UWorld Q Bank: Week of 04/30/18

Question 1

What age is typical of stranger anxiety?

Answer 1

6-24 months

Question 2

Most small-bowel obstructions can be managed with conservative treatment: NG tube suction, correction of metabolic derangements, and bowel rest. What are signs that indicate emergent surgical intervention?

Answer 2

Hemodynamic instability, fever, AMS, significant metabolic acidosis

Question 3

Dark urine indicates high levels of ___________ bilirubin.

Answer 3

conjugated

Question 4

Those with Crohn’s are at increased risk of kidney stones due to increased _______________.

Answer 4

absorption of oxalate

Question 5

A young girl presents with axillary hair but no breast buds. How can you distinguish CAH from premature adrenarche?

Answer 5

CAH causes more significant androgen rise and will result in advanced bone age.

Question 6

True or false: membranoproliferative glomerulonephritis is the only glomerulopathy that is increased in those with HBV.

Answer 6

False

Membranous nephropathy – another nephrotic syndrome – is also seen in those with HBV and is actually significantly more common.

Question 7

___________ can be seen in children with recurrent AOM. Look for it if they have ear drainage and hearing loss.

Answer 7

Cholesteatoma

Question 8

What symptom distinguishes heat stroke from heat exhaustion?

Answer 8

AMS

Think of the name: stroke!

Question 9

____________ presents with hexagonal crystals on urine microscopy.

Answer 9

Cystinuria

Question 10

Which non-opioid medication is sometimes used in the treatment of opioid withdrawal?

Answer 10

Alpha-2 agonists (clonidine)

Question 11

Decompensated CHF leads to what effect in the renal vasculature?

Answer 11

Increased RAAS pathway leads to constriction of both the afferent and efferent arterioles, though moreso the efferent.

Question 12

According to UWorld – this is different from what the HAC lecturers told us – the best treatment for chemotherapy-induced nausea is _____________.

Answer 12

Zofran

Question 13

Which lab value can help distinguish central from peripheral adrenal failure?

Answer 13

Potassium

K is low in primary adrenal failure (like Addison’s or Waterhouse-Friedrichsen) but normal in secondary adrenal insufficiency (like those given high-dose steroids who undergo major stressors like surgery). This is because the RAAS system can operate independently of ACTH.

Question 14

The official time within which oseltamivir must be given is ________________.

Answer 14

within 48 hours of symptom onset

Question 15

Cyanide toxicity –commonly seen in those treated with nitroprusside who also have AKI –can present with lactic acidosis, AMS, and _______________.

Answer 15

seizures

Question 16

Aquagenic pruritis –getting itchy while showering –is a symptom of _______________.

Answer 16

polycythemia vera

Question 17

Don’t forget that diffuse esophageal spasm responds to _____________.

Answer 17

nitrates, another reason why it looks like angina .

Question 18

There are two groups of people with COPD who should be started on long-term oxygen therapy. Give the criteria.

Answer 18

• SpO2 < 88% or PaO2 < 55 mm Hg on RA

* SpO2 < 85% or PaO2 < 59 mm Hg on RA if they have cor pulmonale or Hct > 55%

Question 19

Review the screening guidelines for those with APC mutations.

Answer 19

• Annual sigmoidoscopies starting at age 10-12

* Annual colonoscopies whenever adenomas are detected

Question 20

Carotid endarterectomy should be done in those who meet what criteria?

Answer 20

• TIA or stroke in those with > 70% stenosis

* Asymptomatic with > 80% stenosis

Question 21

This is an important one

Review the criteria for diagnosing gestational diabetes.

Answer 21

•Step 1: 50-gram glucose challenge 24-28 weeks
- Positive if > 140 at 1 hour

•Step 2: 100-gram glucose challenge if step 1 is positive; step two is positive if any two of these four criteria are met.

• Fasting > 95
• 1-hour > 180
• 2-hour > 155
• 3-hour > 140

Question 22

Human placental lactogen is a type of _____________.

