MEDICAL MINUTIAE ROUND 2 Aint the Sharpest Tool

MEDICAL MINUTIAE

ROUND 2 Ain’t the Sharpest Tool in the Shed I Can See Right Through You Pass Me That Thingy Classic Operations A Sign of Things to Come 100 100 100 200 200 200 300 300 300 400 400 400 500 500 500 CLICK HERE TO BEGIN FINAL ROUND

100 Points Pass Me That Thingy Ur-ine a lot of trouble if you don't use this for protection. REVEAL ANSWER

100 Points Pass Me That Thingy What is a bladder retractor? BACK TO GAME BOARD

200 Points Pass Me That Thingy Comes in small, medium and big. It’s name goes along with Nixon. REVEAL ANSWER

200 Points Pass Me That Thingy What are Richardson retractors? BACK TO GAME BOARD

300 Points Pass Me That Thingy It's floppy and prevents you from puncturing the bowel on your fascial closure. REVEAL ANSWER

300 Points Pass Me That Thingy What is the Fish retractor? BACK TO GAME BOARD

400 Points Pass Me That Thingy Doesn't exactly have to do with the longest ruling party in Cuba. . REVEAL ANSWER

400 Points Pass Me That Thingy What is a Castro Viejo needle holder? BACK TO GAME BOARD

500 Points Pass Me That Thingy Walter, Thompson and Omni all sat at the table. REVEAL ANSWER

500 Points Pass Me That Thingy What are the names of three table mounted retractors? BACK TO GAME BOARD

100 Points Classic Operations An operation that includes resection of the head of the pancreas, first part of duodenum, gallbladder and distal bile duct. REVEAL ANSWER

100 Points Classic Operations What is a Whipple? BACK TO GAME BOARD

200 Points Classic Operations A procedure used to remove blockage from the major arteries in the neck. REVEAL ANSWER

200 Points Classic Operations What is a carotid endarterectomy? BACK TO GAME BOARD

300 Points Classic Operations The pylorus is resected and the proximal stomach is anastomosed directly to the duodenum REVEAL ANSWER

300 Points Classic Operations What is a Bilroth I? BACK TO GAME BOARD

400 Points Classic Operations Also known as the left medial visceral rotation REVEAL ANSWER

400 Points Classic Operations What is the "Mattox" maneuver? BACK TO GAME BOARD

500 Points Classic Operations A procedure used to reconstruct the breast where the rectus abdominis muscle is used. REVEAL ANSWER

500 Points Classic Operations What is a TRAM flap? BACK TO GAME BOARD

100 Points A Sign of Things to Come In a known alcoholic admitted for non-operative management of multiple traumatic non-displaced rib fractures, consider this differential diagnosis when he is tachycardic, hypertensive, and febrile on his third hospital day. REVEAL ANSWER

100 Points A Sign of Things to Come What is delirium tremens (DT)? BACK TO GAME BOARD

200 Points A Sign of Things to Come The most common etiology for this condition is infection and is mediated by massive release of TNF-alpha and IL-1 cytokine. It's also a polite form of address, in the plural. REVEAL ANSWER

200 Points A Sign of Things to Come What is systemic inflammatory response syndrome (SIRS)? BACK TO GAME BOARD

300 Points A Sign of Things to Come Suspect this condition in a patient undergoing rapid sequence intubation with etomidate and succinylcholine who exhibits an increase in endtidal carbon dioxide followed by fever, tachycardia, rigidity, hyperkalemia, and rhabdomyolysis. REVEAL ANSWER

300 Points A Sign of Things to Come What is malignant hyperthermia? BACK TO GAME BOARD

400 Points A Sign of Things to Come Consider this differential in a 3 -week-old infant male with severe hypotension, hyponatremia, and hyperkalemia when exam reveals sunken eyes, decreased skin turgor, and normal external genitalia. REVEAL ANSWER

400 Points A Sign of Things to Come What is congenital adrenal hyperplasia (21 hydroxylase deficiency)? BACK TO GAME BOARD

500 Points A Sign of Things to Come Intra-aortic balloon pump (IABP) may be indicated for this post-myocardial infarction complication in which a patient develops hypotension, jugular venous distention, bibasilar crackles, and whose echocardiography reveals severe systolic dysfunction. REVEAL ANSWER

