UWSA 2 Mastery Program: Step-by-Step Score
Optimization
COPD and HF pt comes in with CHF exacerbation; you diurese him, but over the next few days
his renal function declines; BUN 52, Cr 2.1; what is cause? ✔✔prerenal azotemia....
can prerenal azotemia occur despite normal BP? ✔✔yes his bp was 110/70
what is urine sediment like in prerenal azotemia? ✔✔"unremarkable" and "bland"
what does flat neck veins suggest? ✔✔intravascular volume depletion
what should you always check with renal function questions? ✔✔BUN/Cr ratio
drugs commonly causing prerenal failure? ✔✔NSAIDs
you chose hepatorenal syndrome as the cause here cause he had ascites; COPD and RHF d/t
pulm htn was more likely ✔✔
what do you do if a colleague is impaired from old age or drugs and not prescribing the right
meds? ✔✔report them
who do you report colleagues to? ✔✔physican health programs (PHP)
when would you report someone to the stage licencing board? ✔✔PHP doesnt exist
,you chose ask the colleague to get a work up; wrong answer cause you already asked and it may
be confrontational ✔✔
pt got hit with a baseball in the groin; 2 months later he has a nodule IN the testes that does not
transluminate; what is the dx? ✔✔test cancer
Physical exam and lab findings are the most important pieces of infromation ✔✔
most common testicular tumor? ✔✔germ cell tumor (seminoma)
is test tumor painful? ✔✔no
how is a test tumor first found usually? ✔✔following a groin injury or during sex
do most germ cell tumors require chemo? ✔✔yes
person comes in with long standing HTN; has posturing of the left arm and leg; wide dilated
pupil on the right; what is the dx? ✔✔basal ganglia hemorrhage causing uncal herniation
what does an uncal hernitation cause? ✔✔3 CN palsy ipsilaterally
CL extensory posutring
coma
resp depression
which side does uncal herniation cause extensor posturing? ✔✔CL (due to midbrain
compression)
,are extensor posturing seen in cerebellar tosilar herniation? ✔✔no
what is a sign of cerebellar tonsilar herniation? ✔✔neck tilt
flaccid paralysis
respiratory arrest
(no pupillary issues)
lady with mitral valve replacement comes in with SOB for 4 days; also has bibasilar cracks; INR is
1.5; what is dx? ✔✔PVT
what is a risk for prosthetic valves? ✔✔prosthetic valve thromosis (PVT)
is PVT more common with mitral or aortic valves? ✔✔mitral
do all prosthetic valves need aspirin? ✔✔yes
what is target INR on warfarin for aortic mechanical valve? ✔✔2-3
what is target INR on warfaarin for mitral mechanical valve? ✔✔2.5-3.5
what is the presentation of PVT on the mitral valve like? ✔✔mitral stenossi
how to dx PVT? ✔✔echo
, treatment for large valve thrombosis? ✔✔replacement
treatment for severe heart failure from PVT? ✔✔replacement
mild PVT treatment? ✔✔anticoag
can PVT present anywhere from mild sxs to full on heart failure? ✔✔yes
can PVT throw systemic clots too? ✔✔yes
does crackle support the dx of a PE? ✔✔no
how do PVT present? ✔✔heart failure
cancer patient has 3 SIGECAPS sxs including doesn't want her kids to see her like she is,
suggesting shes giving up; what is the next step? ✔✔assess for suicide
sxs that can be used to reliably dx cancer pt MDD? ✔✔anhedonia
worthlessness
guilt
loss of self esteem
SI
you chose reduce her pain meds to cut back fatigue; but this was wrong as assessing for
depression is more important cause it can improve quality of life ✔✔
Optimization
COPD and HF pt comes in with CHF exacerbation; you diurese him, but over the next few days
his renal function declines; BUN 52, Cr 2.1; what is cause? ✔✔prerenal azotemia....
can prerenal azotemia occur despite normal BP? ✔✔yes his bp was 110/70
what is urine sediment like in prerenal azotemia? ✔✔"unremarkable" and "bland"
what does flat neck veins suggest? ✔✔intravascular volume depletion
what should you always check with renal function questions? ✔✔BUN/Cr ratio
drugs commonly causing prerenal failure? ✔✔NSAIDs
you chose hepatorenal syndrome as the cause here cause he had ascites; COPD and RHF d/t
pulm htn was more likely ✔✔
what do you do if a colleague is impaired from old age or drugs and not prescribing the right
meds? ✔✔report them
who do you report colleagues to? ✔✔physican health programs (PHP)
when would you report someone to the stage licencing board? ✔✔PHP doesnt exist
,you chose ask the colleague to get a work up; wrong answer cause you already asked and it may
be confrontational ✔✔
pt got hit with a baseball in the groin; 2 months later he has a nodule IN the testes that does not
transluminate; what is the dx? ✔✔test cancer
Physical exam and lab findings are the most important pieces of infromation ✔✔
most common testicular tumor? ✔✔germ cell tumor (seminoma)
is test tumor painful? ✔✔no
how is a test tumor first found usually? ✔✔following a groin injury or during sex
do most germ cell tumors require chemo? ✔✔yes
person comes in with long standing HTN; has posturing of the left arm and leg; wide dilated
pupil on the right; what is the dx? ✔✔basal ganglia hemorrhage causing uncal herniation
what does an uncal hernitation cause? ✔✔3 CN palsy ipsilaterally
CL extensory posutring
coma
resp depression
which side does uncal herniation cause extensor posturing? ✔✔CL (due to midbrain
compression)
,are extensor posturing seen in cerebellar tosilar herniation? ✔✔no
what is a sign of cerebellar tonsilar herniation? ✔✔neck tilt
flaccid paralysis
respiratory arrest
(no pupillary issues)
lady with mitral valve replacement comes in with SOB for 4 days; also has bibasilar cracks; INR is
1.5; what is dx? ✔✔PVT
what is a risk for prosthetic valves? ✔✔prosthetic valve thromosis (PVT)
is PVT more common with mitral or aortic valves? ✔✔mitral
do all prosthetic valves need aspirin? ✔✔yes
what is target INR on warfarin for aortic mechanical valve? ✔✔2-3
what is target INR on warfaarin for mitral mechanical valve? ✔✔2.5-3.5
what is the presentation of PVT on the mitral valve like? ✔✔mitral stenossi
how to dx PVT? ✔✔echo
, treatment for large valve thrombosis? ✔✔replacement
treatment for severe heart failure from PVT? ✔✔replacement
mild PVT treatment? ✔✔anticoag
can PVT present anywhere from mild sxs to full on heart failure? ✔✔yes
can PVT throw systemic clots too? ✔✔yes
does crackle support the dx of a PE? ✔✔no
how do PVT present? ✔✔heart failure
cancer patient has 3 SIGECAPS sxs including doesn't want her kids to see her like she is,
suggesting shes giving up; what is the next step? ✔✔assess for suicide
sxs that can be used to reliably dx cancer pt MDD? ✔✔anhedonia
worthlessness
guilt
loss of self esteem
SI
you chose reduce her pain meds to cut back fatigue; but this was wrong as assessing for
depression is more important cause it can improve quality of life ✔✔
