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PGY2 > Rosh Review > Flashcards

Rosh Review Flashcards

1
Q

encapsulated bugs

A

SHiN SKiS:
Strep pneumo, H.ib, neisseria meningitidis (NOT GONO), ecoli
Klebsiella, salmonella, and GBS

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2
Q

charcot triad

A

fever, abdominal pain, and jaundice

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3
Q

reynolds pentad

A

fever, abdominal pain, jaundice, confusion, hypotension

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4
Q

MCC of biliary obstruction

A

stones, stenosis (primary biliary sclerosis,), or malignancy

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5
Q

Dx cholangitis

A

RUQ US, CT, ERCP

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6
Q

TX acute cholangitis

A

Zosyn and ERCP; fluids

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7
Q

what is this

A

Boerhaave syndrome

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8
Q

Diagnosis Boerhaave Syndrome

A

CXR, Contrast esophagram, CT

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9
Q

TX Boerhaave

A

supportive, NPO, Abx (Zosyn), surgical consultation

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10
Q

US findings of cholecystitis

A

GB wall thickening (>3mm), pericholecystic fluid, sono murphy sign, cholethiasis

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11
Q
A

CHOLECYSTITS

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12
Q

MC surgical emergency in patients >65 yo

A

acute cholecystitis

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13
Q

Boas sign

A

hyperaesthesia, increased sensitivity, or altered below R scapula

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14
Q

gold standard diagnostic for cholecystitis

A

HIDA

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15
Q

cirrhosis + variceal bleed; what do you give to improve mortality

A

rocephin

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16
Q

Vasoactive drugs for esophageal variceal bleed

A

octreotide, vasopressin (reduces portal pressure), beta blocker

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17
Q

alkali ingestion type of necrosis

A

liquefactive

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18
Q

acid ingestion necrosis

A

coagulation necrosis

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19
Q

liquefactive necrosis can lead to

A

perforation, mediastinitis, peritonitis, and resp distress, shock

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20
Q

TX caustic ingestion

A
  1. decontamination - irrigation vs lavage
  2. dilution (first 30 mins)
  3. NPO
  4. airway
    5.IV PPI or H2 blocker
  5. if suspect mediastinitis or peritonitis - abx
  6. GI and surgical consult
    ***endoscopy must be performed within 12 hours and not > 24hr
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21
Q

veins that are bleeding in the setting of splenic vein thrombosis

A

short gastric veins

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22
Q

TX for CMV esophagitis

A

Ganciclovir

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23
Q

CMV CD4 count

A

<50

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24
Q

forceful retching

A

mallory weiss syndrome

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25
Q

TX mallory weiss

A

supportive (Zofran), endoscopy (active bleed), acid suppression - PPI (not active bleed)

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26
Q

pathology of mallory weiss

A

intramural dissection (longitudinal mucosal lacerations)

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27
Q

TX of esophageal candidiasis

A

Fluconazole x 14-21 days for

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28
Q

CD 4 count for esophageal candidiasis

A

<100

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29
Q

MC location of obstruction of swallowed foreign bodies in peds

A

C6; cricopharyngeus muscles (UES)

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30
Q

where is the coin located

A

esophagus

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31
Q

where is the coin located

A

trachea

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32
Q

GER vs GERD (peds)

A

GER = normal physiological process; GERD = weight loss, anorexia, dysphagia, sleep disturbance, resp sx

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33
Q

Tx GER

A

smaller more frequent feeds; formula change, thickened feeds, and positioning

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34
Q

what position decreases reflux symptoms in kids

A

prone

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35
Q

causes of splenic infarction

A

1.infection - EBV, CMV, malaira, babesiosis
2. clotting - factor V
3. cancer
4. thromboembolism - afib, endocarditis, PFO
5. vasculitis

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36
Q

mesenteric ischemia artery

A

sma

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37
Q

splenic artery originates from

A

celiac trunk

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38
Q
A

splenic infarct

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39
Q

Tx splenic infarcts

A

supportive & AC (heparin)

