A 72-year-old man with chronic bronchitis undergoes laparotomy for treatment of a bowel
obstruction. Three days after surgery, the patient's wound begins to leak large amounts of
clear, salmon-colored fluid after an episode of coughing. The skin staples are open and the
wound is probed with a sterile-tipped applicator. During this procedure, an open segment of
the wound reaching back to the omentum and intestines is noted. Which of the following is
the most appropriate description of this type of postoperative complication?
A. Dehiscence
B. Fistula
C. Hematoma
D. Seroma
E. Wound Infection - ANSWER A. Dehiscence - The classic "salmon-colored" drainage is
concerning for fascial dehiscence
NOT Seroma - Clear or serous-appearing drainage may represent decompressing seroma
A patient is brought to the emergency department after a motor vehicle collision. X-ray
studies of the chest show a pleural effusion. A milky fluid drains from the chest tube. Which
of the follow structures is most likely ruptured?
A. Apical bleb
B. Bronchus
C. Diaphragm
D. Esophagus
E. Thoracic duct - ANSWER E. Thoracic duct
1
, Chylothorax commonly caused by leakage of lymph from the thoracic duct into the pleural
space. A chest x-ray will show if there is a buildup of fluid in the pleural space. If a surgical
drain or chest tube is in place and milky white fluid is noted, it can be sent to the laboratory
to be tested.
A 35-year-old women is brought to the emergency department by a coworker because she
has had pain in the suprapubic region of her abdomen for the past two hours. The patient
says the pain developed while she was at work, after she was asked to complete a double
shift. She has not urinated since the beginning of her shift, but she has no symptoms of
urinary tract infection. The patient has a fear of speaking to other people at work and tries
to avoid writing in public, even signing sales receipts when she uses her credit card. She says
she did not want to come to the emergency department, but her coworker was worried and
insisted. Physical examination shows tenderness to palpation over the suprapubic region of
the abdomen as well as evidence of distention of the bladder. Because the patient is unable
to urinate, a catheter is inserted, and 1200mL of urine is removed. Results of renal function
studies and urinalysis ar - ANSWER E. Social anxiety disorder
NOT Schizoaffective b/c no symptoms of Schizophrenia (Positive/Negative) + mood disorder
(MDD or Mania)
A 63-year-old man comes to the office because he has had a nontender mass in his
abdomen for the past eight months. He is otherwise healthy and takes no medications. Pulse
rate is 88/min, respirations are 13/min, and blood pressure is 158/94 mmHg. Abdomen
examination shows a 7x3-cm, non-pulsatile mass at the midline. A photograph is shown.
Bowel sounds are normoactive, and no hepatosplenomegaly is noted. Which of the
following additional findings on physical examination of this patient is most likely?
A. Aortic bruit
B. Increase in size of the mass with Valsalva maneuver
C. Increased hepatojugular reflex
D. Involuntary abdominal guarding
E. Venous hum in the right upper quadrant of the abdomen - ANSWER B. Abdominal
Hernia - Increases in size of the mass with Valsalva because the increase in intraabdominal
pressure causes the hernia sac to enlarge and protrude through the anatomic defect.
2
obstruction. Three days after surgery, the patient's wound begins to leak large amounts of
clear, salmon-colored fluid after an episode of coughing. The skin staples are open and the
wound is probed with a sterile-tipped applicator. During this procedure, an open segment of
the wound reaching back to the omentum and intestines is noted. Which of the following is
the most appropriate description of this type of postoperative complication?
A. Dehiscence
B. Fistula
C. Hematoma
D. Seroma
E. Wound Infection - ANSWER A. Dehiscence - The classic "salmon-colored" drainage is
concerning for fascial dehiscence
NOT Seroma - Clear or serous-appearing drainage may represent decompressing seroma
A patient is brought to the emergency department after a motor vehicle collision. X-ray
studies of the chest show a pleural effusion. A milky fluid drains from the chest tube. Which
of the follow structures is most likely ruptured?
A. Apical bleb
B. Bronchus
C. Diaphragm
D. Esophagus
E. Thoracic duct - ANSWER E. Thoracic duct
1
, Chylothorax commonly caused by leakage of lymph from the thoracic duct into the pleural
space. A chest x-ray will show if there is a buildup of fluid in the pleural space. If a surgical
drain or chest tube is in place and milky white fluid is noted, it can be sent to the laboratory
to be tested.
A 35-year-old women is brought to the emergency department by a coworker because she
has had pain in the suprapubic region of her abdomen for the past two hours. The patient
says the pain developed while she was at work, after she was asked to complete a double
shift. She has not urinated since the beginning of her shift, but she has no symptoms of
urinary tract infection. The patient has a fear of speaking to other people at work and tries
to avoid writing in public, even signing sales receipts when she uses her credit card. She says
she did not want to come to the emergency department, but her coworker was worried and
insisted. Physical examination shows tenderness to palpation over the suprapubic region of
the abdomen as well as evidence of distention of the bladder. Because the patient is unable
to urinate, a catheter is inserted, and 1200mL of urine is removed. Results of renal function
studies and urinalysis ar - ANSWER E. Social anxiety disorder
NOT Schizoaffective b/c no symptoms of Schizophrenia (Positive/Negative) + mood disorder
(MDD or Mania)
A 63-year-old man comes to the office because he has had a nontender mass in his
abdomen for the past eight months. He is otherwise healthy and takes no medications. Pulse
rate is 88/min, respirations are 13/min, and blood pressure is 158/94 mmHg. Abdomen
examination shows a 7x3-cm, non-pulsatile mass at the midline. A photograph is shown.
Bowel sounds are normoactive, and no hepatosplenomegaly is noted. Which of the
following additional findings on physical examination of this patient is most likely?
A. Aortic bruit
B. Increase in size of the mass with Valsalva maneuver
C. Increased hepatojugular reflex
D. Involuntary abdominal guarding
E. Venous hum in the right upper quadrant of the abdomen - ANSWER B. Abdominal
Hernia - Increases in size of the mass with Valsalva because the increase in intraabdominal
pressure causes the hernia sac to enlarge and protrude through the anatomic defect.
2
