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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
Transplant rejection w/i 6 days to 1 year
Acute | Antidonor T-cell proliferation in recipient
26
Transplant rejection over 1 year later
Chronic | Multiple immune rxns to donor tissue
27
FEV1/FVC
Normal is 80% | 110% may be restrictive
28
Normal A-a gradient
5-15 mm Hg
29
Increased A-a gradient
Pulm embolism Pulm edema R to L shunt
30
False normal A-a gradient w/ hypoxia
High altitudes | Hypoventilation
31
Centor criteria
``` (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 ```
32
Sore throat + amoxicillin = rash
Possible amoxicillin allergy | Possible mononucleosis
33
Muffled "hot potato" voice + sore throat, fever, lockjaw, drooling + abscess on tonsil or uvula deviation
Peritonsillar abscess
34
Complications of strep pharyngitis
Acute rheumatic fever (can be prevented w/ abx) | Post-strep glomerulonephritis (not prevented w/ abx)
35
MCC bronchitis (overall, non-smokers, smokers)
Viral Mycoplasma S. pneumo and H. influenzae
36
PNA + lobar consolidation
Bacterial, typical
37
PNA + diffuse bilateral infiltrates on CXR
Atypical
38
MCC PNA in children
Viral (RSV)
39
MCC PNA in adults
S. pneumo
40
PNA in cystic fibrosis
Pseudomonas
41
PNA in sickle cell
S. pneumo H. influenzae Klebsiella
42
PNA in alcoholics or aspiration
Klebsiella
43
PNA in young adults
Mycoplasma
44
PNA w/ rust-colored sputum
S. pneumo
45
PNA w/ currant-jelly sputum
Klebsiella
46
MCC PNA in neonates
GBS, E coli, Listeria
47
MCC PNA infants - 5 yo
RSV, S. pneumo
48
MCC PNA 5-20 yo
S. pneumo, Mycoplasma, Chlamydophila, RSV
49
MCC PNA 20-60 yo
S. pneumo, Mycoplasma, Viruses, Chlamydophila (<40)
50
MCC PNA 60+ yo
S. pneumo, H. influenzae, Clamydophila, S. aureus, E. coli, Listeria
51
Nosocomial PNA causes
S. aureus Enterobacter Pseudomonas Klebsiella
52
PNA w/ Gram + clusters
S. aureus
53
PNA w/ Gram + pairs
S. pneumo
54
PNA w/ Gram - rods
E. coli
55
PNA w/ Gram + cocci in neonate
GBS
56
PNA + travel to SW US
Coccidiodomycosis
57
PNA + caves/bat droppings
Histoplasmosis
58
PNA + Eastern N. America travel
Blastomycosis
59
PNA + Central America travel
Paracoccidiomycosis
60
PNA + immunocompromised (esp <200 CD4 HIV)
Pneumocystis jirovecii
61
PPD positive at 5 mm
HIV positive Close contact w/ TB-infected patient TB signs on CXR
62
PPD positive at 10 mm
``` Homeless patients Immigrants from developing nations IVDU Chronically ill patients Health care workers Recent incarceration ```
63
PPD positive at 15 mm
Everyone
64
PPD false negative
Anergic Malnutrition Immunocompromised Sarcoidosis
65
Asthma + vasculitis
Churg-Strauss
66
Normal CO2 during asthma exacerbation
Signals impending respiratory failure
67
ARDS common causes
``` Aspiration Acute pancreatitis Air or Amniotic embolism Radiation Drug OD Diffuse lung disease DIC Drowning Shock Sepsis Smoke inhalation ```
68
ARDS diagnostic characteristics
Acute onset respiratory distress PaO2:FiO2 ratio <200 Bilateral pulmonary infiltrates No evidence of cardiac problem
69
PCWP in pulmonary edema
>18 = cardiogenic | < 18 = non-cardiogenic (ARDS)
70
COPD Gold criteria
FEV1 >80% = Gold 1 50-80% = Gold 2 30-50% = Gold 3 <30% = Gold 4
71
DL50 in COPD
Normal in chronic bronchitis | Decreased in emphysema
72
Emphysema distribution
Centrilobular in smoking (MC) | Panlobular (alpha-1-antitrypsin deficiency)
73
Kartagener syndrome
Dextrocardia Sinusitis (dyskinetic cilia) Bronchiectasis (dyskinetic cilia)
74
Dyskinetic cilia
Kartagener syndrome | ADPKD
75
Causes for bronchiectasis
``` Unknown in 50% CF Immunodeficiency Dyskinetic cilia (Kartagener syndrome, ADPKD) Pulmonary infections, obstruction Chronic tobacco use ```
76
Indications for home O2 in COPD
``` SpO2 <88% Pulmonary HTN Peripheral edema Polycythemia Goal SpO2 ~90% ```
77
SPN characteristics favoring benign lesion
Age < 2 cm No evidence of lymphadenopathy (Follow w/ CXR in 3-6 months)
78
SPN characteristics favoring cancer
``` Smoker Age >45 New or progressing lesion No calcifications or irregular calcifications > 2 cm Irregular margins (PET, biopsy, resection) ```
79
MCC lung cancer in non-smokers
Adenocarcinoma
80
"S's" of lung cancer
