Infecciones y Tumores de Cara y Cuello: Lo básico en Urgencias

 

Q 1. What is the most appropriate next step?

  1. Exploratory laparotomy is indicated
  2. Start water soluble oral contrast immediately and perform CT 1 hour later
  3. Don’t bother with oral prep, perform abdominal CT ASAP with V. contrast only
  4. Perform FAST US and observe if no free fluid found

 

A 1. What is the most appropriate next step?

  1. Exploratory laparotomy is indicated
  2. Start water soluble oral contrast immediately and perform CT 1 hour later
  3. Don’t bother with oral prep, perform abdominal CT ASAP with I.V. contrast only
  4. Perform FAST US and observe if no free fluid found

 

Q 2. What is the most appropriate next step?

  1. Exploratory laparotomy is now indicated
  2. Acquire delayed phase (5 to 7 min) CT series
  3. Take patient off CT table immediately and call IR team
  4. Recommend admission and observation, performing serial bedside US exams tomonitor amount of free fluid

 

A 2. What is the most appropriate next step?

  1. Exploratory laparotomy is now indicated
  2. Acquire delayed phase (5 to 7 min) CT series
  3. Take patient off CT table immediately and call IR team
  4. Recommend admission and observation, performing serial bedside US exams to monitor amount of free fluid

 

Q 3. What is the most likely diagnosis for the hyperattenuating focus in the spleen?

  1. Vascular lesion (likely pseudoaneurysm)
  2. Active extravasation of contrast-enhanced blood
  3. Incidental finding (likely hemangioma)
  4. Preexisting intrasplenic aneurysm

 

A.  3 What is the most likely diagnosis for the hyperattenuating focus in the spleen?

  1. Vascular lesion (likely pseudoaneurysm)
  2. Active extravasation of contrast-enhanced blood
  3. Incidental finding (likely hemangioma)
  4. Preexisting intrasplenic aneurysm

 

Q 4. What is the most appropriate next step for this patient?

  1. Laparatomy and splenectomy are now indicated
  2. Recommend selective angiography and embolization with coils
  3. Admit to surgical ward for close observation
  4. Discharge with detailed indications to return immediately to hospital should acute symptoms develop

 

A 4. What is the most appropriate next step for this patient?

  1. Laparatomy and splenectomy are now indicated
  2. 2Recommend selective angiography and embolization with coils
  3. Admit to surgical ward for close observation
  4. Discharge with detailed indications to return immediately to hospital should acute symptoms develop

 

Q 5. What is the most appropriate next step?

  1. Exploratory laparotomy is indicated
  2. Start water soluble oral contrast immediately and repeat CT 1 hour later
  3. Measure attenuation of free fluid in the pelvis
  4. Perform DPL

 

A 5. What is the most appropriate next step?

  1. Exploratory laparotomy is indicated
  2. Start water soluble oral contrast immediately and repeat CT 1 hour later
  3. Measure attenuation of free fluid in the pelvis
  4. Perform DPL

 

Q 6. What is your recommendation for management?

  1. Exploratory laparotomy is indicated
  2. Monitor amount of intraperitoneal fluid with serial US performed every 2 hours, recommend laparotomy only if fluid increases
  3. Perform DPL
  4. Admit for observation and repeat CT with oral contrast in 8 to 12 hours, or earlier if abdominal symptoms develop

 

A 6. What is your recommendation for management?

  1. Exploratory laparotomy is indicated
  2. Monitor amount of intraperitoneal fluid with serial US performed every 2 hours, recommend laparotomy only if fluid increases
  3. Perform DPL
  4. Admit for observation and repeat CT with oral contrast in 8 to 12 hours, or earlier if abdominal symptoms develop

 

Q 7. What is the next step to confirm a bile leak?

  1. Perform paracentesis
  2. HIDA scan
  3. ERCP
  4. MR with hepato-biliary contrast agent

 

A 7. What is the next step to confirm a bile leak?

  1. Perform paracentesis
  2. HIDA scan
  3. ERCP
  4. MR with hepato-biliary contrast agent

 

Q 8. What is the recommendation for definitive therapy?

  1. Schedule multiple paracentesis
  2. Operative repair of laceration
  3. Conservative management unless signs of infection develop
  4. ERCP and temporary stent placement

 

A 8. What is the recommendation for definitive therapy?

  1. Schedule multiple paracentesis
  2. Operative repair of laceration
  3. Conservative management unless signs of infection develop
  4. ERCP and temporary stent placement

 

Q 9. Most likely diagnosis?

  1. Crohn’s disease
  2. Perforation by foreign body
  3. Ischemia and perforation
  4. Diverticulitis
  5. Scleroderma (systemic sclerosis)

 

A 9. Most likely diagnosis?

  1. Crohn’s disease
  2. Perforation by foreign body
  3. Ischemia and perforation
  4. Diverticulitis
  5. Scleroderma (systemic sclerosis)

 

Q 10. What is the likely diagnosis?

