uworld

Question 1

ddx for mediastinal mass with high bhcg and AFP.

Answer 1

4Ts: thyroid, thymoma, teratoma, terrible lymphoma. teratoma= germ cell tumor with high BHCG, ADP. seminoma has high bhcg and normal afp.

Question 2

how to get airway in pt with likely cervical spine trauma

Answer 2

orotracheal intubation (unless there is significant facial trauma). not nasotracheal intubation- this is contraindicated in apnea/hypopneic ps and also contraindicated in pts with basilar skull fracture.

Question 3

pt with seizures or TB gets pins and needles sensation around mouth

Answer 3

drugs like phenytoin, carbamazepine, and rifampin cause vitamin D deficiency by stimulating the P450 cytochrome system in the liver, which degrades vitamin D to inactive metabolites.

Question 4

pt s/p distal gastrectomy gets sxs 20-30 min after means of n/d/cramps. dx? tx?

Answer 4

dumping syndrome. loss of normal action of pyloric sphincter. rapid emptying of hypertonic gastric contents into duodenum and small intestin-> fluid shifts to small intestine-> hypotension, stimulation of autonomic reflexes, release of intestinal vasoactive polypeptides. tx: change diet to small meals with less sugar.

Question 5

gallstone ileus

Answer 5

gallstone passes through biliary enteric fistula into the small bowel causing signs and symptoms of MBO

Question 6

metoclopromide

Answer 6

dopamine antagonist with promotility effects. odansetron- serotonin receptor antagonist-> constipation.

Question 7

what antibodies cause anaphylactic drug reaction

Answer 7

IGA

Question 8

respiratory distress and signs of noncardiogenic edema within 6 hours of blood transfusion

Answer 8

transfusion related acute lung injury- caused by donor anti-leukocyte antibodies

Question 9

fever and chills withins 1-6 hours of transfusion

Answer 9

febrile nonhemolytic - caused by cytokine accumulation during blood storage

Question 10

mild fever and hemolytic anemai 2-10 days after blood transfusion with positive direct coombs tests and positive new antibody screens

Answer 10

delayed hemolytic- caused by anamnestic antibody reponse

Question 11

pt in surgery and then gets high fever (>104F), muscle rigidity, rhabdo, metabolic acidosis, and HD instability

Answer 11

malignant hyperthermia. usually from inhaled anesthetics.

Question 12

pt with stuttering episodes of n/v, pneumobilia (air in biliary tree), hyperactive bowel sounds, and dilated loops of bowel

Answer 12

gallstone ileus! form of mechanical bowel obstruction. occurs when a gallstone passes though a biliary enteric fistula into the small bowel. as it advances it may cause intermittent tumbling obstruction with diffuse abdominal pain and vomiting until finally lodging int he ileum several days later.

Question 13

pt has fever and RUQ and decreased bowel sounds

Answer 13

emphysematous cholecystitis- gallbladder infection due to gas producing organisms. causes ileus.

Question 14

pt performs repetitive arm movements above should height. subacute pain on abduction.

Answer 14

rotator cuff tendinopathy

Question 15

pt in rapid deceleration accident with CXR showing persistent pneumothorax despite chest tube placement, and pneumomediastinum, and ge gas subcutaneous emphysema.

Answer 15

tracheobronchial perforation secondary to blunt thoracic trauma. usually the right main bronchus. confirm fx with high resolution CT, bronchoscopy, or surgical exploration. operative repair is indicated.

Question 16

mc cause of parotitis

Answer 16

staph aureus. form dehydration.

Question 17

ankle branchial index interpretation

Answer 17

ratio of resting SBP at ankle to SBP in brachial artery. 1.3: suggestive of calcified and uncompressible vessels. 0.91-1: normal. ABI is more sensitive and specific than arterial duplex. usually done when considering for interventional procedures.

Question 18

who is umbilical hernia seen in? what causes it.

Answer 18

african american, premies, ehlers danlos, beckwith-wiedemann syndrom, hypothyroidism. caused by incomplete closure of umbilical ring.

Question 19

difference in imaging between tension pneumothorax and spontaneous pneumothorax

Answer 19

SP has absent lung markings and visible pleural line. TP has what SP has PLUS contralateral mediastinal shift, and ipsilateral hemidiphragm flattening.

Question 20

pt with elevated amylase, metabolic acidosis, abdominal pain out of proportion to physical exam

Answer 20

acute mesenteric ischemia. acidosis from elevated serum lactate levels.

Question 21

pt with mild scleral icterus after appendectomy with elevated indirect bill with normal LFT and no evidence of hemolysis.

