Hi-Ho, Hi-Ho

Question 1

burn treatment that might lead to hyponutremia

Answer 1

silver nitrate

does not penetrate

Question 2

burn fluid formula

Answer 2

4ml * kg * %burn

1/2 in 8
1/2 in 16

Question 3

child with holosystolic murmur in left lower border

Answer 3

VSD

Question 4

tetralogy murmur

Answer 4

harsh systolic ejection murmur

Question 5

celiotomy is a?

Answer 5

fancy name for ex-lap

Question 6

Is a FAST exam helpful in abdominal injury with hemodynamic stability?

Answer 6

50% sensitivity for abdominal injury- not great in stable pts

Question 7

SBO s/s and cxr findings with needle shaped crystals in UA

Answer 7

Needs CT

probably has uric acid stones –> ileus (after stone passes, ileus resolves)

Question 8

Family history of clotting pt has an elevated homocysteine. What rx should she be one?

Answer 8

homocysteine- very reactive --> DVTs
↑ homocysteine can usually be resolved by giving: 
B6
Folate
\+/- B12

Question 9

1st feeding intolerance, abdominal distention, and a rapidly dropping platelet count

Answer 9

Necrotizing enterocolitis

usually in pre-mes

Treatment: stop all feedings and administer broad-spectrum antibiotics, IV fluids, and IV nutrition

Question 10

shows up with green vomiting, but instead of a

double bubble there are multiple air-fluid levels throughout the abdomen.

Answer 10

Intestinal atresia

condition results from a vascular accident
in utero.

Question 11

Vital signs vs fluid DETERMINING SURGERY

Answer 11

• minor internal injuries/ responds promptly to fluid resuscitation might not need surgery –> CT
• major injuries and vital signs that do not improve with fluid resuscitation–> surgery.

Question 12

Necrotizing enterocolitis rx

Answer 12

Treatment: stop all feedings and administer broad-spectrum antibiotics, IV fluids, and IV nutrition

Surgical if abdominal wall erythema, air in the portal vein, intestinal pneumatosis (presence of gas in the bowel wall), or pneumoperitoneum (signs of intestinal necrosis and perforation).

Question 13

look for the words _________ in the description of the patient as your clue that you can choose CT scan as the correct answer in this setting.

Answer 13

“hemodynamically stable”

Question 14

“signs of acute rejection of transplant–> RX?

Answer 14

needs steroid bolus

Question 15

patient who is being allowed to pass a ureteral stone spontaneously develops chills, fever spike, and flank pain.

RX

Answer 15

IV antibiotics
immediate decompression of obstruction- ureteral stent or percutaneous nephrostomy

*The combination of obstruction and infection of the urinary tract is a dire emergency

Question 16

Painless ulcer, chronically edematous, indurated, and hyperpigmented above the medial malleolus.

Answer 16

Venous stasis ulcers

ddx: Duplex scan

Treatment= support stockings, Ace bandages, Unna boot.

Surgery =vein stripping, grafting of the ulcer, endovascular ablation with laser or radiofrequency

Question 17

Ulcer looks dirty, with a pale base devoid of granulation tissue. work up?

Answer 17

Doppler studies looking for a pressure gradient –>CT angio, MRI angio or arteriograms –> surgical
revascularization or angioplasty and stents.

Question 18

Ogilvie syndrome

Answer 18

very common “paralytic ileus of the colon.” in elderly. after immobilization

large abdominal distention (tense non tender)

x-rays show massively dilated colon.

After fluid/ electrolyte correction, mechanical obstruction must be ruled out

RX IV neostigmine to restore colonic motility/ long rectal tube

Question 19

Ogilvie syndrome

Answer 19

RX IV neostigmine to restore colonic motility/ long rectal tube

very common “paralytic ileus of the colon.” in elderly. after immobilization (massive dilated colon)

Question 20

produce loss of upper gaze and the physical finding known as “sunset eyes”

Answer 20

Tumors of the pineal gland

Question 21

Brain tumors in children are most commonly in the _____

Answer 21

posterior fossa.

cerebellar symptoms (stumbling around, truncal ataxia)

children often assume the knee-chest position to relieve their headache

Question 22

Brain abscess rx

Answer 22

Actual resection is required.

Question 23

_________ on xray highly suggests traumatic ruptured aorta

Answer 23

widened mediastinum

rx: endovascular repair

Question 24

interval appendectomy

Answer 24

used when there is an abscess
abx and ct guided drainage
appendectomy after several weeks

Question 25

best imaging for pelvic stuff

Answer 25

US

Question 26

Best imaging for abdominal stuff

Answer 26

CT

Question 27

gold standard imaging for PE

Answer 27

pulmonary angiography

Question 28

is a trauma patient with a high INR at risk of dvt?

Answer 28

YES! high INR for them is not protective. They need LMWH within 36 hours of injury

Question 29

Can you start empiric blood thinner if you think someone has a PE?

Answer 29

Yes

you do not have to wait for the test (if the patient is low risk for complications)

Question 30

When would you never use heparin

Answer 30

if someone has ever had HIT

Question 31

Stage 4 cancer means?

Answer 31

there are mets

Question 32

Stage 3 cancer means?

Answer 32

there are lymph nodes involved

Question 33

What chemo is used in colon cancer

Answer 33

FOLFOX
5-FU
leucovorin
oxaliplatin

Question 34

If you find a polyp in colonoscopy, what is colonoscopy follow up

Answer 34

repeat in 3 years

if negative then, every 5 years

Question 35

Rectal cancer needs _____ to reduce recurrence?

Answer 35

neo-adjuvant chemo