UWorld Flashcards
When TPN has to be given in central line
TPN risks to know
2
TPN must be given in central line if >48h
central line infection–highest risk
Cholestasis–risk if >2 weeks of TPN. higher risk of cholelithiasis then.
ecthyma gangrenosum
lesion, often foot, of Pseudomonas
progress from small erythematous macule to large, NONTENDER, necrotic nodule
Suspect when immunocompromsed (eg radiation)
pulsus paradoxus
- indicates what
- how to measure bedside without BP cuff
tamponade. inspiration causes increased preload to R side, pushing into L side’s filling
Loss of palpable radial pulse during inspiration
(or >10mmHg lower BP during inspiration)
AFib risk score, nonvalv anticoag
-what scores to give what tx
CHA2DS2VASc score CHF HTN Age >75 DM Stoke/TIA Vascular (PAD, MI, aortic plaque) Age 65-74 Sex (female)
0–none
1–none, aspirin, or oral anticoag
2–oral anticoag
New baby of diabetic mother
-most likely complication after birth?
respiratory distress (RDS from low surfactant from lung immaturity)
also: limb, cardiac issues
ABI values for PAD
- normal
- PAD
- severe ischemia
what can cause possible false elevation
normal: 1.0-1.3
PAD: 0.4-0.9
severe ischemia: <0.4
Diabetics with calcified noncompressible vessels
What if you see hyperCa to 14.0?
If hyperCa >12, then think malignancy, esp PTH-rp of squamous cell of lung
You also see low phosphate
Primary hyperparathyroidism would go up to 12 usu, and not severely sx.
Gastric bypass and RUQ pain
-think what, do what
Higher risk (40% chance) of gallstones soon after surgery/ b/c of concentration of bile
- ppx with Urso acid 6 mo
- or take out gallbladder if sxs before surgery
How does GI bleed cause hepatic encephalopathy?
-how to know by labs?
High nitrogen state. Digested blood is source of urea, and it reabsorbed in intestine during Upper GI Bleed.
You will see elevated BUN/Cr ratio (>20)
Iron toxicity
-how present
Initially N/V/Diarrhea. Upper GI bleed. Hematemesis and melena. Then hypovolemic shock
can occur with 10 tablets only
Knee injuries:
ACL vs meniscus
Meniscal tear: twisting on uneven ground.
- immediate pain, but usu not severe enough to limit mobility
- Effusion on 2nd day, common
- locking, instability sensation, painful squatting, can limit joint extension.
- Tenderness at joint line, and locking/clicking
ACL:
rapid onset hemarthrosis, does not limit joint extension
How to use urine Na for determining dehydration
Decrase urine Na (Urine Na <20) supports hypovolemia in pt
Sickle cell pt in septic shock
-what bug most likely
Strep pneumo (encapsulated) which is why must get pneumococcal vaccine, ad
Who needs abx ppx for dental procedures? (3)
who doesn’t?
high risk: prosthetic heart valves, hx of IE, unreparied congenital heart dz
Give single dose Amox (or azithro)
No ppx for: bicuspid aortic valve, acquired aortic valve dz, acquired mital valve dz (including MVP)
Hookworm (or other worm) infection:
typical vignette to know
Chronic diarrhea, recently came from poor country
Had an unexplained dry cough for a while, resolved
CBC shows eosinophilia (>3%)
Fe deficiency anemia