500 Points A Sign of Things to Come What is (intrinsic) cardiogenic shock? BACK TO GAME BOARD

100 Points Ain’t the Sharpest Tool in the Shed This study is not only useful in diagnosing the etiology of abdominal ascites but is also therapeutic alleviating shortness of breath secondary to abdominal distention. REVEAL ANSWER

100 Points Ain’t the Sharpest Tool in the Shed What is paracentesis? BACK TO GAME BOARD

200 Points Ain’t the Sharpest Tool in the Shed This study evaluates systolic blood pressures in the upper and lower extremities and is a sensitive test for the diagnosis of peripheral artery disease. REVEAL ANSWER

200 Points Ain’t the Sharpest Tool in the Shed What is ankle-brachial index (ABI)? BACK TO GAME BOARD

300 Points Ain’t the Sharpest Tool in the Shed This study is done in a male trauma patient with pelvic ecchymosis, meatal blood, and a nonpalpable prostate on digital rectal exam before insertion of a Foley catheter. REVEAL ANSWER

300 Points Ain’t the Sharpest Tool in the Shed What is retrograde urethrogram? BACK TO GAME BOARD

400 Points Ain’t the Sharpest Tool in the Shed This imaging study is the best initial test to obtain in a patient with peptic ulcer disease presenting with acute epigastric pain radiating to the shoulder whose physical examination reveals a rigid abdomen. REVEAL ANSWER

400 Points Ain’t the Sharpest Tool in the Shed What is an upright/erect radiograph of the chest? BACK TO GAME BOARD

500 Points Ain’t the Sharpest Tool in the Shed In a breast cancer patient with a prior mastectomy, this tool is used to examine the integrity of a transverse rectus abdominis myocutaneous (TRAM) flap reconstruction postoperatively. REVEAL ANSWER

500 Points Ain’t the Sharpest Tool in the Shed What is Doppler ultrasound? BACK TO GAME BOARD

100 Points I Can See Right Through You A restrained driver of motor vehicle crash presents in respiratory distress with left -sided subcutaneous emphysema, and with this radiograph, also referred to as the x-ray one never should obtain. REVEAL ANSWER

100 Points I Can See Right Through You What is tension pneumothorax? BACK TO GAME BOARD

200 Points I Can See Right Through You Exam findings of this patient reveal toxicappearing male with a distended, firm abdomen and absent bowel sounds. REVEAL ANSWER

200 Points I Can See Right Through You What is pneumoperitoneum? BACK TO GAME BOARD

300 Points I Can See Right Through You The most common cause of mortality in bariatric surgery patients, who may be prescribed treatment perioperatively to prevent this complication. REVEAL ANSWER

300 Points I Can See Right Through You What is pulmonary embolism (PE)? BACK TO GAME BOARD

400 Points I Can See Right Through You This patient complained of severe lower abdominal pain for several hours and constipation for several days. He reports similar but milder previous episodes treated with outpatient antibiotics. REVEAL ANSWER

400 Points I Can See Right Through You What is acute diverticulitis? BACK TO GAME BOARD

500 Points I Can See Right Through You The blood pressure management for this hypertensive patient begins with a shortacting intravenous betablocker such as Esmolol. REVEAL ANSWER

500 Points I Can See Right Through You What is a Type A aortic dissection? BACK TO GAME BOARD

FINAL QUESTION! Each team should add the points earned in rounds 1 & 2 and place a wager on the final question. Think you can diagnose the symptoms that this patient presents? Patient Presents REVEAL CLUE

FINAL QUESTION! 10 yo M with 4 hours of nausea, abdominal pain starting around umbilicus now localized to R lower quadrant with a WBC of 16 (normal 4. 5 -11) is in the ED. He has a positive Rovsing and psoas sign. Patient Presents REVEL ANSWER

FINAL QUESTION! What is acute appendicitis? Patient Presents NEXT

Thanks for playing Medical Minutiae! Acknowledgments ACS Medical Student Community Brad Chernock | Community Administrator Fatima Elgammal, MD | Community Resident Moderator Jonathan Chan | Community Administrator ACS Division of Education’s CMSE Student Resource Task Force Andrea Geddes, MD Brian Monahan ACS Board of Governors – Surgical Training Workgroup Emily Kalata, Administrator | ACS Board of Governors Reema Malick, MD David A. Spain, MD, FACS Sarkis H. Meterissian, MD, FACS Contact us with any questions or concerns hlakew@facs. org