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40
Q

lifestyle RFs for GERD

A

chocolate, caffeine, etoh, and nicotine

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41
Q

Causes of tracheomalacia

A
  1. congenital
  2. complication of esophageal atresia repair or tracheoesophageal fistula
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42
Q

S/Sx of tracheomalacia

A

expiratory stridor, brassy/barking cough
**severe biphasic stridor, dyspnea with feeding

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43
Q

dx tracheomalacia

A

water soluble swallow study

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44
Q
A

achalasia

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45
Q

S/Sx of achalasia

A

dysphagia to solids and liquids, difficulty belching, CP, regurg of undigested food

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46
Q

dx achalasia

A

esophageal manometry

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47
Q

TX achalasia

A

pneumatic dilation, surgical myotomy, botulinum injection

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48
Q

VACTERL

A

vertebral anomalies
anal atresia
cardiac anomalies
tracheoesophageal fistula
esophageal atresia
renal abnorms
limbs anomalies

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49
Q

resistance with NG tube placment

A

tracheoesophageal fistula

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50
Q

Dx tracheoesophageal fistula

A

Upper GI series with contrast, endoscopy with bronchoscopy, chest CT

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51
Q

H.Pylori treatment

A

triple: omeprazole, clarithromycin, and amoxicillin or flagyl
quad: bismuth, flagyl, tetracycline, omeprazole

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52
Q

MCC of impacted esophageal food boluses

A

schatzki rings

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53
Q

medication to help facilitate lower esophageal food bolus

A

glucagon

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54
Q

pyloric stenosis causes what laboratory abnormality

A

hypochloremic metabolic alkalosis

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55
Q

SBP fluid analysis `

A

PMNs >250, WBC >1000, pH <7.34

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56
Q

newborn with abdominal distention, inability to pass meconium and bilious vomiting

A

CF

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57
Q

bugs responsible for SBP

A

E.coli, klebsiella, and proteus

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58
Q

Dx pyloric stenosis

A

US abdomen

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59
Q

What is the most common, life-threatening cause of gastrointestinal bleeding after repair of an abdominal aortic aneurysm

A

aortoenteric fistula

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60
Q

carcinoid syndrome s/sx

A

R sided heart disease, bronchospasm, diarrhea, and skin flushing

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61
Q

dx carcinoid syndrome

A

urine 5 hydroxyindoleacetic acid level
CT or MRI

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62
Q

tx carcinoid syndrome

A

hydration, octreotide, and cyproheptadine

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63
Q

virchow node suggests

A

abdominal malignancy

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64
Q

virchow node location

A

L supraclavicular LN

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65
Q

Which of the following is the most common site of aortoenteric fistula formation?

A

duodenum

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66
Q

crohns disease

A

skip lesions, cobblestones, transmural, fistulas
mouth to anus
pANCA
nonbloody diarrhea

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67
Q

paralytic ileus has

A

air in colon and rectum on abdominal xr; no transition zone

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68
Q

Which of the following X-rays is the most sensitive imaging study to detect free air?

A

lateral chest xr

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69
Q
A

pneumatosis - necrotizing enterocolitis

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70
Q

Lab findings for NEC

A

hyperglycemia and lactic acidosis

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71
Q

TX NEC

A

bowel rest , NG tube, abx

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72
Q

S/sx of NEC

A

first few days of life; abdominal distention and vomiting, bloody stool or + guaiac ; pneumatosis

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73
Q

DX intussusception

A

US or contrast enema

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74
Q

abx for non-complicated diverticulitis

A

Augmentin

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75
Q

Salmonellosis tx

A

supportive care; ciprofloxacin if severe

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76
Q
A

pneumatosis - NEC

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77
Q

hirschsprung disease pathology

A

ailure of neuroblast migration so that ganglion cells do not extend to the distal end of the colon

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78
Q

hirschsprung disease s/sx

A

explosive passage of stook on DRE; failure to pass meconium

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79
Q
A
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80
Q

intestinal malrotation tx

A

NG tube, abx, emergent laparotomy

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81
Q

XR description of toxic megacolon

A

long segments of dilated colon with loss of haustra and “thumb printing” (areas of bowel wall edema).

