UWORLD ASSESSMENT 4

UWorld Self Assessment 4/4 5.0 (1 review) Students also studied Terms in this set (44) Save Uworld 4 143 terms goodth01Preview UWorld NCLEX-RN TEST 2 100 terms MCATBUDDyPreview

UWORLD ASSESSMENT 4

15 terms LMP122012Preview UWOR 60 terms cg4 Ps - Alcoholic liver disease**alcohol withdrawal - evidenced by SNS overactivity = tachy, HTN, dilated pupils, tremor; all after 1 day of being in hospital w/o access to alcohol; AMS> tx = benzos ----- vs cirrhosis > hepatic encephalopathy > clues: low albumin, elevated INR & Bili M - CLLsmudge cells; LAD; lymphocytosis 90%; elderly; ---- vs -hypersegemnted neutorphils > B12 def / folate def

• aur rods > AML
• heinz bodies > G6PD def

-teardrop - Myelofibrosis; bone marrow; metastatic cancer S - Postop infxn**indurated central venous catheter insertion site + gram positive bactermia = catheter assoc blood stream infection; MCC = coag negative staphylococci ---- vs -post op pneumonia - new or worsening hypoxia, cough, sputum production, new infiltrate on CXR vs - atelectasis - seen in post op fever; but not the cause of the fever M - PE chest pain**dyspnea; tachypnea, hypoxemia; CP -substernal or pleuritic; cough and HEMOPTYSIS; s/s of dvt -common scenario - bus/truck driver ----- focal pleuritic CP w/ hemoptysis is consistent w/ peripheral emboli that cause pulm infarction > release of mediators cause by hypoxia & infarction > bronchoconstriction > wheezing ---- vs - acute pericarditis > no hypoxia; + friction rub on Physical exam

M - Hereditary spherocystosisspherocytes > inc risk of gallstones tx - blood transfusions, folic acid supplementation ---- vs -burr cells - echinocytes - renal dz Ps - Efavirenz**AE - "weird, colorful dreams" NNRTI ----- lamivudine ae = hepatotoxicity abacavir ae = lactic acidosis; hepatitis; hypersensitivity rxn didanosine ae = pancreatitis TMP-SMX ae = gi upset, steven johnson syndrome; neutropenia, allergic rxns M - Urge incontinencefrequent voluntary voiding; voiding schedule (aka overactive bladder) ; 2nd step > anti-musc (antiPS > dont pee) -pelvic floor exercises -alpha antagonists useful in men w/ BPH w/urge incontinence not in women P - HSP-bx of lesions > leukocytoclastic vasculitis (postcapillary venules w/ extensive IgA deposition) recent URI; nonblanching skin rash on b/l LEs (purpura) and Buttocks; --- vs - polyarteritis nodosa bx > necrotizing vasculitis S - AAA**only s/s given: hypotensive; tachycardic; dizzy; weak; back pain; bruit over carotid a.; h/o coronary bypass -pain from ruptured ___ > referred to the back -affected pts have atherosclerosis of other vessels such as coronary and carotids -most are asymptomatic M - OAtx - wt loss, exercise; NSAIDs or acetaminophen 2nd line - intraarticular injections; antimalarials O - Placenta previadx - transabdominal US > blood near cervical os s/s painless bleeding **neither bimanual nor speculum vaginal exam until PP is excluded --- vs - placental abruption - painful bleeding > retroplacental clot S - Widened mediastinumblunt chest trauma > widened mediastinum > next step = TEE (ER in unstable pt) or CT scan (in stable pt); -exploratory thoractomoy in acutely unstable pt w/ shock O - Bartholin gland abscessI&D Ps - Cocaine abuse**best tx = psychotherapy w/ individual and group (NA) therapies -clue that psychotic pt is not shizo pt; nice clothes; SNS s/s ex dilated pupils; HTN; tachycardia

