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

3, 4, 5 Star topics 2 Flashcards

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
Q

GI bleed most likely upper (4.5)

A

Hematemesis, coffe-ground emesis, melena

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26
Q

GI bleed most likely lower (4.5)

A

Hematochezia, lightheadedness, hemodynamic instability

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27
Q

Next step GI bleed (4.5)

A

IVF, transfusion if unstable (HR, BP, UO)

Hematocrit >30%, INR <1.5

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28
Q

Next step GI bleed + hemodynamically stable (4.5)

A

NG tube w/ lavage

EGD or colonoscopy

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29
Q

Common causes upper GI bleed (4.5)

A 
MCC = PUD
Mallory-Weiss tears
Esophagitis
Esophageal varices
Gastritis
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30
Q

Common causes lower GI bleed (4.5)

A 
MCC = diverticular disease (<40 yo)
Neoplasm
UC
Mesenteric ischemia
AVMs
Hemorrhoids
Meckel diverticulum
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31
Q

Common causes of acute pancreatitis (4.5)

A 
BAD HITS
Biliary (gallstones, ERCP) (40%)
Alcoholism (35%)
Drugs (HIV esp didanosine, diuretics, valproate, azathioprine, estrogens)
Hypertriglyceridemia/Hypercalcemia
Idiopathic
Trauma
Scorpion sting
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32
Q

PE signs of acute pancreatitis (4.5)

A

Acute epigastric pain radiating to back, N/V
Grey Turner sign (bluish discoloration of flank)
Cullen sign (periumbical discoloration)

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33
Q

Radiology signs of acute pancreatitis (4.5)

A 
Sentinel loop (loop of dilated bowel near pancreas)
Colon cutoff sign (R colon distended until pancreas)
Pseudocyst or enlarged pancreas
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34
Q

Acute pancreatitis complications (4.5)

A 
Pancreatic abscess, pseudocyst
Necrosis, fistula formation
Renal failure
Chronic pancreatitis
Hemorrhage
Shock
DIC
Sepsis
Respiratory failure
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35
Q

Chronic pancreatitis complications (4.5)

A

Ductal obstruction, pseudocyst
Malnutrition
Glucose intolerance
Pancreatic cancer

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36
Q

Most sens/specific lab for chronic pancreatitis (4.5)

A

Low fecal elastase

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37
Q

Treatment acute pancreatitis (4.5)

A

Hydration, NG suction, NPO
Pain control w/ opioids
+/- prophylactic abx
Cholecysectomy if gallstones

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38
Q

Treatment chronic pancreatitis (4.5)

A

Stop alcohol use, smoking
Opioids
Enzyme and vitamin supplementation
Change diet to low-fat, small meals

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39
Q

Hemochromatosis - cause (3)

A

AR, excess iron absorption

Rarely chronic blood transfusions or alcoholism

40
Q

Hemochromatosis - s/sx (3)

A

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
Q

Hemochromatosis - screening test (3)

A

Increased serum ferritin

42
Q

Hemochromatosis - treatment (3)

A

Weekly/biweekly phlebotomy until iron normalizes, then monthly
Maybe deferoxamine for chelation
Avoid excess alcohol consumption

43
Q

Neonatal jaundice - physiological (5)

A

Day 2-3
Bili <10, peaks day 3-5
Usu self-resolves within 2 weeks

44
Q

Neonatal jaundice - exaggerated physiologic (breastfeeding) (5)

A

1st week
Bili <15
Caused by dehydration
Rx: 10+ tube feeds/day w/ proper technique

45
Q

Neonatal jaundice - breast milk jaundice (5)

A 
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
Q

Neonatal jaundice - immunological causes (5)

A

ABO incompatibility

Rh (or other antigen) incompatibility (erythroblastosis fetalis)

47
Q

Neonatal jaundice - traumatic causes (5)

A

Trauma
Cephalohematoma
Bruising

48
Q

Neonatal jaundice + fever, lethargy, poor feeding, +RR, any sign of infection (5)

A

Sepsis until proven otherwise

49
Q

Neonatal jaundice - hereditary causes (5)

A

Polycythemia
Hereditary spherocytosis
G6PD deficiency
Dubin-Johnson, Rotor syndrome, Byler disease (direct)

50
Q

Jaundice + pale stools after 2 weeks old (5)

A

Biliary atresia
Direct >20% of total bili (6-12)
Rx: surgical repair <2 months essential for preventing biliary cirrhosis

51
Q

Antibiotic C/I in neonates w/ hyperbilirubinemia (5)

A

Ceftriaxone (displaces bili from albumin)

52
Q

Characteristics of pathological newborn jaundice (5)

A 
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
Q

Jaundice + NO scleral icterus >6 months old (5)

A

Hypercarotemia (carrots, sweet potatoes, etc)

54
Q

Treatment of newborn jaundice (5)