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82
Q

DX hirshchsprung

A

rectal biopsy or contrast enema

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83
Q

tx of intussusceotion

A

air enema

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84
Q

most common cause of a small bowel obstruction in an 18-month-old previously healthy child?

A

Intussusception

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85
Q
A

cecal volvulus

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86
Q

high risk patients for sigmoid volvulus

A

long term care facilities; neuro and psych dz

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87
Q

tx signoid volvulus

A

flexible sigmoidoscopy; abdomen XR

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88
Q

lab findings with shigella

A

hyponatremia

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89
Q

complications of shigella

A

bacteremia, reactive arthritis, HUS, seizures,

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90
Q

dx intestinal malrotation

A

upper GI series

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91
Q

RF for NEC

A

prematurity

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92
Q

tx intussusception in adults

A

surgery

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93
Q

For which etiology of cardiac arrest does induced hypothermia carry the best improvement in survival with good neurologic outcome?

A

Vfib

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94
Q

what are lateral anal fissures concerning for?

A

systemic illness - crohns, HIV, leukemia, TB, and syphyllis

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95
Q
A

Aortic coarctation

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96
Q

Dx aortic coarctation

A

echo

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97
Q

tx pinworms

A

albendazole

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98
Q

tx lice and scabies

A

permethrin

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99
Q

tx tapeworms

A

praziquantel

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100
Q

beta blocker overdose presentation in children

A

hypoglycemia, seizures, and dysrhythmias

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101
Q

cardiac arrest due to ACS mc presents as

A

Vtach or Vfib

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102
Q

TX transposition of the great vessels

A

prostaglandin at birth (keep ductus arteriosus open), balloon septostomy, surgery

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103
Q

neonate HR < 60; first step

A

1 min of Pos pressure vent then compresssions

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104
Q

side effect of prostaglandin

A

vasodilation, hypotension, hyperthermia, and apnea

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105
Q

tx brugada

A

icd

106
Q

contraindication for targeted temp management

A

non-compressible bleeding

107
Q

MC location of anal fissure

A

posterior midline

108
Q

dyspnea and sweating during feeds

A

anomalous left coronary artery

109
Q

what is an epsilon wave?

A

small positive deflection buried in the end of the QRS complex

110
Q

What does an epsilon wave indicate

A

arrhythmogenic right ventricular cardiomyopathy; can cause sudden death in young patient.

111
Q

Dx arrhythmogenic right ventricular cardiomyopathy

A

EKG, echo, cardiac MRI

112
Q

tx of WPW orthodromic (narrow complex)

A

vagal, adenosine, CCB, BB, and synchronized cardioversion

113
Q

tx of WPW antidromic (wide)

A

procainamide

114
Q

meds for vtach

A

procainamide, amiodarone

115
Q
A

SVT

116
Q
A

svt

117
Q
A

atrial flutter

118
Q
A

afib

119
Q
A

vtach

120
Q
A

svt

121
Q

blood supply to av node

A

RCA

122
Q
A

afib with WPW

123
Q
A

arrhythmogenic right ventricular cardiomyopathy

124
Q

tx arrhythmogenic right ventricular cardiomyopathy

A

activity restriction, bb, implantable defibrillator,

125
Q
A

L: orthodromic; R: antidromic

126
Q

Why is adenosine contraindicated in antidromic WPW

A

adenosine can enhance anterograde conduction through the accessory pathway, leading to degeneration of the rhythm into ventricular tachycardia or ventricular fibrillation.

127
Q

what does orthodromic mean

A

electrical impulse goes through the AV node into the ventricle and returns to atria via the accessory pathway.

128
Q

electrolyte abnormalities assoc with torsades

A

hypokalemia and hypocalcemia

129
Q

what is brugada

A

Cardiac ion channel dysfunction associated with sudden cardiac arrest
Structurally normal heart

129
Q

fusion beats are diagnostic for

A

vtach

129
Q

Lown-Ganong-Levine syndrome

A

cardiac preexcitation syndrome similar in category to Wolff-Parkinson-White syndrome. It causes paroxysms of tachycardia

129
Q

criteria for lown-ganong-levine syndrome

A
  1. short PR
  2. normal QRS
  3. bundle of james
130
Q
A
130
Q
A
130
Q

when to defib vs synch cardioversion in vtach

A

unstable: synch
pulseless: defib

130
Q
A

wellens; deeply inverted or biphasic t waves in V2-3

130
Q

HOCM EKG findings

A

LVH, inverted deep t waves

131
Q

Which of the following is the biggest risk factor for the development of a left ventricular aneurysm?

