
A
Severe hematochezia (bright blood) –> Supportive therapy –> NGT –> No blood + bile (colonoscopy) –> Negative –> pt stops bleeding (no) –> labeled RBC scintigraphy (Te-99) localizes bleeding
18
Q
IJ cath placement –> next step?
A
CXR
19
Q
SCFE tx ?
A
Promptly tx w/ surgical pinning of slipped epiphysis where it lies to lessen risk of avascular necrosis of femoral head and chondrolysis
20
Q
Pulmonary contusion presentation
A
Common in MVA … Sx usually develop in first 24 hours w/ patchy alveolar infiltrate on CXR
21
Q
Orotracheal intubation (RSI) procedure
A
4 people: stabilize pt, induce w/ anesthesia, applies cricoid pressure to prevent passive regurgitation until tube is placed, place tube
22
Q
Definition of oliguria in pt w/out preexisting kidney disease?
A
< 400 cc/day .. will also see elevated BUN:Cr (> 20:1) and FENa < 1
23
Q
New onset oliguria management?
A
Change foley. IV fluid bolus.
24
Acute shoulder pain after forceful abduction and external rotation
Anterior shoulder dislocation --> axillary nerve/artery injury
25
Joint aspiration finding common to ACL tear?
Hemarthrosis
26
Acute GI perforation requires emergent ex-lap. If pt is on Warfarin, how do you reverse the anticoagulation rapidly pre-op?
FFP (not Vit K)
27
Shoulder complication of grand mal tonic-clonic sz?
Posterior dislocation (adducted, internally rotated w/ inability to externally rotate)
28
MC bone to be affected by stress fx?
Anterior tibia in middle 1/3 (jumping sports) and posteromedial distal 1/3 (runners) ... XR frequently normal
29
Urethral injury associated w/ pelvic fx?
Posterior urethral injury (blood at meatus, high riding prostate, scrotal hematoma, inability to void despite urge, palpably distended bladder)
30
Simple way to inc. Functional Residual Capacity (FRC)
Move from supine to sitting (inc. 20-35%) can help prevent post-op atelectasis
31
Traumatic spinal cord injury important early step after Air/Breathe
Urinary cath to assess for urinary retention and prevent distention and damage. Femoral line only if Peripheral IV unable to be obtained or emergent access needed
32
HoTN despite aggressive fluid resuscitation?
Cardiac tamponade is possible (esp. w/ JVD, tachycardia, blunt chest trauma)
33
Major risk factor for pyloric stricture?
acid ingestion
34
Sx of gastric outlet obstruction?
early satiety, N/nonbilious Vomiting, weight loss, succussion splash in epigastrium
35
Paget's disease of bone dx
Inc. bone-specific ALP on routine lab eval usually
36
Paget's disease of bone
osteitis deformans --> disordered bone remodeling --> inc. osteoclast activity --> pain resulting from bowing or fx
37
XR and bone scan findings of Paget's disease of bone
Enlargement of skull bones (frontal bossing, inc. head size), headaches, CN palsies. HEARING LOSS due to cochlear nerve damage
38
Hemoptysis and high clinical suspicion for TB --> management?
Respiratory isolation
39
Hemoptysis algorithm
H&P to r/o other causes --> Mild/moderate --> CXR, CBC, coags, renal function, U/A, rheum ---> CT +/- bronch --> tx via bronch, embolization, resection
Massive bleeding (> 600 mL/24 hrs or 100 mL/hr) --> Secure ABCs --> stops (CXR, CBC, etc) --> cont. (tx)
40
HoTN and back pain after cardiac cath? Management?
Retroperitoneal bleeding --> CT abdomen, pelvis w/ supportive tx
41
CT findings of diffuse axonal injury?
Numerous punctate hemorrhages w/ blurring of grey-white interface
42
Initial DVT tx?
Heparin acutely, Warfarin long-term
43
Uric acid stone eval
Radiolucent --> CT or IV pyelogram to see --> can can cause ureteral colic and a vagal reaction causing an ileus
44
When do you typically see atelectasis? Results from what?
