2011 with explanations (2011_2) Flashcards
• Dog bites a kid on the hand. What do you do next?
a. Nothing
b. Amox-clav
c. Clindamycin
a. Amox-clav
Human bite: alpha strep, accarella
Cat - pasturella
Antibiotics indicated in all high risk bites!\
Initial antibiotic selection needs to cover Staphylococcus and Streptococcus species, anaerobes, Pasteurella species for dog and cat bites, and E. corrodens for human bites. Amoxicillin-clavulanate is an acceptable first-line antibiotic for most bites. Alternatives include second-generation cephalosporins, such as cefoxitin, or a combination of penicillin and a first-generation cephalosporin. Penicillin-allergic patients can receive clindamycin combined with ciprofloxacin (or combined with trimethoprim-sulfamethoxazole if the patient is pregnant or a child). [29] [32] Moxifloxacin has also been suggested as monotherapy.[24] Infections developing within 24 hours of the bite are generally caused by Pasteurella species and are treated by antibiotics with appropriate coverage.[24] Patients with serious infections require hospital admission and parenteral antibiotics such as ampicillin-sulbactam, cefoxitin, ticarcillin-clavulanate or clindamycin combined with a fluoroquinolone or trimethoprim-sulfamethoxazole.[24] Rabies
• Renal transplant guy, presents with fever, back pain and bilateral leg weakness
a. MRI
b. CT
c. LP
d. EMG/NCS
MRI
DDx: Spinal epidural abscess, transveres myelitis, guillan barre syndrome
• Most specific sign of aortic dissection
a. Widened mediastinum
b. Apical cap
Widened mediastinum (50% specific)
Apical cap (pleural blood – not specific)
• Domestic cat bites a kid on the arm
a. Rabies vaccine
b. Antibiotics
c. Nothing
d. Vaccination
Vaccination
(it’s a domestic cat – unlikely rabies)
Tetanus immune globulin and tetanus toxoid should be administered to all bite patients who have had two or fewer primary immunizations. Tetanus toxoid alone can be given to those who have completed a primary immunization series but who have not received a booster for more than five years. (See “Tetanus-diphtheria toxoid vaccination in adults”.)Rabies prophylaxis should be considered in the setting of bites from unvaccinated pets, wild animals and in geographic areas where the prevalence of rabies is high (see “Rabies immune globulin and vaccine”).
• Extraperitoneal bladder rupture
a. Foley
b. OR
Foley
• Chronic renal transplant rejection mediated by
a. Antibodies in the circulation
b. Antigens produced by the graft
c. Host lymphocytes
c. Host lymphocytes
2016 from uptodate looks like it’s an endothelial injury and collagen deposition that causes vascular narrowing leading to rejection
• Guy with laceration with grass and gravel in the wound. Most important thing to do is:
a. Irrigation
b. Antibiotics
c. Tetanus toxoid
a. Irrigation
• Cyclosporine and tacrolimus acts via:
Suppression of IL-2
True/false:
a. Stored blood is at pH 6.2
False: (6.8-7.2 in canadian study)
• Somnolent diabetic postop patient with pH 7.2, Na 145, CO2 34.
a. Hyperosmolar coma
b. Ketoacidosis
c. Renal tubular acidosis
b. Ketoacidosis
• Guy post ileal conduit. Comes back to ER after discharge with serosanguinous drainage from upper part of wound. What do you do?
a. Send fluid for Cr and amylase
b. CT
c. Abdominal binder and close up incision
d. Explore wound
a. Send fluid for Cr and amylase
• All true about PE except
a. Raised CVP
b. Raised pCO2
c. Raised PCWP
b. Raised pCO2 : most common sign is tachypnea = hyperventilation
ABGs usually reveal hypoxemia, hypocapnia, and respiratory alkalosis.
• Congested pale flap
a. Leeches
b. OR
a. Leeches
• When to do a thrombectomy for PE
a. Lobar PE with shock
b. Recurrent PE
c. PE in the IVC
d. PE and ischemic stroke at the same time
Lobar PE with shock
Although systemic hypotension due to PE in a patient in whom thrombolysis is contraindicated is the usual indication for surgical embolectomy, echocardiographic evidence of an embolus trapped within a patent foramen ovale, the right atrium, or the right ventricle has also prompted surgery
• Dude with blood at the urethral meatus
a. Insert foley slightly into the meatus and inject 30cc contrast (i.e. doing a retrograde urethrogram)
b. Insert Foley
c. Suprapubic
a. Insert foley slightly into the meatus and inject 30cc contrast (i.e. doing a retrograde urethrogram)
• Kid with 25% second and third-degree burns. What to do for nutrition?