M - Hyperthyroidismsclera seen above iris on downward gaze = proptosis s/s same as pheo but not episodic = wt loss; HTN, palpitations; diaphoresis ---- extra-adrenal pheos > adjacent to aorta > in organ of zuckerlandl P - Kernig signmeningeal irritation Ps - Opiod overdoserespiratory acidosis due to respiratory depression -pinpoint pupils; M - Triptans**coadministration of triptan and ergotamines may result in prolonged vasospasm due to overactivation of 5HT receptors; thus triptans should not be given for at least 24h after ergotamine is given ----

vs these can be safely combined w/ triptans:

-metoclopramide; promethazine; meperidine; diclofenac P - Kawasakitx - IVIG and ASA to dec risk of coronary artery aneurysms ---- vs -Rocky mountin spotted fever tx = doxycycline S - Cataractlens opacification > worse driving at night > avoid bright lights > "glare" -inc risk in DM; and excessive sunlight exposure tx - surgery to replace the lens S - Splenectomy**Most likely cause of thrombocytosis is prior surgery....particularly ___ bc the spleens role is to remove old platelets from the circulation =scenario - blunt trauma > MC injury is spleen -howell jolly bodies = nuclear fragments that can't be removed since spleen is gone O - Chlamydia infxninfertility if untreated 2/2 PID -friable cervix w/ yellow discharge; intracellular > not seen by microscopy w/ gram stain; but will see many neutrophils tx - azithromycin or doxycycline M - Beta-blockers in CHF-digoxin, loop diuretics help w/ symptom conrol in pts w/ CHF; -ACE inhibitors, aldo antags, and Bblockers > decrease mortality ---- vs -clonidine = alpha blocker for tx of HTN not chf -amiodarone =ventricular arrythmas in pt w/ chf -chlorthalidone = thiazide help if loop is not enough in chf -nifedipine - CI in CHF'; will make it worse

M - Amenorrhea**1st step check TSH, T4

• hypothyroid can present with ___; and even galactorrhea; wt gain

--- CT head not helpful in assessing pituitary ---- ovarian failure > high FSH/LH ratio + hot flashes PCOS - hirsutism, acne, obesity M - Carpal tunnel syndrome**in pregancy - volume overload > accumulation of fluid in CT in hypOthyroid- accumulation of matrix substances in CT in amyloidosis - amyloid fibril depoits in CT; MC in setting of ESRD or chronic hemodialysis due to B2microglobulin deposits in RA - tenosynovial inflammation in acromegaly - synovial tendon hyperplasia O - Preterm labor**preterm = 20-37wks gestation; labor = regular painful uterine contractions, bloody vaginal d/c, effaced/dilated cervix -B-agonists like terbutaline, ritodrine > dec myometral contraction and delay labor AE of B1 agonists > tachycardia, inc stroke volume AE of B2 agonists > vasodilation, bronchodilation > palpitations, chest discomfort; tremor; SOB >>>severe= tachypnea, hypoxia, crackles = pulmonary edema (tachycardia > dec diastolic filling time + excess volume of pregnancy > pulmonary venous congestion >> pulmonary edema) M - Central cyanosiscyanosis in lips/ mucous membranes; warm extremities + tachypnea & diaphoresis while breastfeeding = congenital heart dz!-MCC - low arterial oxygen saturation ---- vs - periphral cyanosis - in distal extremities only; MCC increased 02 extraction 2/2 sluggish bld flow; cool clammy extremities vs - sickle cell dz - s/s dont start until later in life (not while breastfeeding) due to protective effects of fetal hemoglobin (HbF) M - Hypertriglyceridemia**palmar xanthomas = primary hypertriglyceridemia - tx = fenofibrate; gemfibrozil; and fibric acid derivative O - Mgmt of preterm labor**all women btw 24-34wks > give corticosteroids betamethasone injection > to enhance fetal lung maturity; effect peaks at 48h after administration ----- vs - cervical cerclage - if advanced cervical dilation in absence of labor and abrubtion; CI if in labor vs - pelvic rest, bed rest, hydration - don't do anything M - Diabetic nephropathyslow progression to diabetic nephropathy by BLOOD PRESSURE CONTROL!!! <

130/80;

-particularly w/ ACEi or ARBs