A

left anterior descending coronary artery infarction

132
Q

persistent ste >2 weeks after MI

A

left ventricular aneurysm

133
Q

HOCM murmur heard best when

A

standing up (+valsalva)

134
Q

tx HOCM

A

beta blockers

135
Q

Avoid what meds in HOCM

A

nitroglycerin, nifedipine, and diuretics

136
Q

What is the most common presentation of a patient with hypertrophic cardiomyopathy?

A

dyspnea

137
Q

low output HF

A

dilated cardiomyopathy, chronic HTN, and vale heart disease

138
Q

high output HF

A

hyperTSH, beriberi, AV fistula, Paget disease, severe anemia, preggo

139
Q

Sgarbossa criteria (STEMI with LBBB)

A

1) concordant ST elevation ≥ 1 mm in any lead with a positive QRS complex
2) concordant ST depression ≥ 1 mm in V1, V2, or V3
3) excessive discordant ST elevation as ≥ 25% of the depth of the preceding S wave

140
Q
A

left ventricular aneurysm(2 weeks after MI)

141
Q

nitroglycerin MOA

A

vasodilates and reduces preload and afterload

142
Q

Which laboratory abnormality has been associated with a worse prognosis in heart failure

A

hyponatremia, poor kidney function, hypoalbuminemia, elevated LFTs

143
Q

findings of a L circumflex artery occlussion

A

ST segment elevation in V5 and 6

144
Q

posterior wall MI changes

A

STD in V1-3

145
Q

tx NSTEMI

A

heparin, nitrates, and asa

146
Q

what test has high negative predictive value and can be used to risk stratify patients with ACS

A

coronary CTA

147
Q

What is the most common cause of tricuspid regurgitation?

A

dilation of R atrium and ventricle; usually with pulmonary HTN

148
Q

precursor of squamous cell CA

A

actinic keratoses

149
Q
A

actinic keratoses

150
Q

Which of the following clinical manifestations carries the poorest prognosis for untreated aortic stenosis?

A

CHF

151
Q

who gets ppx before dental procedures?

A

prosthetic heart valves, a history of previous infective endocarditis, unrepaired cyanotic congenital heart disease, or congenital heart disease repaired with prosthetic material or devices.

152
Q

lipodermatosclerosis

A

tapering of legs above knees (upside down champagne bottle), brown/red pigmentation, venous stasis

153
Q

murmur associated with turner syndrome

A

aortic stenosis

154
Q

MC complaint of AS

A

dyspnea with exertion, decreased exercise tolerance, syncope, and angina

155
Q

most common complication in patients with endocarditis?

A

CHF

156
Q

Mycotic aneurysm is most commonly a complication of

A

endocarditis

157
Q

ICD + magnet

A

turns off defibrillator

158
Q

pacemaker + magnet

A

goes to default settings and pace at set rate

159
Q

marfan associated with what murmur

A

AR

160
Q
A

erythema nodosum

161
Q

Erythema nodosum etiology

A

delayed hypersensitivity reaction; erythematous tender nodules on shins

162
Q

Tx of erythema nodosum

A

NSAIDs, potassium iodide, steroids

163
Q
A

Erythema multiforme

164
Q

erythema multiforme etiology

A

immune mediated rash ; reactivated herpes simplex; often involve palms and soles

165
Q

tx of erythema multiforme

A

supportive, topical steroids, antivirals

166
Q

Tx of necrotizing fasciitis

A

vanco, zosyn, and clindamycin

167
Q

appearance of nec fasc

A

cellulitis progressing to dusky blue with bullae or vesicles; pai out of portion; subq emphysema

