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Step 2 DIT > Associations 3 > Flashcards

Associations 3 Flashcards

1
Q

Physical findings of basilar skull fracture

A

Raccoon eyes (periorbital bruising)
Battle sign (bruising over mastoid process)
Blood behind TM
CSF rhinorrhea or otorrhea (bad sign)

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2
Q

Signs of increased ICP

A

Cushing’s triad (HTN, bradycardia, bradypnea)
Papilledema
AMS
Pupil asymmetry

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3
Q

Neck zone I structures

A

Clavicles to cricoid

great vessels, aortic arch; trachea, esophagus, lung apices; cervical spine, spinal cord and nerve roots

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4
Q

Neck zone II structures

A

Cricoid to angle of mandible

carotid and vertebral arteries, jugular veins; pharynx, larynx, trachea, esophagus; cervical spine and spinal cord

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5
Q

Neck zone III structures

A

Angle of mandible to base of skull

salivary and parotid glands; esophagus, trachea; carotid arteries, jugular veins; cervical spine, major cranial nerves

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6
Q

Chest trauma with hyperresonance, decreased breath sounds

A

Pneumothorax

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7
Q

Chest trauma with paradoxical breathing

A

Flail chest

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8
Q

Chest trauma with decreased heart sounds, JVD, pulsus paradoxus

A

Cardiac tamponade

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9
Q

Chest trauma with widened mediastinum, unstable vital signs

A

Aortic rupture

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10
Q

Potentially fatal injuries w/ chest trauma

A

Aortic rupture
Tension pneumothorax
Hemothorax
Cardiac tamponade

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11
Q

Sites of significant (>1,500 mL) blood loss frequently not found by PE

A 
Blood left at scene
Pleural cavity (CXR)
Intra-abdominal (CT/US)
Pelvic (CT)
Bleeding into thights (x-ray)
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12
Q

Intraperitoneal rupture of bladder

A

Bladder dome
Usu blunt trauma
Cystoscopy + surgical repair

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13
Q

Extraperitoneal rupture of bladder

A

Anterior/lateral wall
Usu pelvic fx
Can be treated non-operatively

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14
Q

Transplant + maculopapular rash, abdominal pain, N/V, diarrhea, recurrent infections, easy bleeding

A

Graft vs host disease (donor immune cells attack host)

+LFT, decreased Ig, platelets; inflammation and cell death on biopsy of skin/liver

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15
Q

Indications for BM transplant

A

Aplastic anemia
Induction chemotherapy
Leukemia, lymphoma, hematopoietic disorders

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16
Q

Indications for heart transplant

A

Severe heart disease w/ estimated death w/i 2 years (CAD, congenital defects, cardiomyopathy)

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17
Q

Indications for lung transplant

A

COPD (esp alpha-1-antitrypsin)
Primary pulmonary HTN
Cystic fibrosis
Estimated death w/i 2 years

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18
Q

Indications for liver transplant

A 
Chronic hepatitis B or C
Alcoholic cirrhosis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Biliary atresia
Progressive Wilson disease
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19
Q

Indications for renal transplant

A

ESRD requiring dialysis

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20
Q

Indications for pancreas transplant

A

DM type I w/ renal failure

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21
Q

C/I to heart transplant

A 
Pulmonary HTN (need concurrent lung transplant)
Smoking w/i 6 months
Renal insufficiency
COPD
70+
Terminal illness
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22
Q

C/I to lung transplant

A 
Smoking w/i 6 months
Poor cardiac, renal, hepatic fxn
Terminal illness
65+
HIV
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23
Q

C/I to hepatic transplant

A

Alcoholism
Multiple suicide attempts
Liver cancer
Cirrhosis from chronic hepatitis

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24
Q

Transplant rejection w/i 24 hr

A

Hyperacute

Antidonor antibodies in recipient (avoid by crossmatching)

