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Question 1

tredelenburg sign is weakness of which muscles? innervated by which nerve?

Answer 1

gluteus muscles, innervated by superior gluteal nerve

Question 2

falling on outstretched arms causes supracondylar fracture of the humerus, cx?

Answer 2

median nerve and brachial artery damage

Question 3

intermittent bloody d/c from one nipple, no masses. Postmenopausal women. Ddx?

Answer 3

Intraductal papilloma

Question 4

In hemodynamically unstable pts with abd trauma, start fluid resuscitation, and do US. If US shows peritoneal blood, and pt is still unstable, next step?

Answer 4

urgent laparotomy

Question 5

stress (hairline) fx of metatarsal. Tx?

Answer 5

rest and analgesics b/c they heal on their own, no cast needed.

Question 6

Pt recently underwent thoracic aortic aneurysm surgery, then suddenly developed b/l flaccid paralysis and loss of pain and temp. Vibration and proprioception preserved. Ddx?

Answer 6

Anterior spinal cord syndrome (also related to burst fracture of vertebrae)

Question 7

Tachypnea, tachycardia, hypotension, distended neck veins, tracheal deviation. Ddx?

Answer 7

Tension pneumothorax

Question 8

Pt with blunt chest trauma, with jugular venous distension, hypotension and tachycardia despite fluid resuscitation. Chest x-ray shows normal cardiac silhouette and no tension pneumothorax. Ddx?

Answer 8

Acute cardiac tamponade

Question 9

Critically ill pt who on imaging shows thickening of gall bladder walls and pericholecystic fluid. No gallstones. Ddx? Tx?

Answer 9

acalculous cholecystitis

antibiotics and percutaneous cholecystostomy followed by cholecystectomy

Question 10

oliguria, azotemia and BUN/creatinine >20:1 is what?

Answer 10

acute prerenal failure from hypovolemia

Question 11

syringomyelia loses which sensation?

Answer 11

pain and temp in b/l UE

light touch, vibration, proprioception (dorsal column) preserved

Question 12

Male in MVA, x-ray shows patchy irregular alveolar infiltrate on right side. Ddx?

Answer 12

pulmonary contusion

Question 13

premie with pallor, cyanosis, hypotension, seizures, focal neurologic signs, bulging fontanel, apnea and bradycardia. US shows hemorrhage in germinal matrix. Ddx?

Answer 13

IVH

Question 14

4yo immigrant boy with nasal d/c for 10 days, has follicular conjunctivitus and neovascularization over cornea. Ddx?

Answer 14

Chlamydia trachomatis

Question 15

Babies with gastroschisis are at increased risk of neural tube defects. True or false?

Answer 15

False, omphalocele is closely related to neural tube defects.

Question 16

Pt with postgastrectomy, experiences diaphoresis, postprandial abdominal cramps, lightheadedness, weakness. Ddx? Tx?

Answer 16

Dumping syndrome

dietary modification

Question 17

nasopharyngeal cancer is closely assoc with what?

Answer 17

EBV infection

Question 18

Elderly patient with hyperextension, cervical spondylosis, upper extremity weakness with loss of pain and temp sensation. Ddx?

Answer 18

Central cord syndrome

Question 19

Breast abnormalities always need imaging, biopsy/aspiration is after that. Best modality for below 30 and above 30?

Answer 19

below 30: ultrasound

above 30: mammography and ultrasound

Question 20

epidural hematoma shape?

Answer 20

biconvex collection

Question 21

subdural hematoma shape?

Answer 21

crescenteric

Question 22

severe left abdominal pain radiating to the groin, vomiting, cannot lie still. Ddx? Best diagnostic test?

Answer 22

ureterolithiasis

ultrasound or noncontrast spiral CT

Question 23

After MVA, thoracic chest wall is moving inward with inspiration and outward with expiration. multiple rib fx. PEEP makes chest movement normal again. Ddx?

Answer 23

Flail chest

Question 24

abdominal pain after MVA with vertebral fx and retroperiotoneal hemorrhage. Nausea, distended abdomen, absent bowel sounds, x-ray shows dilated small and large bowel. Ddx?

Answer 24

Paralytic ileus (also occurs after abdominal surgery)

Question 25

35 yo female with nipple retraction, mammogram shows coarse calcifications. Core biopsy shows foamy macrophages and fat globules. Ddx? Best next step?

Answer 25

Fat necrosis (benign) no tx, self limited

Question 26

Best first step of management in urethral injury

Answer 26

Retrograde urethrogram

Question 27

Unhealing wounds can develop into what cancer?

Answer 27

SCC

Question 28

Constant and gnawing pain that is worse at night, anorexia with weight loss, jaundice. Migratory thrombophlebitis. Current smoker. Ddx?

Answer 28

Pancreatic cancer

Question 29

When is immediate laparotomy required?

Answer 29

When pt is unstable hemodynamically and there is proof of bleeding.

Question 30

Bilateral hip thigh and butt claudication, impotence and symmetric atrophy of b/l LE. Ddx?

Answer 30

Aortoiliac occulsion

Question 31

Pt w recent AAA repair presents with abdominal pain, bloody diarrhea, fever, leukocytosis. Ddx?

Answer 31

Bowel ischemia and infarction

Question 32

Worsening substernal chest pain radiating to the back, left chest pain after endoscopy. Chronic alcoholism. X-ray shows pleural effusion/pneumothorax that was not there before. Ddx?

Answer 32

Esophageal rupture

Question 33

Blunt abdominal trauma, epigastric pain. Intial CT is normal, but patient returns with fevers, chills, poor appetite and deep abdominal pain. Ddx?

Answer 33

Pancreatic laceration

Question 34

penile fracture best next step?

Answer 34

retrograde urethrogram with surgical exploration

Question 35

Fever, dysphagia, drooling, firm mass and crepitus in submandibular space. Ddx? Source of infx?

Answer 35

Ludwig's angina (infx of submandibular and sublingual glands). Teeth

Question 36

postprandial pain, early satiety, nonbilious vomiting, weight loss, recent acid ingestion. Abdominal succulent splash. Ddx?

Answer 36

Pyloric stricture

Question 37

wrist drop is caused by which nerve damage?

Answer 37

Radial nerve

Question 38

Tx of hydrocele?

Answer 38

Nothing, spontaneous by 12 months

Question 39

Reversal of warfarin?

Answer 39

fresh frozen plasma

Question 40

In prosthetic joints, which organisms cause early onset infection and which cause late onset infx?

Answer 40

early: staph aureus, pseudomonas late: Staph epidermis

Question 41

When do you need tetanus IVIG?

Answer 41

Dirty severe wound with no previous vaccination

Question 42

ulcers that occur on high pressure points such as sole of foot just under first metatarsal bone is due to what?

Answer 42

peripheral neuropathy due to diabetes

Question 43

which drug contributes to postoperative ileus?

Answer 43

morphine

Question 44

Most common cause of lower GI bleeding in elderly?

Answer 44

diverticulosis

Question 45

Patients with fat malabsorption, such as Crohn's disease, have tendency to develop nephrolithiasis. What kind of stones form?

Answer 45

oxalate stones

Question 46

what does the psoas sign suggest?

Answer 46

abscess near the psoas muscle, behind the appendix

Question 47

Blunt trauma. Persistent pneumothorax despite chest tube placement, pneumomediastinum and subcutaneous emphysema. Ddx?

Answer 47

tracheobronchial rupture

Question 48

After cardiac catheterization, pt develops hypotension, ipsilateral flank/back pain. Ddx?

Answer 48

retroperitoneal hematoma