168
Q

Tx pityriasis rosea

A

supportive, antihistamine, zinc oxide

169
Q
A

benign hemangioma

170
Q

jock itch medical name and bacteria

A

trichophyton rubrum; tinea cruris

171
Q

Tinea cruris characteristics

A

scaly dermatitis, does not fluoresce

172
Q

difference between erysipelas and nec fasc

A

well demarcated borders

173
Q

Tx erysipelas

A

elevated limb, mild - penicillin, amoxicillin, cephalexin
severe- rocephin

174
Q
A

pityriasis rosea

175
Q

drug induced hypersensitivity syndrome presentation

A

rash, elevated liver enzymes, eosinophilia, elevated ESR CRP

176
Q

tx of drug induced hypersensitivity syndrome

A

corticosteroids

177
Q

soft, mobile, nontender subcutaneous mass without surrounding erythema. what is this

A

lipoma

178
Q

omphalitis

A

purulent discharge from umbilical stump with surrounding erythema and induration

179
Q

tx omphalitis

A

vanco and gentamicin

180
Q

tx simple cellulits

A

cephalexin, amoxicillin

181
Q

tx MRSA cellulits

A

TMP SMX, doxycycline, clindamycin

182
Q

tx inpatient cellulitis

A

Rocephin, clindamycin, zosyn +/- vanco

183
Q

nec fasc bacteria

A

polymicrobial

184
Q

description of erythema multiforme

A

surrounded by a pale area and halo erythema

185
Q

tx scabies

A

permethrin

186
Q

Which of the following is most commonly associated with erythema nodosum?

A

strepinfection

187
Q

shingles contact precautions

A

airborne with contact

188
Q

hypocalcemia s/sx

A

chvostek sign, perioral numbness, trousseau sign , tetany, lethargy

189
Q

primary adrenal insufficiency electrolyte issues

A

Hyponatremia, hypoglycemia, hyperkalemia

190
Q

tx primary adrenal insufficiency

A

hydrocortisone, supportive, fludrocortisone

191
Q

What is the most common worldwide cause of primary adrenal insufficiency?

A

TB; chronic corticosteroid therapy

192
Q

PE of primary adrenal insufficiency

A

hyperpigmentation, hypotension

193
Q

s/sx of primary adrenal insufficiency

A

ab pain, N/V, diarrhea

194
Q

what is associated with pemphigus vulgaris

A

myasthenia gravis and thymoma

195
Q

bullae and flaccid blisters that slough easily

A

pemphigus vulgaris

196
Q

Which of the following is typically seen in Korsakoff syndrome?

A

impairment of short term memory (long term preserved), confabulation and apathy

197
Q

difference between TEN and SJS

A

TEN >30%; SJS <10%

198
Q

causes of TEN

A

sulfa, carbamazepine, lamotrigine, allopurinol, NSAIDs, mycoplasma PNA

199
Q

primary hyperPTH labs

A

increased PTH, increased calcium, decreased phos

200
Q

MCC of primary hyperPTH

A

adenoma

201
Q
A

HSP’ IgA vasculitis; purpura, arthralgias, and abdominal pain (intussusception)

202
Q

s/sx of pernicious anemia

A

peripheral neuropathy, ataxia, personality change, dementia, glossitis

203
Q

staph scalded skin syndrome tx

A

cephalexin or dicloxacillin

204
Q

PE of staph scalded skin syndrome

A

erythroderma, large, flaccid bullae, desquamation

205
Q
A
206
Q

peds dextrose administration in hypoglycemia formula

A

2 x age in years +8, then apply to dose

207
Q

hypoglycemia formula for >8 year old

A

D50; 1ml/kg

208
Q

hypoglycemia formula for 1-8 year olds

A

D25; 2ml/kg

209
Q

hypoglycemia formula for <1 year-old

A

D10; 2-5ml/kg

210
Q

what class of medications are associated with hypoglycemic episodes

A

sulfonylurea

211
Q

sulfonylurea toxicity

A

calcium influx and stimulates insulin secretion –> increase responsiveness of beta cells