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25
Q

Transplant rejection w/i 6 days to 1 year

A

Acute

Antidonor T-cell proliferation in recipient

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26
Q

Transplant rejection over 1 year later

A

Chronic

Multiple immune rxns to donor tissue

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27
Q

FEV1/FVC

A

Normal is 80%

110% may be restrictive

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28
Q

Normal A-a gradient

A

5-15 mm Hg

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29
Q

Increased A-a gradient

A

Pulm embolism
Pulm edema
R to L shunt

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30
Q

False normal A-a gradient w/ hypoxia

A

High altitudes

Hypoventilation

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31
Q

Centor criteria

A 
(Strep throat)
Fever
Tonsillar exudates
Anterior cervical lymphadenopathy
Absence of cough
(Under 44 yo)
0-1 pt: no cx, no abx
2-3 pt: cx, abx if necessary
4+ pt: empiric abx
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32
Q

Sore throat + amoxicillin = rash

A

Possible amoxicillin allergy

Possible mononucleosis

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33
Q

Muffled “hot potato” voice + sore throat, fever, lockjaw, drooling + abscess on tonsil or uvula deviation

A

Peritonsillar abscess

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34
Q

Complications of strep pharyngitis

A

Acute rheumatic fever (can be prevented w/ abx)

Post-strep glomerulonephritis (not prevented w/ abx)

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35
Q

MCC bronchitis (overall, non-smokers, smokers)

A

Viral
Mycoplasma
S. pneumo and H. influenzae

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36
Q

PNA + lobar consolidation

A

Bacterial, typical

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37
Q

PNA + diffuse bilateral infiltrates on CXR

A

Atypical

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38
Q

MCC PNA in children

A

Viral (RSV)

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39
Q

MCC PNA in adults

A

S. pneumo

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40
Q

PNA in cystic fibrosis

A

Pseudomonas

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41
Q

PNA in sickle cell

A

S. pneumo
H. influenzae
Klebsiella

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42
Q

PNA in alcoholics or aspiration

A

Klebsiella

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43
Q

PNA in young adults

A

Mycoplasma

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44
Q

PNA w/ rust-colored sputum

A

S. pneumo

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45
Q

PNA w/ currant-jelly sputum

A

Klebsiella

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46
Q

MCC PNA in neonates

A

GBS, E coli, Listeria

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47
Q

MCC PNA infants - 5 yo

A

RSV, S. pneumo

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48
Q

MCC PNA 5-20 yo

A

S. pneumo, Mycoplasma, Chlamydophila, RSV

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49
Q

MCC PNA 20-60 yo

A

S. pneumo, Mycoplasma, Viruses, Chlamydophila (<40)

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50
Q

MCC PNA 60+ yo

A

S. pneumo, H. influenzae, Clamydophila, S. aureus, E. coli, Listeria

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51
Q

Nosocomial PNA causes

A

S. aureus
Enterobacter
Pseudomonas
Klebsiella

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52
Q

PNA w/ Gram + clusters

A

S. aureus

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53
Q

PNA w/ Gram + pairs

A

S. pneumo

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54
Q

PNA w/ Gram - rods

A

E. coli

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55
Q

PNA w/ Gram + cocci in neonate

A

GBS

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56
Q

PNA + travel to SW US

A

Coccidiodomycosis

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57
Q

PNA + caves/bat droppings

A

Histoplasmosis

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58
Q

PNA + Eastern N. America travel

A

Blastomycosis

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59
Q

PNA + Central America travel

A

Paracoccidiomycosis

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60
Q

PNA + immunocompromised (esp <200 CD4 HIV)

A

Pneumocystis jirovecii

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61
Q

PPD positive at 5 mm

A

HIV positive
Close contact w/ TB-infected patient
TB signs on CXR

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62
Q

PPD positive at 10 mm

A 
Homeless patients
Immigrants from developing nations
IVDU
Chronically ill patients
Health care workers
Recent incarceration
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63
Q

PPD positive at 15 mm

A

Everyone

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64
Q

PPD false negative

A

Anergic
Malnutrition
Immunocompromised
Sarcoidosis

65
Q

Asthma + vasculitis

A

Churg-Strauss

66
Q

Normal CO2 during asthma exacerbation

A

Signals impending respiratory failure

67
Q

ARDS common causes

A 
Aspiration
Acute pancreatitis
Air or Amniotic embolism
Radiation
Drug OD
Diffuse lung disease
DIC
Drowning
Shock
Sepsis
Smoke inhalation
68
Q

