Ksurgery 600-700

Front 1

Q600. What is the Glascow Coma Score for Verbal response?

Back 1

A600. Verbal response ("Jackson 5"):; 5: Appropriate and oriented; 4: Confused; 3: Inappropriate words; 2: Incomprehensible sounds; 1: No sounds

Front 2

Q601. What is the GCS of a man in a Coma?; Of a Dead man?

Back 2

A601. Coma: 8 or less; Dead: 3

Front 3

Q602. what are the most emergent orthopedic surgeries? (2)

Back 3

A602. 1. Hip Dislocation (must be reduced immediately); 2. Exsanguinating Pelvic fracture (external fixator)

Front 4

Q603. When is a surgical cricothyroidotomy not recommended?; What is done instead/

Back 4

A603. in patient younger then 12-yo; (Perform Needle Cricothyroidectomy)

Front 5

Q604. If you only have one vial of blood from a trauma victim to send to the lab, what test should be ordered?

Back 5

A604. Type and Cross

Front 6

Q605. what is the Tx for human or dog bites? (3 together)

Back 6

A605. Leave wound open, Irrigation and Antibiotics

Front 7

Q606. What test may help identify the site of a massive UGI bleed when endoscopy fails to Dx the cause and blood continues per NGT?

Back 7

A606. Mesenteric Angiography

Front 8

Q607. What are the (3) possible Tx regimens for H. Pylori PUD?

Back 8

A607. MOC, MOA or COA; M: Metronidazole;; O: Omeprazole (PPI);; C: Clarithromycin;; A: Ampicillin

Front 9

Q608. What are the classic Sx of Carcinoid syndrome? (4)*

Back 9

A608. B-FDR (Be FDR in a cool CAR):; Bronchospasm;; Flushing;; Diarrhea;; Right-sided heart failure

Front 10

Q609. what tumors are assoc with carcinoid syndrome? (3)*

Back 10

A609. BLT:; Bronchus CA;; Liver Metastasis;; Testicular CA or Ovary CA; (occurs when venous draining from the tumor gains access to the systemic circulation by avoiding heatic degradation via the portal system)

Front 11

Q610. MCC of colonic Fistulas

Back 11

A610. Diverticulitis

Front 12

Q611. MC fistula type

Back 12

A611. Colovesical fistula

Front 13

Q612. Dx: large air/fluid level in the RLQ forming a "coffee bean" sign

Back 13

A612. Cecal Volvulus

Front 14

Q613. What procedure is used if kindey stones are too large or too hard to remove via lithotripsy?

Back 14

A613. Percutaneous Nephrolithotomy

Front 15

Q614. Crohn's dz or Ulcerative Colitis:; Full-thickness wall involvement

Back 15

A614. Crohn's Dz

Front 16

Q615. Crohn's dz or Ulcerative Colitis:; Crypt Abscess

Back 16

A615. Ulcerative Colitis

Front 17

Q616. Crohn's dz or Ulcerative Colitis:; Pseudopolyps

Back 17

A616. Ulcerative Colitis

Front 18

Q617. Crohn's dz or Ulcerative Colitis:; Bloody Diarrhea

Back 18

A617. Ulcerative Colitis

Front 19

Q618. Crohn's dz or Ulcerative Colitis:; Granulomas

Back 19

A618. Crohn's Dz

Front 20

Q619. MCC of painful Hepatomegaly

Back 20

A619. Hepatocellular CA

Front 21

Q620. Dx: Thrombosis of Hepatic veins

Back 21

A620. Budd-Chiari

Front 22

Q621. Dx:; jaundice, pruritus, palpable nontender distended gallbladder; Tx?

