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Uworld11\ Flashcards

1
Q

Persistent pneumothorax and significant air leak following chest tube placement in patient who has sustained blunt chest trauma suggests

A

tracheobronchial rupture

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2
Q

treatment for third degree burn

A

early excision and grafting

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3
Q

next step in management for head trauma

A

penetrating = surgery

linear skull fracture with not overlying wound - leave alone

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4
Q

management for intraoperative development of coagulopathy

A

platelet packs and fresh-frozen plasma

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5
Q

Any penetrating wound below the 4th intercostal space (below nipples) is considered what

A

abdomen and requires ex. lap in unstable patient

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6
Q

what are your post op fevers?

A 
day of: atelectasis
Day 1-3: pneumonia
Day 3: UTI
Day 5: deep thromnophlebitis
Day 10-15: deep abscesses
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7
Q

Treatment of hemorrhagic shock

A

near trauma center: GO

not: fluids

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8
Q

management of cervical spine injury

A

ooo-tracheal intubation

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9
Q

3 categories in GLASCOW score

A

eye opening
verbal response
motor response

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10
Q

salmon-colored fluid coming from surgical site? next step

A

wound dehiscence

tape securely and go to OR

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11
Q

what is ALT level for gallstone pancreatitis

A

greater than 150

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12
Q

When do you do ERCP in gallstone pancreatitis

A

cholangitis
bile duct obstruction
increasing liver enzymes

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13
Q

Management of pancreatic pseudocyst

A

asymptomatic: expectant management
symptomatic: endoscopic drainage

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14
Q

difference in hepatic and splenic infarctions

A

hepatic: free intraperitoneal fluid
splenic: less likely

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15
Q

Pediatric patients, most often occurs following blunt abdominal trauma? clinical pic? treatment?

A

duodenal hematomas
epigastric pain, vomiting 24-36 hours after initial injury
gastric decompression and parenteral nutrition

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16
Q

Initial management of small bowel obstruction

A

conservative (bowel rest, nasogastric suction, correction of metabolic derangements)

patient develops clinical or hemodynamic instability –> emergent surgery

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17
Q

difference in chest X-ray in cardiac tamponade and bronchial rupture

A

cardiac tamponade: normal cardiac silhouette without tension pneumothorax

bronchial rupture: jugular venous dissension but with tension pneumothorax

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18
Q

when do you do HIDA scan?

A

when ultrasound is undetermined

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19
Q

small-and-large bowel dissension and hypoactive bowels

A

ileum

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20
Q

air-fluid levels in gallbladder? treatment

A

emphysematous cholecystitis

emergent cholecystectomy

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21
Q

difference in timing of small bowel obstruction and ileus

A

small bowel obstruction: weeks to years post-op

Ileus: hours to days post-op

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22
Q

What is a watershed area of the colon

A

splenic flexure and rectosigmoid junction

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23
Q

What is CT scan of colon for ischemic colitits

A

thickened bowel wall

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24
Q

treatment for abscess from diverticular disease

A

less then 3cm –> abs and abs

more than 3cm –> CT guided percutaneous drainage

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25
Q

Dilated common bile duct in absence of stones

A

sphincter of Oddi dysfunction

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26
Q

relate opioids and sphincter of Oddi

A

Opioids cause sphincter contraction and precipitate symptoms

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27
Q

clinical feature of rapid gastric emptying

A

crampy abdominal pain
vomiting
diarrhea
vasomotor symptoms (flushing, palpitations)

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28
Q

One of the most common post-op cholecystectomy

A

bile leak

fever, nausea, VOMITING, and vague abdominal pain 2-10 days after Lap cholecystectomy

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29
Q

fever
RUQ pain
can also cause ileus (decreased or absent bowel sounds)

A

emphysematous cholycestitis

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30
Q

Gilbert Syndrome

A

high unconjugated bilirubin

jaundice

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31
Q

strangulation

A

disruption of blood flow to the involved bowel segment, leading to necrosis

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32
Q

which is more sensitive for acute pancreatitis

A

lipase

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33
Q

succession splash may be heard over the stomach

A

gastric outlet obstruction

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34
Q

painful, fluctuant mass 4-5cm cephalic to the anus in the intergluteal region
mucoid, purulent, or bloody drainage

A

Pilonidal disease

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35
Q

difference between appendicitis and psoas abscess?

