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Uworld Surg corectio
| Question | Answer |
|---|---|
| 16 YOM has a fall off a bicycle with a brief LOC and no seizure. Stable in ER with samll bruise on forehead. No bony abnormalities. Normal exam. Next step? | can discharge home as long as a reliable indivual can monitor them for 24 hours after the injury |
| An alcoholic man has drooling, dysphagia, and fever. He has been sick for 2 days and unable to eat. His mouth is swollen and he feels hot. THere is redness on the whole mouth and on the floor of mouth. He has submandibular crepitus. Dx? | Ludwig angina: rapidly progressive celluitis of submandibular and sublingual space. usually from streptococcus or anaerobes. Comes from teeth |
| Trauma. Neuro exam shows paraplegia, loss of pain and temp in both legs but normal proprioception. No defitis in upper Extremtiezs. + straight leg test. CT spine shows burst fracture at T4. Dx? | Anterior cord syndrome (total loss of motor and pain and temp below level of lesion) MRI best to see extent of damage |
| S 31 y/o biker has a direct blow to his lower abdomen and pelvis leaving a party where he drank a lot of fluid. The pain is referred to the left shoulder. What got injured? | bladder dome ( only part covered by perioneum which can be referred to the left shoulder |
| 24 YOM with 1 w abdominal pain in RLQ exacerbated by motion. For last 2 days, radiates to back, 1 episode of diarrhea 2 days ago. PE has RLQ tenderness without rebound. Flexion of hi elicits pain. WBC elevated. Dx? | appendiceal perforation with psoas abscess |
| PT compains of daytime fatigue, anorexia, wt loss, and viceral abdominal pian interfereing with sleep . Dx? | GI malignancy, (chiocises given make pancreaticv carcinoma most liekly) |
| 25 YO motorcyclist brought ot ED after collision with sutomobile. In obvious pain on arrival. Has an urge to void but cant. Genital exam shows blood at the meatus and scotal hematoma. Dx? | urethral injury |
| What is the best managment for a gentlemas with a diabetic ulcer that has abundant cloudy gray discharge, and dusky, friable subcutaneous tissue? | urgent surgical exploration |
| CXR has a solitaery round lesion in left upper lung 1 cm in diameter with sharp borders not touching the pleura. CXR 3y ago was normal. Next step? | CT chest w/o contrast |
| 65 YOM has hip pain. Present for several months and is constant. No wt loss or appetitie. PMHx has high BP. Unremarkable PE. Akl phos is high. Normal: gamma glutamyl, normal Ca, normal vit D. Increased uptake in several spots on bone scan. Dx? | Paget's disease of bone. Pt at risk of hearing loss |
| 43 YO overwiehgt female complains of periodic knee swelling nad pain for 3 months. Stared on hiking trip when she felt a pop in the knee. On PE there is tenderness of the anterior and medial right knee joint line. Dx? | meniscal tear. MRI for definite diagnosis |
| 34 YOM has clear cute fracture of penis. Next step? | retrograde urethrogram followed by surgical exploration of the penis |
| what is standard of care for someone with acute cholecystitis? | cholecystectomy within 72 hours, dont delay it |
| bright red blood filling the toilet bowel with a normal rectal exam is? | diverticulosis |
| Someone has acute pancreatitis without alcholism. First test to get? | RUQ ultrasound to look for stones |
| A 54 YOM comes to the physician with edema of the right ankle. He has heaviness and crampin in the same leg that is worse after a long day at work. PE normal. some edema in right ankle. Doppler of leg shows no thrombosis. Dx? | venous valve incompetence |
| A 74 YOM has AAA repair. He gets 2 units of red cells in surgery. 1 hour after surgery he gets fever and chills. He has CABG 2 m ago. Temp is 101.3, stabel vitals. PE shows tender wound without redness. Also has foley and central line place 1 day ago. Dx? | transfusion reaction |
| What blood gas is seen in post op atelectasis? | high norm pH. low pO2, low pCO2 |
| What is the mechanism of hyperventialation decr ICP? | decr sympathetic output (CO2 washout leading to cerebral vasoconstriction) |
| A 25 YOM comes to physician with a mass in his mouth. He has had lump for many years , No wt loss. MVC several years ago with a concussion. PE shows a 2x2 cm mass on hard paate that is immobile and bony hard. Most liekly cause? | congenital torus palatinus (most common in asians) |
| An old man, falls, breaks hip. cant remeber details. no obvious cause. Next step before OR? | ECG, CXR, cardiac enzymes to evaluate candidacy |
| An 18 YOM comes with dull aching and fullness of scrotum. Exam shows a soft sided scotal swelling, negative translumination. Swelling increases with a valsalva maneurver. Cause? | dilation of pampiniform plexus, this is a varicoscele |
| Pt presents with hypotension andd back pian after cardiac cath consistent with likely retroperitoneal bleed. Next step? | get CT abdomen pelvis w/o contrast |
| A man has snapping that can be felt in right knee on tibial torsion with knee flexd at 90. Dx? | medial meniscus tear |
| What is the best modality for dx esophageal rupture? | contrast esophagography |
| a 47 YOW has worsening left breast swelling and pain. Had mastitis 20 y ago. Whe has a 7 x 6 cm area of edema and erythema with a poorly localize dmass. Scant bloody dischard. Next stpe? | biopsy for histology and treatment depnding on histology |
| A 39 YO pleontologist has right sided hip pain that makes it difficult to lie on right side sleeping. Says pain is on outer surface of thigh. He has hyperTn and hyperlipidemia. SOmks 1 ppd for 15 years. Dx? | traochanteric bursitis |
| a 36 YOW presents to ED with severe epigastric pain and right shoulder pain for 2 hours. 1 epuisode of emesis. She unintenitally fases yesterday Several hours after presenting. pt resolves completely. Dx and cause? | bilicary colic 2/2 gallstones. viscous distention is the cause of the colicky pain |
| 45 YOM immigrant has n/v of partially digested food for 1 month., also lost 5 lb in that time. Appetite is good aside from early satiety. He has a suicide atemt wuth acid injestion 3 months afo. Abdominal exam shows a sucussion splash on epigastrum. Dx? | pyloric stricture |
| Ca, Phossphate and PTH in vit D deficiency? | low Ca, low phospj, high PTH |
| 33 YOM falls riding bicylce in park. Presents to ED, PE reveals upper abdominal bruises. Abdomen is soft, slightly tender in epigastrum, non distended. 1 weeks later he returns with fever, shaking chills, poor appetite and deep pain. Causes? | pancreatic laceration (this picutre of retroperitoneal abscess) |
| Next step in child with diaprhagm rupture? | CT chest abdomen |
| What is the biggest RF for nasopharyngeal carcinoma? | EBV or viral infection |
| imparied cough and shallow breathing in a person with smoking hx post op is a description of? | atelectasis |
| A 3 YOg is not moving right arm. child was normal this morning but bad since lifted child by forearm. Exam shows arm held in pronation against chest. Child wont move arm. next step? | passive elbow flexion and forearm supination to fix nursemaid elbow |
| tonic clonic seizure followed by pt with inability to externally rotate arm. Dx? | posterior shoulder dislocation |
| After PE what is next best step in claudication evaluation? | ABI |
| What is the next stpe for an inconclusive fast scan on trauma? | diagnositc peritoneal lavage |
| Why might a person with celiac disease has a negative IgA anti tissue transglutaminase? | some people with celiac lack all IgA |
| What imaging is most important to get after a central line? | CXR to eval for pneumoothroax, hemothroax |
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tjs2123