Uworld Mix 9/30

Question 1

44 year old womanwith 5 past pregnancys has frequent loss of urine over the last year. Persists for 3 months despite pelvic floor exercises, and needs to concentrate to hold in her urine. She has a slight bulge in the anterior vaginal wall. Post void volume is 50ml. What is the most appropriate therapy. and what it do.

Answer 1

Oral Oxybutynin, an antimuscarinic drug would increase bladder activity and reduce the hyperactivity.

Question 2

What would differentiate urge incontinence with stress incontinence?

Answer 2

Stress incontence is leakage, happens with valsalva. Often they dont feel like they have to go. Urge incontence would have nocturia.

Question 3

What kind of incontinence is treated with pessary placement.

Answer 3

Stress incontinence

Question 4

What are the treatements, in order, for stress incontinence

Answer 4

Lifestyle, Pelvic floor exercises, surgery, pessary placement.

Question 5

Patient has a lot of pregnancies, has STRONG URGE to void, had a past pelvic surgery for leakage. Do they now have stress or urge incontinence

Answer 5

Urge

Question 6

How long is a cough to be considered Acute Bronchitis

Answer 6

cough >5days to 3 weeks. When it last >5 days, think acute bronchitis first.

Question 7

How often do you do colonoscopies if the patient has UC or Crohns?

Answer 7

8 to 10 years AFTER dx, then repeat EVERY 1-3 years!

Question 8

What condition would you have a colonoscopy every 5 years

Answer 8

a patient that had a previous polyp, or with a family history.

Question 9

Patient presents with Pulsus paradoxus. What is it and what conditions do you see this in

Answer 9

> 10mmHG on inspiration, seen most commonly with Cardiac Tamponade. but ALSO asthma and COPD

Question 10

Mechanism of Pulsus Paradoxus in Tamponade

Answer 10

During inspiration, venous return to the right heart causes the ventricular septum to shift to the LEFT side, reducing the left ventricular EDV. Thus, there is less systemic stroke volume.

Question 11

Mechanism of Pulsus Paradoxus in Asthma or COPD exasperation

Answer 11

the intrathoracic pressure drop is HUGE, causing a pooling of blood to the pulm vascultur, leading to decreasing left ventricular preload. this can impinge on the OUTWARD EXPANSION OF THE HEART, thus like Tamponade.

Question 12

When do you give Gemfibrozil for Tryglyceride reduction

Answer 12

when the levels are over 1000.

Question 13

In patients with a hypertriglyceridemia level of 150-500, what does the patient need BESIDE statin therapy

Answer 13

Lifestyle modification - including weight loss, stop alcohol intake, and increased exercise.

Question 14

What is Cor Pulmonale

Answer 14

right heart failure caused by pulmonary hTN that occurs due to underlying diseases of the lungs, pulm vasculature, or sleep apnea.

Question 15

patient has been on empric IV Vanc. you narrow down the bug to Step Mutans, sensitive to penicillin. However, there is no IV penicillin or amoxicillin available. What can you give?

Answer 15

IV ceftriaxone

Question 16

What vaccines must be given to HIV patients

Answer 16

Hep B, Pneumococcal, Td if indicated. And if the CD4 count is above 200, then they can receive MMR and Varicella

Question 17

45 Female - had recently finished treatment for tuberculosis with RIPE. She drinks alcohol, on OCPs. Now, has fatigue, nausea, icteric, and her LFTs are in the hundreds. BR is 4.8. PT/PTT normal. Hep Serology all negative. Bx shows panlobular mononuclear infiltration and hepatic cell necrosis. What is the dx

Answer 17

Hepatitis from ISONIAZID use

Question 18

What makes isoniazid induced liver injury different from other drug induced liver injury

Answer 18

Other drug induced liver injuries would have a rash, eosinophilia, arthralgias, fever, leukocytosis

Question 19

What kind of hepatitis is characterized as granulomas on liver biopsy.

Answer 19

Tuberculous hepatitis, aka miliary tuberculosis.

