5/11/13

Question 1

Following head trauma, a pt. exhibits right hemiparesis, dilation of the rt. pupil, down-and-out gaze of rt. eye, left homonymous hemianopsia, and altered level of consciousness. What has occured?

Answer 1

transtentorial (uncal) herniation

“I think I just herniated my uncus!”

Question 2

What cranial nerve is affected first by transtentorial herniation?

Answer 2

oculomotor (III)

Question 3

Compression of what structure causes contralateral homonymous hemianopsia in uncal herniation?

Answer 3

PCA

Question 4

Compression of what structure causes ipsilateral hemiparesis in uncal herniation?

Answer 4

contralateral cerebral crus

Question 5

A lesion in which cranial nerve would cause loss of the gag reflex and loss of taste and sensation in the posterior 1/3 of the tongue?

Answer 5

glossopharyngeal nerve (IX)

Question 6

Following surgery, there is intence pain in the wound, decreased sensitivity at the edges of the wound, cloudy grey discharge, and maybe crepitus. Dx?

Answer 6

necrotizing surgical infection

Question 7

What is the most important step in mgmt of necrotizing surgical wounds?

Answer 7

urgent surgical exploration and debridement

Question 8

What is dislocated in Nursemaid elbow?

Answer 8

subluxation of the radial head at the elbow

Question 9

What is the appropriate Tx for a slipped capital femoral epiphysis?

Answer 9

surgical pinning of the femoral head in situ

Question 10

What is the main risk of not pinning a slipped capital femoral epiphysis?

Answer 10

avascular necrosis of the femoral head (and chondrolysis)

Question 11

What is the next best step if free air is seen under the diaphragm on X-ray (pneumoperitoneum)?

Answer 11

emergent exploratory laparotomy

Question 12

What is the first-line diagnostic modality for ureteral stones?

Answer 12

non-contrast CT

Question 13

What should be suspected in every chronic, non-healing wound?

Answer 13

malignancy

Question 14

What kind of skin malignancy arises in chronically wounded, scarred, or inflamed skin?

Answer 14

SCC

Question 15

What do you call an SCC arising from a burn wound?

Answer 15

Marjolin ulcer

Question 16

Pts w/ _______ typically present w/ a nevus that has increased in size, changed color, or become palpable or symptomatic (painful, pruritic, bleeding).

Answer 16

melanoma

Question 17

_______ are melanocytic nevi exhibiting characteristics not seen in standard dysplastic nevi: size greater than 6 mm, irregular borders, and irregular pigmentation.

Answer 17

Dysplastic nevi

Question 18

_______ classically presents on chronically sun-exposed skin as telangiectactic papules with a central “rodent” ulceration.

Answer 18

BCC

Question 19

_______ is a precursor lesion to SCC common on chronically sun-exposed skin.

Answer 19

Actinic keratosis

Question 20

For acute cholecystitis, the pt should be treated with observation and supportive care intitially followed by a cholecystectomy within what amount of time?

Answer 20

72 hrs