A

psoas: subacute
appendicitis: acute

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36
Q

pediatric umbilical hernia management

A

less than 1.5 = spontaneous closure

must close before the age of 5

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37
Q

Management of fleshy immobile mass in midline hard palate in pediatric patient asymptomatic

A

observation

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38
Q

mass anterior edge of sternomastoid muscle

A

branchial cleft cyst

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39
Q

mass in supraclavicular area? Management

A

cystic hygroma

CT before surgery because it may extend into

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40
Q

Vesicles on tonsils and soft plate

A

Herpangina –> coxsackie A virus–> observation

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41
Q

Management of upper neck trauma

A

arterio-graphic diagnosis

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42
Q

Cardiac index and pulmonary wedge pressure values for MI

A

decrease cardiac index

increase pulmonary wedge pressure

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43
Q

difference between thoracic aneurysm and aortic dissection

A

thoracic: Spiral CT no surgery

aortic dissection: surgery

44
Q

GI trauma (costoverterbal tenderness) next step

A

contrast enhanced CT Of abdomen ( even if contrast is contraindicated in kidney failure)

45
Q

DVT in chronic renal failure

A

unfractionated heparin followed by warfarin

46
Q

how does multiple myeloma impact immune system

A

alters normal leukocyte population and causes hypogammagobiulenia

47
Q

treatment for mild hypernatremia? Severe cases of hypernatremia hypovolemia

A

mild: 5 dextrose in 0.45 saline
severe: .9 saline

48
Q

case-control study

A

compare the exposure of people with disease(case) to exposure of people with the disease (control)

49
Q

what measure is case-control study associated with

A

exposure odds ratio

50
Q

What type of study uses prevalence odds ratio

A

cross-sectional studies

51
Q

What type of study uses median survival calculated

A

cohort studies or clinical trials

52
Q

In what study are relative risk or relative rate calculated

A

cohort studies

53
Q

Prominent capillary pulsation’s in the fingertips or nail beds

A

aortic regurgitation

54
Q

What is the most common valvular abnormality detected in patients with infective endocarditits

A

Mitral valve disease, usually mitral valve prolapse with coexisting mitral regurgitation

55
Q

treatment for inflammatory acne?

A

topical retinoids and benzoyl peroxide

56
Q

Treatment for moderate-to-severe cases treatment?

A

topical retinoids and benzoyl peroxide

add topical abs

57
Q

Treatment for severe or recalcitrant acne

A

Oral abs and isotretinoin

58
Q

When is salicylic acid most useful for acne treatment

A

noninflammatory/comedonal acne

59
Q

Effect modification

A

external variable positively or negatively impacts the effect of a risk factor on the disease of interest
- associated with disease (not risk factor)

60
Q

What helps differentiate between confounder or an effect modifier?

A

Stratified analysis

61
Q

Cofounder

A

same as effect modification but

- associated to both disease and risk factor

62
Q

how do you look at stratified analysis?

A

higher the RR, stronger the association

63
Q

weight loss, jaundice and a contender, distended gallbladder on examination

A

pancreatic cancer

64
Q

ulcerating, pustular nodules at the site of inoculation and associated lymphatic channels

A

Sporotrichosis

65
Q

difference between acute tubular necrosis and tubulointersitial nephritis

A

ATN: acute onset
TN: insidious, no need for rash, NSAIDs

66
Q

When do you use tetanus immune globulin

A

symptomatic patients

its who have not received 3 initial doses in childhood

67
Q

pain scale for CMV retinitis

A

painless

68
Q

right for right ventricular heart attack

A

fluids

69
Q

how does positive pressure mechanical ventilation change pressure? impact in hypovolemic patients

A

increases intrathoracic pressure

    • acute loss of right ventricular preload
    • loss of cardiac output
    • cardiac arrest
70
Q

high ADH and high urine sodium

A

SIADH

71
Q

what is associated with dermatomyositits

A

internal malignancy

72
Q

If a test result is negative, what is the probability of having the disease

A

1-negative predictive value

73
Q

What type of shock is the only one with decreased systemic vascular resistance

A

septic shock

74
Q

difference between secondary PTH due to CKD and primary hyperparathyroidism

A

uric aciCKD: phsophorus high. calcium low
Primary: low PTH and high calcium

so basically with CKD the PTH will increase but it won’t actually fix the problem

75
Q

needle-shaped crystal in U/A indicates what?

