A 65 year old man is on his second postoperative day after colon resection for carcinoma. He is on intravenous fluids and nasogastric suction.
Which one of the following would be the most reliable in assessing the state of his hydration?
Correct Answer A: Hydration status can be evaluated by various measures. For example checking eyeballs (for sunken eyes), mucous membranes, heart rate, skin turgor, capillary refill time, and urine output. Close monitoring of urine output is most essential and should be maintained in the early post-operative period.
A 29 year old man is admitted to the emergency department with a facio-maxillary injury and inability to breathe. In the absence of special equipment, an airway is best made through which one of the following structures?
Correct Answer D: In a trauma case it is always essential to keep the airway clear. It may be necessary to carry out procedures to do this under various conditions. The cricothyroid membrane. A large caliber needle may be passed though the cricothyroid membrane to provide an essential airway when the upper airway is obstructed. The cricothyroid membrane fills in the space between the anterior cricoid cartilage and the thyroid cartilage. This and other procedures on the larynx and trachea must be performed strictly in the mid-line to avoid large blood vessels.
A 35 year old woman presents with severe, stabbing abdominal pain radiating from the epigastrium to the back and chest. She is nauseated and says that her abdomen feels bloated as well as painful, and that the pain is worse lying down. She has tachycardia, a low-grade fever, an absence of bowel sounds, guarding, and an exquisitely tender abdomen. Further questioning reveals that she drank excessive amounts of alcohol last night. She has no prior medical or family history for cardiac disease. A plain radiograph of the abdomen shows no air under the diaphragm.
Which of the following processes is most likely in this patient?
Correct Answer D: Acute pancreatitis is inflammation of the pancreas (and, sometimes, adjacent tissues) caused by the release of activated pancreatic enzymes. The most common triggers are biliary tract disease and chronic heavy alcohol intake. The condition ranges from mild (abdominal pain and vomiting) to severe (pancreatic necrosis and a systemic inflammatory process with shock and multiorgan failure). Diagnosis is based on clinical presentation and serum amylase and lipase levels. Treatment is supportive, with IV fluids, analgesics, and fasting.
After a weekend of heavy drinking, a 28-year-old male presents with abdominal pain radiating to the back.
What is the investigative and prognostic modality of choice for the suspected diagnosis?
Correct Answer B: Acute pancreatitis is inflammation of the pancreas (and, sometimes, adjacent tissues) caused by the release of activated pancreatic enzymes. The most common triggers are biliary tract disease and chronic heavy alcohol intake. The condition ranges from mild (abdominal pain and vomiting) to severe (pancreatic necrosis and a systemic inflammatory process with shock and multiorgan failure). Diagnosis is based on clinical presentation and serum amylase and lipase levels.
CT with IV contrast is generally done to identify necrosis, fluid collections, or pseudocysts once pancreatitis has been diagnosed. It is particularly recommended for severe pancreatitis or if a complication ensues (eg, hypotension or progressive leukocytosis and elevation of temperature). Treatment is supportive, with IV fluids, analgesics, and fasting.
A 24-year-old patient was found to have an unstable knee joint after a car accident. With the patient supine (with the hips flexed to 45 degrees, the knees flexed to 90 degrees and the feet flat on table) you support the patient's thigh and calf. The lower leg is moved anteriorly. Excessive passive anterior motion of the lower leg from the femur is noted.
Which one of the following structures is most likely injured in this patient?
Correct Answer C: Sprains of the external (medial and lateral collateral) or internal (anterior and posterior cruciate) ligaments or injuries of the menisci commonly result from knee trauma. Symptoms include pain, effusion, instability (with severe sprains), and locking (with some meniscal injuries). Diagnosis is by physical examination and sometimes MRI or arthroscopy.
Anterior drawer test is one of many medical tests used to determine the integrity of the anterior cruciate ligament. With the patient supine (with the hips flexed to 45 degrees, the knees flexed to 90 degrees and the feet flat on table) the examiner supports the patient's thigh and calf. The lower leg is moved anteriorly. Excessive passive anterior motion of the lower leg from the femur suggests a significant tear.
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