Obj. 15 PART ONE a-e

Question 1

What’s the most fractured bone of the face?

Answer 1

nasal

Question 2

Your pugilistic patient has diplopia, upward gaze, decreased eye movement, and periorbital ecchymosis. What is the problem?

Answer 2

orbital blowout fracture

Question 3

A drunk Stu Price just pulled out his own tooth to prove he’s a good dentist - what are you going to do with the tooth until it can be reimplanted?

Answer 3

Put tooth in one of the following, in descending order of preference:

1. balanced salt solution
2. cold milk
3. saliva
4. saline

Question 4

Abrupt onset of severe, unilateral eye pain with blurry vision and increased intraocular pressure - what do you suspect?

Answer 4

acute glaucoma

Question 5

Name 3 possible causes of painless, unilateral vision loss and how you might differentiate between them.

Answer 5

1. retinal detachment - “curtain” descending over vision, can visualize retina hanging down with fundoscopy
2. central retinal vein occlusion - dilated & tortuous veins, diffuse hemorrhages
3. central retinal artery occlusion - disc pallor, “boxcar” retinal veins, cherry-red fovea

Question 6

What are the main drugs that cause erythematous skin reactions?

Answer 6

~SULFONAMIDES

~penicillin, allopurinol, NSAIDs, anticonvulsants

Question 7

What is the difference between SJS and TEN?

Answer 7

SJS (Stevens-Johnson syndrome): < 10% body surface area skin loss
TEN (toxic epidermal necrolysis): > 30% body surface area skin loss

Question 8

Your patient is a 4 yo child with a hx of impetigo who now has multiple bullae and a positive Nikolsky sign.
What is it?
How will you treat it?

Answer 8

~staphylococcal scalded skin syndrome

~IV nafcillin

Question 9

Your patient is a 32 yo woman who has been feeling ill (vomiting, fever, myalgia) for a few days and now is hypotensive and has a diffuse, blanchable macular erythematous rash and strawberry tongue.
What is it?
What do you expect to happen over the next 2 weeks?
What do you expect to see on blood culture?
How will you treat it?

Answer 9

~Toxic shock syndrome
~the erythema will fade in 3 days, and about a week after that, she will experience desquamation of her hands and feet
~caused by S. aureus, but 85% of the time, blood cultures are negative
~ensure any tampons are removed; admit to ICU; start IV 1st gen ceph or vanco

Question 10

What are two medications used for lice and scabies?

Answer 10

permethrin, lindane

Question 11

What is the treatment for felon?

Answer 11

drain abscess, treat empirically with antistaphylococcal abx for 5 days

Question 12

What is the primary cause of cellulitis and erysipelas?

Answer 12

group A beta-hemolytic streptococcus

could also be staph or other flora

Question 13

Which has erythema with poorly defined borders and which has erythema with well-defined borders, and why?
(cellulitis or erysipelas)

Answer 13

~cellulitis: erythema with poorly defined borders, because it’s a deeper infection
~erysipelas: well-demarcated erythematous areas, because it’s a more superficial infection

Question 14

How would you treat cellulitis/erysipelas?

Answer 14

empirically with IV abx to cover strep (penicillin) and staph (nafcillin)

Question 15

Your patient is a 19 yo male who drives a delivery truck for a living complaining of extreme pain near his buttcrack that is making it hard to sit in his truck. Your inspection reveals a tender, swollen, fluctuant nodule in the superior gluteal fold.
What is it?
How will you treat it?

Answer 15

~pilonidal abscess

~incision and drainage; remove debris from cavity; pack with gauze and have patient return in 2-3 days. Abx NOT needed.

Question 16

What 3 drugs might you give to a patient experiencing angioedema?

Answer 16

1. 1:1000 epinephrine
2. diphenhydramine (benadryl)
3. methylprednisolone

Question 17

This rapidly spreading infection may initially look like cellulitis but will have systemic toxicity and severe pain followed by anesthesia of the involved area as local nerves are destroyed…Surgical exploration is mandatory and extensive debridement is essential for survival.
What is it and what is the most common causative organism?

Answer 17

~necrotizing fasciitis

~group A strep

Question 18

What are the risk factors for primary and secondary spontaneous pneumothorax?

Answer 18

~primary: men 20-40 who smoke

~secondary: hx of COPD, pneumonia, CF, asthma, TB

Question 19

Your 25 yo male patient has pleuritic chest pain, acute-onset dyspnea, and decreased breath sounds on the left side. What is it?

Answer 19

primary spontaneous pneumothorax

Question 20

How is pneumothorax diagnosed, and how is it treated?

Answer 20

~chest x-ray

~chest tube with water seal

Question 21

What additional findings will be present in a tension pneumothorax?

Answer 21

~PMI displaced to opposite side
~tracheal deviation to opposite side
~JVD

Question 22

What 2 signs are very indicative of pericarditis?

Answer 22

~pt feels worse supine and better sitting up and leaning forward
~PR depression on EKG

Question 23

What are the Duke criteria used for?

Answer 23

To diagnose infective endocarditis

Question 24

What are the 3 dead white guy signs that are associated with bacterial endocarditis?

Answer 24

1. Janeway lesions
2. Osler nodes
3. Roth spots

Question 25

What’s the earliest cardiac biomarker that you can test for in suspected MI?

Answer 25

myoglobin - rises within 1-4 hours, returns to normal in 24 hours

Question 26

What cardiac biomarker can you test for retrospective diagnosis of acute MI?

Answer 26

troponin - persists for 7-10 days

Question 27

Your patient has unequal SBP in the arms, unequal radial pulses, and a carotid bruit. What do you suspect?

Answer 27

subclavian steal syndrome

Question 28

Your 24 yo female patient has a sudden onset of moderate unilateral lower abdominal pain that gets worse when she changes position. The pain radiates to her flank.
What 2 tests are you going to perform?
What is the diagnosis?
What is the treatment?

Answer 28

~pregnancy test (negative), Doppler U/S to detect decreased/absent blood flow to affected ovary
~ovarian torsion
~laparotomy

Question 29

Your patient is a 24 yo female with sudden onset of severe, stabbing lower quadrant pain that does not radiate.
What do you suspect?
What tests might you perform?
What is the treatment?

Answer 29

~ectopic pregnancy
~pregnancy test (positive), transvaginal U/S to detect adnexal mass/no uterine pregnancy
~if early pregnancy & stable, methotrexate; otherwise surgery to remove tube

Question 30

What antiemetics could be used for hyperemesis gravidarum?

Answer 30

ondansetron, promethazine

Question 31

Your 19 yo female patient presents with lower abdominal pain, vaginal discharge, fever, cervical motion tenderness, and bilateral lower adnexal tenderness.
What do you suspect?
How will you treat it?

Answer 31

Pelvic inflammatory disease

ceftriaxone + doxycycline

Question 32

If a septal hematoma is not drained, the pt is at increased risk of developing this.

Answer 32

Necrosis –> Saddle nose deformity

Question 33

What might you consider as prophylaxis post-orbital blow-out fracture?

Answer 33

tetanus shot

Question 34

Pt arrives to clinic with “target” lesions on her palms and in her mouth. What do you suspect may be the cause of this presentation? How do you treat it?

Answer 34

Herpes Simplex  (Erythema multiforme MINOR)
Oral Acyclovir