Back 22

A621. Adenocarcinoma of the head of the Pancreas; Tx: Whipple

Front 23

Q622. A patient presents with HTN, HA, polyuria, weakness and Hypokalemia. Dx?; First Diagnostic test?; Tx? (2 depending on type)

Back 23

A622. Dx: Conn's syndrome; Diagnostic test: Plasma Aldosterone and Renin levels; Tx:; 1. Adrenal Adenoma or Unilateral hyperplasia: Laparoscopic Unilateral Adrenalectomy; 2. Bilateral hyperplasia: Spironolactone

Front 24

Q623. A patient presents with a psoriatic-appearing rash over the trunk and limbs, glossitis, stomatitis and new-onset diabetes. His labs show anemia, low amino acid levels and hyperglycemia. Dx?; Diagnostic test?; Tx? (2 together)

Back 24

A623. Dx: Glucagonoma; Diagnostic test: Tolbutamide stimulation test; Tx:; 1. Surgical resection of tumor; 2. Somatostatin for Necrotizing Migratory Erythema rash

Front 25

Q624. what is the Tx for hyperparathyroidism in the MEN-1 and MEN-2 patients?

Back 25

A624. Removal of all parathyroid tissue with autotransplant of some of the parathyroid into the forearm

Front 26

Q625. A patient presents with a palpable neck mass, hypercalcemia and elevated PTH. Dx?; Tx?

Back 26

A625. Parathyroid CA (the key is the neck mass: primary hyperparathyroidism have nonpalpable thyroids); Tx: Remove CA, Ipsilateral Thyroid lobe and all enlarged LN

Front 27

Q626. A patient complains of abdominal pain. On AXR there are "eggshell" calcifications near the RUQ. Dx?

Back 27

A626. Splenic Artery Aneurysm

Front 28

Q627. How are maintenance fluids calculated in children?

Back 28

A627. 4, 2, 1 per hour:; 4cc/kg for the first 10kg; 2cc/kg for the second 10kg; 1cc/kg for every kg over the first 20; ex: 25kg patient is (4 x 10) + (2 x 10) + (1 x 5) = 65cc/hour

Front 29

Q628. Tx for Trachial or Esophageal Foreign Body?

Back 29

A628. RIGID boronchoscope or espohpagoscope

Front 30

Q629. Infant has Bilious vomiting. What is the presumed Dx until proven otherwise?

Back 30

A629. Malrotation of the gut

Front 31

Q630. Malignant tumor of the liver that presents in the first 3 years of life

Back 31

A630. Hepatoblastoma

Front 32

Q631. Define:; Contracture of the forearm flexors secondary to forearm compartment syndrome; MC Cause?

Back 32

A631. Volkmann's contracture; Cause:; Supracondylar humerus fracture

Front 33

Q632. You suspect a newborn has developmental dysplasia. What is the Diagnostic test?

Back 33

A632. Ultrasound; (the bones are too new to see on x-ray)

Front 34

Q633. what is the cause of a fever of 104-105:; 1. Shortly after anesthesia; 2. after instrumentation procedure (like cystoscopy)

Back 34

A633. 1. Malignant Hyperthermia; 2. Bacteremia

Front 35

Q634. What are the (2) MCC of post-operative chest pain? How many days after the operation does each occur?

Back 35

A634. Day 1 - 2: MI; Day 5 - 7: PE

Front 36

Q635. What is the new gold standard as a diagnostic test for a pulmonary embolism?

Back 36

A635. V/Q scan; (previously it was a pulmonary angiogram, but they are costly and time-consuming)

Front 37

Q636. What is the normal urine output?; What is the Dx if the urine output is zero?

Back 37

A636. Normal: about 1/kg/hr; Zero: Mechanical error; (not from kidneys; more likely from a kinked catheter)

Front 38

Q637. Several hours after completion of surgery for multiple gunshot wounds to the abdomen, a 70 Kg., 52-year-old man is reported to have hourly urinary outputs of 17cc, 13cc, and 21cc, in three consecutive hours. His blood pressure has hovered around 95 to 125 systolic during that time. Dx? (2 possible); What is the next step to differentiate b/t the two and results for each?; Tx?

