USMLE 1 Flashcards
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?
Cardiogenic Shock. Inotropic agents - Dobutamine.
What is Kehr sign? Cause? Injury to what part of the bladder could cause Kehr sign?
Abdominal pain that refers to the shoulder from irritation to the diaphragm. Subdiaphragmatic peritonitis. Injury to the bladder dome (covered by peritoneum) causing rupture.
Class I Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?
1000cc, 20%, Compensated, <100, 14-20.
Class II Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?
1000-1500cc, 20-30%, Orthostatic, >100, 20-30.
Class III Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?
1500-2000cc, 30-40%, Decreased, >120, 30-40.
Class IV Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?
> 2000cc, >40%, Profoundly Decreased, >140, >40.
Blunt trauma resulting in epigastric tenderness. One week later develops fever, chills, and deep abdominal pain? Example?
Retroperitoneal abscess. Pancreatic laceration.
First step to managing massive (100-600ml w/in 24 hr) non-traumatic hemoptysis?
Bronchoscopy to localize and control source of bleeding.
Viscus distension in a forty year old woman with transient severe epigastric pain that radiates to the back after a fatty meal?
Biliary Colic.
A patient that received blood during a surgery becomes febrile one hour post op?
Acute Febrile nonhemolytic transfusion reaction (AFNTR)
Normal values for Sodium?
135-145
Normal values for Chloride?
98-106
Normal values for BUN?
7-18
Normal values for Glucose?
70-115
Normal values for Potassium?
3.5-5.1
Normal values for Bicarbonate?
22-29
Normal values for Creatinine?
0.6-1.2
Normal values PT time?
11-15 sec
Normal values for PTT time?
20-35 sec
Normal values for WBC?
4500-11,000
Normal values for platelets?
150k-450k
Normal values for INR? INR on Warfarin?
0.8-1.2 – 2.0-3.0
A patient needs urgent surgery, they take Warfarin, what do you give them pre-operatively so that they don’t bleed out?
Fresh frozen plasma.
Which drugs lower perioperative mortality in elderly patient with cardiac risk factors receiving elective surgery?
Beta blockers such as metoprolol.
What is the first step in diagnosing peripheral artery disease? Normal findings? Abnormal findings?
Ankle-Brachial Index testing. 1-1.3 = normal. <.4 = limb ischemia.
What can produce excess CO2 production in ventilated post op patients?
Excess carbohydrate ingestion.
What is the normal full body steady state RQ? What about for glucose heavy diets?
0.7-8. 1.
A patient suffers a blunt force trauma. They have distended JVP, look SHOCKY despite resuscitation, and have a normal cardiac silhouette?
Cardiac tamponade.
A patient is ventilated and requires PEEP after trauma. What should precede the PEEP as to prevent cardiac arrest.
Fluid resuscitation. PEEP can impede venous return.
An insult to the parotid gland can damage which structure? What will be noticed on exam?
Facial nerve. Unilateral facial droop.
What does a positive drop arm sign suggest on PE?
Rotator cuff tear.
A male in his 20’s presents with acute pain and swelling over his coccyx for the first time?
Pilonidal cyst infection.
An 18 year old presents with a dull aching and fullness of the scrotum, which swells further during the Valsalva maneuver? Cause?
Varicocele - dilation of the pampiniform plexus.
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?
Pulmonary Contusion. No.
What is the easiest way to increase FRC in a post op patient (you are worried about post op atelectasis)?
Tilt the head of the bead up! Decreases intraabdominal pressure on the diaphragm.
Normal values for Calcium?
8.4-10.2
Normal values for total Bilirubin?
0.2-1
What can cause sudden onset of tearing back pain, along with lower extremity weakness?
Thoracic Aortic Dissection.
Arterial occlusion at the aorto-illiac bifurcation is called? Symptoms? Most common risk factor.
Leriche Syndrome. Hip/thigh/buttock claudication, impotence, bilateral lower extremity atrophy. Atherosclerosis from smoking.
Do old patients who suffer orthopedic injuries require immediate surgery?
No. Look for other comorbidities first that might complicate the surgery.
