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Step 2 DIT > 3, 4, 5 Star topics 2 > Flashcards

3, 4, 5 Star topics 2 Flashcards

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1
Q

Cushing’s triad (4)

A

HTN, bradycardia, bradypnea

Sign of increased ICP

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2
Q

Glasgow coma scale categories (3)

A 
Eye opening (4): spontaneous, to voice, to pain, none
Verbal response (5): oriented, confused, inappropriate words, incomprehensible sounds, none
Motor response (6): obeys commands, localizes pain, withdraws from pain, flexion w/ pain (decorticate), extension w/ pain (decerebrate), none
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3
Q

GCS total scores and diagnoses (3)

A

12+ minor brain injury w/ probable recovery
9-11: moderate severity requiring close observation for changes
8 or less: coma, intubate, assoc w/ 50% mortality

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4
Q

Post-op fever causes (3)

A

Wind, Water, Walking, Wound, Wonder drugs
PNA (after day 3)
UTI (after day 3-5)
DVT/PE (any time)
Wound (after day 5-8)
Medications
Also transfusion rxn, thrombophlebitis, sinusitis (NG tube)

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5
Q

Mild intermittent asthma (3)

A

Symptoms < 2x/week
Night symptoms < 2x/month
Inhaled short acting B2 agonist

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6
Q

Mild persistent asthma (3)

A

Symptoms 3-6x/week
Night symptoms > 2x/month
Inhaled short acting B2 agonist +
Daily inhaled low-dose steroid

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7
Q

Moderate persistent asthma (3)

A 
Symptoms daily
Night symptoms > 1x/week
Inhaled short acting B2 agonist +
Daily inhaled low to medium dose steroid +
Long-acting B2 agonist
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8
Q

Severe asthma (3)

A 
Symptoms constantly, w/ minimal activity
Awake multiple times/night
Inhaled short acting B2 agonist +
Daily inhaled high dose steroid +
Long-acting B2 agonist +
Consider systemic steroids, LT inhibitors, theophylline
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9
Q

Crohn’s site (4)

A

Entire GI tract (perianal fistulas, oral ulcers)
MC site: distal ileum
Skip lesions
Entire bowel wall (transmural inflammation)

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10
Q

IBD - watery diarrhea (4)

A

Crohn’s

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11
Q

IBD - bloody diarrhea (4)

A

UC

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12
Q

Crohn’s PE (4)

A

RLQ abdominal mass
Perianal fissures and fistulas
Oral ulcers
Fever, abdominal tenderness

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13
Q

Crohn’s radiology (4)

A

Cobblestoning
Skip lesions
String sign

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14
Q

Crohn’s treatment (4)

A

Azathioprine or Mercaptopurine
Anti-TNFa (infliximab, adalimumab)
Steroids and abx for acute exacerbation
Try to avoid surgical resection

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15
Q

UC treatment (4)

A

Total colectomy is curative
Sulfasalazine
Supplemental iron
Steroids, immunosuppressives

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16
Q

IBD complications (4)

A

Crohn’s - abscess, fistula, fissure, malabsorption, toxic megacolon
UC - significantly increased risk of colon cancer, hemorrhage, toxic megacolon, bowel obstruction

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17
Q

UC radiology (4)

A

Lead pipe colon w/o haustra, colon shortening
Continuous involvement
Pseudopolyps, friable mucosa

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18
Q

UC site (4)

A

Continuous disease, rectum to distal ileum

Only mucosa and submucosa

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19
Q

CRC risk factors (4.5)

A

Colonic polyps (esp adenomas), fam hx, personal hx, hereditary polyposis syndromes, UC, low-fiber/high-fat diet, alcohol, smoking, DM

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20
Q

CRC MC mets (4.5)

A

Lung, liver

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21
Q

CRC radiology sign (4.5)

A

Apple core lesion

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22
Q

CRC treatment (4.5)

A

Surgical resection + regional LN resection (at least 12)

Adjuvant chemo if +LN

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23
Q

CRC monitoring post treatment (4.5)

A

CEA q3 months
CT chest/abd q1 year
Colonoscopy at 1, 3, q5 years

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24
Q

CRC prevention (5)

A

Starting at 50 yo (if family hx in first degree relative, start at 40 yo or 10 years before family member dx)
Annual FOBT
Colonoscopy q10 years OR
Flexible sigmoidoscopy + FOBT + double barium enema q5 years
If polyps are found, colonoscopy q3-5 years
Stop screening at 75 years old or <5 yr life expectancy