Squamous cell and small cell lung cancer Smokers Central
81
Squamous cell lung cancer paraneoplastic syndrome
PTHrP - hypercalcemia
82
Small cell lung cancer paraneoplastic syndromes
ACTH - Cushing SIADH Anti Ca channel Abs - Lambert-Eaton syndrome
83
Pancoast syndrome
``` Horner syndrome (miosis, ptosis, anhydrosis) Brachial plexus involvement ```
84
Superior vena cava syndrome
Obstruction of venous draining through SVC | Head swelling, CNS symptoms
85
"Honeycomb" or reticular pattern on CXR | Ground glass pattern on chest CT
Interstitial pulmonary fibrosis
86
Noncaseating granulomas
Sarcoidosis | Granulomatosis w/ polyangiitis (Wegener)
87
Increased ACE, Ca
Sarcoidosis
88
Bilateral hilar adenopathy
Sarcoidosis
89
Arthritis, CP, erythema nodosum (tender red nodules on shins and arms), vision loss, CN palsies, lymphadenopathy
Sarcoidosis
90
Pneumoconiosis w/ increased risk malignant mesothelioma
Asbestosis (insulation, construction, cars, plumbers)
91
Pneumoconiosis w/ increased risk TB infection
Silicosis (sand, mining, granite)
92
Pneumoconiosis w/ progressive fibrosis
Coal worker disease | Silicosis
93
Pneumoconiosis w/ increased risk of lung cancer
Berylliosis (electronics)
94
Hampton's hump (wedge-shaped infarct on CXR)
Rare classic sign of pulm embolism
95
S1Q3T3
Rare classic EKG sign of pulm embolism
96
Dx of pulm HTN
Echo (cardiac cath is gold standard)
97
Pleural effusion labs - Protein and LDH
Transudative vs exudative
98
Pleural effusion labs - Glucose
Low in TB, malignancy, AI
99
Pleural effusion labs - pH
Acidic in malignancy, TB, empyema
100
Pleural effusion labs - Amylase
High in pancreatitis, esophageal rupture, some malignancies
101
Pleural effusion labs - Triglycerides
High in thoracic duct rupture
102
Light's criteria for exudative pleural effusion (exudate if one of three is positive)
Pleural:Serum protein >0.5 Pleural:Serum LDH >0.6 Total pleural LDH >2/3 upper limit of normal serum LDH
103
Causes of transudative pleural effusion
CHF, cirrhosis, kidney diseases (esp nephrotic)
104
Causes of exudative pleural effusion
(Inflammation) Infection (bacterial infection, TB), malignancy, vasculitis, pancreatitis, pulmonary embolism
105
Tall, thin, young man with sudden CP and SOB
Spontaneous pneumothorax
106
Causes of hemothorax
Trauma, malignancy, TB (or other infection) | Pulm infarction
107
Pretreatment for rapid sequence intubation
Lidocaine (blunt ICP, use in head injuries) Fentanyl (blunt pain response and BP elevation) Atropine (decrease secretions, prevent bradycardia)
108
Confirm proper placement ET tube
End tidal CO2 (rise following expiration) Auscultate for b/l lung expansion, no gastric breath sounds CXR
109
When to convert intubation to tracheostomy
If intubation is required >3 weeks
110
Croup cause
Parainfluenza virus types 1 and 2 | Acute inflammation of larynx
111
Croup s/sx
3 months - 5 yo | URI -> barking cough, worse at night, inspiratory stridor (upper airway); steeple sign on CXR
112
Epiglottitis cause
HiB | Rapidly progressive infection of epiglottis and surrounding tissues that cause airway obstruction
113
Epiglottitis s/sx
2-7 yo | Dysphagia, sudden high fever, drooling, muffled voice, difficulty breathing, toxic looking; thumbprint sign on CXR
114
Bronchiolitis cause
RSV | Infection of bronchioles
115
Bronchiolitis s/sx
MC in winter and spring, children <2 yo URI, expiratory wheezing, respiratory distress, tachypnea, crackles; hyperinflation of lungs and patchy infiltrates on CXR
116
Different URI/breath sounds in kids
Stridor - inspiratory, upper airway; croup | Wheezing - expiratory, lower airway; bronchiolitis (2 yo)
117
Causes of acute stridor in kids
``` ABCDEFGH Abscess Bacterial tracheitis Croup Diphtheria Epiglottitis Foreign body* Gas (poisonous) Hypersensitivity reaction ```
118
Respiratory distress syndrome of newborn cause
24-37 wks gestation (esp <30 wks) | Surfactant deficiency because of lung immaturity that leads to decreased lung compliance, atelectasis
119
Respiratory distress syndrome of newborn s/sx
Presents w/ respiratory distress w/i 2 days of birth | CXR: diffuse hazy interstitial infiltrates (ground glass appearance), air bronchograms, decreased lung volumes