Answer 22

somnatomammotropin

Question 23

Those being treated for TB can develop anemia secondary to _____________.

Answer 23

B6 deficiency (needed for heme synthesis)

Question 24

Those with defective CD40 develop which condition?

Answer 24

Hyper-IgM syndrome

The CD40 ligand induces class switching in B lymphocytes.

Remember, it is X-linked.

Question 25

Lymphopenia presents in which of the immunodeficiency disorders?

Answer 25

SCID and Bruton’s

All of the others – hyper-IgM, CVID, IgG subclass deficiency, and IgA deficiency – present with either normal or elevated lymphocytes.

Question 26

A patient presenting with edema, proteinuria, hepatomegaly, and an S4 should make you think of ____________.

Answer 26

amyloidosis

Question 27

In addition to the classic symptoms of fatigue, weakness, hyponatremia, and hyperkalemia, adrenal insufficiency commonly causes ______________.

Answer 27

diarrhea

Question 28

When you see symptoms/signs of adrenal insufficiency, the best workup is _____________.

Answer 28

cortisol level, ACTH level, and cosyntropin stimulation test

Question 29

Ventricular aneurysms can cause what murmurs?

Answer 29

Mitral regurgitation

The dilation of the ventricle can pull open the mitral annulus.

Question 30

A flow-volume loop showing flattening of the expiratory peak (the top part) and the inspiratory peak (the bottom part) indicates ______________.

Answer 30

upper-airway obstruction (such as laryngeal edema)

Question 31

Intense anogenital pruritus with a pale-appearing vulva and anus indicates _____________.

Answer 31

lichen sclerosus

The big difference between this and vulvovaginal atrophy is perianal involvement.

Question 32

How do torus palatinus develop?

Answer 32

They are congenital.

Question 33

Streptococcus viridans is a member of what group of bacteria that are implicated in endocarditis of damaged valves?

Answer 33

Streptococcus sanguinis

Question 34

Describe bullous myringitis.

Answer 34

AOM can uncommonly cause bullae on the tympanic membrane, called bullous myringitis.

Question 35

By definition, serous otitis media presents with absence of _____________.

Answer 35

inflammatory signs (e.g., fever, immobility of the TM)

Question 36

A patient with mania presents one month after hospitalization with transaminitis and a tremor. What is the likely cause?

Answer 36

DILI from valproate

Question 37

When should the flu vaccine be given in pregnancy?

Answer 37

Whenever it is available. It is safe in every trimester of pregnancy and shoiuld always be given.

Question 38

A man comes in with rhinorrhea, cough, and focal crackles on lung exam. His vital signs are all within normal limits. What is the proper next step?

Answer 38

CXR

Question 39

What is the workup of primary amenorrhea?

Answer 39

•US looking for uterus

• If present, then test FSH
• If absent, then karyotype

Question 40

White plaques on the buccal mucosa in a smoker are likely ______________.

Answer 40

leukoplakia, a precancerous lesion

Question 41

All people should start colonoscopy screening at age 50 or __________.

Answer 41

ten years before the age at which any first-degree relatives developed colon cancer

Question 42

HIT rarely causes platelets to drop below ___________.

Answer 42

20,000

Question 43

HIT causes what pattern of clotting?

Answer 43

Arterial and venous

Question 44

What timeline is typical of HIT?

Answer 44

HIT usually starts 5-10 days after administration of heparin, but it can start as early as 1 day.

Question 45

Describe the presentation and treatment of amniotic fluid embolism.

Answer 45

Presentation:

• Cardiogenic shock (hypotension, cold extremities, tachycardia)
• Hypoxemic respiratory failure
• Petechiae
• DIC

Treatment:

• Intubation and mechanical ventilation to maximize respiratory drive
• Hemodynamic support (fluids and possible RBC transfusion)

Question 46

True or false: long-acting opioids have a lower risk of morbidity.