Back 38

A637. Dx: Dehydration or Renal Failure (Oliguria can be from shock, but in the presence of an adequate perfusing pressure, it is one of these two); Next step: Test Urine Sodium; Dehydration: Low (20 - 30Meq); Tx: Give more Fluids; Renal Failure: High (>40Meq); Tx: Stop Fluids

Front 39

Q638. 12 days after surgery for multiple gunshot wounds, a 27- year-old man becomes progressively disoriented and unresponsive. He’s had multiple complications, including several intraabdominal abscesses that have been percutaneously drained. He has bilateral pulmonary infiltrates, and a PO2 of 65 while breathing 40% oxygen. Meticulous attention has been paid to his fluid balance, and there is no evidence that he is in congestive heart failure. Dx?; Next step?

Back 39

A638. Dx: ARDS; Next step: PEEP; (then check for underlying reason, like sepsis from abscess)

Front 40

Q639. An alcoholic patient presents with Acute Pancreatitis with a septic abdomen. On post-operative day 2 he begins to get disoriented. Why?

Back 40

A639. Delerium Tremens; (seen in post-op day 2 in alcoholics)

Front 41

Q640. If a patient presents with post-operative disorientation, what are the 6 possible reasons?; What schold be checked with each?

Back 41

A640. 1. ARDS - check blood gases; 2. DT - if alcoholic; 3. HypoN/HyperN - check serum sodium; 4. DM/TPN - Hypoglycemia - check blood sugar; 5. Hepatic Enceph in Cirrhotic patient - check Ammonia level; 6. Check Medications

Front 42

Q641. What "type" of esophageal problem:; 1. Inability to swallow solids then liquids; 2. Inability to swallow liquids then solids; give one example of each

Back 42

A641. solids to liquids: Mechanical (cancer); liquids to solids: Mobility (DES)

Front 43

Q642. A patient presents 2 days after a hernia repair with signs of a bowel obstruction. Dx?; Diagnostic test/Tx?

Back 43

A642. Dx: Paralytic Ileus; Diagnostic test/Tx: Barium Tag; (a little bit of barium at a time over a few hours)

Front 44

Q643. What does an acute appendicitis usually begin with?

Back 44

A643. Anorexia; (then periumbilical pain to RLQ pain; if the paient looks like appendicitis, but can eat well, its probably not an appendicitis)

Front 45

Q644. What is the main presentation of Right-sided Colon cancer?; Left-sided?

Back 45

A644. Right-sided: Anemia; Left-sided: Blood in stool

Front 46

Q645. A 32-yo male presents with excessive bleeding from the rectum. First Diagnostic test?; Depending on the results, what is the next test?

Back 46

A645. First Dx Test: NG tube; If blood in stomach: Endoscopy; If no blood in stomach: Angiography; (not a colonoscopy--that much blood makes it hard to visualize)

Front 47

Q646. Aside from an increased conjugated bilirubin, what is the signature lab result for obstructive jaundice?; in what "benign" Dx will you see this value at an extreme high?; First Dx test?

Back 47

A646. Increased Alk Phos; Extreme Alk Phos: Acute Ascending Cholangitis; Dx Test: ERCP

Front 48

Q647. what does TSH and T-4 look like if a patient has a thyroid cancer?

Back 48

A647. Normal

Front 49

Q648. A patient presents with HTN, HypoK and is not on diuretics. Dx?; Diagnostic test?

Back 49

A648. Dx: Hyperaldosteronism (Conn's Syndrome); Diagnostic test:; Increased Aldosterone with a Decreased Renin

Front 50

Q649. In a patient with a congenital diaphragmatic hernia, what is the first step to Tx?

Back 50

A649. Tx the Hypoplastic lung

Front 51

Q650. What does a decreasing platelet count signify in a child with Necrotizing Enterocolitis?

Back 51

A650. Sepsis

Front 52

Q651. How do you differentiate intermittent claudication form a neurogenic source versus a vascular source?