212
Q

tx sulfonylurea toxicity

A

D50 & octreotide

213
Q

MCCs of SIADH

A

lung infections, CNS disorders, and drugs

214
Q

long acting sulfonylurea

A

glyburide

215
Q

signs patient has renal aa stenosis

A

hypertension that is refractory to antihypertensive medications, hypokalemia, and metabolic alkalosis

216
Q

laxatives can cause what electrolyte abnormality

A

hypermagnesemia

217
Q

Tx hypermagnesemia

A

IVF, furosemide, and calcium

218
Q

hypermagnesemia s/sx

A

loss of DTRs, weakness, hypotension, vasodilation, dysrhythmia, asystole

219
Q

tx hypercalcemia

A

IVF, bisphosphonates, steroids, calcitonin, dialysis

220
Q

hypercalcemia ekg changes

A

short QT

221
Q

stones, bones, groans, and psych overtones

A

hypercalcemia

222
Q

what is the end point of HHS

A

correction of serum osmolality

223
Q

refeeding syndrome electrolyte abnormality

A

hypophosphatemia

224
Q

hypermagnesemia ekg changes

A

prolonged qt, widened qrs, dysthymia

225
Q

presentation of myxedema coma

A

thickened, nonpitting edema of skin; puffy face, enlarged thyroid, bradycardia, hypothermia

226
Q

lab findings of myxedema coma

A

hypoglycemia, hyponatremia, hypoxemia, hypercapnia, prolonged QT, pericardial effusion

227
Q

tx myxedema coma

A

supportive, hydrocortisone, levothyroxine

228
Q

why does hypothyroidism cause hyponatremia

A

decreased metabolic rate leading to decreased kidney function and water excretion

229
Q

subacute thyroiditis presentation

A

fever, myalgias, fatigue, anterior neck pain

230
Q

lab values of subacute thyroiditis

A

decreased TSH and elevated T3/4

231
Q

tx subacute thyroiditis

A

NSAIDs

232
Q

types of thyroiditis

A

hashimoto, post partum, subacute, and infectious

233
Q

order of tx for hyperthyroidism

A

propranolol, PTU, methimazole, iodine, steroids

234
Q

Which o history or physical exam findings is most common in a child with hyperthyroidism?

A

goiter

235
Q

what condition should you not give ketamine

A

pheochromocytoma

236
Q

why is ASA contraindicated with thyroid storm

A

displaces t4 form binding proteins and potentiate thyrotoxicosis

237
Q

what medications blocks the release of stored thyroid hormone?

A

iodine

238
Q

what can distinguish primary adrenal insufficiency from secondary adrenal insufficiency?

A

hyperkalemia: secondary affects pt gland or hypothalamus and would have normal aldosterone

239
Q

thyroid storm clinical presentation

A

tachycardia, heart failure, hypotension, afib, hyperpyrexia, agitation,

240
Q

scorpion s/sx

A

extremity jerking that resembles seizures, oculomotor dysfunction, pharyngeal dysfunction, respiratory compromise, tongue fasciculations, motor restlessness, and hypersalivation.

241
Q

components of decompression sickness

A

the bends - pain in joints
the staggers - neuro s/sx
the chokes - pul and cardiac s/sx

242
Q

MC bacteria in dog bites

A

pasteurella

243
Q

fatal bacteria from dog bites

A

Capnocytophaga canimorsus,

244
Q

what early sign that is most suggestive of high-altitude cerebral edema?

A

ataxia

245
Q

Which blood cells are preferentially damaged in acute radiation injuries?

A

lymphocytes

246
Q

copperhead snake description

A

triangular head, nostrils pits, elliptical pupils, folding fangs

247
Q

type 1 vs 2 of decompression sickness

A

1 - msk, skin, and lymphatics
2 - neuro, ear, lungs

248
Q

acute mountain sickness elevation

A

6500 ft

249
Q

keraunoparalysis

A

temporary paralysis of the extremities which may appear blue, mottled, and cold.

250
Q

sea urchin tx

A

hot water immersion

251
Q

tx of HACE

A

descent, dexamethasone,

252
Q

what creature bite can mimic acute abdomen

A

black widow

253
Q
A

PGY2 (7 decks)

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