POD 2-3 ... results from weak cough and shallow breathing due to pain following abdominal or thoracoabdominal surgery
45
Prevention of atelectasis?
Adequate pain control, deep-breathing exercises, directed coughing, early mobilization, incentive spirometry
46
Signs of fat embolism
respiratory distress, mental status changes and petechiae following latent period of 12-72 hours after initial injury
47
Pulmonary contusion signs/sx
dyspnea, tachypnea, chest pain, hypoxemia worsened by intravascular volume expansion, patchy and irregular alveolar infiltrates
48
Femoral nerve anatomic innervation
Anterior compartment of thigh (quadriceps femoris, sartorius, pectineus) and is responsible for knee extension and hip flexion. Sensation to anterior thigh and medial leg (saphenous nerve)
49
Tibial nerve innervation
posterior compartment of thigh, leg, and plantar muscles of foot. Flexion of knee and digits, and plantar flexion. Sensation to leg (not medial) and plantar foot
50
Obturator nerve innervation
Medial compartment of thigh (gracilis adductor longus, adductor brevis, anterior adductor magnus) and adducts thigh. Sensation over medial thigh
51
Common peroneal nerve innervation
Superficial and deep peroneal nerves. Anterior and lateral leg. Sensation to anterolateral leg and dorsum of foot
52
Another name for common peroneal nerve?
Fibular nerve
53
Nasopharyngeal cancer (Mediterranean and Far East)
EBV association
54
AAA repair complications
Bowel ischemia (can present w/ abdominal pain, bloody diarrhea, fever, leukocytosis) and can present w/in 24 hours of surgery
55
Post-op parotitis
Acute bacterial parotitis w/ painful swelling can present w/ fever and tenderness, edema, erythema and can be prevented by adequate fluid hydration and oral hygiene. S. aureus
56
Clavicular fx work-up?
Neurovascular exam (angiogram especially if bruit heard)
57
carboxyhemoglobin level indicative of upper airway and/or smoke inhalation injury?
> 10%
58
Ischemia-reperfusion syndrome
Following 4-6 hours of ischemia, tissues suffer intracellular and interstitial edema on reperfusion --> compartment syndrome
59
Non bleeding esophageal varices tx?
Nonselective beta antagonists (Propranolol --> dec. portal venous pressure) , IV PPI, oral lactulose for encephalopathy (if present), diuresis for ascites (if present)
60
When would hypoglossal nerve be vulnerable to injury?
Tongue palsy --> surgery below mandible (submandibular salivary gland)
61
Central cord syndrome
Hyperextension injuries (elderly w/ spondylosis)
weakness more pronounced in UE than LE w/ localized pain/temp deficits
62
Early signs/sx of CO inhalation
Neurological and include agitation, confusion, somnolence
63
Transtentorial (Uncal) Herniation
Compression of contralateral crus cerebri --> ipsilateral hemiparesis
Compression of ipsilateral CN III by herniated uncus --> Loss of PNS (mydriasis ; occurs early), loss of motor (ptosis, down and out gaze via unopposed CN IV, VI ; late)
Compression of ipsilateral posterior cerebral aa. (visual cortex) --> contralateral homonymous hemianopsia
Compression of reticular formation --> altered LOC, coma
64
Cushing's reflex
HTN, bradycardia, respiratory depression indicates elevated ICP
65
How does hyperventilation dec. ICP?
CO2 washout --> vasoconstriction
66
Signs/sx of post-traumatic syringomyelia
Whiplash often inciting event; sx mo to years later; enlargement of central canal due to CSF retention
Impaired strength, pain/temp sensation in UE
67
Acute onset back pain, profound HoTN, syncope, gross hematuria
AAA rupture; gross hematuria from rupture of fragile and distended bladder veins from an aortocaval fistula
68
Unilateral subacute hip pain in male child w/ progressive antalgic gait, thigh muscle atrophy, dec. hip ROM, collapse of ipsilateral femoral head
Suggestive of avascular necrosis associated w/ Legg-Calve-Perthes
69
Legg-Calve-Perthes etiology?
