UWORLD

Question 1

OSA does what to blood?

Answer 1

decreased O2 = kidney increases EPO = polycythemia (increase in Hct/Hgb)

Question 2

JAK2 mutation

Answer 2

polycythemia vera

Question 3

itching after bathing + facial plethora/ruddy cyanosis + splenomegaly + low EPO

Answer 3

polycythemia vera

Question 4

recurrent nose bleeds + oral lesions + increase Hct

Answer 4

hereditary telangiectasia (Osler Weber Rendt syndrome) occurs with artereiovenous shunting due to AVMs = hypoxia with reactive polycythemia

Question 5

new onset TCP + arterial venous thrombosis + increased in PTT, nml PT

Answer 5

HIT

Question 6

increased MCHC + hemolytic anemia , jaundice, splenomegaly, cholecystitis

Answer 6

hereditary spherocytosis

Question 7

hypercalcemia, normocytic anemia, protein gap > 4 (t pro - alb) + rouleaux/stacking on peripheral smear

Answer 7

multiple myeoloma

Question 8

MCC megaloblastic anemia in alcoholics

Answer 8

folate deficiency

Question 9

chronic abdominal pain + increase ESR + anemia, +watery diarrhea, mouth ulcers

Answer 9

crohns

Question 10

GU compliance of sickle cell

Answer 10

hyposthenuria (impairs ocuntercurrent exchange and free H20 reabsorption = nocuturia

Question 11

effect of lupus anticoagulant of coag numbers

Answer 11

increased PTT in vitro

Question 12

painful joint swelling, decreased ROM, usually in epiphyseal area of long bones…xray shows expansile/eccentric/”soap bubble” lyric area

Answer 12

giant cell tumor of bone (benign and locally aggressive) usually in young adults, treat with surgery

Question 13

MCC of abnormal hemostasis in aptients with chronic renal failure (BT prolonged, but PT/PTT/ and plt count normal)

Answer 13

platelet dysfunction (usually due to uremia)
treat with ddavp

Question 14

hemolytic anemia + thrombocytopenia + venous thromboembolism (intrabdominal/cerebral venous thrombosis) dx, test, treatment

Answer 14

paroxysmal nocturnal hemoglobinuria
dx with cytometery (lack of CD55 and CD59)
treat with immune modulators like eculizimab

Question 15

How to differentiate between CML and leukomoid reaction?

Answer 15

CML will have decreased leukocyte alkaline phosphatase score

Question 16

nonhealing, painless, bleeding/oozing skin ulcer associated with chronic scar

Answer 16

suggests squamous cell carcinoma!!

biopsy that shit then refer for mohs micrographic surgery if high risk/cosmetic

Question 17

how do glucocorticoids cause leukocytosis

Answer 17

mobilization of marginated neutrophils

Question 18

numbness/pain between 3rd/4th toes….clicking sensation

Answer 18

Morton neuroma, treat conservatively

Question 19

compression of tibial nerve at ankle…burning, numbness, and aching of distal plantar surface

Answer 19

tarsal tunnel syndrome

Question 20

pain plantar surface of heel, worse when initiating running or first steps of day

Answer 20

plantar fascitis

Question 21

young female athelete, anterior knee pain, pain reproducible when patella is compressed into trochlear groove)

Answer 21

patellofemoral pain syndrome

rx with activity modification and strengthing/stretching exercises

Question 22

elderly patient, back pain radiating to bilateral thighs, worse with standing and standing still, better with leaning forward (sitting/biking)

Answer 22

lumbar spinal stenosis
rx with physical therapy

not to be confused with disc herniation which will get WORSE with leaning over/biking

Question 23

pregnant g3po lady comes in with positive VRDL negative FTA ABS…what treatment to start

Answer 23

low molecular weight heparin!!! 2 miscarriages concern for APS…can give false negative VRDL

Question 24

side effect of mycophenolate

Answer 24

mmmmmmycophenolate gives bone mmmmmmmarrow suppression

Question 25

signs of cyclosporine toxicity

Answer 25

usually in patient transplant nephrotoxicity, hyperkalemia, hirsuitism, gum enlargement, tremor similar to tacro but tacro doesn't give hirsuitism

Question 26

azothioprine toxicity

Answer 26

dose related diarrhea, luekopenia, hepatotoxicity

Question 27

nasal congestion, rhinorrhea, sneezing, post nasal drip no identifiable triggers/etiology, boggy/erythematous nares...dx and rx

Answer 27

``` nonallergic rhinitis (allergic will usually have trigger/pattern and will have pale/blue nasal mucosa).... treat with intranasal antihistamine or glucocorticoids ```

Question 28

b symptoms, large anterior mediastinal mass, elevated bHcg and AFP

Answer 28

nonseminomatous germ cell tumor

Question 29

tumor, pregnancy, elevated bHCG

Answer 29

choriocarcinoma

Question 30

dry cough, weight loss, pain in right arm, 30 year pack history, lesion in top lobe of lung

Answer 30

superior pulmonary sulcus (pancoast tumor) can involve brachial plexus

Question 31

initial treatment of PE in patient with GFR<30

Answer 31

UNFRACTIONATED HEPARIN then warfarin once INR therapeutic

Question 32

patient treated with radiation for hodgkins lymphoma develops left sided chest pain circle on xray

Answer 32

watch out for new malignancy (common in patients treated with chemo and radiation for hodgkins)....can eb seen in lung, breast, thyroid, bone, and GI

Question 33

patient treated with antibiotic (bactrim) for UTI has resolving of symptoms but now has dark urine that stains Prussian blue

Answer 33

prussian blue = hemosiderin = hemolysis | due to oxidatve stress from bactrim (g6pd)

Question 34

enlarging chronic non healing skin lesion with keratinization and ulceration/crusting/bleeding...patient on immunosuppressive therapy

Answer 34

squamous cell carcinoma!!!

Question 35

depigmented macules on acral areasa/extensorsurfaces...gradual onset

Answer 35

vitiliggo | associated with autoimmune disorders like pernicious anemia, hashimotos