Answer 46

False

They have a higher risk.

Question 47

Heinz bodies are made of _______________.

Answer 47

hemoglobin precipitated due to oxidative stress (when glutathione is not there to take the oxidative damage generated by metabolism)

Question 48

True or false: febrile seizure within one week of giving a vaccine is a contraindication to future doses of that vaccine.

Answer 48

False

Only encephalopathy and anaphylaxis are contraindications to future vaccine.

Question 49

“Careful chewing” is Step 2 code for ____________.

Answer 49

dysphagia

Question 50

Describe the screening protocols for bladder cancer.

Answer 50

No screening is indicated, even in those with multiple risk factors.

Question 51

How often is right-ventricular MI seen in those with inferior MI?

Answer 51

About 50%

Question 52

What kind of fluid should be given to those with DKA?

Answer 52

NS

Question 53

When those with DKA have potassium less than 3.3, you need to hold _____________.

Answer 53

insulin

Question 54

According to UWorld, the proper initial management of Kawasaki’s is _____________.

Answer 54

aspirin and IVIG followed by echocardiography

Question 55

Describe the tools to diagnose aneuploidies.

Answer 55

• The maternal quad screen is done at 9-13 weeks and is a screening.
• The nuchal translucency is done at 15 weeks and is also a screening.
• Chorionic villus sampling is done at 9-13 weeks and can diagnose aneuploidies early.
• Amniocentesis is also able to diagnose aneuploidies and can be done 15-22 weeks.

(Think: chorionic vil1u3 sampling and amn1ocente5is.)

Question 56

Varicella immune globulin should only be given ______________.

Answer 56

to those who are immunocompromised

Question 57

Those with peripheral artery disease are actually more likely to develop _____________ than critical limb ischemia.

Answer 57

myocardial infarction

Question 58

What is the one instance in which parental refusal of medical care can be overruled?

Answer 58

If a parent refuses life-saving therapy for a child, then you must overrule. For instance, if a child needs to be intubated and a parent refuses you must act in the interest of the child.

Question 59

How does pH affect serum calcium?

Answer 59

Alkalosis causes more calcium to bind to albumin. Acidosis causes albumin to release calcium.

This is why hyperventilation causes paresthesias: the drop in pCO2 causes a shift in calcium from the serum to the albumin, thus causing hypocalcemia and hence paresthesia.

Question 60

What are some features of hirsutism that make it more likely to be due to a testosterone-secreting tumor or CAH?

Answer 60

• Rapid-onset (less than 6 months)
• Extreme hirsutism (back hair, coarse facial hair)
• Presence of voice deepening or clitoromegaly

Question 61

How is the Rinne test done?

Answer 61

You place a tuning fork on the mastoid. When the person reports no longer hearing it, you move it to the external auditory meatus. They should be able to hear it. If they can’t, this indicates a conductive hearing loss (as opposed to sensorineural).

Question 62

Otosclerosis commonly presents in ____________.

Answer 62

young people (20s and 30s)

Question 63

Visual problems and inflammatory cells in the anterior chamber after cataract surgery indicate _______________.

Answer 63

post-operative endophthalmitis

Question 64

Describe the diagnosis of HCV.

Answer 64

• First, test for HCV antibody.

* Second, test for HCV RNA. (This is needed to confirm ongoing infection, which would indicate treatment.)

Question 65

How does tension pneumothorax lead to decreased CO?

Answer 65

By occluding the IVC/SVC

This is important: a left-sided tension pneumothorax does not occlude the aorta or LV.

Question 66

Describe the management of PPROM.

Answer 66

• PPROM = preterm premature rupture of membranes (leaking fluid with no labor before 37 weeks)
• No matter the date, any sign of fetal compromise (by FHR or NST) indicates urgent delivery
• 34 - 37 weeks without compromise: antibiotics, steroids, non-urgent delivery
• < 34 weeks without compromise: antibiotics, steroids, observation

Question 67

The triad of Meniere disease: ________________.