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25
GI bleed most likely upper (4.5)
Hematemesis, coffe-ground emesis, melena
26
GI bleed most likely lower (4.5)
Hematochezia, lightheadedness, hemodynamic instability
27
Next step GI bleed (4.5)
IVF, transfusion if unstable (HR, BP, UO) | Hematocrit >30%, INR <1.5
28
Next step GI bleed + hemodynamically stable (4.5)
NG tube w/ lavage | EGD or colonoscopy
29
Common causes upper GI bleed (4.5)
``` MCC = PUD Mallory-Weiss tears Esophagitis Esophageal varices Gastritis ```
30
Common causes lower GI bleed (4.5)
``` MCC = diverticular disease (<40 yo) Neoplasm UC Mesenteric ischemia AVMs Hemorrhoids Meckel diverticulum ```
31
Common causes of acute pancreatitis (4.5)
``` BAD HITS Biliary (gallstones, ERCP) (40%) Alcoholism (35%) Drugs (HIV esp didanosine, diuretics, valproate, azathioprine, estrogens) Hypertriglyceridemia/Hypercalcemia Idiopathic Trauma Scorpion sting ```
32
PE signs of acute pancreatitis (4.5)
Acute epigastric pain radiating to back, N/V Grey Turner sign (bluish discoloration of flank) Cullen sign (periumbical discoloration)
33
Radiology signs of acute pancreatitis (4.5)
``` Sentinel loop (loop of dilated bowel near pancreas) Colon cutoff sign (R colon distended until pancreas) Pseudocyst or enlarged pancreas ```
34
Acute pancreatitis complications (4.5)
``` Pancreatic abscess, pseudocyst Necrosis, fistula formation Renal failure Chronic pancreatitis Hemorrhage Shock DIC Sepsis Respiratory failure ```
35
Chronic pancreatitis complications (4.5)
Ductal obstruction, pseudocyst Malnutrition Glucose intolerance Pancreatic cancer
36
Most sens/specific lab for chronic pancreatitis (4.5)
Low fecal elastase
37
Treatment acute pancreatitis (4.5)
Hydration, NG suction, NPO Pain control w/ opioids +/- prophylactic abx Cholecysectomy if gallstones
38
Treatment chronic pancreatitis (4.5)
Stop alcohol use, smoking Opioids Enzyme and vitamin supplementation Change diet to low-fat, small meals
39
Hemochromatosis - cause (3)
AR, excess iron absorption | Rarely chronic blood transfusions or alcoholism
40
Hemochromatosis - s/sx (3)
Iron deposits in liver, pancreas, heart, pituitary Abd pain, hepatomegaly Dilated/restrictive cardiomyopathy Polydipsia, polyuria; testicular atrophy, impotence Arthralgias, pigmented rash (bronze hue) Lethargy
41
Hemochromatosis - screening test (3)
Increased serum ferritin
42
Hemochromatosis - treatment (3)
Weekly/biweekly phlebotomy until iron normalizes, then monthly Maybe deferoxamine for chelation Avoid excess alcohol consumption
43
Neonatal jaundice - physiological (5)
Day 2-3 Bili <10, peaks day 3-5 Usu self-resolves within 2 weeks
44
Neonatal jaundice - exaggerated physiologic (breastfeeding) (5)
1st week Bili <15 Caused by dehydration Rx: 10+ tube feeds/day w/ proper technique
45
Neonatal jaundice - breast milk jaundice (5)
``` 2nd week Bili >5.5 Caused by substance(s) in breast milk Dx: disappears w/ formula 48-72 hrs Rx: self-resolves / resolves w/ d/c breast feeding ```
46
Neonatal jaundice - immunological causes (5)
ABO incompatibility | Rh (or other antigen) incompatibility (erythroblastosis fetalis)
47
Neonatal jaundice - traumatic causes (5)
Trauma Cephalohematoma Bruising
48
Neonatal jaundice + fever, lethargy, poor feeding, +RR, any sign of infection (5)
Sepsis until proven otherwise
49
Neonatal jaundice - hereditary causes (5)
Polycythemia Hereditary spherocytosis G6PD deficiency Dubin-Johnson, Rotor syndrome, Byler disease (direct)
50
Jaundice + pale stools after 2 weeks old (5)
Biliary atresia Direct >20% of total bili (6-12) Rx: surgical repair <2 months essential for preventing biliary cirrhosis
51
Antibiotic C/I in neonates w/ hyperbilirubinemia (5)
Ceftriaxone (displaces bili from albumin)
52
Characteristics of pathological newborn jaundice (5)
``` Any jaundice in 1st 24 hrs Rise in total bili by >0.5 mg/dL/hr or >5 mg/dL/day Direct >20% of total bili or >1.5 Total bili >13 Jaundice after 2-3 wks old ```
53
Jaundice + NO scleral icterus >6 months old (5)
Hypercarotemia (carrots, sweet potatoes, etc)
54
Treatment of newborn jaundice (5)
Phototherapy of physiologic jaundice lasting several days Workup nonphysiologic causes, may need exchange transfusion IVIG may reduce need for transfusion if blood type incompatibility