ARDS diagnostic characteristics

A

Acute onset respiratory distress
PaO2:FiO2 ratio <200
Bilateral pulmonary infiltrates
No evidence of cardiac problem

69
Q

PCWP in pulmonary edema

A

> 18 = cardiogenic

< 18 = non-cardiogenic (ARDS)

70
Q

COPD Gold criteria

A

FEV1 >80% = Gold 1
50-80% = Gold 2
30-50% = Gold 3
<30% = Gold 4

71
Q

DL50 in COPD

A

Normal in chronic bronchitis

Decreased in emphysema

72
Q

Emphysema distribution

A

Centrilobular in smoking (MC)

Panlobular (alpha-1-antitrypsin deficiency)

73
Q

Kartagener syndrome

A

Dextrocardia
Sinusitis (dyskinetic cilia)
Bronchiectasis (dyskinetic cilia)

74
Q

Dyskinetic cilia

A

Kartagener syndrome

ADPKD

75
Q

Causes for bronchiectasis

A 
Unknown in 50%
CF
Immunodeficiency
Dyskinetic cilia (Kartagener syndrome, ADPKD)
Pulmonary infections, obstruction
Chronic tobacco use
76
Q

Indications for home O2 in COPD

A 
SpO2 <88%
Pulmonary HTN
Peripheral edema
Polycythemia
Goal SpO2 ~90%
77
Q

SPN characteristics favoring benign lesion

A

Age < 2 cm
No evidence of lymphadenopathy
(Follow w/ CXR in 3-6 months)

78
Q

SPN characteristics favoring cancer

A 
Smoker
Age >45
New or progressing lesion
No calcifications or irregular calcifications
> 2 cm
Irregular margins
(PET, biopsy, resection)
79
Q

MCC lung cancer in non-smokers

A

Adenocarcinoma

80
Q

“S’s” of lung cancer

A

Squamous cell and small cell lung cancer
Smokers
Central

81
Q

Squamous cell lung cancer paraneoplastic syndrome

A

PTHrP - hypercalcemia

82
Q

Small cell lung cancer paraneoplastic syndromes

A

ACTH - Cushing
SIADH
Anti Ca channel Abs - Lambert-Eaton syndrome

83
Q

Pancoast syndrome

A 
Horner syndrome (miosis, ptosis, anhydrosis)
Brachial plexus involvement
84
Q

Superior vena cava syndrome

A

Obstruction of venous draining through SVC

Head swelling, CNS symptoms

85
Q

“Honeycomb” or reticular pattern on CXR

Ground glass pattern on chest CT

A

Interstitial pulmonary fibrosis

86
Q

Noncaseating granulomas

A

Sarcoidosis

Granulomatosis w/ polyangiitis (Wegener)

87
Q

Increased ACE, Ca

A

Sarcoidosis

88
Q

Bilateral hilar adenopathy

A

Sarcoidosis

89
Q

Arthritis, CP, erythema nodosum (tender red nodules on shins and arms), vision loss, CN palsies, lymphadenopathy

A

Sarcoidosis

90
Q

Pneumoconiosis w/ increased risk malignant mesothelioma

A

Asbestosis (insulation, construction, cars, plumbers)

91
Q

Pneumoconiosis w/ increased risk TB infection

A

Silicosis (sand, mining, granite)

92
Q

Pneumoconiosis w/ progressive fibrosis

A

Coal worker disease

Silicosis

93
Q

Pneumoconiosis w/ increased risk of lung cancer

A

Berylliosis (electronics)

94
Q

Hampton’s hump (wedge-shaped infarct on CXR)

A

Rare classic sign of pulm embolism

95
Q

S1Q3T3

A

Rare classic EKG sign of pulm embolism

96
Q

Dx of pulm HTN

A

Echo (cardiac cath is gold standard)

97
Q

Pleural effusion labs - Protein and LDH

A

Transudative vs exudative

98
Q

Pleural effusion labs - Glucose

A

Low in TB, malignancy, AI

99
Q

Pleural effusion labs - pH

A

Acidic in malignancy, TB, empyema

100
Q

Pleural effusion labs - Amylase

A

High in pancreatitis, esophageal rupture, some malignancies

101
Q

Pleural effusion labs - Triglycerides

A

High in thoracic duct rupture

102
Q

Light’s criteria for exudative pleural effusion (exudate if one of three is positive)

