2009 exam part II Flashcards
Guy with NG, output is 1500 cc/day. He becomes lethargic and weak, and has ileus. What is most likely?
a) hypomagnesemia
b) hypochloremic metabolic alkalosis
c) hypokalemic metabolic alkalosis
d) hyponatremia
NG = hypokalemia, met alk
Low magnesium, which is a sign?
tremor
its when you have HIGH mag that you have loss of DTRs, hence when a patient is on mag you check the reflexes as a way to monitor mag levels and toxicity
Patient with carpal tunnel syndrome, which are you most likely to find?
weak thumb abduction
weak thumb adduction
weak thumb abduction
Patient with mediastinitis (picture provided, large wound) post CABG. What is the best management?
Debridement, rigid sternal fixation, myocutaneous flap
Shown picture of a child with burn to right thorax and right arm. Erythematous. What is the degree of burn?
second or third degree.
second degree = blistering
third degree is fullthickness and extends thru the entire dermis
Shown picture of a large keloid on earlobe. What is the management?
intralesional steroid injection ( kenalog)
Shown picture of an ulcer on the sole of a diabetic foot. What is the mechanism by which this occurs?
neuropathy
Shown picture of venous stasis ulcer, which is best management?
compression stalking/dressings
Shown picture of TRAM to right breast POD#2. Upper part of flap is good cap refill, good pulse by Doppler, and warm. Picture shows upper part is normal color, but lower looks venous congested and has small bullae. What is the best management?
leeches
anytime there is venous congestion from a graft or flap its leech therapy. god knows why we cant come up with something better
Shown a picture of mole on face. You do not feel that you can excise the lesion and do primary closure. What is the best management?
- FNA
- Incisional biopsy of the mole
- Incisional biopsy of the mole and normal skin
- Shave biopsy of entire lesion
if its melanoma you need to take the whole thing, plus some normal skin =
incisional + normal skin
Shown picture of big ulcerated lesion over lower leg. Patient had tibia fracture 20 years ago with chronic draining sinus, which has been enlarging for past few months. What is most likely?
- Superinfection
- SCC
- Osteosarcoma
- Something else
SCC
What is the deepest burn that you can get for spontaneous epithelialization to still occur?
deep papillary dermis
Shown picture of carpal tunnel release intraop, with 2 longitudinal lines that are thin and look like veins. What is the etiology? Congenital Systemic disease Inflammation Factitious
congenital
Shown picture of electrical burn to right hand and arm, no eschar. Patient has extreme pain on passive stretch of fingers. What do you do?
immediate fasciotomy
Shown picture of kid with dog bite to face. What is the best management?
Irrigate, debride, and careful multiple layer closure
Senior resident never respects gowning and hand-washing procedure during an MRSA outbreak. What CanMEDs competency is he failing to show?
professionalism
Anion that is not measured and contributes to your normal anion gap?
albumin
What gives you decreased platelet count and qualitative defect in platelet function?
VWF
15 year-old guys shows up with retracted testicle, absent cremasteric reflex, 6 hours post start of pain. Best management?
Go to OR urgently for detorsion of left testicle and left orchiopexy
Go to OR urgently for detorsion of left testicle and bilateral orchiopexy.
OR, bilateral pexy to correct the congenital bell clapper deformity that is likely present on both sites and is the most common cause of testicular torison
Shown an axial slice of CT showing right SC(sterno clavicular) joint dislocation, with head of clavicle displaced posteriorly. There is no pneumo at the lung apices. Patient has distended neck veins, plethora in the face, and complains of respiratory distress. What is the best management?
SC joint reduction
reduce the joint!!
Woman with medullary thyroid cancer, has 12 and 15 year old child. What is most appropriate screening test for her children?
RET
Guy post MVC, presents with tachypnea, tachycardia, decreased air entry on one side, hyperresonant percussion, and trachea deviated to contra-lateral side. What do you do?
Needle decompression 2nd ICS mid clavicular line
Which of the following is not an absolute contraindication to a chest tube? Spontaneous pneumo Open pneumo Chylothorax s/p thoracic surgery for drainage
spont pneumo??