MC in boys 4-10 w/ classic presentation as hip, knee or groin pain + antalgic gait
70
Management of Legg-Calve-Perthes
Observation and bracing but surgery if femoral head not well contained in acetabulum
71
Duodenal hematoma pathophysiology?
MC seen in children; blood collects between submucosa and muscular layers causing obstruction
72
Classic presentation of duodenal hematoma?
Epigastric pain + N/V
73
Course and management of duodenal hematoma?
Typically resolve spontaneously in 1-2 weeks w/ NGT and parenteral nutrition. Surgery if non-op fails or if hemorrhage or perforation
74
Widened mediastinum w/ mediastinal air...
Esophageal perforation (iatrogenic, Boerhaave, pill esophagitis [KCL], ulcer, infectious [Candida], caustic ingestion)
75
Presentation of esophageal perforation?
Sudden-onset and severe pain located retrosternally, or in neck/back/abdomen made worse w/ swallowing. Subcutaneous emphysema (Hamman sign)
76
Dx of esophageal perforation?
Contrast esophagogram (Gastrografin)
77
Management of esophageal perforation?
Broad-spectrum ABx, parenteral nutrition, surgical repair
78
MCC of bright red bleeding in an elderly pt?
Diverticulosis
79
Formation of colonic diverticula?
High intraluminal colonic pressure --> mucosa and muscularis herniate through wall (false)
80
Colonic angiodysplasia
inc. w/ age, but still uncommon and less likely cause of hemorrhage
81
Rare neurologic complication of aortic aneurysm surgery?
Spinal cord ischemia --> abrupt onset of weakness and bowel/bladder dysfunction, flaccid paralysis, sexual dysfunction, HoTN, loss of DTRs
82
Post-op ischemic stroke a likely possibility w/ intact vibratory, BL involvement and normal UE function?
Probably not
83
When is CT/US scan useful in a suspected apply?
Atypical presentations, pregnant women, elderly
84
Would you see pneumomediastinum w/ Mallory-Weiss tears? Boerhaave?
No, as the tear is incomplete. Yes, the tear is complete.
85
Management of stress/hairline fx of metatarsal?
Rest and analgesics. Plaster cast if failure of this.
86
At what level is a penetrating injury considered to be in the abdomen?
Anything below 4th ICS (level of nipples) is considered to involve the abdomen and requires an ex-lap in unstable patients
87
(+) Trendelenburg sign?
Contralateral hip drop when standing on one foot. Superior gluteal nerve injury (innervates gluteus medius and minimus)
88
Morton neuroma PE signs?
Clicking sensation when squeezing 3rd/4th metatarsals together w/ pain on plantar surface
89
What is Morton neuroma? Tx?
Mechanically induced degenerative neuropathy commonly seen in runners. Conservative w/ bilateral shoe inserts, surgery for failure
90
Tx of Nursemaid elbow (subluxation of radial head)?
1. Extend and distract the elbow
2. Supinate the forearm
3. Hyperflex the elbow w/ thumb over radial head to feel the reduction
91
Management of complicated diverticulitis w/ abscess formation?
Percutaneous drainage
92
Splenic trauma. Dx?
Can present w/ delayed sx including HoTN, abdominal pain, left shoulder pain. CT w/ contrast
93
Typical presentation of venous valve incompetence?
MCC of LE edema. Worsens throughout the day and resolves overnight
94
Imaging of choice for suspected urinary stone?
Non-contrast spiral CT
95
Nerve commonly injured w/ midshaft humerus fx?
Radial nerve --> numbness and extensor weakness
96
Fluid in spleno-renal angle. BP responsive to fluids --> next step? BP unresponsive to fluids?
Responsive and stable = CT
| Unresponsive unstable = immediate ex-lap
97
Common cause of post-op atelectasis?
pharyngeal secretions, tongue prolapsing into pharynx, airway tissue edema, residual anesthetic effects
98
When is atelectasis more common?
Following abdominal and thoracoabdominal procedures
99
Physiology behind ABG of atelectasis?