A

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
Q

Nonrandom assignment of subjects to study groups (4)

A

Enrollment (selection) bias

56
Q

Subjective interpretation of data by investigator deviates towards ‘desired’ conclusions (4)

A

Investigator bias

57
Q

Screening test provides earlier diagnosis but does NOT increase time of survival (4)

A

Lead-time bias

58
Q

Screening test detects slowly progressive cases of disease but misses rapidly progressive cases (4)

A

Length bias

59
Q

Subjects respond differently because of awareness of being studied (4)

A

Observational bias

60
Q

Studies that show a difference are more likely to be published than those that don’t (affects meta analyses) (4)

A

Publication bias

61
Q

Subjects’ memory errors produce incorrect data, esp because of prior confounding experiences (4)

A

Recall bias

62
Q

Patients with certain medical hx are more likely to enroll in studies (type of selection/enrollment bias) (4)

A

Self-selection bias

63
Q

Risk factors RCC (3)

A

Smoking (1st)
Cadmium, asbestos exposure
Age

64
Q

Associated w/ RCC, ~15% (3)

A

Scrotal varocele

65
Q

Treatment RCC (3)

A

Nephrectomy or resection w/ LN dissection (usu w/o biopsy if good imaging)
Immunotheraphy, radiation, chemo if nonresectable or metastatic (poor prognosis)

66
Q

Central pontine myelinolysis (4)

A

Too rapid correction of hyponatremia (no faster than 12-20 meq/24 hrs)

67
Q

Hyponatremia treatment (4)

A

Treat underlying condition
Salt and free water restriction
Loop diuretics or hypertonic saline if severe (correct slowly)

68
Q

Hyponatremia causes (4)

A

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
Q

Central DI causes (4)

A

Failure of PP to secrete ADH

Cerebral trauma, pituitary tumors, hypoxic encephalopathy, anorexia, idiopathic

70
Q

Nephrogenic DI causes (4)

A

Failure of kidneys to respond to ADH

Hereditary renal disease, lithium, hypercalcemia, hypokalemia

71
Q

Dx DI (4)

A

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
Q

Central DI treatment (4)

A

Desmopressin (DDAVP)

73
Q

Nephrogenic DI treatment (4)

A 
Salt restriction, increased water intake
Thiazide diuretics (1st line)
Indomethacin (2nd line)
Amiloride (for lithium-induced)
74
Q

Monitor heparin (3.5)

A

PTT

75
Q

Monitor LMWH (3.5)

A

Not needed

Could use anti-Factor Xa (renal disease, obese, elderly)

76
Q

Monitor warfarin (3.5)

A

PT/INR

77
Q

Drop in platelets >50% in hospital (4)

A

HIT

78
Q

HIT treatment (4)

A

Stop heparin

Use direct thrombin inhibitors (lepirudin, argatroban) until platelets >100K, then warfarin ~3 months

79
Q

Drugs causing thrombocytopenia (4)

Familiar don’t memorize

A 
Usu cause absent/reduced megakaryocytes
Heparin, abciximab
Carbamazepine, phenytoin, valproate
Cimetidine
Acyclovir, rifampin
Sulfonamides
Procainamide, quinidine
Quinine, gold compounds
80
Q

Platelets <50K (4)

A

ITP (r/o other causes)

Autoimmune B-cell antiplatelet antibodies

81
Q

Treatment ITP (4)

A

Children - self-limited

Adults - steroids, IVIG, plasmapheresis, splenectomy

82
Q

Hemolytic anemia + uremia + thrombocytopenia (4)

A

HUS

83
Q

TTP pentad (4)

A 
Hemolytic anemia
Uremia
Thrombocytopenia +
Neuro sx (coma, seizures)
\+/- Fever
84
Q

HUS-TTP treatment (4)

A

Steroids, plasmapheresis, FFP

85
Q

Causes TTP-HUS (4)

A

Assoc w/ endothelial injury and E. coli O157:H7

86
Q

HUS or TTP lab abnormalities (4)

A

Low platelet number -> +BT

87
Q

Hemophilia lab abnormalities (4)

A

+PTT

88
Q

von Willebrand disease lab abnormalities (4)

A

+BT, +PTT

89
Q

DIC lab abnormalities (4)

A

Low platelet number -> +BT

+PT, +PTT

90
Q

Warfarin lab abnormalities (4)

A

+PT, +PTT

91
Q

End stage liver disease lab abnormalities (4)

A

+PT, +PTT

Normal/low platelet count -> normal/+BT

92
Q

Aspirin use lab abnormalities (4)

A

+BT

93
Q

Mono cause (4)

A

EBV affecting B cells

94
Q

Mono labs (4)

A

+Heterophile antibodies
+EBV serology (Monospot test)
+LFTs
Maybe hemolytic anemia, thrombocytopenia

95
Q

Treatment Mono (4)

A

Self-limited (supportive)

No contact sports for 4 weeks

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