Patient comes in with trauma, needs blood. His blood is checked for ABO and Rh compatibility, but not cross-matched. What is the chance that he will get an acute hemolytic reaction?
0.1%
Answer: A Which of the following is not a feature of acute rejection in kidney transplant. hypertension pancytonia tenderness at graft increased graft size
pancytopenia Im guessing is what they were trying to say
Regarding acute rejection in transplant, all true except? Cell mediated Most common rejection reaction Most are asymptomatic Biospy shows intravascular coagulation
asymptomatic - thats not true at all
Which of the following causes reversible nephrotoxicity? Cyclophosphamide Azathioprine Cyclosporin A Steroids
cyclosporin A
In heart transplant, all are used except?
methotrexate
tacrolimus
azathioprine
methotrexate
Patient with pH 7.55, pCO2 24, PO2 60 on 30% O2. He is on respirator at RR 12 and tidal volume 10cc/kg, PEEP 5. What is the first step? increase FiO2 increase tidal volume increase dead space of tubing sedate patient more
increase FiO2
Which of the following is the most common mechanism of hypoxia in acute lung injury? diffusion problem right to left shunt ventilation perfusion mismatch something else
diffusion problem
What is the rate of transmission of HCV from a single unit PRBC transfusion?
1 in 300,000
What is not a criteria for SIRS? respiratory rate > 20 temp > 38.5 HR < 85 sBP < 90
recall that SIRS is actually just heart rate, resp rate, temp and white count.
BP is not in there,
and the HR value they gave here is incorrect
Which is not consistent with severe PE? increased CVP increased wedge pressure decrease in PaCO2 increase in A-a gradient
increased PCWP pulm cap wedge pressure. this is a reflection of pressure in the left atrium
What is a contraindication to tPA?
Surgery 10 days ago
Old stroke on CT
Failure of urokinase
A- surgery ten days ago
Patient with pmhx of dvt, gets into MVC. Fracture L femur and R medial malleolus. Cerebral edema on MRI, rest of scans normal. What is the best way to anticoagulate? SCDs Unfractionated heparin q12h LMWH Warfarin
LMWH
What determines dBP?
peripheral vascular resistance
cardiac output
blood volume
peripheral vascular resistance
Lady with breast ca, getting intramedullary nail of femur for impending fracture. Anesthetist alerts you that she has become hypotensive, tachypneic, and difficult to ventilate. What is the diagnosis? Acute PE Fat embolus MI Anaphylaxis Answer: B
fat embolus
Guy with open fracture of tibia, loss of anterior coverage of 6 cm. What is the best option for coverage? Primary closure Rotational flap medial gastroc flap free tissue transfer
free tissue transfer
What is the best option to eliminate dead space post debridement of dead bone?
Myocutaneous flap
Closed suction drain
Skin graft
myocutaneous flap
What is an absolute indication to reimplantation?
Complete ring avulsion of 4th digit in 45 year old woman
15 year old had saw injury with amputation at MCP joint of thumb
any amputation through the thumb is an indication for surgery
Which is true about management of a contaminated open fracture?
early immobilization decreases infection risk
Shown an outlet view of a pelvis, obvious open book fracture. What is the mechanism?
AP compression
Lateral compression
Vertical shear
AP compression
During ureteral repair, which of the following is not true? Debridement Stent placement is optional Water tight closure Tension-free anastomosis
stent placement is optional
Which of the following has the highest metabolic rate 1 week post injury? Major burn Peritonitis/sepsis Elective abdominal procedure Skeletal procedure
major burn
omeone with 6th and 7th rib fractures, has failed SQ and PO narcotics, what do you do? Chest physio Epidural Surgical fixation of fractures Bracing
epidural
What tissue has longest warm ischemia time? skin muscle kidney small bowel
skin
What is the general recognized maximal ischemia time for muscle and nerve? 4 hours 6 hours 8 hours 10 hours Answer: B
6 hrs
you have to get a pulseless limb to the OR in 6 hrs
Young chap with 20% grease burn to hand and upper extremity. What is the management?
Start Ringers at 3500 cc/hr, give tetanus toxoid, and local wound care
Start resuscitation, give tetanus shot and transfer to tertiary burn unit
resus, give tetanus, transfer to burn center