Back 52

A651. Neurogenic source: Positional and does not stop with rest

Front 53

Q652. What is the Tx if claudication does not interfere with daily life?; If it does, what is the first Dx test?; Tx?; when is it not a surgical possibility to Tx?

Back 53

A652. Not interfering with life: do Nothing; If it is:; First: Dopler studies (then Arteriogram); Tx: Angioplasty with stent or saph vein bypass; Not surgical: if no Pressure Gradient seen on Doppler (means Dz is in the small vessels)

Front 54

Q653. A child presents with a mass at the base of the neck, in the supraclavicular area. Dx?

Back 54

A653. Cystic Hygroma

Front 55

Q654. A child presents with a mass up and down the anterior edge of the sternomastoid. Dx?

Back 55

A654. Branchial cleft cysts

Front 56

Q655. What is removed in a Thyroglossal cyst repair?; (3)

Back 56

A655. 1. the Mass,; 2. the Middle segment of the Hyoid bone; 3. a core of muscle from the Tongue all the way back to the Foramen Cecum

Front 57

Q656. 3 months ago, an 18-year-old woman noticed the presence of a 2 cm., firm, non-tender node located in the left jugular chain, at the level of the hyoid bone. She thinks it is larger now than when it first came to her attention. For the past 3 weeks she has had low grade fever and night sweats. Physical exam confirms the presence of the node, and also shows 2 other smaller nodes on that side of the neck, as well as enlarged nodes in both axillas. Dx?; First Diagnostic test?

Back 57

A656. Dx: possible Lymphoma (The timetable of inflammatory neck nodes is measure in weeks, while that of neoplastic nodes is typically of months); First Dx test: FNA (an excisional Biopsy will be needed to establish tumor type)

Front 58

Q657. A 72-year-old man seeks help for a 4 cm., fixed, hard mass in the left jugular chain, at the level of the upper edge of the thyroid cartilage. Patient says that he found it a week ago, but his wife claims that it has been present for at least 6 months. The patient has a long-standing history of alcohol and tobacco abuse, and he has terrible oral hygiene. Dx?; Diagnostic test?

Back 58

A657. Dx: Metastatic Squamous Cell CA; from a primary in the head or neck mucosa; Diagnostic test: FNA (do NOT BIOPSY the tumor)

Front 59

Q658. Aside from palpable mass in the neck, what are (3) other potential presentations for a metastatic SCC of the head or neck mucosa?

Back 59

A658. 1. Persistent unilateral ear ache with serous otitis media; 2. Persistent hoarseness; 3. Unhealing ulcer in the mouth

Front 60

Q659. what (2) times do you Never do a tissue Biopsy to diagnose cancer in the face/neck?

Back 60

A659. 1. mass in neck when suspecting Metastasis SCC from head or neck mucosa; 2. PAROTID gland (too close to facial nerve)

Front 61

Q660. Neurological problems of vascular nature have sudden onset. By HPI, how can you tell if it is occlusive versus hemorrhagic?

Back 61

A660. without Headache = Occlusive; with very severe headache = Hemorrhagic

Front 62

Q661. Location of brain tumor in patient with:; Anosmia

Back 62

A661. base of Frontal Lobe

Front 63

Q662. Location of brain tumor in patient with:; Loss of upper gaze

Back 63

A662. Pineal area

Front 64

Q663. Location of brain tumor in patient with:; Ataxia, unstable gait

Back 64

A663. Posterior Fossa

Front 65

Q664. What is the best imaging method for a brain tumor?

