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Uworld11\ Flashcards

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1
Q

Persistent pneumothorax and significant air leak following chest tube placement in patient who has sustained blunt chest trauma suggests

A

tracheobronchial rupture

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2
Q

treatment for third degree burn

A

early excision and grafting

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3
Q

next step in management for head trauma

A

penetrating = surgery

linear skull fracture with not overlying wound - leave alone

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4
Q

management for intraoperative development of coagulopathy

A

platelet packs and fresh-frozen plasma

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5
Q

Any penetrating wound below the 4th intercostal space (below nipples) is considered what

A

abdomen and requires ex. lap in unstable patient

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6
Q

what are your post op fevers?

A 
day of: atelectasis
Day 1-3: pneumonia
Day 3: UTI
Day 5: deep thromnophlebitis
Day 10-15: deep abscesses
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7
Q

Treatment of hemorrhagic shock

A

near trauma center: GO

not: fluids

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8
Q

management of cervical spine injury

A

ooo-tracheal intubation

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9
Q

3 categories in GLASCOW score

A

eye opening
verbal response
motor response

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10
Q

salmon-colored fluid coming from surgical site? next step

A

wound dehiscence

tape securely and go to OR

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11
Q

what is ALT level for gallstone pancreatitis

A

greater than 150

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12
Q

When do you do ERCP in gallstone pancreatitis

A

cholangitis
bile duct obstruction
increasing liver enzymes

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13
Q

Management of pancreatic pseudocyst

A

asymptomatic: expectant management
symptomatic: endoscopic drainage

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14
Q

difference in hepatic and splenic infarctions

A

hepatic: free intraperitoneal fluid
splenic: less likely

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15
Q

Pediatric patients, most often occurs following blunt abdominal trauma? clinical pic? treatment?

A

duodenal hematomas
epigastric pain, vomiting 24-36 hours after initial injury
gastric decompression and parenteral nutrition

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16
Q

Initial management of small bowel obstruction

A

conservative (bowel rest, nasogastric suction, correction of metabolic derangements)

patient develops clinical or hemodynamic instability –> emergent surgery

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17
Q

difference in chest X-ray in cardiac tamponade and bronchial rupture

A

cardiac tamponade: normal cardiac silhouette without tension pneumothorax

bronchial rupture: jugular venous dissension but with tension pneumothorax

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18
Q

when do you do HIDA scan?

