First Uworld Assessment Flashcards
What is the greatest risk related to parenteral nutrition?
Central line-associated bloodstream infection
Cholestasis is common in patients receiving parenteral nutrition and may increase the risk of cholelithiasis. However, cholestasis is typically not seen until patients have been on it for how long?
> 2 weeks
Lesions with this progress very rapidly from a small erythematous macule to larger, nontender nodules with necrosis?
-What is the common organism?
- Ecthyma gangrenosum . . . seen in immunocompromised
- Pseudomonas
Pulsus paradoxus is a typical feature of pericardial tamponade and is defined as a large decrease in systolic blood pressure on inspiration . . It is demonstrated by what physical exam finding?
Loss of a palpable radial pulse during inspiration
HSV encephalitis shows CT, MRI, and EEG abnormalities in what part of the brain?
Frontotemporal region
PROTRACTION of labor is cervical change slower than expected +/- inadequate contrations and is treated how?
Oxytocin
ARREST of labor is no cervical change for 4 hours WITH adequate contractions OR no cervical change for 6 hours WITHOUT adequate contraction . . what is treatment
C section
Tuberculous effusion are exudative effusions characterized by what values of thoracentesis
- Very high protein levels (always >4 g/dL)
- Lymphocytic leukocytosis
- Low glucose levels (< 60)
Patients with Superior vena cava syndrome often have headaches described as what?
-Worse when leaning forward due to decreased gravitational effects on the blood column
Patient with evidence of cirrhosis and has findings concerning for SBP like fever, ascites, diffuse abdominal pain, tachycardia, and mental status changes . . what is the mechanism of how this happened
enteric bacteria are thought to translocated across the intestinal wall and seed ascitic fluid in the peritoneal cavity
Prenatal vitamins typically have the recommended amount of folic acid to minimize the risk of neural tube defects in average risk patients (.4 mg/ daily). Who are the high risk patients who require addition folic acid supplementation (4 mg daily)
- Neural tube defect in prior pregnancy
- on anti-epileptic meds
poorly controlled diabetes during FIRST trimester of pregnancy increases risk for what things?
- Congenital heart disease
- Neural tube defects
- Small left colon syndrome
- Spontaneous abortion
Lab findings in SLE
- Hemolytic anemia, thrombocytopenia, and leukopenia
- Hypocomplementemia (C3 and C4)
- Antibodies: ANA and Anti-dsDNA and anti-Sm
- Renal: Proteinuria and elevated creatinine
Roux-en-Y gastric bypass is a significant risk factor for symptomatic gallstones due to what?
the rapid weight loss that promotes their formation
An elevated phosphate level and a low calcium level in the setting of chronic kidney disease are characteristic of what?
- Secondary hyperparathyroidism
- the resulting elevation in parathyroid hormone can cause renal osteodystrophy with associated bone pain
What color can diarrhea be due to iron toxicity
green due to presence of disintegrated iron tablets
New onset seizures are a common presentation of brain tumors, the most common of which in adults are astrocytomas. The prognosis of astrocytomas is most affected by what?
tumor grade, with increased atypia, mitoses, neovascularity, or necrosis conveying a worse prognosis
Rituximab is a common first-line therapy for CLL and it attacks what
it is a monoclonal antibody against the CD20 antigen expressed on B lymphocytes
this is the most common type of ovarian cancer in postmenopausal women. Symptoms are often vague and include pelvic and abdominal discomfort as well as urinary symptoms. Pleural effusion and rectovaginal nodularity are signs of metastatic spread
Epithelial ovarian carcinoma
What type of cholestatis does ursodeoxycholic acid help in?
INTRAhepatic
Advanced pancreatic cancer can cause jaundice and pruritis by obstructing the common bile duct (extrahepatic cholestasis). Treatment is usually palliative with what?
endoscopic common bile duct stent replacement to relieve the obstruction
- constitutional symptoms
- Normocytic anemia
- Renal insufficiency
- Hypercalcemia
Multiple myeloma
Renal insufficiency is a common complication of MM. What is most often the cause?
Light chain cast nephropathy with resultant tubular injury
this is a potential complication of a thoracentesis and it should be suspected in patients who develop a rapid reaccmulation of pleural effusion, difficulty breathing, and hemodynamic instability shortly after the thoracentesis is performed
Hemothorax
This is typically diagnosed in children age < 7 who have a wide array of seizure types accompanied by mental retardation
Lennox-Gastaut syndrome
Malabsorption can cause steatorrhea, and what is the most sensitive initial test for malabsorptive syndromes and why?