Answer 67

tinnitus, vertigo, hearing loss

Question 68

A person with neutropenia, hemoptysis, and nodular opacities in a single lobe of the lung likely has ______________.

Answer 68

invasive aspergillosis (which can present with ground-glass opacities around the nodules)

Question 69

New-onset hirsutism and acne in a pregnant woman with bilateral ovarian masses is likely _____________.

Answer 69

luteomas, a benign tumor presentation of testosterone-secreting ovarian masses that resolves with delivery

Fetal virilization is common.

More commin in AA women.

Question 70

Pain with extension of the knee while pressing down on the patella is indicative of ________________.

Answer 70

patellofemoral pain syndrome

Question 71

Patellofemoral pain syndrome presents with anterior knee pain that worsens with _______________.

Answer 71

climbing stairs

Question 72

Which part of the eye is usually affected in anterior uveitis?

Answer 72

The iris

Look for signs of inflammation of the iris, particularly synechiae (adhesions of the iris that overly the pupil), Koeppe nodules, and peri-iris inflammation.

Question 73

Prolonged contact use can lead to _______________.

Answer 73

keratitis, a bacterial infection of the cornea usually caused by Pseudomonas or Serratia

On exam, look for opacification and ulceration of the cornea with inflammation of the conjunctiva.

Question 74

The diaphragm can rise as high as the ______________ on expiration, so exploratory laparotomy should be considered in any penetrating trauma below this level (especially if the person is hemodynamically unstable).

Answer 74

nipples (4th intercostal space)

Question 75

When you suspect SVC syndrome –based on edema of the upper extremities and head that is worst upon awakening –the best diagnostic is ____________.

Answer 75

CXR

Question 76

What is a biophysical profile? When is it done?

Answer 76

• The biophysical profile is a set of five tests: Heart rate variability, Volume of amniotic fluid, fetal Movement, fetal Tone, and fetal Breaths. (Remember the mnemonic “Help Visualize My Tiny Baby.”)
• The categories are scored 0-2 for a total of 10 possible. ≥ 8 is normal, 6-7 is equivocal, and < 6 indicates delivery.
• It is usually done at 41 weeks to assess post-dates babies. It can be done earlier to assess the fetus if there is any question.

Question 77

Sudden-onset pain with vaginal bleeding and a firm uterus likely indicates _____________.

Answer 77

placental abruption

This could describe placental rupture, but (1) the woman would need to be in labor and (2) she would be extremely hemodynamically unstable.

Question 78

Those with what comorbidity are at increased risk of hypocalcemia in a transfusion?

Answer 78

Liver injury

The liver can rapidly metabolize citrate (the moledule in RBCs that is responsible for hypocalcemia), but if the person has liver dysfunction this clearance is impaired.

Question 79

Septic emboli from tricuspide endocarditis can lead to what pulmonary manifestation?

Answer 79

Scattered cavitary lesions in the lung parenchyma

Question 80

Review the differential for anterior, middle, and posterior mediastinal masses.

Answer 80

• Anterior: thymom, teratoma, terrible lymphoma, and thyroid goier
• Middle: bronchogenic cyst, lymphoma, lymphadenopathy, aortic aneurysm, tracheal tumor
• Posterior: esophageal cancer, neuroblastoma

Question 81

Screening for lead poisoning is usually done with capillary finger pokes. Describe how you interpret a positive result.

Answer 81

Capillary measurements are prone to false positives. If you see a positive capillary result, you need to verify it with a venous draw.

Question 82

Although molluscum contagiosum is common in people with no other problems, ________ testing should be considered if an adult has many MC lesions that are large.

Answer 82

HIV

Question 83

____________ can be used to treat molluscum contagiosum.

Answer 83

Podophyllotoxin

Question 84

MPGN is caused by what antibodies?

Answer 84

IgG against C3 convertase, which activates the complement pathway. This allows for the GBM to stain for C3 but not IG.

