Mastering the boards

Question 1

Pt under 35 and has no cardaic disease; which test is needed for preop?

Answer 1

EKG

Question 2

Pt with blunt abdominal trauma and right flank pain with bruising suggests what?

Answer 2

pancreatitis

Question 3

bruising around the umbilicus (Cullen sign)

Answer 3

hemorrhagic pancreatitis, ruptured AAA

Question 4

bruising in flank (Grey Turner sign)

Answer 4

retroperiotoneal hemorrhage

Question 5

pain in the left shoulder

Answer 5

splenic rupture

Question 6

dull percussion on the left and shifting dullness on the right

Answer 6

splenic rupture

Question 7

pt with severe abdominal pain, 10/10, after eating, bloody diarrhea and no other findings. Peritoneal signs. Elevated WBCs. Ddx? best next step?

Answer 7

Acute mesenteric ischemia

angiography

Question 8

right shoulder/scapula referred pain. Cause?

Answer 8

gall bladder

Question 9

referred pain in back. Cause?

Answer 9

Pancreas

Question 10

referred pain in left lower quadrant, cause?

Answer 10

appendix

Question 11

referred pain in tip of penis/perineum, cause?

Answer 11

prostate

Question 12

what tests are contraindicated in diverticulitis (closely associated w/ constipation)?

Answer 12

barium enema and colonoscopy in case of perforation

Question 13

Tx for diverticulitis?

Answer 13

Antibiotics for first attack; surgical resection if it recurs or perforates

Question 14

Which medication helps with stool impaction in patients with chronic opioid use?

Answer 14

methylnaltrexone

Question 15

Elevated lactate with marked acidosis, severe waves of intermittent abdominal cramps, fever, hyperactive bowel sounds, hypovolemia due to third spacing. Ddx?

Answer 15

Bowel obstruction

Question 16

Best initial test of fecal incontinence? Most accurate test?

Answer 16

Sigmoidoscopy/anoscopy

anorectal manometry

Question 17

Tx for open fracture?

Answer 17

Surgery

Question 18

Best diagnostic test for stress fx?

Answer 18

CT or MRI; X-ray doesn’t really show

Question 19

Arm held to the side with externally rotated forearm and with severe pain. Ddx?

Answer 19

Anterior shoulder dislocation

Question 20

Tx for trigger finger (acutely flexed and very painful)

Answer 20

Steroid injection