genitourinary

Question 1

What should be treated as a ruptured ectopic pregnancy until proven otherwise.

Answer 1

The combination of a FAST positive for free fluid and positive pregnancy test

Question 2

Methotrexate may be considered in hemodynamically stable patients: 4 things?

Answer 2

Without evidence of rupture
With β-hCG < 5000 mIU/mL
With gestations < 4 cm
Without fetal cardiac activity

Question 3

What is considered the discriminate zone?

Answer 3

5-6k transabdominal, 1-2k transvaginal

Question 4

2 most common presenting symptoms of PID

Answer 4

bilateral lower pelvic pain and purulent discharge

Question 5

If we are thinking PID and there is unilateral adnexal tenderness what are we thinking?
What about PID and right right upper quadrant pain?

Answer 5

tubo ovarian abscess

fitz hugh curtis syndrome and the infection has reached the liver

Question 6

What is the diagnositc image choice for TOA?

Answer 6

US

Question 7

Where do we most commonly see ovarian torsion?

What is the most common cause?

Answer 7

right

enlargement of the ovary because of cyst or mass

Question 8

The best initial imaging for ovarian torsion is?

Answer 8

a transvaginal ultrasound with Doppler.

Question 9

The most common ultrasound finding in torsion is?

Answer 9

enlargement or edema of the ovary. Commonly an ovarian mass or cyst can be visualized and in, later stages, free pelvic fluid

Question 10

Which testicle is more commonly affected in torsion?
What is prehns sign?
What reflex is commonly lost?

Answer 10

left
elevation of the testicle providing pain relief
cremasteric

Question 11

image of choice for testicular torsion?

Answer 11

US

Question 12

In pregnancy, What is the most common non-obstetric surgical emergency.

Answer 12

appendicitis

Question 13

image choice for appendicitis for kids, pregnancy and others?

Answer 13

US for kids and pregnancy

CT others

Question 14

Typically the first place that jaundice is manifest is in the?

Answer 14

scleara of the eyes

Question 15

What is the difference between partial and complete bowel obstruction?

Answer 15

gas and liquid stool can get through

nothing

Question 16

What is my thinking with the cause of obstruction on the bowel?

Answer 16

because adhesions is most common, consider recent surgery or history of surgery. Then move on to history of bowel problems or dsisease like crohns. Then if the patient has no history of any of it, I need to start thinking of hernias and masses or tumors.

Question 17

Findings on plain film that suggest SBO include?

Answer 17

air-fluid levels in the small bowel or dilated loops of small bowel.

Question 18

most dangerous complication of obsturction?

Answer 18

strngulation

Question 19

What is classic presentaiton of mesenteric ischemia?

Answer 19

over 60, more females, out of proportion pain to exam. acute pain coming on.

Question 20

what is the most common cause of mesenteric ischmia?

Answer 20

mesenteric artery embolus

Question 21

3 risk factors for mesenteric artery embolus?

Answer 21

afib, post MI mural thrombus and valve disease

Question 22

What is the constellation of these symptoms termed chronic mesenteric ischemia? 4

Answer 22

abdominal angina, diarrhea, fear of food, and weight loss.

Question 23

MVT occurs in younger patient populations and is most likely due to?

Answer 23

hypercoagulable states

Question 24

What is gold standard imaging for mesenteric ischmeia?

Answer 24

multidetector CT angiography of the abdomen and pelvis

Question 25

What is non occlusive mesenteric ischemia?

Answer 25

something is wrong with supply, maybe shock, sepsis, cardiac output sucks in some way

Question 26

How are we treating mesenteric ischmemia?

Answer 26

embolectomy, stent, bypass, fix underlying supply problem

Question 27

incarcerated inguinal hernia reduction should be performed with the patient in what position?

Answer 27

trendelenburg

Question 28

what test to diagnose malaria?

Answer 28

peripheral blood smear to see it in the red blood cells