  1. Amebic abscess
  2. Renal tumor
  3. Renal abscess
  4. Psoas muscle hematoma
  5. None of the above

 

A 10. What is the likely diagnosis?

  1. Amebic abscess
  2. Renal tumor
  3. Renal abscess
  4. Psoas muscle hematoma
  5. None of the above

 

Q 11. What is the next step to make the diagnosis?

  1. Measure serum tumor markers
  2. Laparoscopy
  3. Full imaging workup for suspected metastatic tumor
  4. Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
  5. Obtain a detailed history about medications administered

 

A 11. What is the next step to make the diagnosis?

  1. Measure serum tumor markers
  2. Laparoscopy
  3. Full imaging workup for suspected metastatic tumor
  4. Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
  5. Obtain a detailed history about medications administered

 

Q 12. What is the most likely diagnosis?

  1. Actinomycosis
  2. Endometriosis
  3. Pelvic carcinomatosis
  4. Bacterial pelvic inflammatory disease (PID)
  5. Tuberculosis

 

A 12. What is the most likely diagnosis?

  1. Actinomycosis
  2. Endometriosis
  3. Pelvic carcinomatosis
  4. Bacterial pelvic inflammatory disease (PID)
  5. Tuberculosis

 

Q 13. Diagnosis?

  1. Acute diverticulitis
  2. Perforation by foreign body
  3. Ischemia and perforation
  4. Crohn’s disease exacerbation
  5. Acute appendicitis

 

A 13. Diagnosis?

  1. Acute diverticulitis
  2. Perforation by foreign body
  3. Ischemia and perforation
  4. Crohn’s disease exacerbation
  5. Acute appendicitis (IN MALROTATION)

 

Q 14. Diagnosis for finding in liver?

  1. Active extravasation
  2. Contained vascular injury (pseudoaneurysm)
  3. Hemangioma
  4. No true lesion in the liver
  5. Calcification

 

A 14. Diagnosis for finding in liver?

  1. Active extravasation
  2. Contained vascular injury (pseudoaneurysm)
  3. Hemangioma
  4. No true lesion in the liver (SVC obstruction, flow through collateral circulation)
  5. Calcification

Q 15. Most likely diagnosis?

  1. Crohn’s disease
  2. Perforation by foreign body
  3. Ischemia and perforation
  4. Diverticulitis
  5. Scleroderma (systemic sclerosis)

 

A 15. Most likely diagnosis?

  1. Crohn’s disease
  2. Perforation by foreign body
  3. Ischemia and perforation
  4. Diverticulitis
  5. Scleroderma (systemic sclerosis)

 

Q 16. What is the likely diagnosis?

  1. Amebic abscess
  2. Renal tumor
  3. Renal abscess
  4. Psoas muscle hematoma
  5. None of the above

 

A 16. What is the likely diagnosis?

  1. Amebic abscess
  2. Renal tumor
  3. Renal abscess
  4. Psoas muscle hematoma
  5. None of the above

 

Q 17. What is the next step to make the diagnosis?

  1. Measure serum tumor markers
  2. Laparoscopy
  3. Full imaging workup for suspected metastatic tumor
  4. Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
  5. Obtain a detailed history about medications administered

 

A 17. What is the next step to make the diagnosis?

  1. Measure serum tumor markers
  2. Laparoscopy
  3. Full imaging workup for suspected metastatic tumor
  4. Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
  5. Obtain a detailed history about medications administered

 

Q 18. What is the most likely cause of the symptoms and CT findings?

  1. Ischemia
  2. Bacterial enteritis
  3. Medications
  4. Crohn’s disease
  5. Tuberculosis

 

A 18. What is the most likely cause of the symptoms and CT findings?

  1. Ischemia
  2. Bacterial enteritis
  3. Medications: angiotensin converting enzyme (ACE) inhibitors
  4. Crohn’s disease
  5. Tuberculosis

 

Q 19. Diagnosis?

  1. Pancreatic contusion
  2. Pancreatic laceration, main duct injury
  3. Retroperitoneal hematoma
  4. Active extravasation of blood
  5. No pancreatic injury

 

A 19. Diagnosis?

  1. Pancreatic contusion
  2. Pancreatic laceration, main duct injury
  3. Retroperitoneal hematoma
  4. Active extravasation of blood
  5. No pancreatic injury

 

Q 20. What is the most likely diagnosis?

  1. Internal hernia
  2. Adhesive band causing small bowel obstruction
  3. Small bowel volvulus
  4. Transmesenteric internal hernia
  5. Focal ileus

 

A 20. What is the most likely diagnosis?

  1. Internal hernia
  2. Adhesive band causing small bowel obstruction
  3. Small bowel volvulus
  4. Transmesenteric internal hernia
  5. Focal ileus
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