UWorld form 1

Question 1

when do you do amnioinfusion

Answer 1

Cord Compression –> repetitive variables

Question 2

painless ulcer with black necrotic center in immunocomp patient

Answer 2

ecythma gangrenosum= pseudomonas

Question 3

in brief, CSF in HSV meningitis

Answer 3

lymphocytic pleocytosis, inc protein, nl gluc

inc red cells= from hemorrheage of frontotemporal lobes

Question 4

why do you get hyperpigmentation with AI and ectopic ACTH

Answer 4

because POMC gets cleaved to ACTH –> both have high ACTH

Question 5

features of hypercortisolism

Answer 5

high BP, purple straie, easy bruising, easy fatiguability

**most common paraneoplastic in Small cell lung cancer!!

Question 6

when do you consider a pt in labor “arrest” and move to section

Answer 6

no cervical change >4 hours WITH good contractions

no cervical change >6 hours with bad contractions

Question 7

most common reason for “protracted” labor

Answer 7

inadequate contractions, give IV oxy

Question 8

TB pleural effusion vs empyema

Answer 8

TB= very high protein (>4), Glucose <60, lymphocytic predom

Empyema= very low glucose <30, neutrophils, FEVER!!

Question 9

headache worse with leaning forward, some JVD, but no peripheral edema….

Answer 9

SVC syndrome, most commonly due to malignancy

Question 10

SBP

Answer 10

enteric bacteria from gut translocates and causes infection. Present with fever, abd pain, ascities,

• empirics= cephalosporin
• proph= FQ

Question 11

age demographic and prodrome to bullous pempHigoid

Answer 11

elderly, presents with urticarial/eczematous prodrome

Question 12

classic ALS

Answer 12

UMN + LMN (fasciulations/ atrophy are signs of denervation)

Question 13

three biggest risks of ALL types of diabetic mothers

Answer 13

macrosomia
RDS
premature delivery

Question 14

“serositis” in SLE

Answer 14

pleurisy
pericarditis –> effusion
peritonitis

(**migratory joint pains)

Question 15

drug of choice in monomorphic Vtach (stable)

Answer 15

AMIODORONE

Question 16

thin, shiny skin in a person with CVD is ALWAYS:

Answer 16

PAD –> evaluate with ABI

Question 17

most common cause of primary hyperaldosteronism (2)

Answer 17

bilateral adrenal hyperplasa –> tx with SPIRONOLACTNE

aldo producing adenoma –> adrenalectomy

Question 18

hypercalcemia in primary PTH vs malignancy

Answer 18

much higher in malignancy

<12 in PTH

Hyperthyroidism can also cause hypercalcemia from increased bone turnover

Question 19

overflow incont classic presentation

Answer 19

urinary freq, NOCTURIA, frequent dribbling

high post void residual

• men >50
• women >150

Question 20

how do you treat incontinence:

• stress
• urge
• overflow

Answer 20

stress= kegels, pessary, urethral sling procedure, pelvic floor surgery

urge= bladder training, antimuscarinics

overflow= cholinergics (bethanecol), intermittent self cath (neurogenic bladder)

Question 21

BUN:Cr that suggests hepatic encephalopathy is due to GI bleed

Answer 21

> 20:1

Question 22

differentiate galbladder mass from pancreatic

Answer 22

Pancreatic has jaundice and elevated alk phos/bili because it is OBSTRUCTING the gb

GB cancer is (much more rare) but also would still be able to produce bile and it wouldn’t show obstructive signs

Question 23

signs of acute iron toxicity

Answer 23

• hemmoragic gastroenteriris (caustic to GI tract)
• dark stools, can be green

deFEroxamine!!

Question 24

t/f: chronic ESRD can reactivate TB?

Answer 24

true

Question 25

reactivation TB vs primary TB

Answer 25

presents with fever, COUGH, NIGHT SWEATS, HEMOPTYSIS, weight loss, fatigue and EFFECTS UPPER LOBES PRIMARILY primary TB is usually mild, often turns latent, and is in LOWER/MIDDLE LOBE

Question 26

miliary TB

Answer 26

systemic spread of dz --> effects bone, liver, lymphatics mostly, but can really go anwhere

Question 27

three types of infx that TB can decide to do

Answer 27

1. parimary/latent --> heal by fibrosis, mostly in kids 2. miliary 3. reactivation

Question 28

potts deisease

Answer 28

when TB effects the bones

Question 29

prognostic factor of astrocytoma

Answer 29

differentiation!! Most common brain tumor in adults I/II lack central necrosis and increased mitosis GBM= grade Iv

Question 30

infections in sickle cell dz

Answer 30

ENCAPSULATED ORGS - sepsis/meningitis/bacteremia= strep pneumo, h flu - osteomyelitis= salmonella, (staph too)

Question 31

dysgerminoma/seminoma

Answer 31

adolescents | -secrete bHCG and LDH

Question 32

granulosa cell tumor: young girl vs postmenopausal women

Answer 32

sx are bsed on high estrogen expression, so precocious puberty or endometrial bleeding

Question 33

c diff

Answer 33

don't forget about c diff with recent antibiotic use!! don't forget it can turn into toxic megacolon

Question 34

AHIA like looking picture but add decreased fibrinogen and increased INR...

Answer 34

DIC

Question 35

pain with relief of teste elevation suggests...

Answer 35

epididymitis --> treat with antibiotics

Question 36

absent cremasteric reflex suggest....