A

Pleural:Serum protein >0.5
Pleural:Serum LDH >0.6
Total pleural LDH >2/3 upper limit of normal serum LDH

103
Q

Causes of transudative pleural effusion

A

CHF, cirrhosis, kidney diseases (esp nephrotic)

104
Q

Causes of exudative pleural effusion

A

(Inflammation) Infection (bacterial infection, TB), malignancy, vasculitis, pancreatitis, pulmonary embolism

105
Q

Tall, thin, young man with sudden CP and SOB

A

Spontaneous pneumothorax

106
Q

Causes of hemothorax

A

Trauma, malignancy, TB (or other infection)

Pulm infarction

107
Q

Pretreatment for rapid sequence intubation

A

Lidocaine (blunt ICP, use in head injuries)
Fentanyl (blunt pain response and BP elevation)
Atropine (decrease secretions, prevent bradycardia)

108
Q

Confirm proper placement ET tube

A

End tidal CO2 (rise following expiration)
Auscultate for b/l lung expansion, no gastric breath sounds
CXR

109
Q

When to convert intubation to tracheostomy

A

If intubation is required >3 weeks

110
Q

Croup cause

A

Parainfluenza virus types 1 and 2

Acute inflammation of larynx

111
Q

Croup s/sx

A

3 months - 5 yo

URI -> barking cough, worse at night, inspiratory stridor (upper airway); steeple sign on CXR

112
Q

Epiglottitis cause

A

HiB

Rapidly progressive infection of epiglottis and surrounding tissues that cause airway obstruction

113
Q

Epiglottitis s/sx

A

2-7 yo

Dysphagia, sudden high fever, drooling, muffled voice, difficulty breathing, toxic looking; thumbprint sign on CXR

114
Q

Bronchiolitis cause

A

RSV

Infection of bronchioles

115
Q

Bronchiolitis s/sx

A

MC in winter and spring, children <2 yo
URI, expiratory wheezing, respiratory distress, tachypnea, crackles; hyperinflation of lungs and patchy infiltrates on CXR

116
Q

Different URI/breath sounds in kids

A

Stridor - inspiratory, upper airway; croup

Wheezing - expiratory, lower airway; bronchiolitis (2 yo)

117
Q

Causes of acute stridor in kids

A 
ABCDEFGH
Abscess
Bacterial tracheitis
Croup
Diphtheria
Epiglottitis
Foreign body*
Gas (poisonous)
Hypersensitivity reaction
118
Q

Respiratory distress syndrome of newborn cause

A

24-37 wks gestation (esp <30 wks)

Surfactant deficiency because of lung immaturity that leads to decreased lung compliance, atelectasis

119
Q

Respiratory distress syndrome of newborn s/sx

A

Presents w/ respiratory distress w/i 2 days of birth

CXR: diffuse hazy interstitial infiltrates (ground glass appearance), air bronchograms, decreased lung volumes

120
Q

Lung maturity signs esp in 34-37 wks

A

Lecithin:sphingomyelin ratio >2

Phosphatidyl glycerol present in amniotic fluid

121
Q

Transient tachypnea of newborn CXR

A

Increased lung volumes w/ diaphragm flattening
Prominent vascular markings from hilum (sunburst)
Maybe fluid streaking in interlobular fissures, pleural effusions

122
Q

Cystic fibrosis pulmonary infection bugs

A

Pseudomonas

S. aureus

123
Q

Hepatitis vaccines available

A

Hep A
Hep B
Hep D (Hep B)

124
Q

Hep B extrahepatic manifestations

A 
Polyarteritis nodosa
Glomerular disease (membranous nephropathy or membranoproliferative GN, adults > children)
125
Q

Hep C extrahepatic manifestations

A 
Membranoproliferative GN
Essential mixed cryoglobinemia
Lymphoma
Thyroiditis
DM
Porphyria cutanea tarda
Lichen planus
126
Q

Hepatitis mostly spread through sexual contact

A

Hep B (also blood)

127
Q

Hepatitis mostly spread through blood

A

Hep C (also sexual contact)

