UWorld Q Bank: Week of 05/07/18 (#2)

Question 1

How can you use the woman’s cycle to differentiate between ovarian cyst rupture and ectopic pregnancy rupture?

Answer 1

Ectopic pregnancies usually rupture weeks into a gestation, so if a woman had a period in the last 4 weeks and normally has a regular cycle, ectopic pregnancy is extremely unlikely.

Also, ovarian cysts usually rupture in the second half of a woman’s cycle, so if a woman presents with sudden-onset lower-quadrant pain 3 weeks after her LMP, then this is highly likely to be ovarain cyst.

Question 2

Although heavy peritoneal bleeding does not usually occur with ruptured ovarian cysts, they can in women who _______________.

Answer 2

are on anticoagulation

Question 3

Those with major depression typically have increased levels of what lab marker?

Answer 3

Cortisol

Question 4

How does sleep change in those with depression?

Answer 4

They have decreased REM latency and slow-wave sleep

Question 5

The best treatment for acute stress disorder is ____________.

Answer 5

to educate the person on the range of responses to stress

Question 6

IUFD after ______ weeks gestation should only be managed with vaginal delivery.

Answer 6

24

Prior to that, vaginal delivery or dilation and evacuation can be offered.

Question 7

Those with Beckwith-Wiedemann synrome have the following features:

• Hemihypertrophy
• Macroglossia
• Umbilical hernia
• _____________
• _____________
• _____________

Answer 7

Wilms tumor; macrosomia (continuing to be large until age 4); hypoglycemia

Question 8

A red, sharply defined rash surrounding the anus of a young child is likely ________________.

Answer 8

perianal Streptococcal dermatitis

This presents with itching, pain, and sometimes bleeding with defecation.

Question 9

Papillary muscle rupture typically presents after occlusions to what artery?

Answer 9

RCA

Question 10

What is cardioversion?

Answer 10

Synchronized shock of the QRS complex which can sto the arrhythmia without leading to ventricular fibrillation (which can occur if you shock during repolarization).

Question 11

Cardiovert all tachyarrhythmias that are ____________.

Answer 11

unstable

Question 12

How quickly can alcoholics develop megaloblastic anemia?

Answer 12

5 to 10 weeks!

Alcohol inhibits the absorption and enterohepatic circulation of folate.

Question 13

A person has an unprovoked DVT. Subsequent testing reveals high levels of homocysteine. What can you give to reduce the risk of future DVTs?

Answer 13

B6

Pyridoxine stimulates the conversion of homocysteine to methionine, thus lowering the thrombotic effects of elevated homocysteine.

Question 14

True or false: hypothyroidism with hoarseness is suggestive of malignant thyroid cancer.

Answer 14

False

Hypothyroidism can cause hoarseness on its own.

Question 15

Vascular surgery for renal artery stenosis is only indicated when ____________.

Answer 15

the person’s BP is refractory to multiple medicines

Bonus points: don’t forget to manage the vascular risk factors with statins, ASA, diabetes management, and exercise.

Question 16

Well-defined skin lesions that come and go quickly are very likely ____________.

Answer 16

urticaria

Hives are one of the only lesions to rapidly wax and wane.

Question 17

When do you need to do a colonoscopy/sigmoidoscopy in the evaluation of hemorrhoids?

Answer 17

• Person > 50, blood mixed with stool, or any other symptoms suggestive of cancer: colonoscopy
• Person 40-49, no blood mixing or worrisome features: sigmoidoscopy
• Person < 40 with no worrisome features and no mixing: anoscopy

Question 18

Those with nephrotic syndrome have accelerated rates of _____________.

Answer 18

atherosclerosis (due to the hyperlipidemia)

Question 19

Bronze skin, diabetes, cirrhosis, and ___________ are features of hemochromatosis.

Answer 19

decreased libido (due to deposition of iron in the pituitary)

Question 20

What calculation can differentiate ethylene glycol toxicity from other causes of anion gap metabolic acidosis?

Answer 20

Osmolar gap greater than 10

They need to give you a measured osmolality. From that, you subtract the calculated osmoloarity: (2 x Na) + (BUN / 2.8) + (glucose/18)

Question 21

____________ permission must be given before a physician can discuss medical care with a third party.

Answer 21

Verbal or written

Meaning a patient can tell a doctor that it is ok for him or her to discuss their care with their employer.

Question 22

Classs IC drugs cause ________ at faster heart rates.

Answer 22

QRS widening

They are use-dependent, so the QRS effects are seen most at fast heart rates.

Question 23

Explain the rule of the “rare disease assumption” in statistics.