Question 20

once drug induced and viral induced hepatitis is ruled out, what do you consider

Answer 20

autoimmune hepatitis

Question 21

What kind of liver abnormalities can be caused by OCPs

Answer 21

LFTs, hepatic adenoma. but NOT necrosis. or dysfunction.

Question 22

54 year old male stepped on a nail, his last TD vaccine was 12 years ago. What kind of vaccine/booster does he get.

Answer 22

Tdap, meaning the full vaccine, not just the booster. Recommendation is a Td booster every ten years after 18, and adult patients should get the Tdap as a one time dose in place of the booster.

So - Tdap, 10 years after 18, another Tdap, then ten years.

Question 23

Patient has hypotension, JVP, muffled heart sounds, with pulsus paradoxus. His complains of worsening weakness and exertional dyspnea for 2 days. WHat is the cause of his complaints?

Answer 23

Decreased Left ventricular preload - he has Cardiac Tamponade - which is fluid in the pericardial cavity.. This RESTRICT VENOUS RETURN to the heart, thus decreasing preload.

Question 24

75 year old man has a 6 month history of chronic stable angina. He was given three meds, ASA, nitro, and something else. What is the mechanism of the something else.

Answer 24

firstline is BB, second line is CCB. either way, they both REDUCE MYOCARDIAL CONTRACTILITY and heart rate, thus reducing myocardial oxygen demand.

Question 25

Once cholesterol levels are above 190, should you wait for statin therapy after lifestyle change?

Answer 25

No

Question 26

Patient is an old man with repeated pneumonia and infections. He has a fever now. Theres bronchial breath sounds on the lower left lung. Theres point tenderness on the right side of the ribs. X ray shows osteolytic lesions. labs show increased leukocytes. What does he have, and why cant he fight infections.

Answer 26

He has multiple myeloma, and thus has decreased immunity because he cant make antibodies.

Question 27

What disease would be from a immunodeficiency through complement or MAC deficiency

Answer 27

Neisseria Gonorrhea

Question 28

What is more common a cause for MR, Myxomatous Degeneration, or Rheumatic Heart disease

Answer 28

Myxomatous Degeneration - this would cause MVP. More common in developed countries.

Question 29

What age would UC present?

Answer 29

BIMODAL distribution. MOST at 15-40, but some will present at 50-80.

Question 30

28 female IV drug uses has a fever, dry mucus membranes, poor dentition, and a early diastolic murmur had the LSB at full expiration. ECG shows 2:1 2nd degree AV block. Leukocytosis of 13K is there too. Is this tricuspid valve endocarditis or perivalvular abcess.

Answer 30

Perivalvular abcess. If this was TV endocarditis, this would be a HOLOSYSTOLIC murmur, bigger with inspiration, and conduction abnormalities are much less common.

Question 31

Management of moderate hypercalcemia - 12-14

Answer 31

if any tx, IVF>

Question 32

Management of severe or symptomatic hypercalcemia - >14

Answer 32

NS with calcitonin, avoid loop diuretics (unless theres volume overload.
Long term - bisphosphonates.

Question 33

When would you use glucocorticoids for hypercalcemia?

Answer 33

Granulomatois diseases like sarcoidosos or lymphomas. These areas would have more 1,25 dihydroxyvitamin D

Question 34

Why shoudl you NOT use Loop diuretics to help hypercalcemia?

Answer 34

could worsen the volume depletion that is caused by hypercalcemia.

Question 35

When would you give a patient both Tdap vaccine AND tetanus Immunoglobulin?

Answer 35

When the wound is severe or dirty, and they are either unimmunized, <3 doses of toxoid, or uncertain of when.

Question 36

When should an adult recieve their adult vaccination of Tdap

Answer 36

if they have not received one within 5 years, post their 3 tetanus toxoid doses

Question 37

This lady has mood instability after a break up, hx of cutting herself, blah blah Borderline Personality Disorder. What would she most likely have a history of?

