Bootcamp Flashcards
A 63-year-old man presents with a skin lesion ,diagnosed as basal cell carcinoma. Which one of the following is the best treatment option?
radiotherapy curettage surgical excision Cryotherapy chemotherapy
Excision
23-year-old man came with pain and swelling on the radial side of the wrist after a fall and he mentions point tenderness around the dorsal radial wrist and x-ray reveals no fracture. Which one of the following treatments is the most appropriate?
- plaster immobilization for 2 weeks and re-x-ray
- plaster immobilization for 6 weeks and reassess
- compression bandage for 2 weeks and re-x-ray
- reassurance and analgesics
- compression bandage for a few days and early active exercise
Plaster immobilization for 2k and re XR
MRI will Dx scaphoid #
40 year old woman is brought to the ER, unconscious following a head injury in a MVA.
There is bruising over the upper abdomen. Blood pressure is 85 mm Hg systolic, pulse 130/minute. What is the most important initial step in the management of this patient?
perform emergency burr holes immediate laparotomy diagnostic peritoneal lavage(DPL) x-ray (three views) of abdomen draw blood sample and start IV fluids
draw blood and start IVF
A continuous machinery murmur is heard on auscultation of a mass in the anterior thigh of a 40 year old man with high-output heart failure. The origin of this mass is most likely associated with which one of the following?
- mycotic aneurysm
- blunt trauma
- congenital malformation
- previous femoral artery bypass
- penetrating injury
penetrating injury.
77-year-old woman came with a 11 month history of low-back pain, exacerbated by walking. She admits to gait disturbance with ambulation. Examination is unremarkable for symmetrically decrease in both ankle and Knee reflexes. X-rays of the lumbosacral area show degenerative changes. Which one of the following is the most likely diagnosis?
- Polymiositis
- acute lumbar disk herniation
- normal pressure hydrocephalus (NPH)
- cervical stenosis
- lumbar stenosis
lumbar stenosis (neurogenic claudication)
type of hemorrhoids suitable for treatment by elastic-band ligation?
- external hemorrhoids with pruritus ani
- internal hemorrhoids with bleeding
- external hemorrhoids with thrombosis
- internal hemorrhoids with fecal soiling
- external hemorrhoids with ulceration
Internal hemorrhoids with bleeding
25-year-old man sustains a blow-out fracture of his left orbit while playing squash. The possible finding would be
- blood behind the left tympanic membrane.
- retinal detachment.
- horizontal diplopia.
- left enophthalmos.
- depression of the zygomatic arch on the left side.
Left Enopthalmos
When something hits orbit it is most likely to hit the inferior orbital bone. In that space there is the inferior orbital nerve (numbness around cheek). Inferior rectus located inside the inferior orbit and therefore trap the inferioir rectus muscle.
THEREFORE get vertical diploplia and Enopthalmos
37 year-old woman came with 10 days history of hemorrhoids that slightly prolapse and bleed with some bowel movements. She feels itchy. Which treatment you would recommend for this patient?
- hemorrhoidectomy
- acetaminophen suppositories
- laxatives
- hemorrhoid banding
- stool softeners and high fibre diet
Hemorrhoid banding
After a collision 29-year-old man is admitted to the hospital with a fracture of the tenth rib on the left side. He is noted to be pale, restless, and sweating, and his bp is low. On examination there is pronounced guarding in the left upper quadrant of the abdomen. Which one of the following viscera is most likely damaged?
left kidney Spleen left lung Pericardium left diaphragm
Spleen
(fracture of lower ribs on L side = spleen, # of lower ribs on R side = liver)
(penetrating injury = Liver injury, Blunt abdo trauma = splenic injury)
19 yo old man sustains a severe blow to the head. Skull x-rays show air in the cranial vault. This finding represents which one of the following?
- skull fracture
- severe contusion
- fracture of the nasal septum
- severe concussion
- subdural hematoma
Skull # (vault #/linear #)
Pneumocephalus (must have broken skull to get air)
Layers of skull; Skull – Dura (if penetrate dura = air) – Arachnoid – Pia
Know approach to skull fractures (vault and basilar skull #)
Basilar skull # = racoon eyes, hemotympanum, mastoid bruises)
55 year-old woman has a 2.5 cm carcinoma in the upper outer quadrant of her left breast, with no palpable axillary nodes. Which one of the following is the most appropriate treatment?
