UWorld Assessment 1 Flashcards
Patient’s on parenteral nutrition for >48 hours have an increased risk of developing what?
Central line-associated bloodstream infection
MC d/t coagulase-negative Staph and S. Aureus.
Antifreeze will cause what on ABG? What in urine?
Antifreeze=Ethylene glycol
Increased anion gap metabolic acidosis (low pH, low HCO3, compensated slightly low pCO2)
Calcium oxalate crystals
Reactive NST for > 32 weeks
> /= 2 FHR accelerations that peak at >/= 15 bpm above baseline and lasts >/= 15s
Progressive dyspnea on exertion for 6 months, can’t do ADLs, hx of HTN, 30 pack year hx
BP 130/80, pulse 82, RR 18, SpO2 92%, BMI 34
Lungs bibasilar fine crackles
FEV1 65%
FVC 58%
FEV1/FVC 85%
Dx? Pathophys?
Interstitial Lung Dz, lung stiffening due to fibrosis
Progressive dyspnea, nonproductive cough, fine crackles
Decreased FEV1, FVC, TLC; Normal FEV1/FVC
Restrictive Spirometry
Decreased FEV1, FVC, TLC (<80%)
Normal or increased FEV1/FVC
Obstructive spirometry
Decreased FEV1
Normal FVC
Decreased FEV1/FVC
What type of a molecule is ACTH
Polypeptide hormone
Tx of protracted active phase of labor
Oxytocin
What is protracted active labor in G1P0
<1 cm every 2 hours, inadequate contractions (ideal is 2-3 min)
Light criteria for pleural effusion
Transudate = 0.5 protein pleural/serum AND
= 0.6 LDH pleural/serum AND
Pleural LDH = 2/3 upper limit of normal serum LDH
Exudate >0.5 protein pleural serum OR
>0.6 LDH pleural/serum OR
Pleural LDH > 2/3 upper limit of normal serum LDH
Cause of exudate pleural effusions
Infection: parapneumonic, TB, fungal, empyema
Malignancy
PE
Cause of Transudative pleural effusions
Hypoalbuminemia d/t cirrhosis, nephrotic
CHF
What vaccines do you give adults with HIV
HAV, HBV, HPV, Influenze (inactivated), Meningococcus, Pneumococcus, Tdap
Only give Live is CD4>200
NOT BCG
Headaches worse when leaning forward
JVD
No peripheral edema
Facial and UE swelling
Superior vena cava syndrome
How to prevent aspiration pneumonia
Oral care, diet modification, elevating head of bed
Pathophys of SBP
Intestinal bacterial translocation
Patient has a history of neural tube defects, what is recommended for her next pregnancy?
Folic acid supplementation, 4 mg
Pathophys of tension pneumothorax
Allows air to enter pleural space but can’t escape
Increase intracellular pressure, compress mediastinal structures (SVC)
Impedes venous return to heart
Multiple episodes of unresponsive ness, fumbling hand movements
MCC?
Focal seizure with impaired awareness = Temporal lobe epilepsy
Tx of V tach
Amiodarone
Calcifications within the pancreas
Chronic pancreatitis
Early Complications of Roux-en-Y
Anastomotic leak, bowel ischemia
Late complications of Roux-en-Y
Anastomatic stricture
Marginal ulcer
Cholecystitis
Dumping syndrome
Neurogenic bladder tx
Cholinergic agents, bethanechol
Urge incontinence tx
Muscarinic antagonist and beta agonist
Metabolic acidosis in presence of septic shock, pathophys?
Increased tissue metabolic acid (lactic acid) production
Jaundice, decreased appetite, weight loss, abdominal discomfort, fullness in RUQ
Pancreatic cancer
Best predictor of prognosis in astrocytomas in adults
Degree of Ana plasma
Small hemorrhagic lesions on the retina
What are they? What causes from?
Roth spots
Infectious endocarditis
MCC bactermia in sickle cell disease
Strep pneumoniae, HiB
MCC osteomyelitis in sick cell dz
S. Aureus, salmonella
MCC ovarian cancer
Epithelial ovarian cancer
Large, non painful, unilateral pleural effusion
Cancer history
Rapid weight loss
Dx?
Malignant pleural effusion
Acute pleuritic pain
Signs of infection
Painful effusion
Dx?
Parapneumonic effusion
Septic shock, persistent hypotension after fluids
What do you give?
IV Norepinephrine
What causes renal injury in multiple myeloma?
Renal tubular damage
renal insufficiency leading to intratubular cast formation and toxicity
MC associated inherited syndrome to Autism?
Genetic mutation?
Fragile X syndrome
Tri nucleotide repeat of FMR1 gene
Severe delirium tx
IM haloperidol, low dose
Patient with RA develops septic arthritis, MC organism class?
Not sexually active, immune compromised or old
Gram + bacteria
List the nephrotic syndromes
Focal segmental glomerulosclerosis Membranous nephropathy Mambranoproliferative glomerulonephritis Minimal change disease IgA nephropathy
Neonate with sudden onset, recurrent, forceful bilious vomiting
Upper GI series shows a corkscrew in the mid abdomen
Dx?
Malrotation with volvulus
Corkscrew is due to duodenum
Risk factors for Listeria monocytogenes
Tx?
Pregnant, > 50, immune compromised, chronic glucocorticoids
Ampicillin
Shoulder pain Horner syndrome Neuro S/S in the arm (invasion of C8-T2 nerves) Supraclavicular lymphadenopathy Weight loss
Superior pulmonary sulcus tumor (Pancoast tumor)
R heart cath of septic shock
Decreased SVR
Decreased PCWP
Elevated mixed venous oxygen saturation
Increased cardiac index
Upper respirtoary tract involvement
Lower respiratory tract involvement
Kidney involvement
Cutaneous manifestations
Tx?
Granulomatosis with polyangiitis
Steroids and immunomodulators
Patient who just had chemo now has leukocyte count of 600 and alt mental status
Dx?
Bacterial infection
Pathophys of DKA
Without insulin, fatty acids break down to ketones in th liver, which leaks to acidosis
Rouleaux formation
Multiple myeloma
Pregnant women with high protest probability for PE but low probability V/Q scan, what next?
CTA
Conjunctivitis Rash Asian Strawberry tongue Hands and feet desquamation Fever >/= 5 days
Kawasaki
Causes of reactive thrombocytosis
Recent surgery, infection, malignancy, asplenia
Basically inflammation
Dysuria but UA has WBC of 50+ only
Dx? Cause? Sequela?
Sterile pyruria
Chlamydia trachomatis
PIC and infertility
Tocolytic for <32 weeks
Indomethacin
Tocolytic 32-34 weeks
Nifedipine
Tx of severe hypertriglyceridemia d/t familial dysbetalipoproteinemia
Fenofibrate
Tx Raynaud
CCB
Drank lots of alchohol, had 3 seizures, now dark urine
Dx?
Rhabdomyolysis
Side effect of sotalol
Prolong QT, Torsades de pointes
How to prevent torsades de pointe
Magnesium
