UWorld 2

Question 1

Findings in Meniere disease?

Answer 1

Recurrent episodes
Unilateral hearing loss and tinnitus
Feeling of fullness in the ear

Question 2

Findings in BPPV?

Answer 2

Brief episodes triggered by head movement

Dix-Halpike maneuver causes nystagmus

Question 3

Findings in vestibular neuritis?

Answer 3

Acute, single episode that can last for days
Often follows viral syndrome
Abnormal head thrust test

Question 4

Findings of vertigo in migraine?

Answer 4

Vertigo associated with headache or other migrainous phenomena (auras, eg)
Symptoms resolve completely between episodes

Question 5

Findings of vertigo in a brainstem or cerebellar stroke?

Answer 5

Sudden onset, persistent vertigo

Usually other neurologic signs

Question 6

What arteries are affected in fibromuscular dysplasia?

Answer 6

Renal
Internal Carotid
Vertebral, iliac, and mesenteric arteries are less commonly affected.

Question 7

Presentation of dermatitis herpetiformis

Answer 7

Group pruritic vesicles on the buttocks and extensor surfaces. Occurs with autoimmune dermal reaction to dietary gluten. IgA antibodies to epidermal translutaminase

Question 8

Clinical features and treatment of cocaine use?

Answer 8

Sympathetic hyperactivity: tachycardia, hypertension, dilated pupils. Agitation, seizures, chest pain 2/2 coronary vasoconstriction

Benzodiazepines (BP/anxiety), aspirin, Nitroglycerin and CCB for pain. Cardia catheterization if indicated. No fibinolytics, and beta blockers contraindicated

Question 9

Statins are recommended for what populations regardless of other risk factors?

Answer 9

Clinically significant atherosclerotic disease (ACS, MI, Stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, PAD)

Patients age 40-75 with Diabetes

LDL over 190

Estimated 10 year ASCVD ask over 7.5%

Question 10

Malaria prophylaxis?

Answer 10

Mefloquine chemoprophylaxis starting 2 weeks before and extending 4 weeks after returning.
Atovaquone-proguanil and doxycycline may also be used

Question 11

What is electrical alternans?

Answer 11

Variable amplitude QRS complexes that may be seen in pericardial effusion, likely due to heart moving back and forth in pericardial fluid

Question 12

Membranoproliferative glomerulonephritis pathogenesis

Answer 12

Deposition of C3 complexes that result from IgG antibodies to C3 convertase of the alternative complement pathway.

Question 13

Chromium deficiency

Answer 13

Impaired glucose control in diabetics

Question 14

Copper deficiency

Answer 14

Brittle hair
Skin depigmentation
Neurologic dysfunction/ataxia
Sideroblastic anemia
Osteoporosis

Question 15

Selenium deficiency

Answer 15

Thyroid dysfunction
Cardiomyopathy
Immune dysfunction

Question 16

Zinc deficiency

Answer 16

Alopecia
Pustular skin rash
Hypogonadism
Impaired wound healing
Impaired taste
Immune dysfunction

Question 17

Cardiac selective beta blockers?

Answer 17

Metoprolol
Atenolol
Bisoprolol
Nebivolol

Can still trigger asthma when administered in large doses

Question 18

Presentation and Tx of acute adrenal insufficiency?

Answer 18

Hypotension, tachycardia, abdominal pain, vomiting and weakness.

Tx: IVF and dexamethasone

Question 19

Presentation and Tx of thyroid storm?

Answer 19

Fever to 104-106
Tachycardia, hypertension, cognitive heart failure, cardiac arrhythmias
Agitation, delirium, coma, seizures
Goiter, lid lag, tremor, warm and moist skin,
Nausea, vomiting, diarrhea, jaundice

Tx: Beta-blocker, PTU, corticosteroids, ID and treat trigger

Question 20

Clinical associations of focal segmental glomerulonephritis?

Answer 20

African american and hispanics
Obesity
HIV
Heroin use

Question 21

Clinical associations of membranous nephropathy?

Answer 21

Adenocarcinoma (breast, lung)
NSAIDs
Hep B
SLE

Question 22

Clinical associations of membranoproliferative glomerulonephritis?

Answer 22

Hep B
Hep C
Lipodystrophy

Question 23

Clinical associations of minimal change disease?

Answer 23

NSAIDs

Lymphoma

Question 24

Clinical associations of IgA nephropathy?

Answer 24

URI

Question 25

Causes of myopathy?

Answer 25

Connective tissue disease (poly/dermato-myositis, vasculitis) Endocrine/metabolic (hypothyroid, thyrotoxicosis, cushing, e-lyte abnormalities) Drugs/Toxins (corticosteroids, zidovudine, colchicine, alcohol cocaine) Misc (infections, trauma, hyperthermia)

Question 26

Norcardiosis

Answer 26

Gram positive, branching or beaded appearance, partially acid-fast, aerobic. Infects the elderly or immunosuppressed via inhalation or cutaneous penetration (while gardening) TB-like pneumonia, brain abscess, cutaneous involvement TMP-SMX and drainage of abscesses

Question 27

Differentiate viral arthritis 2/2 parvovirus B19 from RA and SLE

Answer 27

Parvovirus may have weakly positive RA factor and ANA antibodies, but is more common than RA or SLE. RA and SLE typically produce a more prominent synovitis and follow a more protracted course, SLE also may show renal involvement. B19 infection causes fevers and a temporary polyarthritis that spontaneously resolves and does not cause renal damage.

