uworld 4

Question 1

people who have gone transabominal blunt trauma who are hemodynamically stable with negative FAST exam but high risk features (anemia, guarding) should undergo what?

Answer 1

CT

Question 2

what is this: fever, phayrngeal pain, earache, pooling of saliva, deviation of uvula

Answer 2

peritonsillar abscess

Question 3

how can syringomyelia develop?

Answer 3

years after spinal cord injury (whiplash) –> CSF retention –> enlargement of central canal

Question 4

what is this: soft scrotal mass that increases with valsalva and decreases in supine?

Answer 4

varicocele

Question 5

bad outcome of varicocele

Answer 5

subfertility, testicular atrophy

Question 6

treatment of varicocele

Answer 6

boys, young men: gonadal vein ligation

older, post-baby making: scrotal support, NSAIDs

Question 7

varicocele happens more on left or right and why?

Answer 7

left

because the left spermatic vein drains into the left renal vein which can become compressed where it passes between the SMA and the aorta

Question 8

hydroceles are peritoneal fluid where?

Answer 8

between layers of parietal and visceral layers of tunica vaginalis

Question 9

how does hyperventilating help decrease ICP?

Answer 9

CO2 washout–> cerebral vasoconstriction

Question 10

is RA pressure (preload) elevated or decreased in hypovolemic, septic, and cardiogenic shock

Answer 10

hypovolemic: decreased
septic: normal or decreased
cardio: increased

Question 11

is pulmonary capillary wedge pressure elevated or decreased in hypovolemic, septic, and cardiogenic shock

Answer 11

hypovolemic: decreased
septic: normal or decreased
cardio: increased

Question 12

is SVR elevated or decreased in hypovolemic, septic, and cardiogenic shock

Answer 12

hypovolemic: increased
septic: decreased
cardio: increased

Question 13

unilateral leg edema that worsens with activity is most likely…

Answer 13

venous valve incompetency

Question 14

stress fracture risk factors

Answer 14

repetitive activities
low Ca and vitamin D
female athlete triad: low bone density, amenorrhea, low calories

Question 15

stress fracture vs shin splints (medial tibial stress syndrome)

Answer 15

stress fracture: athletes; point tenderness

shin splints: overweight people; diffuse tenderness

Question 16

management of small vs. large primary spontaneous pneumothorax

Answer 16

small (<2 cm): observe, oxygen

large (>2cm): needle aspiration, chest tube

Question 17

myocardial contusion presentation

Answer 17

tachycardia
new bundle branch blocks
arrhythmias

Question 18

diaphragm rupture presentation

Answer 18

abdominal pain
pain referred to shoulder
SOB
vomiting

Question 19

bronchial rupture presentation

Answer 19

pneumothorax that doesn’t improve with chest tube

pneumomediastinum

subcutaneous emphysema

Question 20

most common complication supracondylar fracture of humerus

Answer 20

entrapment of brachial artery and median nerve

Question 21

which nerve damaged with proximal humerus fracture?

Answer 21

axillary nerve

Question 22

which nerve damaged with anterior shoulder dislocation?

Answer 22

axillary nerve

Question 23

diagnosis of ischemic colitis

Answer 23

CT: bowel wall thickening, fat stranding

c-scope: cyanotic, friable mucosa, hemorrhagic ulcerations

Question 24

manage ischemic colitis

Answer 24

bowel rest, IVF

antibiotics- enteric coverage

if necrosis–> resect

Question 25

differential for anterior mediastinal mass

Answer 25

thymoma
teratoma
thyroid neoplasm
terrible lymphoma

4 T’s

Question 26

acute mediastinitis presentation

Answer 26

post-op cardiac surgery –> wound contamination

fever, tachy, WBCs, chest pain, wound drainage

Question 27

diagnosis and treatment of acute mediastinitis

Answer 27

dx: clinical
tx: drainage and abx

Question 28

patients with septic shock should be given what type of fluid

Answer 28

crystalloid 0.9% saline

Question 29

is ejection fraction increased or decreased in hypovolemic shock?

Answer 29

increased

Question 30

what type of bladder injury would cause peritoneal signs?

Answer 30

rupture of bladder dome

Question 31

two most common artery aneurysms

Answer 31

1. popliteal

2. femoral

Question 32

all patients with clavicle injuries should undergo what?

Answer 32

neurovascular exam- check out brachial plexus and subclavian artery

Question 33

most common organ injuries due to blunt abdominal trauma

Answer 33

spleen

liver

Question 34

acalculous cholecystitis presentation

Answer 34

in critically ill patients (multiple organ failure, trauma, sepsis etc)

similar to cholecystitis symptoms

Question 35

imaging of acalculous cholecystitis

Answer 35

gall bladder wall thickening and distention

pericholecystic fluid

Question 36

treatment of acalculous cholecystitis

Answer 36

abx

percutaneous cholecystectomy, under radiology guidance