a. Feeding tube with enteral feeds
b. Central line right away with TPN
a. Feeding tube with enteral feeds
Hypermetabolic response to burns. Increased metabolic demand. Early enteral feeding in pts with burns >25% is beneficial. Formula for caloric needs: 25 kcal/kg/day + 40 kcal/% body sa burned (cuerrie formula)
• Unstable a fib, HR 180, BP 70/40
a. Cardioversion
b. Metoprolol
c. Lie in fetal position in the corner
a. Cardioversion
True or false:
• Coagulopathy of acute trauma does not occur before they reach the trauma bay
false. it does occur
• End of life guidelines from the American College of Surgeons say all EXCEPT:
a. Meet their spiritual and emotional needs
b. Offer chemo
b. Offer chemo
• You find incidental abnormalities on CXR in what percentage of people?
a. 3%
b. 5%
c. 7%
d. 10%
?? 7 or 10%
• Breast cancer patient who’s not feeling so great, now bone pain and mets, hypercalcemia, what is the initial management?
a. Fluids and lasix
b. Bisphosphonates
c. Calcitonin
a. Fluids and lasix
• Brain death patient, initially ok, now hypotensive, Na going up (140/154), u/o >500cc/hr
a. D5W bolus
b. Vasopressin infusion
(undergoing DI basically)
b. Vasopressin infusion
The most important endocrine problem in the brain dead donor is central diabetes insipidus, caused by inadequate antidiuretic hormone (ADH) production within the posterior pituitary gland. Hypotonic urine volumes exceeding 1000 mL/hour may be seen and can be devastating if not treated adequately .Although volume replacement will help ensure euvolemia, excessive diuresis is more easily managed by the administration of desmopressin or vasopressin to keep urine output in the 100 to 200 mL per hour range.
• Some lady with worsening peripheral vascular disease. Poiselle’s law basically…The resistance through the vessel is:
a. Directly proportional to the fourth power of the radius and inversely proportional length of the stenosis
b. Inversely proportional to the fourth power of the radius and proportional to the length of the stenosis
b. Inversely proportional to the fourth power of the radius and proportional to the length of the stenosis
more narrow = more resistance
• Comparing survival curves
a. Wilcom rank sum test
b. Independent t tests
c. Log rank test
c. Log rank test – specifically for survival curves (nonparametric)
• A diagnostic test is accurate for the purpose that it’s designed to do if it has
a. Positive predictive value
b. Validity = accuracy/ reproducibility is percision
c. Sensitivity
Validity = accuracy/ reproducibility is precision
• Incidence is known as
a. The proportion of new cases in patients who previously didn’t have the disease
b. New cases
c. Total cases
d. Proportion of cases in a population at a given point in time
a. The proportion of new cases in patients who previously didn’t have the disease
• CO2 in laparoscopic surgery causes all except the following:
a. Hypercarbia
b. Increased preload
c. Stress on the heart
b. Increased preload – maybe initial increase but overall decrease because of collapse of veins.
• Tendon injury to the hand and decreased sensation
a. Explore in OR right away
b. Splint in the ER and consult plastics in AM
c. Repair in the ER
b. Splint in the ER and consult plastics in AM
Joint involvement and vascular compromise will neccesitate OR right away.
• IO access in kids
a. Slower than IV access
b. Aim away from the knee
b. Aim away from the knee – avoid epiphisis
• Pyloric stenosis kid whose Cl cannot correct despite giving NaCl. Why?
a. Hypokalemia
b. Starvation
Hypokalemia
Finally, severe hypokalemia (plasma potassium concentration usually below 2 meq/L) may enhance bicarbonate reabsorption by an additional mechanism. Via an unknown mechanism, distal chloride reabsorption is diminished in this setting [21]. As a result, sodium reabsorption is associated with a greater than usual degree of luminal negativity, since this gradient is usually dissipated in part by chloride reabsorption. The enhanced electrical gradient can promote hydrogen secretion [21]
• Least reactive suture
a. Polyester
b. Silk
c. Polypropylene
d. Polyglycolic
c. Polypropylene (second to steel)
Polyglycolic = least reactive of the absorbables
• Most prevalent form of collagen laid down in proliferative phase
a. Type I
b. Type III
b. Type III – elastic collagen
• Despite normal coags, likely to bleed – all except
a. Trousseau’s syndrome
b. Ehler-Danlos
c. Marfan’s
d. Osteogenesis imperfecta
a. Trousseau’s syndrome - venous thrombosis of the upper and lower extremities associated with visceral cancer.
• 44 y/o guy post-renal transplant, 8 years out, most likely to have
a. BCC
b. Prostate cancer – decreased risk
c. Testicular cancer
a. BCC
• Most likely to have wound infection
a. Obesity
b. Anemia
c. Thrombocytopenia
a. Obesity
• Multitrauma guy. Best nutritional support
a. 25 kCal/kg/day, 1.0g/kg protein, 20% lipid
b. 25kCal/kg/day, 1.0 g/kg protein, 50% lipid
c. 35 kCal/kg/day, 2.0g/kg protein, 20% lipid
d. 35 kCal/kg/day, 2.0 g/kg protein, 50% lipid
c. 35 kCal/kg/day, 2.0g/kg protein, 20% lipid
20% is the maximum formulation that we can find. Protein: 1/kg normal, 1.5 moderate, 2/kg in severe burns/trauma etc.
