UWorld Assessment 1

Question 1

Patient’s on parenteral nutrition for >48 hours have an increased risk of developing what?

Answer 1

Central line-associated bloodstream infection

MC d/t coagulase-negative Staph and S. Aureus.

Question 2

Antifreeze will cause what on ABG? What in urine?

Answer 2

Antifreeze=Ethylene glycol

Increased anion gap metabolic acidosis (low pH, low HCO3, compensated slightly low pCO2)

Calcium oxalate crystals

Question 3

Reactive NST for > 32 weeks

Answer 3

> /= 2 FHR accelerations that peak at >/= 15 bpm above baseline and lasts >/= 15s

Question 4

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?

Answer 4

Interstitial Lung Dz, lung stiffening due to fibrosis

Progressive dyspnea, nonproductive cough, fine crackles

Decreased FEV1, FVC, TLC; Normal FEV1/FVC

Question 5

Restrictive Spirometry

Answer 5

Decreased FEV1, FVC, TLC (<80%)

Normal or increased FEV1/FVC

Question 6

Obstructive spirometry

Answer 6

Decreased FEV1
Normal FVC
Decreased FEV1/FVC

Question 7

What type of a molecule is ACTH

Answer 7

Polypeptide hormone

Question 8

Tx of protracted active phase of labor

Answer 8

Oxytocin

Question 9

What is protracted active labor in G1P0

Answer 9

<1 cm every 2 hours, inadequate contractions (ideal is 2-3 min)

Question 10

Light criteria for pleural effusion

Answer 10

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

Question 11

Cause of exudate pleural effusions

Answer 11

Infection: parapneumonic, TB, fungal, empyema
Malignancy
PE

Question 12

Cause of Transudative pleural effusions

Answer 12

Hypoalbuminemia d/t cirrhosis, nephrotic

CHF

Question 13

What vaccines do you give adults with HIV

Answer 13

HAV, HBV, HPV, Influenze (inactivated), Meningococcus, Pneumococcus, Tdap

Only give Live is CD4>200

NOT BCG

Question 14

Headaches worse when leaning forward
JVD
No peripheral edema
Facial and UE swelling

Answer 14

Superior vena cava syndrome

Question 15

How to prevent aspiration pneumonia

Answer 15

Oral care, diet modification, elevating head of bed

Question 16

Pathophys of SBP

Answer 16

Intestinal bacterial translocation

Question 17

Patient has a history of neural tube defects, what is recommended for her next pregnancy?

Answer 17

Folic acid supplementation, 4 mg

Question 18

Pathophys of tension pneumothorax

Answer 18

Allows air to enter pleural space but can’t escape
Increase intracellular pressure, compress mediastinal structures (SVC)
Impedes venous return to heart

Question 19

Multiple episodes of unresponsive ness, fumbling hand movements

MCC?

Answer 19

Focal seizure with impaired awareness = Temporal lobe epilepsy

Question 20

Tx of V tach

Answer 20

Amiodarone

Question 21

Calcifications within the pancreas

Answer 21

Chronic pancreatitis

Question 22

Early Complications of Roux-en-Y

Answer 22

Anastomotic leak, bowel ischemia

Question 23

Late complications of Roux-en-Y

Answer 23

Anastomatic stricture
Marginal ulcer
Cholecystitis
Dumping syndrome

Question 24

Neurogenic bladder tx

Answer 24

Cholinergic agents, bethanechol

Question 25

Urge incontinence tx

Answer 25

Muscarinic antagonist and beta agonist

Question 26

Metabolic acidosis in presence of septic shock, pathophys?

Answer 26

Increased tissue metabolic acid (lactic acid) production

Question 27

Jaundice, decreased appetite, weight loss, abdominal discomfort, fullness in RUQ

Answer 27

Pancreatic cancer

Question 28

Best predictor of prognosis in astrocytomas in adults

Answer 28

Degree of Ana plasma

Question 29

Small hemorrhagic lesions on the retina What are they? What causes from?

