NBME Flashcards
What is the landmark of the ETT tip placement?
4-6cm ABOVE tracheal CARINA (level of clavicular heads, ridge of cartilage dividing two bronchi)
What is the landmark of the CENTRAL LINE tip placement?
Tip placed above RIGHT ATRIUM in SVC
What is the landmark of the SWAN-GANZ CATHETER tip placement?
Tip placed WITHIN R. or L. MAIN PULMONARY ARTERIES
What is the landmark of a NASOGASTRIC TUBE placement?
PROXIMAL to gastric PYLORUS
DISTAL to ESOPHAGOGASTRIC junction
What is the artery of bleeding that does not stop despite anterior nasal packing?
SPHENOPALATINE ARTERY
When ABG level shows DECREASED PaO2, what are the two possible options of switching parameters?
1) INCREASE FiO2
2) INCREASE PEEP
When should you INCREASE TIDAL VOLUME during intubation?
HIGH PaCO2
What is normal postvoid residual volume?
<50mL = normal
<100 is acceptable
SPINAL CORD COMPRESSION
SYMMETRIC LE weakness + SENSORY LOSS + Loss of rectal tone + EARLY LMN (hyporeflexia) /LATER UMN (hyper-reflexia) + URINARY RETENTION** Bladder flaccidity
CAUDA EQUINA (LMN) SYNDROME
ASYMMETRIC severe radicular pain + SADDLE HYPO/ANESTHESIA + HYPO/AREFLEXIA + LATE onset bowel/bladder dysfn
CONUS MEDULLARIS SYNDROME
SYMMETRIC LE WEAKNESS + Sudden onset severe back pain + LMN/UMN SX (Hyper-reflexia) + EARLY onset bowel/bladder dysfn
DIFFUSE Mucosal inflammation + Nuclear inclusion bodies resulting in need for total abdominal colectomy with ileostomy for perforated cecum = WHAT VIRAL INFECTION?
CMV COLITIS
PANCREATIC TUMOR resulting in CHRONIC WATERY DIARRHEA + Resulting dehydration/hypokalemia/achlorydria + Vasodilation (FLUSHING/HYPOTENSION) + Hypercalcemia/ Hyperglycemia = ?
VIPoma
What is the difference between HYDROCELE and TESTICULAR CANCER?
HYDROCELE - Can be transilluminated
TESTICULAR Ca/ VARICOCELE - NOT transilluminated
SPERMATOCELE vs HYDROCELE
SPERMATOCELE = epididymal, painless fluid-filled cyst along head of EPIDIDYMUS ABOVE testes
HYDROCELE = fluid filling scrotal sac
Trauma resulting in ECCHYMOSES, TENDERNESS OVER R. ILIAC CREST (Flank pain), ABRASIONS ON R. FLANK is indicative of __? What is the next step in diagnosis?
UNILATERAL KIDNEY TRAUMA
Next step = CT ABDOMEN W/ CONTRAST (can give contrast to a pt with a single kidney and normal Cr)
OSTEOLYSIS (OSTEOPENIA) -> BONY DISRUPTION -> DEFORMITY (Decreased sensation to proprioception, pain, and light touch) most commonly in the ANKLE
CHARCOT DISEASE - Lack of joint sensation
LEIOMYOMA vs LEIOMYOSARCOMA
LEIOMYOMA - PRE-MENOPAUSAL, benign, multiple pelvic masses
LEIOMYOSAROCMA - POST-MENOPAUSAL, malignant, single pelvis mass
CT scan: ASCITES (fluid wave) + MULTIPLE PELVIC MASSES + OMENTAL THICKENING = What malignant dx?
OVARIAN ADENOCARCINOMA
What are the major indications for URGENT PRE-OP DIALYSIS before an elective surgery? Why is the pt dialyzed?