120
Lung maturity signs esp in 34-37 wks
Lecithin:sphingomyelin ratio >2 | Phosphatidyl glycerol present in amniotic fluid
121
Transient tachypnea of newborn CXR
Increased lung volumes w/ diaphragm flattening Prominent vascular markings from hilum (sunburst) Maybe fluid streaking in interlobular fissures, pleural effusions
122
Cystic fibrosis pulmonary infection bugs
Pseudomonas | S. aureus
123
Hepatitis vaccines available
Hep A Hep B Hep D (Hep B)
124
Hep B extrahepatic manifestations
``` Polyarteritis nodosa Glomerular disease (membranous nephropathy or membranoproliferative GN, adults > children) ```
125
Hep C extrahepatic manifestations
``` Membranoproliferative GN Essential mixed cryoglobinemia Lymphoma Thyroiditis DM Porphyria cutanea tarda Lichen planus ```
126
Hepatitis mostly spread through sexual contact
Hep B (also blood)
127
Hepatitis mostly spread through blood
Hep C (also sexual contact)
128
Hepatitis with a high maternal mortality in pregnant women
Hep E
129
Hepatitis that tends to develop chronic state
``` Hep C (80%) Hep B (90% children, 5% adults) ```
130
Hepatitis w/ increased risk of HCC
``` Hep B (3-5%) (check aFP) Hep C (slight risk) ```
131
HBV surface antigen (HBsAg)
Active disease (except window period, 12-20 wks)
132
HBV envelope antigen (HBeAg)
Active viral replication (high transmissability) Acute infection (4-12 wks) Chronic infection w/ active replication
133
HBV surface antibody (Anti-HBs)
Positive in recovery and vaccination
134
HBV core antibody (Anti-HBc)
``` Positive in any history of active disease IgM early (12-20 wks) IgG late (chronic infx or recovery) ```
135
HBV serology in acute infection 4-12 wks post-exposure
+HBsAg +IgM Anti-HBc +HBeAg
136
HBV serology in acute infection window period (12-20 wks post exposure)
+IgM Anti-HBc
137
HBV serology in chronic infection w/ active viral replication (high transmissability)
+HBsAg +IgG Anti-HBc +HBeAg
138
HBV serology in chronic infection w/ lesser viral replication (less transmissability, good prognosis)
+HBsAg +IgG Anti-HBc +Anti-HBe
139
HBV serology in past infection (recovered)
+Anti-HBs | +IgG Anti-HBc
140
HBV serology in vaccination only
+Anti-HBs
141
MC salivary gland neoplasm
Pleomorphic adenoma (benign)
142
Dysphagia w/ solids
Obstructive (peptic strictures, esophageal webs or rings, cancer, radiation/chemical fibrosis)
143
Iron levels + dysphagia
+Iron can cause esophageal strictures | IDA can be part of Plummer-Vinson syndrome w/ esophageal webs
144
Dysphagia w/ solids and liquids
NM (achalasia, motility disorders, scleroderma)
145
Impaired peristalsis, decreased LES relaxation, "bird's beak" on barium swallow
Achalasia
146
"Corckscrew" pattern on barium swallow
Diffuse esophageal spasm
147
Esophageal diverticula locations
Zenker (just above UES) Traction (midpoint) Epiphrenic (just above LES)
148
MC esophageal cancers
``` Squamous cell (worldwide) Adenocarcinoma (US) ```
149
Risk of ischemia/incarceration of stomach in hernia?
Paraesophageal hiatal hernia
150
Type A gastritis
10%, fundus Autoantibodies for parietal cells Assoc w/ pernicious anemia, thyroiditis
151
Type B gastritis
90%, antrum H. pylori infection Assoc w/ PUD, gastric cancer
152
Pernicious anemia
Autoantibodies destroy parietal cells Decreased intrinsic factor Vitamin B12 malabsorption -> megaloblastic anemia (or loss of terminal ileum -> B12 malabsorption)
153
Next step for refractory PUD
Think Zollinger-Ellison syndrome Serum gastrin level Secretin-stimulation test
154
PUD, Gastric ulcer
Age >50, H. pylori, NSAID use, 25% Soon after eating, normal/low gastric acid, high gastrin Eating may worsen symptoms, cause N/V
155
PUD, Duodenal ulcer
Younger age, H. pylori (almost all), 75% 2-4 hrs after eating, high gastric acid, normal gastrin Eating temporarily improves symptoms, worsen later
156
PUD workup in different patients
40, previous ulcer need EGD w/ biopsy to r/o cancer
157
Virchow node
L supraclavicular LN | Gastric cancer
158
Sister Mary Joseph node
Periumbilical node Gastric cancer Some GYN cancers
159
Krukenberg tumor
Metastasis to ovary from GI/breast cancers

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