Question 28

Furunculosis vs hidradenitis supporativa

Answer 28

A furuncle is a skin abscess commonly caused by Staph aureus, presenting as a painful pustule or nodule typically draining purulent material. HS occurs in intertriginous areas (or any area with hair), due to chronic inflammatory occlusion of the folliculopilosebaceous units preventing keratinocytes from shedding from the epithelium. Typically causes inflamed nodules that may drain supportive fluid.

Question 29

Differentiate Mobitz I from Mobitz II

Answer 29

Mobitz I - Blockage at the AV node, Progressive elongation of PR until there is a dropped beat. Exercise and atropine improve Mobitz I, vagal maneuvers worsen it. Mobitz II - Blockage below the AV node in bundle of His, no change in PR, occasional dropped beat. QRS may be narrow or wide, Exercise or atropine worsens type II block, Vagal maneuver improves type II. Higher risk of complete block, indication for pacemaker placement.

Question 30

Diagnostic requirements for acute liver failure?

Answer 30

Severe acute liver injury (AST, ALT above 1000) Signs of hepatic encephalopathy (confusion, asterixis) Synthetic liver dysfunction (INR above 1.5)

Question 31

Signs of disseminated gonococcal infection?

Answer 31

Polyarthralgia Skin lesions Tenosynovitis Not associated with morning stiffness, oral ulcers, or glomerulonephritis (these point toward SLE).

Question 32

Cryptosporidium vs CMV vs MAC in HIV patients?

Answer 32

Crypto: High volume watery diarrhea, low fever MAC: High Volume watery diarrhea, HIGH fever CMV: Low volume bloody diarrhea, low fever

Question 33

Digitalis toxicity cause what kind of heart abnormality?

Answer 33

Atrial tachycardia with AV block. Increases ectopy in the atria causing more frequent contractions, but not a-fib.

Question 34

Signs of bradyarrhythmia in a syncopal patient?

Answer 34

Prolonged PR and QRS, sinus pauses | Also seen in sick sinus syndrome and AV block

Question 35

Presentation of sarcoidosis?

Answer 35

``` Constitutional symptoms Cough dyspnea and chest pain Extra pulmonary findings - Skin lesions - Anterior/posterior uveitis - Lofgren syndrome ``` Young adults and african americans Non-caseating granulomas that are negative for bacteria and fungi

Question 36

Precipitating factors for hepatic encephalopathy?

Answer 36

``` Drugs (sedatives, narcotics) Hypovolemia (diarrhea) Electrolyte changes (hypokalemia) Inc nitrogen load (BUN, Gi bleeding) Infection (pneumonia, UTI, SBP) Portosystemic shunting (TIPS) ```

Question 37

Clinical presentation and treatment of hepatic encephalopathy?

Answer 37

Sleep pattern changes, altered mental status, asterixis, ataxia Correct precipitating causes (fluids, e-lytes, antibiotics, etc) Decrease blood ammonia concentration (lactulose, rifaximin)

Question 38

Major side effect of fluoroquinolones? risk factors?

Answer 38

Tendinopathy and increased risk of tendon rupture (most commonly achilles, also rotator cuff, hand, biceps, thumb, and others) ``` Age over 60 Female Normal BMI Concurrent oral steroid use Organ transplant ```

Question 39

How does sodium bicarbonate resolve TCA overdose? Aspirin overdose?

Answer 39

TCA: TCAs bind to fast sodium channels in the His-Purkinje system and myocardium. NaHCO increases the concentration of Na to compete for these channels and the HCO3 raises the pH which lowers TCA affinity for the channels. Aspirin: NaHCO alkalinizes the urine, increasing the excretion of aspirin.

Question 40

Lung cancer screening guidelines for smokers?

Answer 40

Annual low-dose chest CT for: Age 55-80 30+ pack year smoking history Currently smoking or quit within past 15 years Sputum cytology does not effectively screen for cancer and does not improve mortality. Don't use it.

Question 41

Causes of acute pancreatitis other than alcohol and gall stones?

Answer 41

Hypertriglyceridemia (1,000+, yellow-red skin papules may represent familial HLD) Drugs (azathioprine, valproic acid, thiazides) Infections (CMV, Legionella, Aspergillus) Iatrogenic (Post-ERCP, ischemic/atheroembolic)

Question 42

Clinical features and testing for chronic autoimmune thyroiditis?

Answer 42

Hashimoto's thyroiditis Predominant hypothyroid features Diffuse goiter Tests: TPO antibody positive, variable radioiodine uptake

Question 43

Clinical features and testing for painless thyroiditis?

Answer 43

``` Silent thyroiditis (Variant of chronic autoimmune thyroiditis) Mild, brief hyperthyroid phase, Small, non-tender goiter, spontaneous recovery ``` Postive TPO antibody, Low radio iodine uptake

Question 44

Clinical features and testing for subacute thyroiditis?

Answer 44

DeQuervain's Thyroiditis Likely post-viral inflammatory process, Prominent fever and hyperthyroid symptoms, Painful, tender goiter (think deQuervains tendonitis) Elevated ESR and CRP (inflammatory), low radio-iodine uptake

Question 45

Antidote for organophosphate poisoning?

Answer 45

Atropine - competes with acetylcholine at muscarinic receptors and blocks its effect OP block ACh-esterase overload and the NMJ with ACh. Physostigmine is an acetylcholinesterase inhibitor and worsens this condition.