- lumpectomy and axillary dissection
- lumpectomy, axillary dissection and radiotherapy
- lumpectomy and tamoxifen
- lumpectomy followed by radiotherapy
- modified radical mastectomy
-lumpectomy, axillary dissection and radiotherapy. This is Grade IIA
Management of Breast CA Grade I <2cm Grade IIa- 2-5cm (no lymph nodes palpable) Grade Iib 2 – 5cm (palpable lymph nodes) Grade III
17 yo old boy presents with history of a football injury to the left flank .He mentions that at the time of injury he only had the wind knocked out of him and recovered in a few minutes. after 1 hour, he began to experience pain in the left upper quadrant and left shoulder and light-headedness on standing. Which is the most likely diagnosis?
- contusion of the left kidney
- left-sided pneumothorax
- dislocation of the left shoulder
- ruptured spleen
- broken rib on the left side
Ruptured Spleen
Kehr’s Sign from splenic rupture
After collision, 25 yo old man presents with bruising of the eyelid and clear fluid is observed leaking from his nose. Which is the most likely cause?
- linear fracture of the vault of skull
- squamous temporal bone fracture
- anterior cranial fossa fracture
- petrous bone fracture
- foramen magnum fracture
Anterior cranial fossa # (is the base of the skull)
Basilar skull fractures involve at least one of the five bones that comprise the base of the skull: cribiform plate of the ethmoid, orbital plate of the frontal bone, petrous and squamous portion of the temporal bone, and the sphenoid and occipital bones.
37 year-old female keyboard operator is having pain and numbness in her hands that radiates up her arms. Which of the following is most likely to have been injured?
axillary nerve radial nerve median nerve brachial plexus / triceps muscle ulnar nerve
radial
After a collision, 25 yo old man has obvious blunt chest and abdominal injuries, but the striking feature is his marked restlessness. Which one of the following is the most important step to start?
Check for causes of hypoxia Give him a sedative Check him for head injury Catheterize his bladder Give him morphine
Hypoxia
Airway and C spine precautions
After a severe motor vehicle accident, 30 year old man is having an unstable knee joint. Under anesthesia, it is possible to pull the tibia forward excessively on the femur. Which one of the following structures is mostly injured in this patient?
Anterior cruciate ligament Medial collateral ligament Ligamentum patellae Lateral meniscus Oblique popliteal ligament
ACL
25 yo old basketball player presents with swelling of his left knee. The injury occurred while he was turning with his left knee slightly bent. Which one of the following is most likely injured?
- Medial collateral ligament
- Medial meniscus
- Ligamentum patellae
- Fibrous capsule of the knee
- Anterior cruciate ligament
Medial Meniscus
When land with knee extended then ACL tear
Meniscal injuries occur when knee is flexed
77 year old woman with Alxheimer’s disease falls in the nursing home and hits her head. No fractures are noted on a skull radiograph. She has fluctuating levels of consciousness and complains of a several headache on the left side of her head. Mydriasis is noted in the left pupil. Which one of the following is the most likely diagnosis in this patient?
- Epidural hematoma
- Intracerebral hemorrhage
- Subdural hematoma
- Hemorrhagic infraction of the brain
- Subarachnoid hemorrhage
Subdural Hematoma
Epidural Hematomas; rarely see <2y or over 60y. Tend to be associated with skull #, lucid interval. Maintaining GCS within 2h then NO epidural. No headache they’re ok.
Subdural higher in Elderly pts; can cause intermittent confusion (bridging veins)
If GCS 15 2 hours after injury then NO epidural because
65 year old man came with blood pressure is slightly elevated and a left flank mass is palpated. Which one of the following tests is most likely to confirm the nature of the mass lesion?
- Angiogram
- Retrograde ureteropyelogram
- Intravenous pyelogram
- Radioisotope renogram
- Computed tomography
CT
Approach to flank masses;
- US (cystic vs solid)
- CT
T/F does renal cell Ca cause paraneoplastic syndrome
YAS
Stimulates erythropoietin so get polycythemia
35 days after the removal of a cast from 57 yo old woman’s leg, she is unable to dorsiflex her foot, which one of the following nerve is most likely injured?