Back 65

A664. MRI

Front 66

Q665. What (2) classes of people are UTIs not expected?; What is the work-up for in this case?; (2 together)

Back 66

A665. Not in:; 1. Children; 2. Men; Work-up: as if it were an Obstruction:; 1. massive Antibiotics; 2. Decompression of urinary tract above the "obstruction"

Front 67

Q666. A 74-year-old man has a 3mm. ureteral stone lodged just above the ureterovesical junction. He is receiving IV fluids and analgesics, with the expectation that the stone will pass. He suddenly develops chills, his temperature shoots up to 104, and he complains of severe flank pain. Dx?; Tx? (2 together)

Back 67

A666. Dx: Obstruction plus Infection; Tx:; 1. massive Antibiotics; 2. Decompression of urinary tract above the obstruction; (In the presence of infection, manipulating and attempting to extract the stone would be hazardous)

Front 68

Q667. A 59-year-old man reports an episode of gross, painless hematuria, without any history of trauma. He has normal renal function. Diagnostic test? (2); why are these tests done?; If he had "poor renal flow" or "a history or renal failure", what is the Dx test? (2)

Back 68

A667. Dx Test:; 1. IVP; 2. Cystoscopy; (Performed to rule out Cancer of the Kidney, ureter or bladder); Poor kidney function (creatinine > 2):; 1. CT scan; 2. Cystoscopy

Front 69

Q668. A man presents with a painless enlargement of the right testis. He began feeling heaviness in that part of the scrotum 6 months ago. There is diffuse enlargement but it is difficult to determine if it is intratesticular or extratesticular. What is the next step?

Back 69

A668. Ultrasound; (best way to discriminate b/t intra- or extra- testicular mass)

Front 70

Q669. A patient presents with an acute subdural hematoma without a midline shift or anisocoria (unequal pupils). What is the next step?

Back 70

A669. Hyperventilation, Diuresis and fluid restriction

Front 71

Q670. What is the first step when suspecting a pulmonary embolism?

Back 71

A670. Arterial Blood Gas; (an increased alveolar-arterial oxygen difference supports the Dx; a Duplex Doppler and V/Q scan are important for confirming the Dx, but a blood gas should be done first)

Front 72

Q671. What can occur with massive blood loss with multiple transfusions during an abdominal procedure?; Tx?

Back 72

A671. Coagulopathy; Tx: FFP and Platelets

Front 73

Q672. What is the first step in Tx of a rib fracture in an elderly patient?

Back 73

A672. Intercostal nerve block; (eliminating pain without interfering with ventilation)

Front 74

Q673. A patient is shot in the lateral thigh. What is the next step in management?

Back 74

A673. Tetanus prophylaxis; (since there is no damage to vessels, no Doppler, surgical exploration or arteriogram is indicated)

Front 75

Q674. MCC of Transitional cell tumors of the bladder

Back 75

A674. Smoking; (66% compared to 15% from Aniline dyes)

Front 76

Q675. When there is a trauma patient that has a hematocrit of < 30, what should be transfused?

Back 76

A675. Packed RBC

Front 77

Q676. What nerve can be affected if an anesthesiologist wants to perform an axillary block for local pain control and the posterior wall of the axillary artery is pierced during the procedure?

Back 77

A676. Ulna nerve

Front 78

Q677. How do you treat a patient with a big, palpable pseudocyst of the pancreas?

Back 78

A677. Endoscopic Cystogastrostomy; (an endoscopic anastomosis b/t the cyst and the stomach)

Front 79

Q678. A man is shot in the upper zone of the neck yet is conscious, hemodynamically stable and neurologically intact. What is the next step?

Back 79

A678. Arteriogram

Front 80

Q679. What is the best drug for a estrogen/progesterone receptor positive breast tumor in postmenopausal patients?

Back 80

A679. Anastrozole; (suppresses production of estrogens)

Front 81

Q680. What nerve during a carotid endarterectomy is prone to damage producing a difficulty in swallowing?

Back 81

A680. Glossopharyngeal

Front 82

Q681. Lack of what procedure can predispose a man to penile cancer?

Back 82

A681. Circumcision

Front 83

Q682. What electrolyte is extremely increased with a crush injury?

Back 83

A682. Potassium (causing Hyperkalemia)

Front 84

Q683. An asymptomatic patient form Mexico has a CT scan done of the abdomen which shows four thin-walled structures 1cm in diameter throughout his liver. Dx?