Answer 36

testicular torsion of spermatic cord (pampiniform plexus)

Question 37

JME

Answer 37

progression from absence --> myoclonus --> GTC (in teens) worse with sleep deprivation

Question 38

what features typlica of ACTH dependeant process are NOT typical of ACTH independant process (exogenous steroids, adrenal adenoma)

Answer 38

hyperpigmentation androgen xs

Question 39

best way to relieve PAIN of ACS

Answer 39

nitrates: venous dilation --> decreased preload/RV volume/wall stress--> decreased O2 demand

Question 40

gout treatment

Answer 40

1st line= lifestyle 1st line acute= NSAIDs ( indomethacin) --> next: steroids or colchicine if RENAL contraindications for NSAIDs Chronic= allopurinol for >2 attack/ year but DO NOT start right away

Question 41

celiac is what type of disorder?

Answer 41

AI malabsorption due to villous atrophy ***lactose intol DOES NOT cause fat malabsoprtion of fe deficiancy anemia

Question 42

albuminocytologic dissociation

Answer 42

normal leukocyte count with ELEVATED PROTEIN seen in GBS

Question 43

factitious disorder

Answer 43

INTENTIONAL production of sx to assume sick role

Question 44

viral (cocksakie A) strep

Answer 44

runny nose, cough, vesicles on posterior pharynx/tonsiler pillars

Question 45

wegners (granulomatosis with polyangitis)

Answer 45

ANCA small-medium necrotizing vasculitis upper airway: ENT, saddle nose deformity lower airyway kidney: rapidly progressive GN skin: urticaria, pyoderma gangrenosum, NON HEALING WOUNDS,

Question 46

malnutrition in elderly

Answer 46

common in dementia - hypoalbuminemia --> edema - brusing --> C/K - gums --> C?

Question 47

risk/dx of myelodysplastic syndrome

Answer 47

older people and peopel with previous chemo/rad -ovalomacrocytes (messed up red blood cells) and neutrophil hyposegmentation/ hypergranulation usually presents with cytopenias dx= BM tgap with hypocellular marrow

Question 48

EKG signs of impending hyperkalemia

Answer 48

flattening of P wave and wiening of QRS --> in the clinical context of something like recent seizure or rhabdo where K is on the rise

Question 49

pheo

Answer 49

adrenal medulla (from neuro endocrine cells) - makes you pale - beta blockade can cause RISE in BP --> tx first with alpha block, then add beta

Question 50

genetic disorders associated with peho

Answer 50

RET VHL NF1

Question 51

what complication of GAS does impetigo progress into

Answer 51

PSGN

Question 52

glucocorticoids in COPD exacerbation

Answer 52

decrease length of hospital stay

Question 53

neutropenic fever!!!!

Answer 53

sepsis with abnormal immune response in someone getting chemo

Question 54

mechanism of ketosis in DKA

Answer 54

fatty acids transfered to liver, broken down by lipolysis

Question 55

how do you CONFIRM CLL?

Answer 55

flow --> looking for monoclonal B cells | *treat with rituximab

Question 56

test for aortic rupture/ dissection

Answer 56

CT with contrast or tEe not TTE

Question 57

painful, unilateral, fluctuant swelling on medial aspect of labia majora that extends into the introitus

Answer 57

bartholin gland cyst- pain with sitting, walking, sex *usually e. coli

Question 58

sx of Graves: - skin - nails - eyes - menstrual cycle - ltyes

Answer 58

Skin: pretibial myxedema Nails: onycholysis (nail separating from bed), CLUBBING!! Eyes: lid log, proptosis Menstural cycle: ammenorrhea/ irregularity Lytes: HYPERcalcemia, hyperglycemia, bone loss

Question 59

headache, GI distress, petechial rash

Answer 59

rocky mountain spotted fever

Question 60

inreasing "night blindness"

Answer 60

cataracts! also see loss of distance vision - mostly happens to older people but idabetes is a risk too - expect to see loss of red reflex due to increasing opacification

Question 61

secondary thrombocytosis

Answer 61

think of spelnectomy

Question 62

sterile pyuria

Answer 62

>3 WBC with NO bacteria --> sign of chlamydia urethritis!

Question 63

order of tocolytics in pregnancy

Answer 63

INT Indomethacin --> cox inhibitor --> can't use past 32 week because risk closing ductus Nifedipine --> 32-34 weeks --> can cause tachy, flushing, nasuea, headaches Terbutaline (beta ag) --> used short term in patient

Question 64

use of Mg as "tocolytic"

Answer 64

neuroprotection for babe. it is a weak tocolytic

Question 65

types of cyanosis in a new born

Answer 65

CENTRAL: highly vascular things like lips, mm --> due to decreased O2 sat PERIPHERAL: blue extremeties--> NORMAL O2 sat but INC O2 extraction

Question 66

striate palmar xanthomas

Answer 66

yellow streaks on palms indicative of high triglycerides like in dysbetalipoprteinemia

Question 67

differentiate rash of measles and rubella

Answer 67

both occur with fever and spread from face down measles= "dark brick red" rubella= lighter

Question 68

what do you see on UA in rhabdo

Answer 68

"blood" on dipstick but it is false positive because it thinks its hemoglobin no casts!! unless ATN

Question 69

decreased cancer risk with OCPs

Answer 69

endometrial | ovarian

Question 70

class III antiarrythmics

Answer 70

can cause arrythmias --> look for precipitants like diarrhea to push someone into wide QRS --> into torsades