Answer 21

gilbert syndrome- the most common inherited disorder of bilirubin glururonidation. decreased activity of UDP glucuronyltransferase.

Question 22

pt has anterior knee pain, localized swelling, tenderness, erythema.

Answer 22

prepatellar bursitits. often due to staph aureus. which can infect the bursa via penetrating trauma, repetitive direction, or extension from local cellulitis.

Question 23

pt s/p fracture of long bone-> dyspnea, confusion, and petechiae in upper part of body

Answer 23

fat embolism. tx: prompt respiratory support. use of heparin, steroids, and LMW dextran is controversial.

Question 24

acute shoulder pain after forceful abduction and external rotation at the glenohumeral joint. nerve injury?

Answer 24

anterior hsoulder dislocation. may cause injury to axillary nerve or artery.

Question 25

pt gets fracture of humeral midsahft. nerve injury?

Answer 25

radial nerve. or from use of improperly fitted crutches. sxs= wrist drop, sensory loss of posterior arm, forearm, o lateral dorsal hand.

Question 26

pt fractures medial epicondyle of humerus. nerve injury?

Answer 26

ulnar nerve injury-> claww hand, snsory loss on dorsal and ventral medial hand.

Question 27

pt on warfarin with INR of 2.1 w/acute GI perforation. what to do next?

Answer 27

need to reverse anticoaguation by infusion of FFP. giving vitamin K is not fast enough.

Question 28

pt presents with a week of abdominal pain RLQ, vomiting, decreased appetite, mild fever, increase pulse, WBC count. dx? tx?

Answer 28

pts who present with appendicitis >5 days after the onset of symptoms have a high incidence of perforation with abscess formation. they often have a contained abscess. if pts are otherwise stable, they may be treated with IV hydration, antibiotics, bowel rest, and interval appendectomy.

Question 29

Pt with recent hx of skin infection who presents with fever and abdominal pain radiating to the groin

Answer 29

Psoas abscess. From hematogenous spread or from direct extensions. RF: HIV, IVFU, DM, crohns. Dx: CT scan. TX: drain, get blood and abscess cultures to guide antibiotic therapy.

Question 30

Pt after horseback riding has perineal tenderness, hematoma, normal prostate, bleeding from urethra

Answer 30

Damage to anterior urethra (urethral distal to urogenital diaphragm)

Question 31

Pt after pelvic injury has suprapubic pain and an inability to void. Blood at urethral meatus, high riding prostate due to displacement of prostate by pelvic hematoma

Answer 31

Posterior urethral injury.

Question 32

Blood gas levels in atelectasis

Answer 32

Hypoxemia-> hyperventilation -> hypocapnea -> respiratory alkalosis. Similar to PE.

Question 33

Child falls on arm and gets supra condylar fracture. Risk of injury time

Answer 33

Brachial artery, median nerve. Tx: analgesia and mobilization

Question 34

New military recruit gets foot pain with slow onset pain that initially occurs only with activity but now already occurs. Plain film shows hairline fx of shaft of second metatarsal. Next step?

Answer 34

Rest and analgesics. Fxs of the 2nd, 3rd, and 4th metatarsals are managed conservatively bc surrounding metatarsals act as splint and nonunion is uncommon

Question 35

yougne rat has acute popping sensation in knee with catching locking and reduced range of motion, and slow onset joint effusion.

Answer 35

do MRI. meniscal tear. management: rest, activity modification. if persistent sxs:surgery.

Question 36

asian man has neck swelling and epistaxis. mass in posterior nasal cavity. what is risk factor

Answer 36

viral infection. tis is nasopharyngeal carcinoma, an undifferentiated SCC. EBV association. EBV titer levels can be used to track progress of therapy for this malignancy. cancer also associated with smoking and chronic nitrosamine consumption.

Question 37

If child falls on outstretched hand and has a displaced supracondylar fracture of the humerus, what do you worry about

Answer 37

Brachial artery or median nerve injury. Also compartment syndrome/volkmann ischemic contracture

Question 38

What causes dumping syndrome

Answer 38

Loss of normal action of the pyloric sphincter bc of injury or surgical bypass

Question 39

What is used to predict prognosis of coma? To dx coma?

Answer 39

Dx: brain stem activity (pupillary light, extra ocular or corneal reflexes)

Question 40

Widening of femoral ring puts you at risk for

Answer 40

Femoral hernias

Question 41

fever chills and deep abdominal pain

Answer 41

suggest a retroperiotneal abscess