Answer 23

When diseases are extremely rare, the odds ratio is taken to approximate the RR since the RR would be extremely difficult to measure.

Question 24

If a question tells you that a hospitalized patient had a “visitor” and then had a change in status, then they’re telling you that _____________.

Answer 24

the visitor brought them recreational drugs

Question 25

HIV and pulmonary pathologies like PCP can cause what electrolyte imbalance?

Answer 25

SIADH

Question 26

Describe the differences between macular degeneration and diabetic retinopathy.

Answer 26

• Macular degeneration: - Central vision loss / scotoma - Wet (angiogenesis) and dry (yellow exudate) usually without arterial changes • Diabetic retinopathy: - Decreased visual acuity overall - Arterial nicking, cottonwool spots, and macular edema

Question 27

In which cases should you give RhoGAM?

Answer 27

*  Rh-negative mother with uncertain or Rh+ father at 28 weeks and within 72 hours *  After threatened abortions * Abdominal trauma * Procedures * Cephalic version * Molar pregnancy * Ectopic pregnancy

Question 28

Interventions targeted at _______________ have been shown to decrease medication reconciliation issues.

Answer 28

pharmacists

Question 29

Effervescent rash (a rash that worsens with fever) is characteristic of __________________.

Answer 29

juvenile idiopathic arthritis

Question 30

Infants born SGA have increased risk of what future complications?

Answer 30

* Hypoxia * Polycythemia (secondary to hypoxia) *  Hypoglycemia * Hypocalcemia * Meconium aspiration

Question 31

When is screening for toxoplasmosis done?

Answer 31

Only with symptoms (so not a true screen)

Question 32

In those with CAIS, you do a gonoadectomy __________.

Answer 32

after puberty

Question 33

True or false: in a person with combined folate and B12 deficiency, giving folate will correct the megaloblastosis.

Answer 33

True But their neurologi findings will likely worsen.

Question 34

MRI showing a diffuse increase in the intensity of white matter is likely _______________.

Answer 34

HIV-associated neurocognitive disorders (HAND) PML, by contrast, will show asymmetric, isolated white-matter lesions that enhance.

Question 35

Panacinar emphysema is caused by ___________.

Answer 35

alpha-1 antitrypsin deficiency

Question 36

What is a factorial design?

Answer 36

A study in which people are first randomized to one group and then re-randomized to another subgroup Example: Patients are divided first into receiving amlodipine or lisinopril and then divided into a high-BP or low-BP subgroup.

Question 37

In what form is epinephrine given to those with anaphylaxis?

Answer 37

Intramuscular

Question 38

What infection can mimic sarcoidosis?

Answer 38

Histoplasmosis *  Hilar LAD *  Erythema nodosum * Cough *  Non-caseating granulomas that are negative on AFB stain and Gram stain

Question 39

True or false: physicians cannot accept any gifts from patients.

Answer 39

False There is no official rule on this, so physicians ought to handle gifts on a case-by-case basis. The intent, type of gift, value, and patient's mental state need to be taken into account.

Question 40

How do you treat scabies?

Answer 40

Pemethrin or ivermectin

Question 41

What should you do when a patient has extrapyramidal symptoms on a first-generation antipsychotic?

Answer 41

Switch to a second-generation one

Question 42

Which second-generation antipsychotics should you avoid in those with diabetes?

Answer 42

Olanzapine and clozapine

Question 43

The main reason asymptomatic bacteriuria is treated in pregnancy is ______________.

Answer 43

that pregnant women are more prone to pyleonephritis secondary to the effects of estrogen on the ureter

Question 44

Why does Bactrim cause a mild RTA type 4?

Answer 44

Trimethoprim blocks sodium channels in the collecting duct – like amiloride or triamterene – which induces the RTA 4 (hyperkalemia and metabolic acidosis).

Question 45

How can you slow the progression of diabetic nephropathy once proteinuria has begun?

Answer 45

Intensive BP control (< 140/90 or even < 130/80) Recall that the pathophysiology of diabetic nephropathy starts as hyperfiltration due to hypertension. This stretches the mesangium and leads to protein. Stopping the hypertensive hyperfiltraiton is key to slowing the disorder.

Question 46

Cat-scratch disease presents with LAD and ____________.

Answer 46

a papule at the site

Question 47

Any murmur that is ______________ requires further workup.

Answer 47

diastolic A midsystolic murmur is common in some young adults and doesn't indicate workup by itself. The Still's murmur is a musical, vibratory murmur heard over the left sternal border during systole. Most commonly during ages 2-7.

Question 48

Kidney involvement is less common in ___________ lupus.

Answer 48

drug-induced

Question 49

Although most places will likely have an autoimmune panel that includes a slew of SLE labs, what is the "right" order to do the tests in diagnosing lupus?