Question 85

__________ can present with a single group of vesicles on the hand after a viral prodrome.

Answer 85

HSV

This is herpetic Whitlow from touching genital herpes.

Question 86

I don’t think this is the case in real life, but UWorld says that you can see ____________ on the chest x-ray of someone with tamponade.

Answer 86

enlarged cardiac silhouette

I’ve read sources that say that acute tamponade occurs from as little as 150 mL which will not lead to noticeable cardiac enlargement on CXR.

Question 87

Target PaO2 to a range of ___________ when a person is on a ventilator.

Answer 87

55 - 80 mm Hg (which usually corresponds to an SpO2 of 88% - 95%)

Question 88

The initial HIV illness presents with LAD, pharyngitis, fever, ____________, ____________, and ____________.

Answer 88

arthralgia; GI upset (e.g., diarrhea, vomiting); mucosal ulcerations

Question 89

Which three veins account for > 90% of PEs?

Answer 89

Popliteal, femoral, and iliac

Question 90

Acute _____________ can cause a fourth heart sound.

Answer 90

coronary syndrome

It’s thought that the myocardial dysfunction can lead to the S4 sound.

Question 91

____________ vaccines work by a T-cell-dependent B-cell respone.

____________ vaccines work by an independent B-cell response.

Answer 91

Conjugate protein (IgG PNA vaccine)

Polysaccharide (IgM PNA vaccine)

Question 92

What physical feature can let you know that an ulcer is caused by pressure?

Answer 92

If it is over a bony protuberance: icshial tuberosity, trochanters, heal, metatarsal head, malleoli, etc.

Question 93

___________ is caused by cytokine storage in RBCs before transfusion.

Answer 93

Febrile non-hemolytic reactions

This presents with fever and chills 1-6 hours after transfusion.

Question 94

_____________ is caused by anamnestic antibody responses.

Answer 94

Delyaed hemolytic reaction

This is like the acute hemolytic reaction –which is caused by ABO incompatibility –but it is delayed because the antibodies develop later. Timeline = 2-10 days later.

Question 95

Severe acute hemolytic transfusion reactions can cause ___________.

Answer 95

DIC

Question 96

How do you treat acute hemolytic transfusion reaction?

Answer 96

Cease the transfusion and give fluids.

Question 97

Antibiotics, hospitalization, and ___________ all increase the risk of Clostrioides difficile infection (yes, I’m a tool and I used the new nomenclature).

Answer 97

PPIs

Question 98

True or false: alcoholic hepatitis causes transaminitis in the thousands.

Answer 98

False

Generally, transaminitis is in the hundreds (with the classic AST:ALT >2).

Question 99

A young man presents with fulminant liver failure (evidenced by prolonged PT and hepatic encephalopathy) following an acetaminophen ingestion. What is the proper management?

Answer 99

Contact transplant surgery

Question 100

True or false: post-partum thyroiditis is not antibody-mediated.

Answer 100

False

It is associated with anti-thyroid peroxidase antibodies.

Question 101

Patients with many signs of acute limb ischemia –such as pain, pallor, parethesia, paralysis, pulseless, and poikilothermia –should be managed with ____________.

Answer 101

intravenous heparin

Although there are diagnostic studies that could confirm it (namely, Doppler US), you ought to start heparin first due to the risk of delayed diagnosis.

Question 102

A woman learns that she is pregnant and states that she wants an abortion. Your office does not allow abortions secondary to its religious funding. Do you
a) Ask her why she wants an abortion?
or
b) Give her a list of other offices that provide abortions.

Answer 102

b)

I thought this was a little tricky because in most other question types the “tell me more why you want this procedure” answer is usually correct. UWorld clarifies that this response could be interpreted as trying to persuade the woman not to get an abortion, which is borderline unethical since this would be you imposing your beliefs on her.

Question 103

The best antibiotic for uncomplicated bacterial sinusitis is _______________.