HYPERKALEMIA (>5.5) + VOLUME OVERLOAD
Pt dialyzed due to INCREASED RISK OF BLEEDING with UREMIA (Inhibits both PLT adhesion and aggregation)
PAIN OUT OF PROPORTION to PASSIVE EXTENSION + normal capillary refill time/normal sensation/normal peripheral pulses = ?
What’s the treatment?
COMPARTMENT SYNDROME
Tx = FASCIOTOMY (SURGICAL DECOMPRESSION)
CORE NEEDLE BX = NEEDLE-LOCALIZED OPEN BX for breast ca
CORE NEEDLE = NEEDLE LOCALIZED OPEN BX WITH MAMMOGRAPHIC GUIDANCE
3 Factors that allow closure of PATENT DUCTUS ARTERIOSUS
1) INCREASED O2 tension
2) DECREASED PGE2
3) INCREASED NE release -> Vasoconstriction -> Closure of PDA
What are indications of SURGICAL RESECTION of an ovarian cyst?
1) COMPLEX CYST
2) 5-8CM SIMPLE CYST that is SYMPTOMATIC
3) OVARIAN CYST that has INCREASED IN SIZE
What type of ovarian cyst is NOT surgically resected?
PRE-MENOPAUSAL <8cm SIMPLE CYST, normal CA-125, Asx
When a pt presents with NORMAL AG, HYPERCHLOREMIC METABOLIC ACIDOSIS, what are the two possible etiologies of this?
BICARBONATE LOSS FROM GI TRACT
OR
BICARBONATE LOSS FROM KIDNEY
Radioactive Iodine uptake:
DIFFUSE UPTAKE -
FOCAL, NODULAR UPTAKE -
DIFFUSE - Hyperthyroidism: GRAVE’S, TSH-secreting pituitary adenoma// Hypothyroidism: Hashimoto’s, I2 deficiency
NODULAR - Hyperthyroidism: Toxic thyroid adenoma// Hypothyroidism: Thyroid adenoma, cancer, cyst
DURATION of nerve blockade anesthesia is dependent on which factor? What are the 3 classes?
LIPID SOLUBILITY
SHORT ACTING (C-cut it short): Chloroprocaine (45-90min) INTERMEDIATE (LM): Lidocaine, mepivacaine (90-180min) LONG ACTING (BR): Bupivacaine, levobupivacaine, ropivacaine (4-18hrs)
What mediates CACHEXIA in malignancy (temporal wasting, scaphoid abdomen, BMI <18)?
INCREASED TNF-a (nicknamed cachexin), IFN gamma, IL-6
CENTRAL RETINAL ARTERY OCCLUSION (CRAO) vs CENTRAL RETINAL VEIN OCCLUSION (CRVO)
CRAO - Retina = grossly SWOLLEN/PALE with prominent fovea + Cherry red spots + PALLOR OF OPTIC DISC + MACULAR EDEMA + THIN ARTERIOLES + SAUSAGE-LIKE NARROWING OF RETINAL VEINS
CRVO - SPLOTCHES of HEMORRHAGES on SWOLLEN DISC + COTTON WOOL SPOTS DIFFUSELY
EXCESSIVE NERVOUS/SWEATINg + TREMORS + TACHYCARDIA + HUNGER (sx of hypoglycemia) WORSENED by FASTING = what tumor of pancreas?
INSULINOMA
Which tumor of pancreas has the pentad: DIABETES + WEIGHT LOSS + CHOLELITHIASIS + DIARRHEA/STEATORRHEA + ACHLORYDRIA/HYPOCHLORHYDRIA
SOMATOSTATINOMA
What is a CELIOTOMY?
CELIOTOMY = LAPAROTOMY (INCISION OF ABDOMEN)
What is the finding that best indicates ADEQUATE RESUSCITATION in a trauma pt?
URINE OUTPUT 30-40mL/hr
What is the GCS minimum for requiring INTUBATION?
GCS<8 - impending INTUBATION