Because fat has the most complex digestive requirements of all macronutrients, assay of the stool for fat is most sensitive
What accentuateds the decrescendo diastolic murmur of Aortic regurg and why?
Sitting up and leaning forward while holding his breath in full expiration (bringing the aortic valve closer to the stethoscope
Spinal epidural abscess most commonly arises with concurrent distant infection (eg, skin/soft tissue), injection drug use, or spinal procedure. The classic triad of symptoms is fever, back pain, and neurologic manifestations. Treatment requires what?
broad-spectrum antibiotics (eg, vanc + ceftriaxone) and aspiration or surgical decompression
Cause of ulcer in patient with possible granulomatosis with polyangiitis?
necrotizing vasculitis
Almost all patients with Myelodysplastic syndrome have normocytic or macrocytic anemia with insufficient reticulocytosis. Leukopenia with immature granulocytes and thrombocytopenia are also common. Peripheral blood smear is notable for what?
dysplastic erythrocytes (eg, ovalomacrocytosis) and granulocytes (HYPOsegmentation, hypogranulation)
Peripheral blood smear in B12 deficiency anemia
HYPERsegmented neutrophils
Gene involved in MEN2
RET
This involves a pervasive pattern of impulsivity, mood instability, and an unstable sense of self. Associated characteristics include fear of abandonment and unstable, chaotic relationships. Transient paranoia and psychosis may occur and last minutes to hours; these have been termed “micropsychotic episodes”
Borderline personality disorder
Patient has clsssic symptoms of hypothyroidism. Depressed mood is also a common finding. In severre cases, patients may become paranoid and experience hallucinations (ie, psychosis); this is sometimes referred to as what?
Myxedema madness
Tear-drop shaped RBCs can be seen in what disorders?
Myelofibrosis or beta thalassemia (especially after splenectomy)
Smudge cells are the pathognomonic finding on peripheral blood smear in CLL . . . what are these?
fragile but mature lymphocytes
This HIV medication is known to cause neuropsychiatric side effects; these include insomnia with vivid dreams, depression, and anxiety that can occur shortly after initiating treatment
Efavirenz, a non-nucleoside reverse transcriptase inhibitor
Treatment of Urge incontinence
- Bladder training is first line
- If symptoms do not improve, antimuscarinic therapy (eg, oxybutynin) is prescribed
Patients may have blunt chest trauma-related injury to the great vessels while remaining hemodynamically stable with few chest-related complaints. The finding of a widened mediastinum on chest x-ray requires further work-up with what?
transESOPHAGEAL echo or CT scan
Patient has a number of features suggesting hyperthyroidism including weight loss, palpitations, HTN, menstrual irregularities, onycholysis, and lid lad. Mild hypercalcemia is also common due to increased bone turnover . . Describe what onycholysis and lid lag are?
- Onycholysis: separation of the nail from the nail bed
- Lid lag: sclera is seen above the iris on downward gaze
Describe the BP, thermoregulation, and bowel sounds in opioid intoxication?
- HYPOtension
- HYPOthermia
- decreased bowel sounds
Coadministration of a triptan and an ergot derivative or an additional triptan after a first dose may result in what?
prolonged vasospasm due to overactivation of serotonin receptors, which can lead to severe elevations in BP, MI, or stroke
Patient has urethritis (dysuria) and sterile pyuria . .what is sterile pyuria?
urine specimen has WBCs (eg, >3/hpf) in the absence of bacteriuria
What is the most common cause of sterile pyuria with associated urethritis in a sexually active patient with non-monogamous sexual contacts
Chlamydia . . . ascending to PID . . . . Scarring . . . infertility and ectopic pregnancy
Certain beta-blockers have been shown to improve symptoms and overall long-term survival in stable patients with heart failure and left ventricular systolic dysfunction (LV ejection fraction < 40%) . . which beta blocks?
- Metoprolol succinate
- Carvedilol
- Bisoprolol
First line tocolytic in pregnancy < 32 weeks?
Indomethacin
First line tocolytic 32-34 weeks?
Nifedipine
What are the maternal side effects when using Nifedipine as tocolytic?
- Tachycardia/palpitations
- Nausea
- Flushing
- Headache
Terbutaline is a short term tocolytic used for inpatient purposes . . what is its mechanism of action
Beta agonist
The single most effective intervention for slowing the progression of diabetic nephropathy is what?
tight blood pressure control
What is the most common cause of hemoptysis in the pediatric population
CF with associated bronchiectasis