55
Nonrandom assignment of subjects to study groups (4)
Enrollment (selection) bias
56
Subjective interpretation of data by investigator deviates towards 'desired' conclusions (4)
Investigator bias
57
Screening test provides earlier diagnosis but does NOT increase time of survival (4)
Lead-time bias
58
Screening test detects slowly progressive cases of disease but misses rapidly progressive cases (4)
Length bias
59
Subjects respond differently because of awareness of being studied (4)
Observational bias
60
Studies that show a difference are more likely to be published than those that don't (affects meta analyses) (4)
Publication bias
61
Subjects' memory errors produce incorrect data, esp because of prior confounding experiences (4)
Recall bias
62
Patients with certain medical hx are more likely to enroll in studies (type of selection/enrollment bias) (4)
Self-selection bias
63
Risk factors RCC (3)
Smoking (1st) Cadmium, asbestos exposure Age
64
Associated w/ RCC, ~15% (3)
Scrotal varocele
65
Treatment RCC (3)
Nephrectomy or resection w/ LN dissection (usu w/o biopsy if good imaging) Immunotheraphy, radiation, chemo if nonresectable or metastatic (poor prognosis)
66
Central pontine myelinolysis (4)
Too rapid correction of hyponatremia (no faster than 12-20 meq/24 hrs)
67
Hyponatremia treatment (4)
Treat underlying condition Salt and free water restriction Loop diuretics or hypertonic saline if severe (correct slowly)
68
Hyponatremia causes (4)
High glucose/mannitol/hypertonic intake High lipids/proteins Renal failure; cirrhosis, CHF, nephrotic syndrome SIADH, hypothyroidism; polydipsia Diuretics, ACE; vomiting, diarrhea, fluid sequestration (eg pancreatitis)
69
Central DI causes (4)
Failure of PP to secrete ADH | Cerebral trauma, pituitary tumors, hypoxic encephalopathy, anorexia, idiopathic
70
Nephrogenic DI causes (4)
Failure of kidneys to respond to ADH | Hereditary renal disease, lithium, hypercalcemia, hypokalemia
71
Dx DI (4)
Water deprivation test (2-3 hrs): NL = urine osmolality increases DI = urine osmolality stays low Then give ADH Central DI = urine osmolality increases Nephrogenic DI = urine osmolality stays low
72
Central DI treatment (4)
Desmopressin (DDAVP)
73
Nephrogenic DI treatment (4)
``` Salt restriction, increased water intake Thiazide diuretics (1st line) Indomethacin (2nd line) Amiloride (for lithium-induced) ```
74
Monitor heparin (3.5)
PTT
75
Monitor LMWH (3.5)
Not needed | Could use anti-Factor Xa (renal disease, obese, elderly)
76
Monitor warfarin (3.5)
PT/INR
77
Drop in platelets >50% in hospital (4)
HIT
78
HIT treatment (4)
Stop heparin | Use direct thrombin inhibitors (lepirudin, argatroban) until platelets >100K, then warfarin ~3 months
79
Drugs causing thrombocytopenia (4) | Familiar don't memorize
``` Usu cause absent/reduced megakaryocytes Heparin, abciximab Carbamazepine, phenytoin, valproate Cimetidine Acyclovir, rifampin Sulfonamides Procainamide, quinidine Quinine, gold compounds ```
80
Platelets <50K (4)
ITP (r/o other causes) | Autoimmune B-cell antiplatelet antibodies
81
Treatment ITP (4)
Children - self-limited | Adults - steroids, IVIG, plasmapheresis, splenectomy
82
Hemolytic anemia + uremia + thrombocytopenia (4)
HUS
83
TTP pentad (4)
``` Hemolytic anemia Uremia Thrombocytopenia + Neuro sx (coma, seizures) +/- Fever ```
84
HUS-TTP treatment (4)
Steroids, plasmapheresis, FFP
85
Causes TTP-HUS (4)
Assoc w/ endothelial injury and E. coli O157:H7
86
HUS or TTP lab abnormalities (4)
Low platelet number -> +BT
87
Hemophilia lab abnormalities (4)
+PTT
88
von Willebrand disease lab abnormalities (4)
+BT, +PTT
89
DIC lab abnormalities (4)
Low platelet number -> +BT | +PT, +PTT
90
Warfarin lab abnormalities (4)
+PT, +PTT
91
End stage liver disease lab abnormalities (4)
+PT, +PTT | Normal/low platelet count -> normal/+BT
92
Aspirin use lab abnormalities (4)
+BT
93
Mono cause (4)
EBV affecting B cells
94
Mono labs (4)
+Heterophile antibodies +EBV serology (Monospot test) +LFTs Maybe hemolytic anemia, thrombocytopenia
95
Treatment Mono (4)
Self-limited (supportive) | No contact sports for 4 weeks

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