Good evidence supports which one of the following measures for reducing the risk of postoperative pulmonary complications after major abdominal surgery?
Correct Answer B: Use of an incentive spirometer and similar lung expansion techniques such as chest physiotherapy have been shown to have significant benefit for reducing postoperative complications. A course of preoperative corticosteroids has been shown to be beneficial, such as in a patient with COPD. Prolonged antibiotic prophylaxis and postoperative total parenteral nutrition have not been shown to have any benefit.
A 32-year-old female who is an avid runner presents with knee pain. You suspect patellofemoral pain syndrome.
Which one of the following signs or symptoms would prompt an evaluation for an alternative diagnosis?
Correct Answer D: Patellofemoral pain syndrome is a clinical diagnosis and is the most common cause of knee pain in the outpatient setting. It is characterized by anterior knee pain, particularly with activities that overload the joint, such as stair climbing, running, and squatting. Patients complain of “popping,” “catching,” “stiffness,” and “giving out.” On examination there will be a positive “J” sign, with the patella moving from a medial to a lateral location when the knee is fully extended from the 90° position. This is caused by an imbalance in the medial and lateral forces acting on the patella.
“Locking” is not characteristic of patellofemoral pain syndrome, so loose bodies or a meniscal tear should be considered if this is found.
A 30-year-old male complains of the gradual onset of anterior right knee pain on climbing the stairs. On examination there is no effusion, but there is tenderness over the medial retinaculum. There is good ligament strength, and range of motion is normal. When the knee is extended from 90° flexion to full extension, the patella deviates laterally.
Which one of the following would be the best initial treatment for this condition?
Correct Answer E: This patient has patellofemoral stress syndrome. It is often called runner's knee or anterior knee pain. The patellofemoral joint comprises the patella and femoral trochlea. The best initial treatment is physical therapy. Bracing, taping, and medications are unlikely to have better outcomes. Arthroscopic surgery is not indicated.
During a well child examination of a healthy-appearing 4-week-old white male born at term, his mother questions you about a prominence in the left side of his scrotum, which she has noted since his baths were begun. Your physical examination reveals an oblong, nontender, non-reducible, light-transmitting mass closely adhered to or involving the testis.
You should recommend which one of the following?
Correct Answer A: A hydrocele of the tunica vaginalis testis occurs frequently at birth but usually resolves in a few weeks or months. No treatment is indicated during the first year of life unless there is a clinically evident hernia. A simple scrotal hydrocele without communication with the peritoneal cavity and no associated hernia should be excised if it has not spontaneously resolved by the age of 12 months. Aspirating the mass for diagnostic or therapeutic reasons is not recommended, since a loop of bowel may be injured; removing the fluid is ineffective.
Which one of the following decreases pain from infiltration of local anesthetics?
Correct Answer E: The pain from infiltration of local anesthetics can be decreased by using a warm solution, using small needles, performing the infiltration slowly, and adding sodium bicarbonate to the mixture. It also helps to inject the agent through the edges of the wound (assuming the wound is not contaminated) and to pretreat the wound with topical anesthetics.
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