Next best step

Question 1

Suspected aortic dissection

Answer 1

CT and aortic angiography

Question 2

Acute pancreatitis

Answer 2

Fluid resuscitation

Question 3

Hypocalcemia after parathyroid removal

Answer 3

administration of calcium gluconate

Question 4

s/p MVC, stable, gross blood on urinalysis, spine intact

Answer 4

CT w contrast to look for kidney injury

Question 5

FAP

Answer 5

prophylactic total proctocolectomy

Question 6

Fever after endoscopy

Answer 6

water soluble (gastrograffin) contrast upper GI study

Question 7

microcalcifications on breast biopsy

Answer 7

percutaneous palpation-guided or image-guided biopsy

Question 8

breast mass in woman under 30

Answer 8

ultrasound; if suspicious, then core needle biopsy

Question 9

breast mass in woman over 30

Answer 9

diagnostic mammogram and core needle biopsy

Question 10

choledochal cyst

Answer 10

excise

Question 11

blood at urethral meatus

Answer 11

retrograde urethrography

Question 12

ovarian torsion

Answer 12

surgery

Question 13

BRBPR

Answer 13

colonoscopy, nuclear tagged RBC scan, arteriography

Question 14

suspected meniscal tear dx

Answer 14

MRI

Question 15

dx of diverticulitis

Answer 15

CT

Question 16

tx diverticulitis

Answer 16

IV fluids, NPO, antibiotics

Question 17

dx carpal tunnel syndrome

Answer 17

nerve conduction studies

Question 18

tx carpal tunnel

Answer 18

splinting
glucocorticoids
surgery for severe or refractory pain

Question 19

insulinoma

Answer 19

CT w/contrast to localize; excise

Question 20

mesenteric ischemia tx

Answer 20

exlap w/ embolectomy

Question 21

suspected hemolytic transfusion rxn

Answer 21

immediately stopping the transfusion, providing hemodynamic support, and repeat crossing and typing

Question 22

tx small, spontaneous pneumothorax

Answer 22

obs

Question 23

dx mastoiditis

Answer 23

CT

Question 24

tx for acute surgical mastoidtitis

Answer 24

mastoidectomy w/ insertion of tympanostomy tube

Question 25

torus platinus tx

Answer 25

obs

Question 26

laryngeal papillomas

Answer 26

laser fulguration

Question 27

young patient with newly discovered, enlarged lymph node

Answer 27

come back in 3 weeks

Question 28

dx plummer vinson syn

Answer 28

barium esophagram (swallow)

Question 29

suspected ischemic colitis

Answer 29

flexible sigmoidoscopy

Question 30

tx ischemic colitis

Answer 30

NPO, IV fluids, antibiotics

Question 31

Tx sigmoid volvulus

Answer 31

endoscopic decompression followed by elective sigmoid colectomy

Question 32

tx cecal volvulus

Answer 32

urgent colectomy

Question 33

tx sigmoid volvulus

Answer 33

if peritoneal: exlap | if stable: decompress with colonoscopy

Question 34

dx epidural abscess

Answer 34

MRI

Question 35

tx slipped capital femoral epiphysis

Answer 35

pinning of hip joint

Question 36

dx slipped capital femoral epiphysis

Answer 36

xray

Question 37

clavicle fx

Answer 37

neurovascular exam to r/o brachial plexus and axillary/subclavian injury

Question 38

clavicle fx w/ bruit

Answer 38

CT angiogram

Question 39

tx ITP

Answer 39

steroids then IVIG, then splenectomy

Question 40

intussusception

Answer 40

barium enema to dx and tx

Question 41

tx mild peripheral artery disease

Answer 41

smoking cessation, exercise program, cilostazol

Question 42

suspected cervical trauma

Answer 42

CT

Question 43

hard signs of vascular injury

Answer 43

OR

Question 44

no hard signs of vascular injury, but it is suspected

Answer 44

ABI

Question 45

suspicion of developmental dysplasia of hip but equivocal exam

Answer 45

sonography

Question 46

tx developmental dysplasia of hip

Answer 46

abduction w/ Pavlik harness for 6 mo

Question 47

colles fx treatment

Answer 47

close reduction and cast

Question 48

scaphoid fx treatment

Answer 48

open reduction and internal fixation

Question 49

tx femoral neck fx

Answer 49

intramedullary rod | emergency when open (must be cleaned out within 6 hrs)

Question 50

hip dislocation

Answer 50

emergency reduction to prevent necrosis

Question 51

post-op thrombophlebbitis dx

Answer 51

doppler of deep leg and pelvic veins

Question 52

tx post op thrombophlebitis

Answer 52

anticoag with heparin and then warfarin

Question 53

dx PE

Answer 53

spiral CT aka CT angio

Question 54

tx PE

Answer 54

anticoag or IVC filter in someone with contraindication

Question 55

tx sigmoid volvus

Answer 55

rectal tube and sigmoidoscopy

Question 56

tx adrenal hyperplasia

Answer 56

medical | spironolactone

Question 57

tx adrenal adeoma

Answer 57

CT and surgical removal

Question 58

tx R sided colon cancer

Answer 58

R hemicolectomy after dx colonoscopy and biopsy

Question 59

dx L sided colon cancer

Answer 59

flexible proctosigmoidoscopic exam w biopsy