What is the sequence of events in wound healing?
a. Vasoconstriction, vasodilation, PMN migration, re-epithelialization, collagen deposition, contraction
• Guy with with C. Diff on TPN, starting to get septic, has non-anion gap metabolic acidosis from:
a. TPN
b. Lactic acidosis
a. TPN
• Example of a clean-contaminated wound is:
a. Appendectomy of non-perforated appendicitis
b. Open fracture
c. Bowel perforation, shite everywhere…
a. Appendectomy of non-perforated appendicitis
• Dirty operation, antibiotics given, chance of wound infection
a. 15%
b. 30%
c. 40% this is the number for NO antibiotics
b. 30%
Sabiston: 1-5 clean, 3-11 clean/contam, 3-17 contam, >27% dirty
40% is the number for NO antibiotics
• Chemoprophylaxis for
a. Breast cancer
b. Melanoma
c. Thyroid cancer
d. Astrocytoma
a. Breast cancer - tamoxifen
• Rhabo causes
a. Hypercalcemia and hypophosphatemia
b. Hypercalcemia and hyperphosphatemia
c. Hypocalcemia and hyperphosphatemia
d. Hypocalcemia and hypophosphatemia
c. Hypocalcemia and hyperphosphatemia
• If blood is grouped for ABO and Rh but not crossmatched, what are the chances of a reaction
a. 0.1%
b. 1%
c. 5%
d. 10%
d. 10% - due to HLA
• LMWH – all except
a. Binds to antithrombin III and potentiates
b. Can be measured by apt factor Xa assay
c. Reversable by protamine –
d. Reversible by FFP
C. Protamine doesn’t work. Anti xa can give you lmwh levels
Previous
b. Can be measured by apt factor Xa assay
LMWH is partially neutralized by protamine but not completely
• Patient on unfractionated heparin develops UGI bleed and hypotension. You stop the UH and then:
a. Do nothing
b. Give FFP
c. Give protamine
c. Give protamine
• Pelvic fracture bleeding from the
a. Posterior venous plexus
b. Pudendal vessels
c. Femoral vessels
a. Posterior venous plexus
• Increased caloric intake causes
a. Decreased respiratory work
b. Dehydration
b. Dehydration – water used to utilize/digest energy
• Best test to distinguish between ATN and prerenal ?
Fractional Na excretion (>2% atn,
• Guy who had an adrenalectomy now hypotensive. What test do you do?
a. 1mg dexamethasone suppression test
b. AM cortisol
c. 24 hour urinary cortisol
d. ACTH stim test
d. ACTH stim test
• When to give stress steroids periop?
a. Received 2 weeks of 20mg steroids like 5 years ago
b. Received 40mg IV hydrocortisone 4 months ago
c. 15mg for RA, now undergoing total knee arthroplasty
c. 15mg for RA, now undergoing total knee arthroplasty
prolonged >5 mg prednisone equivalent/day for greater than one year or >20 mg for greater than 3-4 weeks in the past year.
• Give 1L of ringer’s, how much will go into plasma?
a. 1L
b. 250cc
c. 100cc
b. 250cc
• Conditions that cause Na retention, all EXCEPT
a. Cirrhosis
b. CHF
c. Hypercortisolism
d. Hypoaldosteronism
d. Hypoaldosteronism
• All false EXCEPT:
a. Depressed skull fractures are caused by low energy trauma
b. Linear skull fractures aren’t significant unless they cause vascular trauma
c. Depressed skull fractures usually at the thick part of the bone
b. Linear skull fractures aren’t significant unless they cause vascular trauma
• You do a fasciotomy for compartment syndrome in the anterior and lateral lower leg. Then the person develops numbness over the dorsum of their foot. It is caused by:
a. Surgical complication
b. Ischemic neuropathy
c. Vascular complication
d. Compartment syndrome
a. Surgical complication – superficial peronial nerve.
unlikely to have 1 nerve isolated ischemic neuropathy?
• When would you not resect pulmonary mets?
a. When the primary tumour is not controlled
b. Bilateral pulmonary mets
c. Multiple mets
a. When the primary tumour is not controlled
• Someone with neck trauma, stridorous, enlarging neck hematoma, not looking so great…
a. Endotracheal intubation
b. Cricothyroitomy
c. CT
a. Endotracheal intubation
• Post thyroidectomy patient, dyspnea, expanding neck mass
a. Drain hematoma
b. Intubate
a. Drain hematoma
• Abdominal trauma guy who’s resuscitated with IV fluids, responds to fluids. What would prompt laparotomy?
a. Positive DPL
b. Positive blood on FAST
c. Positive blood on CT
d. Hemodynamic instability despite resuscitation
d. Hemodynamic instability despite resuscitation
• Patient comes in for spirometry preop. Best predictor of pulmonary complications
a. FEV1
b. Tidal volume
c. Vital capacity
a. FEV1
• Stimulants of MH include all EXCEPT – all inhalational and sux. Autosomal dominant.
a. Halothane
b. Sevoflurane
c. Propofol
d. Succinylcholine
c. Propofol
