Surgery NBME 1

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MudPhud20XX

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previously healthy 8 y/o came for intermittent pain of Rt. anterior thigh over the past 3 wks. his activity level is high and has remained unchanged during this period. his mom says he limps intermittently. he is at 25th percentile for height/weight. temp is 36.8, pulse 76, RR 24, bp 95/70. exam shows antalgic gait. abduction and internal rotation of the femur is limited. which of the following is the most likely mech of this child's condition?

A. avascular necrosis of the femoral head
B. bacterial infection of the bone
C. chronic inflammation of the synovium
D. congenital defect of the femoral head
E. malignant infiltraion
F. mechanical slippage of the femoral head

Any thoughts?

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previously healthy 8 y/o came for intermittent pain of Rt. anterior thigh over the past 3 wks. his activity level is high and has remained unchanged during this period. his mom says he limps intermittently. he is at 25th percentile for height/weight. temp is 36.8, pulse 76, RR 24, bp 95/70. exam shows antalgic gait. abduction and internal rotation of the femur is limited. which of the following is the most likely mech of this child's condition?

A. avascular necrosis of the femoral head
B. bacterial infection of the bone
C. chronic inflammation of the synovium
D. congenital defect of the femoral head
E. malignant infiltraion
F. mechanical slippage of the femoral head

Any thoughts?

Sounds like Legg-calve perthes so A
 
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Routine mammorgraphy on a 52 YOw shows six stippled microcalcification in a cluster in the upper outer quadrant of the left creast, not presen t 1 y ago. No lump. Next step?

A. follow up mammo in 4-6 months
B. Lt. upper outer quadrantectomy
C. FNA of the lesion
D. needle localized open biopsy
E. thermography

I am leaning toward A, any thought?
 
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Q. Four days after undergoing coronary artery bypass grafting, a hospitalized 47-year-old man has the sudden onset of severe pain in his left great toe. He was admitted to the hospital 10 data ago for evaluation of chest pain with exertion, and received aspirin and heparin therapy for 3 days. Cardiac catheterization on admission showed coronary artery disease involving three vessels. The operation and initial postoperative course were uncomplicated. Vital signs are within normal limits. Examination shows a tender, cyanotic left great toe. There are new ecchymoses over the trunk and upper and lower extremities. The surgical incision appears clean and intact. The remainder of the examination shows no abnormalities. Laboratory studies show,


Hematocnt 37%
Leukocyte count 12,200/mm3
Platelet count 8000/mm3
Prothrombin time 12 sec (INR=1)
Partial thromboplastin time 18 sec

Which of the following is the most likely diagnosis?

A) Cholesterol embolizaton syndrome
B) Disseminated intravascular coagulopathy
C) Gout
D) Heparin-induced thrombocytopenia(this would be the answer right?)
E) Immune thrombocytopenic purpura

Or we assume blue toe after any vascular surgery/instrumentation --> cholesterol embolization? ....and disregard low platelet count possiblty caused by HIT which can also induce thrombosis
 
Routine mammorgraphy on a 52 YOw shows six stippled microcalcification in a cluster in the upper outer quadrant of the left creast, not presen t 1 y ago. No lump. Next step?

A. follow up mammo in 4-6 months
B. Lt. upper outer quadrantectomy
C. FNA of the lesion
D. needle localized open biopsy
E. thermography

I am leaning toward A, any thought?
I put A, it was wrong... sooo? Maybe D? Sounds malignant maybe?
 
Q. Four days after undergoing coronary artery bypass grafting, a hospitalized 47-year-old man has the sudden onset of severe pain in his left great toe. He was admitted to the hospital 10 data ago for evaluation of chest pain with exertion, and received aspirin and heparin therapy for 3 days. Cardiac catheterization on admission showed coronary artery disease involving three vessels. The operation and initial postoperative course were uncomplicated. Vital signs are within normal limits. Examination shows a tender, cyanotic left great toe. There are new ecchymoses over the trunk and upper and lower extremities. The surgical incision appears clean and intact. The remainder of the examination shows no abnormalities. Laboratory studies show,


Hematocnt 37%
Leukocyte count 12,200/mm3
Platelet count 8000/mm3
Prothrombin time 12 sec (INR=1)
Partial thromboplastin time 18 sec

Which of the following is the most likely diagnosis?

A) Cholesterol embolizaton syndrome
B) Disseminated intravascular coagulopathy
C) Gout
D) Heparin-induced thrombocytopenia(this would be the answer right?)
E) Immune thrombocytopenic purpura

Or we assume blue toe after any vascular surgery/instrumentation --> cholesterol embolization? ....and disregard low platelet count possiblty caused by HIT which can also induce thrombosis

HIT was correct! HIT causes weird hypercoagulability, which I think is what they were going for in this q.
 
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