Answer 37

Childhood trauma, such as sexual abuse and neglect.

Question 38

Treatment for Borderline Personality Disorder.

Answer 38

Psychotherapy - with adjunctive ppharm with 2nd gen antipsychotics

Question 39

Sexually active female after a gangbang with a painless ulcer and some LAN has tested negative with RPR and HSV PCR. What is the next best step in managment

Answer 39

give penicillin empirically anyway. Cant hurt

Question 40

2nd trimester: What does a decreased AFP, HCG, Estriol, and normal Inhibin A mean

Answer 40

Trisomy 18.

Question 41

2nd trimester: what does an increase in bHCG & inhibin A, with a decrease in AFP and Estriol mean?

Answer 41

Trisomy 21. think - Downs are MORE INHIBITED but MORE HCGable

Question 42

2nd trimester - what DEFECT does an increased AFP mean.

Answer 42

Neural Tube defect of Abdominal Wall defect.

Question 43

11 year old boy has a pruritic skin rash for 2 weeks. It wakes him at night. he had a cousin over with the same symptoms. he has 2-3 erythmatous papules and vesicles with excoriation on his neck, hands, feet and waistline. not his chest or upper arms. What does he have, and what do you give., and what is the key

Answer 43

Scabies - so give him topical permethrin. The key here is the hands, feet, and WAISTLINE, and the fact that it avoided the chest and upper arms. it goes towards the flexors.

Question 44

Patient is a 54m post laprascopic sugery for biliary pancreatitis. 4 days later, they have decreased breath sounds at both bases, and PO2 is low, with low CO2. What do they have and why

Answer 44

Atelectasis, due to impaired cough and shallow breathing. They postoperatively have a change in lung compliance, shallow breathing, limiting recruitment of alveoli. This is why you need incentive spirometry.

Question 45

patient possibly OD’d on something for heart disease THey have profound bradycardia and an av block. atropine doesnt work. Treatment? would trancutaneous pacing work?

Answer 45

Glucagon. OD’s on BB. Pacing would NOT help in an OD.

Question 46

24 female started noticing chest pains with exercising. She’s always had this murmur on the first right intercostal space, mid systolic, with a palpable thrill. What is causes the chest pains.

Answer 46

She has a SUPRAVALVULAR aortic stenosis. Which is like AS but higher. its congenitla. They would get hypertrophy over time, as well as coronary artery stenosis. thus, they would get myocardial ischemia, thus the anginal symptoms from INCREASED MYOCARDIAL OXYGEN DEMAND

Question 47

How would acute lead toxicity present in adults?

Answer 47

Gastrointestinal (abdominal pain, constipation), Neuropsychiatric (forgetfulness and neuropathies), and MICROCYTIC ANEMIA. = basophliic stippling.

Question 48

What would be the first line therapy for bullous pemphigoid

Answer 48

a topical steroid like CLOBETASOL

Question 49

What is the treatment of spontaneous Pneumothorax?

Answer 49

if small, Observation and oxygen. If LARGE - needle aspiration or chest tube.

Question 50

What is the difference between syphillis and granuloma inguinal

Answer 50

Granuloma Inguinal has no LAN and is usually seen in India, Guyana and New Guinea

Question 51

What would cause benign jaundice (with increased uncongugated BR despite normal total BR)

Answer 51

decreased heaptic uridine diphosphogluconurate glucoronosyltransferase (UGT). These levels dont reach “adult levels” until 2 weeks post birth.

Question 52

What is first tretment for physiologic jaundice if there is rapidly arising hyperbilirubinemia

Answer 52

phototherapy. Exchang transfusion if >20-25

Question 53

Side effects of Cyclophosphamide - not just one

Answer 53

Hemorrhagic Cystitis, Bladder carcinoma, Sterility, and myelopsupression.

Question 54

What chemo/immunosupression drug causes cochlear dysfunction

Answer 54

cisplatin

Question 55

What drug that starts with C could cause Gout?

Answer 55

Cyclosporine