Answer 103

Augmentin

Increasing rates of beta-lactamase production among S. pneumoniae make clavulanic acid necessary.

Question 104

A man presents three days after a CABG with post-operative mediastinits. The proper treatment for this is ________________.

Answer 104

surgical debridement and antibiotics

Question 105

Cyanide poisoning can present with what CNS abnormalities?

Answer 105

Hyperreflexia due to thiocyanate accumulation

Question 106

Which indicates earlier infection, anti-HBVc or anti-HBVe?

Answer 106

Anti-HBVc is earlier

Remember this is the window period.

Anti-HBVe is seen in the recovereeeeeee phase.

Question 107

True or false: anti-HBVe antibody indicates a recovered past infection.

Answer 107

False

This antibody is seen in the recovery phase, but it actualy disappears in a fully recovered infection.

Anti-HBVc indicates a past infection.

Question 108

Why do those with lobar pneumonia become hypoxemic when they lie on their affected side?

Answer 108

More blood is shunted to the dependent side and perfuses areas that are not ventilated.

Question 109

How do you treat magnesium toxicity?

Answer 109

Stop the infusion of Mg (as most cases of hypermagnesemia are iatrogenic) and give calcium.

Question 110

The most common predisposing factor for bacterial sinusitis is ______________.

Answer 110

viral URI

Question 111

What is the nationally accepted guideline for physicians accepting gifts from pharmaceutical companies?

Answer 111

Only small, nonmonetary gifts that directly benefit patients are acceptable (per an AMA statement that is considered standard).

Question 112

“Accentuate peripheral pulses” are seen in which congenital heart defect?

Answer 112

Patent ductus arteriosus

Question 113

Glomerulonephritis, painful fingertip pads, and positive rheumatoid factor are seen in _______________.

Answer 113

infective endocarditis

Question 114

The initial workup of lower-urinary tract obstruction includes urinalysis, urine cytology, BMP, and __________.

Answer 114

renal ultrasound (to look for hydronephrosis)

Question 115

Before treating a man for low testosterone who has low LH/FSH, you need to _____________.

Answer 115

check prolactin levels; if this is normal, then you can treat with testosterone, but you need to rule out a prolactinoma first

Question 116

If a person has lethargy and hyponatremia, you need to give them _______________.

Answer 116

3% hypertonic saline

Lethargy counts as AMS, which indicates rapid correction.

Question 117

Describe the diagnosis and management of penile fracture.

Answer 117

• Penile fracture occurs when the tunica albuginea –which surrounds the corpus cavernosa –ruptures. This leads to an audible pop followed by rapidly spreading hematoma.
• Penile fracture needs to be managed with urgent operation. Because urethral injury can accompany penile fracture, you need to evaluate with a retrograde urethrogram if he has dysuria.

Question 118

How should you treat paroxetine withdrawal?

Answer 118

Paroxetine withdrawal presents with malaise, GI upset, dysphoria, and neurologic symptoms (such as dizziness, tremors, and paresthesia). The best method to treat this is to reinstitute paroxetine and taper more slowly.

Question 119

True or false: anaphylaxis affects the airway mainly through bronchospasm.

Answer 119

False

Laryngeal edema (an upper-airway obstruction) is the most common method of respiratory compromise in anaphylaxis.

Question 120

A rapid spread of monomorphic papules on the shoulders, back, and upper arms might be what kind of drug reaction?

Answer 120

Steroid-induced acne

Systemic steroids can cause acne. The pattern is unique from other types of acne by the monomorphic appearance; non-drug-induced acne typically presents in various stages.

Question 121

The best confirmatory diagnostic for bronchiectasis is ___________.

Answer 121

high-res CT

Question 122

Describe post-cholecystectomy syndrome.

Answer 122

Occurring after a chole, this syndrome presents with pain similar to cholelithiasis. The bile duct should be evaluated for strictures or dilation.