A

when ultrasound is undetermined

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19
Q

small-and-large bowel dissension and hypoactive bowels

A

ileum

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20
Q

air-fluid levels in gallbladder? treatment

A

emphysematous cholecystitis

emergent cholecystectomy

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21
Q

difference in timing of small bowel obstruction and ileus

A

small bowel obstruction: weeks to years post-op

Ileus: hours to days post-op

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22
Q

What is a watershed area of the colon

A

splenic flexure and rectosigmoid junction

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23
Q

What is CT scan of colon for ischemic colitits

A

thickened bowel wall

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24
Q

treatment for abscess from diverticular disease

A

less then 3cm –> abs and abs

more than 3cm –> CT guided percutaneous drainage

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25
Dilated common bile duct in absence of stones
sphincter of Oddi dysfunction
26
relate opioids and sphincter of Oddi
Opioids cause sphincter contraction and precipitate symptoms
27
clinical feature of rapid gastric emptying
crampy abdominal pain vomiting diarrhea vasomotor symptoms (flushing, palpitations)
28
One of the most common post-op cholecystectomy
bile leak | fever, nausea, VOMITING, and vague abdominal pain 2-10 days after Lap cholecystectomy
29
fever RUQ pain can also cause ileus (decreased or absent bowel sounds)
emphysematous cholycestitis
30
Gilbert Syndrome
high unconjugated bilirubin | jaundice
31
strangulation
disruption of blood flow to the involved bowel segment, leading to necrosis
32
which is more sensitive for acute pancreatitis
lipase
33
succession splash may be heard over the stomach
gastric outlet obstruction
34
painful, fluctuant mass 4-5cm cephalic to the anus in the intergluteal region mucoid, purulent, or bloody drainage
Pilonidal disease
35
difference between appendicitis and psoas abscess?
psoas: subacute appendicitis: acute
36
pediatric umbilical hernia management
less than 1.5 = spontaneous closure | must close before the age of 5
37
Management of fleshy immobile mass in midline hard palate in pediatric patient asymptomatic
observation
38
mass anterior edge of sternomastoid muscle
branchial cleft cyst
39
mass in supraclavicular area? Management
cystic hygroma | CT before surgery because it may extend into
40
Vesicles on tonsils and soft plate
Herpangina --> coxsackie A virus--> observation
41
Management of upper neck trauma
arterio-graphic diagnosis
42
Cardiac index and pulmonary wedge pressure values for MI
decrease cardiac index | increase pulmonary wedge pressure
43
difference between thoracic aneurysm and aortic dissection
thoracic: Spiral CT no surgery | aortic dissection: surgery
44
GI trauma (costoverterbal tenderness) next step
contrast enhanced CT Of abdomen ( even if contrast is contraindicated in kidney failure)
45
DVT in chronic renal failure
unfractionated heparin followed by warfarin
46
how does multiple myeloma impact immune system
alters normal leukocyte population and causes hypogammagobiulenia
47
treatment for mild hypernatremia? Severe cases of hypernatremia hypovolemia
mild: 5 dextrose in 0.45 saline severe: .9 saline
48
case-control study
compare the exposure of people with disease(case) to exposure of people with the disease (control)
49
what measure is case-control study associated with
exposure odds ratio
50
What type of study uses prevalence odds ratio
cross-sectional studies
51
What type of study uses median survival calculated
cohort studies or clinical trials
52
In what study are relative risk or relative rate calculated
cohort studies
53
Prominent capillary pulsation's in the fingertips or nail beds
aortic regurgitation
54
What is the most common valvular abnormality detected in patients with infective endocarditits
Mitral valve disease, usually mitral valve prolapse with coexisting mitral regurgitation
55
treatment for inflammatory acne?
topical retinoids and benzoyl peroxide
56
Treatment for moderate-to-severe cases treatment?
topical retinoids and benzoyl peroxide | add topical abs
57
Treatment for severe or recalcitrant acne
Oral abs and isotretinoin
58
When is salicylic acid most useful for acne treatment
noninflammatory/comedonal acne
59
Effect modification
external variable positively or negatively impacts the effect of a risk factor on the disease of interest - associated with disease (not risk factor)
60
What helps differentiate between confounder or an effect modifier?
Stratified analysis
61
Cofounder
same as effect modification but | - associated to both disease and risk factor
62
how do you look at stratified analysis?
higher the RR, stronger the association
63
weight loss, jaundice and a contender, distended gallbladder on examination
pancreatic cancer
64
ulcerating, pustular nodules at the site of inoculation and associated lymphatic channels
Sporotrichosis
65
difference between acute tubular necrosis and tubulointersitial nephritis
ATN: acute onset TN: insidious, no need for rash, NSAIDs
66
When do you use tetanus immune globulin
symptomatic patients | its who have not received 3 initial doses in childhood
67
pain scale for CMV retinitis
painless
68
right for right ventricular heart attack
fluids
69
how does positive pressure mechanical ventilation change pressure? impact in hypovolemic patients
increases intrathoracic pressure - - acute loss of right ventricular preload - - loss of cardiac output - - cardiac arrest
70
high ADH and high urine sodium
SIADH
71
what is associated with dermatomyositits
internal malignancy
72
If a test result is negative, what is the probability of having the disease
1-negative predictive value
73
What type of shock is the only one with decreased systemic vascular resistance
septic shock
74
difference between secondary PTH due to CKD and primary hyperparathyroidism
uric aciCKD: phsophorus high. calcium low Primary: low PTH and high calcium so basically with CKD the PTH will increase but it won't actually fix the problem
75
needle-shaped crystal in U/A indicates what?
uric acid stones --> radiolucent on CT
76
subacute (de Quervain) thyroiditis? treatment?
fever, neck pain, tender goiter following URI | beta blockers and NSAIDs
77
Suppurative thyroid
rare | euthryoid
78
painless thyroiditis (silent thyroiditis)
thyrotoxicosis with mild thyroid enlargement suppressed TSH thyroid scintigraphy shows decreased radio iodine uptake
79
Parents who themselves are minors, can they give consent for medical treatment of their child?
yes
80
from an unemanciapted minor, do you need consent from both parents
one will do
81
Parents refuse to consent to treatment of their child for a non-emergency but fatal medical condition. next step
seek court order
82
Spondylolithesis
forward slip of vertebrae - preadolescent children - back pain, urinary incontinence, "Step-off" at the lumbosacral area
83
Bone cancer: central lytic lesion, onion skinning, and moth-eaten appearance with some extension into the soft tissue
Ewing sarcoma
84
Bone cancer: central lytic bone defect with surrounding sclerosis
osteomyelitis
85
equines and various of calcaneum and talus varus of midfoot adduction of forefoot
clubfoot
86
management of clubfoot
stretching and manipulation of foot immediately serial plaster casts surgery between 3-6 months of age
87
Down syndrome patient with upper motor neuron findings
atlantoaxial instability
88
How do you diagnose Henoch Schonlein Purpura
clinical diagnosis | confirmed with skin biopsy in unclear cases
89
How does a child get a supracondylar fracture of the humerus
fall on an outstretched hand most common
90
What is a rare but potentially devastating complication of supracondylar fracture
Compartment syndrome accompanied by forearm fractures which can lead to Volkmann contracture
91
Clinical features of juvenile idiopathic arthritis
daily fever and rash | chronic uveitis
92
Lab values for juvenile idiopathic arthritis
Leukocytosis thrombocytosis elevated inflammatory markers
93
Treatment for juvenile idiopathic arthritits
NSAID and steroids
94
what should be on the differential for a solitary, painful lytic long bone lesion with overlying swelling and hypercalcemia in a child
langerhans cell histiocytosis
95
bone cancer: sunburst pattern
osteosarcoma
96
Flexible positioning Medial deviation of forefoot Neutral position of hind foot
Metatarsus adducts
97
Treatment for metatarsus adductus
reassurance
98
traction of apophysitis of tibial tubercle
Osgood-Schlatter
99
Difference between Ehler's Danlos and Osteogenesis imperfecta
Ehlers: no fractures Osteogenesis: fractures
100
Blue sclera | Opalescent teeth/Dentinogensis imperfect (teeth translucent and gray)
Osteogenesis imperfecta
101
how long does arthritis need to be present for to diagnose juvenile idiopathic arthritis
greater than 6 weeks
102
type of patient who gets slipped capital femoral epiphysis
obese boys | thin adolescents who recently went through growth spurt
103
Management of slipped capital femoral epiphysis
surgical pining
104
well-circumscribed mass that does not transilluminate in the inferior portion of the sternocleidomastoid muscle can be seen in what child condition
torticollis
105
what causes Trendelenburg sign
weakness or paralysis of gluteus medium and minimum muscles | - innervated by superior gluteal nerve
106
risk factor for vitamin D deficiencies in children
exclusive breastfeeding increased skin pigmentation lack of sun exposure

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