Back 84

A683. Simple Liver Cysts; (Amebic abscesses present with fever, leukocytosis, a tender liver and elevated Alk Phos)

Front 85

Q684. A 27-yo woman from Asia moved to the US and presents with gross hematuria. She reports a low-grade fever and weight loss for over one year. Urinalysis shows pyuria, but cultures are negative for bacteria. IVP reveals diminished contrast excretion and cavitary lesions in the right kidney. Dx?

Back 85

A684. Tuberculosis; (Secondary TB commonly affects the kidneys and can spread to the epididymis and prostate in men; this is a classic presentation with hematuria, weight loss, low fever, negative cultures and increased leukocytes, and cavitary lesions)

Front 86

Q685. If a patient presents with a TIA consisting of no bleeding and no signs of extensive infarction within the first 3 hours of onset, what is the next step?

Back 86

A685. IV infusion of Tissue-type Plasminogen Activator; (tPA can be used as a “clot buster” in patients w/in first 3 hours, though better if started in first 90 minutes of Sx)

Front 87

Q686. What is the next step in the fracture of a clavicle?

Back 87

A686. Figure-eight Cast; (not arteriogram)

Front 88

Q687. A 45-yo man presents with a pale, pulseless, paresthetic, painful and paralytic right lower extremity. On exam, no pulses are apparent in the RLE. Dx?; Tx?

Back 88

A687. Dx: Emboli in Rt Common Iliac; Tx: Fogarty Balloon-tipped Catheter

Front 89

Q688. Before performing a Pneumonectomy for SCC of the lung, what should be done?

Back 89

A688. CT scan of the Chest and upper Abdomen; (to rule-out metastasis)

Front 90

Q689. What is the next step to confirm a Dx of PE in a patient that has atelectasis and patchy pneumonic infiltrates?

Back 90

A689. Spiral CT scan of the Chest; (a V/Q scan is not reliable for a patient with atelectasis and infiltrates)

Front 91

Q690. A 14-year-old boy is hit over the right side of the head with a baseball bat. He loses consciousness for a few minutes, but recovers promptly and continues to play. One hour later he is found unconscious in the locker room. His right pupil is fixed and dilated. Dx?; How is it diagnosed?; Tx?

Back 91

A690. Dx: Acute epidural hematoma (probably right side); Diagnostic Test: CT scan; Treatment: Emergency surgical decompression (craniotomy); Good prognosis if treated, fatal within hours if it is not.

Front 92

Q691. A 32-year-old male is involved in a head-on, high-speed automobile collision. He is unconscious at the site, regains consciousness briefly during the ambulance ride and arrives at the E.R. in deep coma, with a fixed, dilated right pupil. Dx?; Diagnostic Test?; Tx?

Back 92

A691. Dx: Acute Subdural hematoma; Diagnostic Test: CT scan; (Also need to check cervical spine!); Treatment: Emergency craniotomy; poor prognosis because of brain injury

Front 93

Q692. A 77-year-old man becomes “senile” over a period of three or four weeks. He used to be active and managed all of his financial affairs. Now he stares at the wall, barely talks and sleeps most of the day. His daughter recalls that he fell from a horse about a week before the mental changes began. Dx?; Diagnostic Test?; Tx?

Back 93

A692. Dx: Chronic subdural hematoma. Diagnostic Test: CT scan; Treatment: Surgical decompression (craniotomy); Spectacular improvement expected

Front 94

Q693. A car hits a pedestrian. He arrives in the ER in coma. He has …(raccoon eyes… or clear fluid dripping from the nose…or clear fluid dripping from the ear…or ecchymosis behind the ear)…; Dx?; Diagnostic Test?; Tx?

Back 94

A693. Dx: Base of the skull fracture. Diagnostic Test: CT scan and cervical spine X-Rays. Tx: needs neurosurgical consult and antibiotics

Front 95

Q694. A 45-year-old man is involved in a high-speed automobile collision. He arrives at the ER in coma, with fixed dilated pupils. He has multiple other injuries (extremities, etc). His blood pressure is 70 over 50, with a feeble pulse at a rate of 130. What is the reason for the low BP and high pulse rate?