Compensation for hypoxemia --> hyperventilation --> respiratory alkalosis --> dec. PaCO2 -->
100
What is the upper triangle sign?
Some pts w/ R lower lobe collapse you can see a triangular shadow in RUL field cont. w/ mediastinum and apex pointing towards the right hills. Represents a shift of upper anterior mediastinum to the right
101
Direct radiologic signs of atelectasis? Indirect?
Crowded pulmonary vessels, crowded air bronchograms, displacement of interlobar fissures.
Opacification, elevation of diaphragm, shift of [trachea, heart, mediastinum], hilar displacement, compensatory hyperexpansion of surrounding parenchyma, approximation of the ribs, shifting granulomas
102
Types of atelectasis?
Segmental, lobar, whole lung
103
Fat necrosis vs cancer of breast?
Fat necrosis = fat globules and foamy macrophages
Can mimic cancer on imaging
No tx
105
Volkmann's ischemic contracture?
final sequel of compartment syndrome in which dead muscle has been replaced w/ fibrous tissue
106
MC peripheral artery aneurysms?
Popliteal > femoral --> both associated w/ AAA
107
Pain w/ forceful torsion of knee at 90, popping sound at injury, commonly (+) McMurray's
Meniscus tear. Bucket handle tear leads to locking w/ terminal extension
108
S/p repair of femoral fx and femoral artery injury --> now has passive movement pain, paresthesias, pallor, paresis
Compartment syndrome --> fasciotomy
109
Dx of esophageal perforation
Water-soluble contrast esophagogram
110
Penile fx management
Emergent retrograde urethrogram and surgical exploration
111
Acute mediastinitis tx
can occur following surgery and presents w/ fever, CP, leukocytosis, and mediastinal widening on CXR
requires drainage, debridement, ABx
112
First physiologic changes visible in hypovolemia
Tachycardia and peripheral vascular constriction are first changes
113
Class I hemorrhage
< 750 cc lost, normal BP, normal HR, normal cap refill, normal CNS sx
114
Class II hemorrhage
750 - 1500 cc, slight dec. BP, HR: 100-120, delayed cap refill, dec. urine output
115
Class III hemorrhage
1500-2000 cc, HR > 120, markedly dec. BP, dec. urine output, confusion
116
Retroperitoneal hemorrhage + lumbar fx w/ gaseous distention and absent bowel sounds
Paralytic ileus
117
Classic presentation of embolic occlusion in extremity?
sudden-onset severe pain w/ asymmetric pulses
118
TBI w/ LOC, vomiting, headache need what? TBI w/out sx need what?
CT scan. No scan neeeded, just brief ED observation
119
Tetanus prophylaxis after injury?
Unimmunized, uncertain, or < 3 toxoid doses
- Minor and clean wound --> tetanus toxoid only
- Severe/dirt --> Toxoid and Ig
> 3 toxoid doses
- Minor/clean --> None
- Severe/dirt --> toxoid if booster given > 5 yrs ago
120
Presentation of varicocele
dull, aching testis pain and MC on left side, inc. w/ Valsalva
121
Epidural vs subdural
Epidural --> LOC followed by lucid interval followed by deterioration (N/V, headache)
122
(+) psoas sign
Psoas abscess which is known complication of perforated appendicitis
123
Normal resting respiratory quotient (RQ)
0.8
124
RQ > 1
indicates carbs are being served as sole nutritional source and net lipogenesis is occurring
125
Metabolism of proteins alone = ? RQ
0.8
126
Metabolism of fatty acids alone = ? RQ
0.7
127
Importance of RQ in mechanical ventilation?
Overfeeding w/ carbs can cause excessive CO2 production making weaning more challenging
128
Ludwig angina? Classic origin? Cause?
rapidly progressive bilateral cellulitis of submandibular and sublingual area. 2nd or 3rd molar. Streptococcus and anaerobes
129
Presentation of ludwig angina?
fever, dysphagia, odynophagia, and drooling, crepitus w/ asphyxiation MCC of death
