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Flashcards in Associations 3 Deck (159):
1

Physical findings of basilar skull fracture

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

2

Signs of increased ICP

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

3

Neck zone I structures

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

4

Neck zone II structures

Cricoid to angle of mandible
carotid and vertebral arteries, jugular veins; pharynx, larynx, trachea, esophagus; cervical spine and spinal cord

5

Neck zone III structures

Angle of mandible to base of skull
salivary and parotid glands; esophagus, trachea; carotid arteries, jugular veins; cervical spine, major cranial nerves

6

Chest trauma with hyperresonance, decreased breath sounds

Pneumothorax

7

Chest trauma with paradoxical breathing

Flail chest

8

Chest trauma with decreased heart sounds, JVD, pulsus paradoxus

Cardiac tamponade

9

Chest trauma with widened mediastinum, unstable vital signs

Aortic rupture

10

Potentially fatal injuries w/ chest trauma

Aortic rupture
Tension pneumothorax
Hemothorax
Cardiac tamponade

11

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

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

12

Intraperitoneal rupture of bladder

Bladder dome
Usu blunt trauma
Cystoscopy + surgical repair

13

Extraperitoneal rupture of bladder

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

14

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

Graft vs host disease (donor immune cells attack host)
+LFT, decreased Ig, platelets; inflammation and cell death on biopsy of skin/liver

15

Indications for BM transplant

Aplastic anemia
Induction chemotherapy
Leukemia, lymphoma, hematopoietic disorders

16

Indications for heart transplant

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

17

Indications for lung transplant

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

18

Indications for liver transplant

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

19

Indications for renal transplant

ESRD requiring dialysis

20

Indications for pancreas transplant

DM type I w/ renal failure

21

C/I to heart transplant

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

22

C/I to lung transplant

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

23

C/I to hepatic transplant

Alcoholism
Multiple suicide attempts
Liver cancer
Cirrhosis from chronic hepatitis

24

Transplant rejection w/i 24 hr

Hyperacute
Antidonor antibodies in recipient (avoid by crossmatching)

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