drake19

7+ Year Member
Jul 26, 2010
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2) 57 y/o comes to E.R. with 1-day history of fever, chills, generalized weakness. Underwent splenectomy for ITP 10 years ago. Received all vaccines. Takes no medications. Appears weak but answers questions appropriately, temperatuer 102.8 F, pulse 100/min, RR 20 breaths per min, BP 80/50, crackles at right lung base.
Hb 12.5
Leukocyte count 18,500
Segs 85% / Bands 10% / Lymphs 5% / Platelets 125,000
Blood smear shows Howell Jolly bodies, CXR shows consolidation, best next step?

A) Ceftriaxone, vancomycin therapy
B) Imipenem
C) Quinine and clindamycin therapy
D) TMP-SMX
E) Plasmapharesis

-Answer is NOT B

15) 42 y/o with 2 day history of right upper abdominal pain, generalized itching. During past 2 months 3 episodes of similar symptoms with nausea. She has not had fever or vomiting, No past medical history and no medications, temperature 99.1 / pulse 94 / BP 127/78. Exam shows scleral icterus. Mildly tender mass palpated in RUQ of abdomen. No peritoneal signs. Leukocytes 10,000, serum T.bili 6 mg/dL with direct component of 5 mg/dL. US of RUQ of abdomen shows mild distention of gallbladder but no gallstones. CT shows 5 cm cystic structure medial to gallbladder with moderate dilation of proximal intra-hepatic ducts. Best next step.

A) Cholescintigraphy
B) CHolecystectomy w/ exploration of common bile duct
C) Endoscopic sphincteroomty
D) Roux-en-Y-cystojejunostomy
E) surgical excision of cyst
Not A - had no idea what this was - some sort of cancer?

16. 37 y/o brought to ER 30 min. after MVA. On arrival reports abdominal pain, pulse 84/min., respirations 18/min, BP 110/82, Abdominal exam shows diffuse tenderness. Bowel sounds are decreased. Supine X-ray shows bubble under diaphragm. Likely diagnosis
A) Gastric perf.
B) lung abscess
C) Pneumo-pericardium
D) pneumothorax
E) Ruptured diaphragm

not A

24) 18 y/o brought to ER 10 min. after sustaining a stab wound to the right chest. On arrival he has SOB. Pulse 120/min, BP 70/40. Breath sounds are absent on right. Trachea is midline, Neck-veins flat. Diagnosis?
A) lobar atelectasis
B) massive hemothorax
C) pulmonary embolism
D) ruptured bronchus
E) tension pneumo
not D) - trachea is midline - so it can't be hemothorax and tension pneumo or is it hemothorax?


35) 30 y/o with aceniform infection of left axilla for 2 weeks. Previous infections in the same region and groin area. Exam shows acute inflammatory changes w/ purulent drainage from small sinus openings along the indurated skin of axilla. Multiple sinus openings along both groins and the right axilla. This infection most likely inolves which of the following?
A) Apocrine glands
B) Eccrine glands
C) Hair folilcles
D) lymph nodes
E) sebaceous glands
Answer is not C

47) 76 y/o with midshaft right femur fracture during MVA. Circumference of right thigh is two times greater than left. pulse is 120/min, regular, respirations are 16/min, BP is 80/60. Large bore IV-catheter is inserted for fluid and blood infusion and Foley inserted. Which indicates adequate resuscitation in this patient?
A) decreased pulse to 90/min.
B) respiration to 12/min
C) increased SBP to 100 or greater
D) urine output of 30-50 ml/h
E) normal capillary filling pressure
not C
 

thehundredthone

7+ Year Member
Aug 20, 2012
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Fellow [Any Field]
Feb 20, 2015
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Medical Student
2. I Chose A and got it right. I figured you need to cover for the encapsulated bacteria that he is at risk for without a spleen- vanc for strep pneumo and ceftriaxone for n meningitis.
15. I got this wrong too but I think it might actually be E, surgical excision and not the cystojejunostomy. You need to reconnect the liver to the bowel, not the gallbladder, so I think "cystojejunostomy" is wrong even though Roux-en-Y is right.
 
Jan 9, 2016
1
0
I just wanted to add one correction after finishing my test and getting it right.

24) 18 y/o brought to ER 10 min. after sustaining a stab wound to the right chest. On arrival he has SOB. Pulse 120/min, BP 70/40. Breath sounds are absent on right. Trachea is midline, Neck-veins flat. Diagnosis?
A) lobar atelectasis
B) massive hemothorax
C) pulmonary embolism
D) ruptured bronchus
E) tension pneumo

The correct answer is B.
He's just been stabbed: hypotensive (bleeding into lung), tachy, SOB with absent breath sounds, flat neck veins, midline trachea.