renal surgery uworld

Question 1

multiple stab wounds, normal voice, but has subcutaneous air (emphysema) in the tissues in the neck and upper chest

Answer 1

expanding neck hematoma or emphysema
airway will soon be lost
next step: bronchoscope guided intubation via nasal tracheal route flexible

Question 2

severe maxillofacial injuries, unsuccessful intubation

Answer 2

cricothyroidotomy
not indicated below 12 years old** can cause subglottic stenosis (do needle cricothyrdoidotomy)

Question 3

pediatric IV access:

Answer 3

IV standard antecubital fossa but if cant reach interosseous UPPER 1/3 OF TIBIA

Question 4

adults IV access: trauma

Answer 4

2 peripheral IV lines 16 gauge SHORT catheter
antecubital fossa
alternatives: percutaneous femoral vein catheter or saphenous vein cut down

Question 5

depressed skull fractures

Answer 5

take to OR to fix depression, for risk of meningitis

Question 6

acute subdural hematoma management

Answer 6

crescent shaped hematoma
craniotomy if midline shift and lateralizing signs
if not: ICP monitoring
hyper ventilate: bring PaCo2 <35 but not lower than 32
deep sedation and hypothermia

Question 7

diffuse axonal injury

Answer 7

ct scan: diffuse blurring of gray white matter interface, multiple small punctate hemorrhages
tx:
head elevation, hyperventilation PaCO2 < 35
IV hydration, mannitol, furosemide
sedation to deep coma and hypothermia

Question 8

pt with painless progress visual loss 00 capillary hemangioblastoma, father dies of cerebral hemorrhage at 52, pt has 2 small cystic enhancing nodules in the cerebellum, renal u/s shows multiple cysts in other kidneys
dx?

Answer 8

von hippel-lindau disease

Question 9

Question 10

45F with lateral hip pain, started 2 mo after long hike, point tenderness over the greater trochanter, passive leg abduction worsens the pain
dx
tx

Answer 10

Question 11

drop test

Answer 11

Question 12

pt with pulmonary edema
can hypoxemia be corrected with O2?
lung compliance?
A-a gradient?

Answer 12

No O2 correction

LOW lung compliance

High A-a gradient

Question 13

Hypovolemic shock:

Answer 13

severe hypovolemia –> decreased Central Venous Pressure –> decrease in venous return to Right atrium* –> decreased cardiac output

Question 14

venous AIR EMBOLISM from placement of central Cath
management

Answer 14

place in Left Lateral decubitus position and give high flow o2

Question 15

Emergency Thoracotomy

Answer 15

in extreme bleeding
1) bloody output > 1500mL
2) persistent hemorrhage > 200mL/hr for more than 2 hours