128
Q

Hepatitis with a high maternal mortality in pregnant women

A

Hep E

129
Q

Hepatitis that tends to develop chronic state

A 
Hep C (80%)
Hep B (90% children, 5% adults)
130
Q

Hepatitis w/ increased risk of HCC

A 
Hep B (3-5%) (check aFP)
Hep C (slight risk)
131
Q

HBV surface antigen (HBsAg)

A

Active disease (except window period, 12-20 wks)

132
Q

HBV envelope antigen (HBeAg)

A

Active viral replication (high transmissability)
Acute infection (4-12 wks)
Chronic infection w/ active replication

133
Q

HBV surface antibody (Anti-HBs)

A

Positive in recovery and vaccination

134
Q

HBV core antibody (Anti-HBc)

A 
Positive in any history of active disease
IgM early (12-20 wks)
IgG late (chronic infx or recovery)
135
Q

HBV serology in acute infection 4-12 wks post-exposure

A

+HBsAg
+IgM Anti-HBc
+HBeAg

136
Q

HBV serology in acute infection window period (12-20 wks post exposure)

A

+IgM Anti-HBc

137
Q

HBV serology in chronic infection w/ active viral replication (high transmissability)

A

+HBsAg
+IgG Anti-HBc
+HBeAg

138
Q

HBV serology in chronic infection w/ lesser viral replication (less transmissability, good prognosis)

A

+HBsAg
+IgG Anti-HBc
+Anti-HBe

139
Q

HBV serology in past infection (recovered)

A

+Anti-HBs

+IgG Anti-HBc

140
Q

HBV serology in vaccination only

A

+Anti-HBs

141
Q

MC salivary gland neoplasm

A

Pleomorphic adenoma (benign)

142
Q

Dysphagia w/ solids

A

Obstructive (peptic strictures, esophageal webs or rings, cancer, radiation/chemical fibrosis)

143
Q

Iron levels + dysphagia

A

+Iron can cause esophageal strictures

IDA can be part of Plummer-Vinson syndrome w/ esophageal webs

144
Q

Dysphagia w/ solids and liquids

A

NM (achalasia, motility disorders, scleroderma)

145
Q

Impaired peristalsis, decreased LES relaxation, “bird’s beak” on barium swallow

A

Achalasia

146
Q

“Corckscrew” pattern on barium swallow

A

Diffuse esophageal spasm

147
Q

Esophageal diverticula locations

A

Zenker (just above UES)
Traction (midpoint)
Epiphrenic (just above LES)

148
Q

MC esophageal cancers

A 
Squamous cell (worldwide)
Adenocarcinoma (US)
149
Q

Risk of ischemia/incarceration of stomach in hernia?

A

Paraesophageal hiatal hernia

150
Q

Type A gastritis

A

10%, fundus
Autoantibodies for parietal cells
Assoc w/ pernicious anemia, thyroiditis

151
Q

Type B gastritis

A

90%, antrum
H. pylori infection
Assoc w/ PUD, gastric cancer

152
Q

Pernicious anemia

A

Autoantibodies destroy parietal cells
Decreased intrinsic factor
Vitamin B12 malabsorption -> megaloblastic anemia
(or loss of terminal ileum -> B12 malabsorption)

153
Q

Next step for refractory PUD

A

Think Zollinger-Ellison syndrome
Serum gastrin level
Secretin-stimulation test

154
Q

PUD, Gastric ulcer

A

Age >50, H. pylori, NSAID use, 25%
Soon after eating, normal/low gastric acid, high gastrin
Eating may worsen symptoms, cause N/V

155
Q

PUD, Duodenal ulcer

A

Younger age, H. pylori (almost all), 75%
2-4 hrs after eating, high gastric acid, normal gastrin
Eating temporarily improves symptoms, worsen later

156
Q

PUD workup in different patients

A

40, previous ulcer need EGD w/ biopsy to r/o cancer

157
Q

Virchow node

A

L supraclavicular LN

Gastric cancer

158
Q

Sister Mary Joseph node

A

Periumbilical node
Gastric cancer
Some GYN cancers

159
Q

Krukenberg tumor

A

Metastasis to ovary from GI/breast cancers

Step 2 DIT (23 decks)

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