Sural Femoral Saphenous Common peroneal Tibia
Common peroneal. (wraps around the head of the fibula)
Make sure cast doesn’t touch head of fibula.
After a collision, patient with a clear fluid leaking from his ear and bruising in the mastoid region (Battle’s sign). Which one of the following injuries is most likely?
Fracture of the supraorbital ridge Linear fracture of the vault of skull Middle cranial fossa fracture Ethmoid bone fracture Foramen magnum fracture
Ethmoid Bone
25 yo old man presents with a wound on the front of his left wrist, at the level of the proximal transverse crease. There is diminished sensation over the lateral half of the palm of the hand and the palmar aspect of the lateral three and on half fingers. He is unable to oppose his thumb to the other figures. Which one of the following is likely to have been injured?
Ulnar nerve Musculocutaneous verve Radial nerve Brachial nerve Median nerve
MEdial Nerve
A soccer player was struck on the left side of the head with the ball. The player fell to the ground, but did not lose consciousness. After a few hours he has seen to be confused and irritable. Which one of the following is the most likely diagnosis?
Subdural hematoma Intracerebral hemorrhage Subarachnoid hemorrhage Post-concussion syndrome Extradural hematoma
Extradural Hematoma
Hyperventilation done to decrease ICP
25 yo old woman came with damaged radial nerve due to fracture of the lower third of the humerus. Which one of the following will be patient experience?
A weakness in pronating the forearm
An inability to oppose the thumb
A loss of wrist extension, leading to wrist drop
A sensory loss over the ventral aspect of the base of the thumb
An inability to abduct the fingers
loss of wrist extension
After a car accident 55 yo old man came with chest pain, on examination, at the end of the expiration his blood pressure is 130/90 mmHg and at the end of inspiration it is 110/92 mmHg. Which one of the following condition is most likely?
- Pneumothorax
- Acute myocardial infraction
- Multiple rib fractures
- Aortic rupture
- Cardiac tamponade
tamponade (pulsus paradoxus)
3 hrs after application of the plaster cast for supracondylar fracture, a patient comes back with a complaint of severe pain in the hand, swelling of the fingers and cyanosis. Which one of the following is the best management?
-To administer vasodilators
-Cut open the plaster near the fingers
T-o administer analgesics
-Cut open the entire plaster cast immediately
-To observe the patient
cut open the entire plaster cast immediately
Brachial artery, median nerve and ulnar nerve can be injured.
33 year old male is admitted to the emergency department 1 hour after he sustained major burns to the thorax, the neck and the face. Aside from hypovolemic shock, the most immediate life threatening complication to anticipate is
- Hemorrhage secondary to a stress ulcer
- Gram negative sepsis
- Acute gastric dilation
- Secondary inhalation injury
- Acute renal failure
Secondary Inhalation Injury
Ringers Lactate Parkland Formula; 4cc/kg x % BSA burned
Singed eyebrows, soot in mouth - direct evidence of inhalation injury
25 year old woman who is breastfeeding presents to the ER with 2 day history of pain and redness in the right breast. Her temperature is 38 C. On examination there is a fluctuant 10cm diameter area of induration, redness and extreme localized tenderness. Which one of the following is the most appropriate step in management?
Discontinue breast-feeding (from both breasts)
Incise and drain the indurated area
Express milk from the right breast with pump and discontinue breast feeding (from the left)
Apply a hot compress and prescribe an anti-inflammatory (medication)
Prescribe a course of cloxacillin
Incise and Drain the indurated area
Mastitis vs Breast Abscess
- This is abscess re: fluctuating mass
Staph aureus is the bug (use clod)
63 year old woman is prescribed tamoxifen therapy following surgery for breast cancer. Which one of the following best described the mode of action of this drug on reducing the patient’s risk of recurrent disease?
It decreases secretion of FSH
It blocks the binding of estrogen to estrogen receptors
It enhances biliary excretion of estrogens
It has direct cytotoxic effects
It has progestational activity that limits the growth-promoting effects of estrogens
Blocks binding of estrogen to estrogen receptors
69 year old woman presents to your office with a lump in her breast. Which one of the following is the greatest risk factor for cancer?
