Pestana questions Flashcards
How do you manage linear skull fractures if they are closed (no overlying wound)
leave alone
Urethral injury occurs almost exclusively in men, and is typically associated with a pelvic fracture, and may present with blood at the meatus. more complete clinical picture might include a scrotal hematoma, for posterior injuries the sensation of wanting to void but not being able to, and a “high riding” prostate on rectal exam . . . what should be done
retrograde urethrogram
Intertrochanteric fx of hip are less likely to lead to avascular necrosis and are usually treated how
ORIF with post op anticoagulation
Femoral neck fx, particularly if displaced compromise the very tenuous blood supply of the femoral head. Faster healing and earlier mobilization can be achieved how?
by replacing the femoral head with a prosthesis
While repairing an elevator shaft, a 39 year old worker falls from a height of 2 stories, landing on his feet. Both calcanei are obviously fractured. Further evaluation should include x rays of what?
Thoracic and lumbar spine
This is a squamous cell carcinoma that is found in the classic setting of many years of healing and breaking down, such as seen in untreated third degree burns that underwent spontantous healing, or in chronic draining sinuses secondary to osteomyelisis
Marjolin ulcer
treatment for complete arterial occlusion of lower extremity
-embolectomy with Fogarty catheter and fasciotomy should be added if several hours have passed before revascularization
Most testicular cancers are exquisitely radiosensitive and also respond to what type of chemo
platinum based chemo
A pedestrian is hit by a car. He arrives in the ER in coma. He has clear fluid dripping from the left ear and a dark bruise behind his ear and over his left mastoid area. As he is being taken to the CT scanner for a scan of the head, you would recommend what?
The CT be extended to include his neck
A 31 year old woman crashes her car against a bridge. She has multiple injuries, including upper and lower extremity fractures. Her Blood pressure is 135/75, and her pulse rate is 82. ON physical exam she has a rigid, tender abdomen with guarding and rebound on all quadrants. What is the next step in management?
Exploratory Laparotomy
A 22 year old man is shot twice in the abdomen with a .22 handgun. One entry wound lies to the left of the umbilicus, with the bullet lodged in the right psoas muscle. The second entry wound is just above the pubis, and that bullet is in the middle of his abdomen. He has gross hematuria. Evaluation of the hematuria would best be done by what?
exploratory laparotomy
53 year old women come in because of a breast mass. Two days ago she noticed a lump on self exam. She has a 2 cm firm nontender mass in the left breast, which is movable within the breast. She has no prior history of breast disease, but she is well-read and well-informed patient who gets regular screening mammograms and is due for her next one in 3 months. The next step in management is what?
Do mammographically or sonographically guided core biopsies
What urinary output are we shooting for when replacing fluids in a severely burned patient?
1 or 2 mL/kg/hr
3 hours ago, a 72 kg man sustained second and third degree flame burns to an estimated 35% of his body surface. Ringer lactate without sugar has been infused at a rate of 1 L/hr, and his urinary output has been measured by an indwelling catheter. In those first 3 hours his urinary output was 290, 315, and 350 mL/h. Based on that info, you should?
decrease the rate of fluid administration
Genu Valgus (knock-knee) is normal between what ages and no treatment is needed?
4 and 8
A 68 year old woman arrives in the ER with a clinically obvious fx of the radius and a possible dislocation of the ulnar stylus process. When questioned about the trauma that caused the injury, the woman reports that there was none: She attempted to lift a heavy bag of groceries and “my arm broke”. you immediately suspect what?
Metastatic osteolytic cancer
A 21 year old male has had multiple problems while in the ICU recovering from a laparotomy for a gunshot wound. Initially, his chest x-rays and respiratory function were normal, but he now has bilateral pulmonary infiltrates and a PO2 of 65 while breathing 40% oxygen. There is no evidence of congestive heart failure. The diagnosis and appropriate therapy are what?
- Adult respiratory distress syndrome (ARDS)
- Positive expiratory pressure (PEEP)
All abdominal hernias should be electively repaired to avoid the risk of intestinal obstruction and strangulation . . what are the exceptions?
- Umbilical hernias in patients younger than 2-5 years of age (they may close by themselves)
- Esophageal sliding hiatal hernias (which are not “true” hernias)
A 42 year old, right handed man has a history of progressive speech difficulties and right hemiparesis for 5 months. He has had progressively severe headaches for the last 2 months, which are worse in the mornings. At the time of admission he is confused and vomiting and has blurred vision, papilledema, and diplopia. Shortly thereafter, his BP goes up to 190/110 and he develops bradycardia. The rise in his BP is due to what?
-A compensatory response to preserve brain perfusion (Cushing reflex)
On a routine physical exam, a 65 year old man is found to have a 1.5 cm, rock-hard mass in his prostate. His PSA is normal for his age. The next step in management is to do what?
Do a transrectal needle biopsy of the mass
The preferred route of fluid resuscitation in the trauma setting is 2 peripheral IV lines, 16-gauge. If they cannot be inserted, percutaneous femoral vein catheter or saphenous vein cut-downs are alternative. In children under 6 years of age, what is the alternate route?
Intraosseus cannulation of the proximal tibia
a 77 year old man becomes “senile” over a period of 3 or 4 weeks. He used to be active and made an excellent living writing fiction and movie scripts. Now he stares at the wall all day long, barely recognizes his family, and is “a completely different person”. Two weeks before the mental changes began, he fell from a horse but apparently sustained no serious injuries. You expect a CT scan of his head to show what?
Chronic subdural hematoma
A 22 year old woman loses control of an all-terrain vehicle, falls to the ground, and then is crushed . She arrives to the ER with stable vital signs but obvious physical evidence of a pelvis fracture. When a Foley catheter is inserted, it recovers bloody urine. The best way to evaluate her urological injury would be what?
Retrograde cystogram including post-void films
During a hunting trip, a young man is bitten by a coyote. The bite drew blood, but the flow was easily stopped by local pressure. The animal was captured and brought alive to the authorities. The need for rabies prophylaxis in this patient should be determine by what?
Killing the animal and examining the brain
