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)