Positive family history Early menarche Use of hormone replacement therapy Advanced age Nulliparity
Advanced age
Two most common RF is sex and age (greatest RF for BC)
62 year old woman with breast carcinoma was treated with a partial mastectomy. Which one of the following suggests a better prognosis?
- The primary tumor was 2.5 cm in diameter
- Presence of estrogen receptors
- Absence of metastasis in the liver
- Positivity of only 5 lymph nodes
- Recurrence-free in the first 6 months
Presence of ER
67 year-old previously healthy woman has palpable 1.5-cm mass in the upper outer quadrant of the left breast. Which one of the following is the most likely diagnosis? acute mastitis Carcinoma fibroadenoma Paget's disease of the breast fibrocystic disease
Carcinoma
- Fibroadenoma (mobile and solid, no fluid on aspiration)
- Pagets (affects the skin, eczema, peau d’orange around nipple and areola)
- Fibrocystic Disease (common age 30 -50) menopause causes fibrocysts to shrink
29 year old male complains that for 7 weeks, food has been getting “stuck” in his throat. He says that he has difficulties swallowing liquids and solids. On further questioning, he confirms that he occasionally regurgitates undigested food that he ate several hours prior. Which of the following studies would you expect to yield abnormal results?
- Computed tomography of the chest without oral contrast
- Esophagogastroduodenoscopy
- Esophageal manometry
- Electrocardiogram
- Computed tomography of the chest with oral contrast
Esophageal Manometry
Zenkers Diverticulum; with foul smell, obstructive dysphagia
An elderly patient who underwent orthopedic repair of a hip fracture developed abdominal distention and dull diffuse abdominal pain. He denies fever or diarrhea. WBC count was 4.8. An abdominal plain film shows right sided colonic distention Colonoscopy revealed no obstruction or other abnormalities. Which is the likely inciting factor in the development of this condition?
Prior abdominal surgery Narcotic administration Recent exposure to antibiotics Transmural inflammation Colonic perforation during hip fixation
Ogilivies - constipation from narcotics.
A 14-year-old girl with persistent melena and chronic anemia undergoes colonoscopy. The findings are shown in the photograph. Which of the following correctly describes the nature of her disease? (polyps multiple on colonoscopy)
Mutation of an oncogene on chromosome 5
Mutation of a tumor suppressor gene on chromosome 2
Mutation of an DNA mismatch repair gene on chromosome 7
Mutation of a tumor suppressor gene on chromosome 5
None of the above
Mutation of tumour suppressor gene on chromosome 5
A 47-year-old male is brought to the emergency department for severe vomiting. He reports passing no flatus for 12 hours despite an increasingly distended abdomen. Which of the following represents the greatest risk factor for small bowel obstruction?
History of colon cancer History of asymptomatic diverticulosis History of colon resection History of recent travel History of fecal impaction
hx of colon resection (adhesions from prior surgery)
Any pelvic surgery can do that as well.
A 63-year-old male presents with lower back pain to his primary care physician. Physical examination shows a hard nodule on digital rectal examination. Prostate adenocarcinoma is suspected. Which lobe(s) of the prostate is most commonly affected by prostate adenocarcinoma?
Middle lobe Lateral lobe Anterior lobe Posterior lobe Lateral and middle lobes
Posterior lobe - prostate Ca
Medial lateral lobe = BPH
A 65-year-old man presents with increased frequency of urination, nocturia and difficulty starting and stopping his stream of urine. Laboratory work shows an increased level of free prostate-specific antigen. What is the mechanism of action of the drug used to treat this condition?
Inhibition of testosterone synthesis and interference with the fungal synthesis of ergosterol
Inhibition of 5-alpha-reductase
Nonsteroidal competitive inhibitor of androgens at the testosterone receptor
Antagonist of gonadotropin relasing hormone when used in continuous fashion
Inhibition of aldosterone by competing for intracellular aldosterone receptors
BPH and dihydrotestosterone (5 aplha reductase converts form testosterone)
Therefore 5 alpha reductase inhibitors used to treat bph
