USMLE 1

Question 1

SHOCKY MVC patient receives 1L of saline. His PCWP increases but his BP does not. What type of Shock is this? How is it treated?

Answer 1

Cardiogenic Shock. Inotropic agents - Dobutamine.

Question 2

What is Kehr sign? Cause? Injury to what part of the bladder could cause Kehr sign?

Answer 2

Abdominal pain that refers to the shoulder from irritation to the diaphragm. Subdiaphragmatic peritonitis. Injury to the bladder dome (covered by peritoneum) causing rupture.

Question 3

Class I Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

Answer 3

1000cc, 20%, Compensated, <100, 14-20.

Question 4

Class II Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

Answer 4

1000-1500cc, 20-30%, Orthostatic, >100, 20-30.

Question 5

Class III Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

Answer 5

1500-2000cc, 30-40%, Decreased, >120, 30-40.

Question 6

Class IV Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

Answer 6

> 2000cc, >40%, Profoundly Decreased, >140, >40.

Question 7

Blunt trauma resulting in epigastric tenderness. One week later develops fever, chills, and deep abdominal pain? Example?

Answer 7

Retroperitoneal abscess. Pancreatic laceration.

Question 8

First step to managing massive (100-600ml w/in 24 hr) non-traumatic hemoptysis?

Answer 8

Bronchoscopy to localize and control source of bleeding.

Question 9

Viscus distension in a forty year old woman with transient severe epigastric pain that radiates to the back after a fatty meal?

Answer 9

Biliary Colic.

Question 10

A patient that received blood during a surgery becomes febrile one hour post op?

Answer 10

Acute Febrile nonhemolytic transfusion reaction (AFNTR)

Question 11

Normal values for Sodium?

Answer 11

135-145

Question 12

Normal values for Chloride?

Answer 12

98-106

Question 13

Normal values for BUN?

Answer 13

7-18

Question 14

Normal values for Glucose?

Answer 14

70-115

Question 15

Normal values for Potassium?

Answer 15

3.5-5.1

Question 16

Normal values for Bicarbonate?

Answer 16

22-29

Question 17

Normal values for Creatinine?

Answer 17

0.6-1.2

Question 18

Normal values PT time?

Answer 18

11-15 sec

Question 19

Normal values for PTT time?

Answer 19

20-35 sec

Question 20

Normal values for WBC?

Answer 20

4500-11,000

Question 21

Normal values for platelets?

Answer 21

150k-450k

Question 22

Normal values for INR? INR on Warfarin?

Answer 22

0.8-1.2 – 2.0-3.0

Question 23

A patient needs urgent surgery, they take Warfarin, what do you give them pre-operatively so that they don’t bleed out?

Answer 23

Fresh frozen plasma.

Question 24

Which drugs lower perioperative mortality in elderly patient with cardiac risk factors receiving elective surgery?

Answer 24

Beta blockers such as metoprolol.

Question 25

What is the first step in diagnosing peripheral artery disease? Normal findings? Abnormal findings?

Answer 25

Ankle-Brachial Index testing. 1-1.3 = normal. <.4 = limb ischemia.

Question 26

What can produce excess CO2 production in ventilated post op patients?

Answer 26

Excess carbohydrate ingestion.

Question 27

What is the normal full body steady state RQ? What about for glucose heavy diets?

Answer 27

0.7-8. 1.

Question 28

A patient suffers a blunt force trauma. They have distended JVP, look SHOCKY despite resuscitation, and have a normal cardiac silhouette?

Answer 28

Cardiac tamponade.

Question 29

A patient is ventilated and requires PEEP after trauma. What should precede the PEEP as to prevent cardiac arrest.

Answer 29

Fluid resuscitation. PEEP can impede venous return.

Question 30

An insult to the parotid gland can damage which structure? What will be noticed on exam?

Answer 30

Facial nerve. Unilateral facial droop.

Question 31

What does a positive drop arm sign suggest on PE?

Answer 31

Rotator cuff tear.

Question 32

A male in his 20's presents with acute pain and swelling over his coccyx for the first time?

Answer 32

Pilonidal cyst infection.

Question 33

An 18 year old presents with a dull aching and fullness of the scrotum, which swells further during the Valsalva maneuver? Cause?

Answer 33

Varicocele - dilation of the pampiniform plexus.

Question 34

After a car crash a patient develops tachypnea, tachycardia, and hypoxia. Fluid resuscitation does not improve his symptoms. They have diminished breath sounds. You notice a patchy alveolar infiltrate (opacification) on chest x-ray? Are broken ribs always found?

Answer 34

Pulmonary Contusion. No.

Question 35

What is the easiest way to increase FRC in a post op patient (you are worried about post op atelectasis)?

Answer 35

Tilt the head of the bead up! Decreases intraabdominal pressure on the diaphragm.

Question 36

Normal values for Calcium?

Answer 36

8.4-10.2

Question 37

Normal values for total Bilirubin?

Answer 37

0.2-1

Question 38

What can cause sudden onset of tearing back pain, along with lower extremity weakness?

Answer 38

Thoracic Aortic Dissection.

Question 39

Arterial occlusion at the aorto-illiac bifurcation is called? Symptoms? Most common risk factor.

Answer 39

Leriche Syndrome. Hip/thigh/buttock claudication, impotence, bilateral lower extremity atrophy. Atherosclerosis from smoking.

Question 40

Do old patients who suffer orthopedic injuries require immediate surgery?

Answer 40

No. Look for other comorbidities first that might complicate the surgery.