Answer 29

Roth spots Infectious endocarditis

Question 30

MCC bactermia in sickle cell disease

Answer 30

Strep pneumoniae, HiB

Question 31

MCC osteomyelitis in sick cell dz

Answer 31

S. Aureus, salmonella

Question 32

MCC ovarian cancer

Answer 32

Epithelial ovarian cancer

Question 33

Large, non painful, unilateral pleural effusion Cancer history Rapid weight loss Dx?

Answer 33

Malignant pleural effusion

Question 34

Acute pleuritic pain Signs of infection Painful effusion Dx?

Answer 34

Parapneumonic effusion

Question 35

Septic shock, persistent hypotension after fluids What do you give?

Answer 35

IV Norepinephrine

Question 36

What causes renal injury in multiple myeloma?

Answer 36

Renal tubular damage renal insufficiency leading to intratubular cast formation and toxicity

Question 37

MC associated inherited syndrome to Autism? Genetic mutation?

Answer 37

Fragile X syndrome Tri nucleotide repeat of FMR1 gene

Question 38

Severe delirium tx

Answer 38

IM haloperidol, low dose

Question 39

Patient with RA develops septic arthritis, MC organism class? Not sexually active, immune compromised or old

Answer 39

Gram + bacteria

Question 40

List the nephrotic syndromes

Answer 40

``` Focal segmental glomerulosclerosis Membranous nephropathy Mambranoproliferative glomerulonephritis Minimal change disease IgA nephropathy ```

Question 41

Neonate with sudden onset, recurrent, forceful bilious vomiting Upper GI series shows a corkscrew in the mid abdomen Dx?

Answer 41

Malrotation with volvulus Corkscrew is due to duodenum

Question 42

Risk factors for Listeria monocytogenes Tx?

Answer 42

Pregnant, > 50, immune compromised, chronic glucocorticoids Ampicillin

Question 43

``` Shoulder pain Horner syndrome Neuro S/S in the arm (invasion of C8-T2 nerves) Supraclavicular lymphadenopathy Weight loss ```

Answer 43

Superior pulmonary sulcus tumor (Pancoast tumor)

Question 44

R heart cath of septic shock

Answer 44

Decreased SVR Decreased PCWP Elevated mixed venous oxygen saturation Increased cardiac index

Question 45

Upper respirtoary tract involvement Lower respiratory tract involvement Kidney involvement Cutaneous manifestations Tx?

Answer 45

Granulomatosis with polyangiitis Steroids and immunomodulators

Question 46

Patient who just had chemo now has leukocyte count of 600 and alt mental status Dx?

Answer 46

Bacterial infection

Question 47

Pathophys of DKA

Answer 47

Without insulin, fatty acids break down to ketones in th liver, which leaks to acidosis

Question 48

Rouleaux formation

Answer 48

Multiple myeloma

Question 49

Pregnant women with high protest probability for PE but low probability V/Q scan, what next?

Answer 49

CTA

Question 50

``` Conjunctivitis Rash Asian Strawberry tongue Hands and feet desquamation Fever >/= 5 days ```

Answer 50

Kawasaki

Question 51

Causes of reactive thrombocytosis

Answer 51

Recent surgery, infection, malignancy, asplenia Basically inflammation

Question 52

Dysuria but UA has WBC of 50+ only Dx? Cause? Sequela?

Answer 52

Sterile pyruria Chlamydia trachomatis PIC and infertility

Question 53

Tocolytic for <32 weeks

Answer 53

Indomethacin

Question 54

Tocolytic 32-34 weeks

Answer 54

Nifedipine

Question 55

Tx of severe hypertriglyceridemia d/t familial dysbetalipoproteinemia

Answer 55

Fenofibrate

Question 56

Tx Raynaud

Answer 56

CCB

Question 57

Drank lots of alchohol, had 3 seizures, now dark urine Dx?

Answer 57

Rhabdomyolysis

Question 58

Side effect of sotalol

Answer 58

Prolong QT, Torsades de pointes

Question 59

How to prevent torsades de pointe

Answer 59

Magnesium