UWorld 2

Question 1

In a patient who has received less than 3 doses of tetanus toxoid (the full childhood series) and presents with a wound contaminated with dirt and soil (high-risk), what should you provide?

Answer 1

Tetanus toxoid and tetanus immunoglobulin

Question 2

In a patient with a clean wound and a tetanus vaccine that is more than 10 years old, what should you provide

Answer 2

Tetanus toxoid

Question 3

When do you provide tetanus immunoglobulin (2)

Answer 3

1) patient has had less than 3 lifetime tetanus toxoid vaccines (has not received full childhood schedule) and the wound is high-risk
2) on-going symptomatic tetanus disease

Question 4

When do you provide tetanus toxoid in a patient with a complete childhood vaccine history (>3 doses) and: 1) a clean minor wound, 2) a high-risk wound

Answer 4

1) If last TT was > 10 years ago

2) If last TT was >5 years ago

Question 5

What it the organism that causes tetanus

Answer 5

Clostridium tetani

Question 6

What is the appropriate imaging for a patient with a history of trauma and signs of hemorrhagic shock?

Answer 6

Do a FAST scan, if positive move to laparotomy

Question 7

What are to most common abdominal viscera damaged in trauma cases

Answer 7

spleen > liver > kidney

Question 8

When is it appropriate to do a CT abdomen over a FAST scan in a trauma patient

Answer 8

Can CT if patient is hemodynamically stable

Question 9

What is the typical mechanism of injury for a scaphoid fracture and what is the clinical presentation

Answer 9

1) fall on outstretched hand with hyperextension injury

2) pain over anatomical snuffbox

Question 10

What is the treatment for a scaphoid fracture that is clinically suspected but not confirmed by xray? What is the fear?

Answer 10

1) thumb spica and repeat xray in 2-3 weeks

2) AVN due to tenuous blood supply

Question 11

How is suspected esophageal perforation diagnosed

Answer 11

radiographic contrast study with water-soluble constrast

Question 12

Describe ‘dumping syndrome’ (5)

Answer 12

1) postgastrectomy complication
2) hypertonic gastric contents emptied into duodenum prematurely
3) fluid shift from intravascular space to small intestin
4) stimulation of autonomic reflexes
5) result: light-headedness, cramps, and diaphoresis

Question 13

What is the appropriate treatment for dumping syndrome following gastrectomy?

Answer 13

dietary modifications - small and frequent meals

Question 14

What is the appropriate treatment for dumping syndrome resistant to dietary modifications (2)

Answer 14

1) octreotide - a somatostatin analog

2) reconstructive surgery