Back 95

A694. significant blood loss to the outside (could be scalp laceration), or inside (abdomen, pelvic fractures)…not from neurological injury

Front 96

Q695. A 22-year-old gang member arrives in the E.R. with multiple guns shot wounds to the abdomen. He is diaphoretic, pale, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pulse rate is 150, barely perceptible. Dx?; Management? (3); Tx?

Back 96

A695. Dx: Hypovolemic shock; Management: Big bore IV lines, Foley catheter and I.V. antibiotics. Tx: Ideally Exploratory Lap immediately for control of bleeding, and then fluid and blood administration.

Front 97

Q696. A 22-year-old gang member arrives in the E.R. with multiple guns shot wounds to the chest and abdomen. He is diaphoretic, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pule rate is 150, barely perceptible. He has big distended veins in his neck and forehead. He is breathing OK, has bilateral breath sounds and no tracheal deviation. Dx?; Diagnostic test?; Tx?

Back 97

A696. Dx: Pericardial tamponade; Diagnostic test: No X-Rays needed, this is a clinical diagnosis!; Do Pericardial window. Tx: If positive, follow with Thoracotomy, and then Exploratory Lap.

Front 98

Q697. A 22-year-old gang member arrives in the E.R. with a single gunshot wound to the precordial area. He is diaphoretic, cold, shivering, anxious, asking for a blanket and a drink of water. His blood pressure is 60 over 40. His pule rate is 150, barely perceptible. He has big distended veins in his neck and forehead. He is breathing OK, has bilateral breath sounds and no tracheal deviation. Dx?; Management?

Back 98

A697. Dx: Pericardial Tamponade; Management: Exploratory Lap; (when the location of the wound strongly suggests pericardial tamponade, emergency thoracotomy might be done right away without prior pericardial window)

Front 99

Q698. A 22-year-old gang member arrives in the E.R. with multiple gun shot wounds to the chest and abdomen. He has labored breathing is cyanotic, diaphoretic, cold and shivering. His blood pressure is 60 over 40. His pulse rate is 150, barely perceptible. He is in respiratory distress, has big distended veins in his neck and forehead, his trachea is deviated to the left, and the right side of his chest is tympantic, with no breath sounds. Dx?; Management? (2 steps); Tx?

Back 99

A698. Dx: Tension pneumothorax; Management:; 1. Immediate big bore IV catheter placed into the right pleural space (2nd intercostal midclavicular); 2. followed by Chest Tube to the right side, Immediately!; (Watch out for trap that offers chest X-Ray as an option. This is a clinical diagnosis, and patient needs that chest tube now. He will die if sent to X-Ray.); Tx: Exploratory lap will follow

Front 100

Q699. A 72 year old man who lives alone calls 911 saying that he has severe chest pain. He cannot give a coherent history when picked up by the EMT, and on arrival at the ER he is cold and diaphoretic and his blood pressure is 80 over 65. He has an irregular, feeble pulse at a rate of 130. His neck and forehead veins are distended and he is short of breath. Dx?; Management?

Back 100

A699. Dx: Cardiogenic shock, from massive MI; Management: verify high CVP. EKG, enzymes, coronary care unit etc. Do not drown him with enthusiastic fluid “ resuscitation”, but use thrombolytic therapy if offered

Front 101

Q700. A 17 year old girl is stung by a swarm of bees…or a man of whatever age breaks out with hives after a penicillin infection …or a patient undergoing surgery under spinal anesthetic… eventually develop BP of 75 over 25, pulse rate of 150, but they look warm and flushed rather than pale and cold. CVP is low. Dx?; Management? (2)

Back 101

A700. Dx: Vasomotor shock; (massive vasodilation, loss of vascular tone); Management: Vasoconstrictors and Volume replacement as needed