A

uric acid stones –> radiolucent on CT

76
Q

subacute (de Quervain) thyroiditis? treatment?

A

fever, neck pain, tender goiter following URI

beta blockers and NSAIDs

77
Q

Suppurative thyroid

A

rare

euthryoid

78
Q

painless thyroiditis (silent thyroiditis)

A

thyrotoxicosis with mild thyroid enlargement
suppressed TSH
thyroid scintigraphy shows decreased radio iodine uptake

79
Q

Parents who themselves are minors, can they give consent for medical treatment of their child?

A

yes

80
Q

from an unemanciapted minor, do you need consent from both parents

A

one will do

81
Q

Parents refuse to consent to treatment of their child for a non-emergency but fatal medical condition. next step

A

seek court order

82
Q

Spondylolithesis

A

forward slip of vertebrae

  • preadolescent children
  • back pain, urinary incontinence, “Step-off” at the lumbosacral area
83
Q

Bone cancer: central lytic lesion, onion skinning, and moth-eaten appearance with some extension into the soft tissue

A

Ewing sarcoma

84
Q

Bone cancer: central lytic bone defect with surrounding sclerosis

A

osteomyelitis

85
Q

equines and various of calcaneum and talus
varus of midfoot
adduction of forefoot

A

clubfoot

86
Q

management of clubfoot

A

stretching and manipulation of foot immediately
serial plaster casts
surgery between 3-6 months of age

87
Q

Down syndrome patient with upper motor neuron findings

A

atlantoaxial instability

88
Q

How do you diagnose Henoch Schonlein Purpura

A

clinical diagnosis

confirmed with skin biopsy in unclear cases

89
Q

How does a child get a supracondylar fracture of the humerus

A

fall on an outstretched hand most common

90
Q

What is a rare but potentially devastating complication of supracondylar fracture

A

Compartment syndrome accompanied by forearm fractures which can lead to Volkmann contracture

91
Q

Clinical features of juvenile idiopathic arthritis

A

daily fever and rash

chronic uveitis

92
Q

Lab values for juvenile idiopathic arthritis

A

Leukocytosis
thrombocytosis
elevated inflammatory markers

93
Q

Treatment for juvenile idiopathic arthritits

A

NSAID and steroids

94
Q

what should be on the differential for a solitary, painful lytic long bone lesion with overlying swelling and hypercalcemia in a child

A

langerhans cell histiocytosis

95
Q

bone cancer: sunburst pattern

A

osteosarcoma

96
Q

Flexible positioning
Medial deviation of forefoot
Neutral position of hind foot

A

Metatarsus adducts

97
Q

Treatment for metatarsus adductus

A

reassurance

98
Q

traction of apophysitis of tibial tubercle

A

Osgood-Schlatter

99
Q

Difference between Ehler’s Danlos and Osteogenesis imperfecta

A

Ehlers: no fractures
Osteogenesis: fractures

100
Q

Blue sclera

Opalescent teeth/Dentinogensis imperfect (teeth translucent and gray)

A

Osteogenesis imperfecta

101
Q

how long does arthritis need to be present for to diagnose juvenile idiopathic arthritis

A

greater than 6 weeks

102
Q

type of patient who gets slipped capital femoral epiphysis

A

obese boys

thin adolescents who recently went through growth spurt

103
Q

Management of slipped capital femoral epiphysis

A

surgical pining

104
Q

well-circumscribed mass that does not transilluminate in the inferior portion of the sternocleidomastoid muscle can be seen in what child condition

A

torticollis

105
Q

what causes Trendelenburg sign

A

weakness or paralysis of gluteus medium and minimum muscles

- innervated by superior gluteal nerve

106
Q

risk factor for vitamin D deficiencies in children

A

exclusive breastfeeding
increased skin pigmentation
lack of sun exposure

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