Answer 49

1) ANA 2) Anti-dsDNA 3) Others that are case-dependent (like anti-histone for drug-induced lupus) The reason you do it in this order is that ANA is the most sensitive. If this is negative, you can stop here. The anti-dsDNA is more specific and has prognostic value.

Question 50

Echinococcus cysts must have history that includes exposure to ___________.

Answer 50

dogs and sheep

Question 51

Viral arthritis can last up to _____________.

Answer 51

weeks

Question 52

Review the side effects of methimazole and propylthiouracil.

Answer 52

* Methimazole: agranulocytosis, teratogen, cholestasis | *  PTU: agranulocytosis, hepatic failure, ANCA vasculitis

Question 53

The only PFT affected by pulmonary hypertension is _____________.

Answer 53

decreased DLCO

Question 54

Those with Crohn's can get osteomalacia due to _____________.

Answer 54

impaired vitamin D and calcium absorption with resultant secondary hyperparathyroidism

Question 55

Babies with Edward's syndrome have the following constellation of symptoms: - Prominent occiput - Micrognathia - Low-set ears - Rocker-bottom feet - ____________ - ____________

Answer 55

VSD; renal anomalies | Think of edVard to remember that it is Vsd and not asd.

Question 56

If you had to pick one agent to treat neutropenic fever, the best option would be _____________.

Answer 56

Zosyn Neutropenic fever is most commonly caused by translocation of gut bacteria, with Pseudomonas being the most common. Gram-positive bacteria and anaerobic bacteria can also cause neutropenic fever, however, so you need to cover for these organisms as well.

Question 57

Thyrotoxicosis can cause hypertension through what effect?

Answer 57

Increased myocardial contractility Hyperthyroidism most often causes a systolic hypertension through inotropic effects. Note: don't be tricked into thinking it is through increased SVR. Although catecholamines can cause this, the levels have to be extremely high to induce increased SVR.

Question 58

An injury with a negative knee exam but pain over the anterior medial tibia is likely _____________.

Answer 58

pes anserine bursitis Look for this when a person has chronic knee pain with point tenderness over this area with no other positive findings.

Question 59

Verrucous skin lesions and lytic bone lesions are likely what syndrome?

Answer 59

Blastomycosis Blasto causes an ulcerated, warty lesion. It can also erode bone.

Question 60

What is the pathophysiology of non-classical congenital adrenal hyperplasia?

Answer 60

Decreased activity of the enzyme that converts 17-OH to 11-ß This leads to elevated DHEAS and testosterone without any BP or electrolyte abnormalities.

Question 61

Steroids can hasten the resolution of interstitial nephritis. Why are they not used, usually?

Answer 61

Interstitial nephritis most often results from antibiotics, which are usually given for infections. The person may have residual infection, so giving immunosuppresive doses of steroids would be dangerous.

Question 62

The HACEK organisms commonly arise from what predisposing condition?

Answer 62

Periodontal disease This is even in those with normal native valves.

Question 63

The presentation of cryptococcal meningitis is different from other types of meningitis in that ________________.

Answer 63

there is usually no neck stiffness or photophobia

Question 64

In considering treatment with sildenafil for those with ED, it is important to note that _______________.

Answer 64

loss of libido may be a consequence of ED (i.e., sildenafil can treat those with loss of libido)

Question 65

Do not treat with testosterone unless the ______________.

Answer 65

the level is low

Question 66

In treating someone with ARDS, it is important to wean the FiO2 < ___% as soon as possible, provided PEEP can maintain their PaO2 > 60 mm Hg.

Answer 66

60

Question 67

A woman in her 30's presents with S3, bibasilar crackles, and a holosystolic apical murmur. Her pathology likely began as _____________.

Answer 67

myxomatous degeneration of the mitral valve Severe mitral regurgitation can lead to dilated cardiomyopathy and atrial fibrillation in young people.

Question 68

You cannot give indomethacin after ________ weeks due to the potential to close the DA.

Answer 68

32 Thus, if a woman presents with preterm labor after this point, use nifedipine.

Question 69

Parents refuse to give chemotherapy for their 10-year-old daughter. If they continue to refuse despite extensive education on the risks and benefits, the ultimate course of action would be to ______________.

Answer 69

get a court order Parents can't refuse life-saving therapies for their kids.

Question 70

The initial treatments for amaurosis fugax are _______________.

Answer 70

(1) ocular massage, which can help push emboli further down the arterioles and possibly even break them up, and (2) decreasing intraocular pressure with the aid of glaucoma drugs and fluid extraction to lessen the external pressure on the blocked arteries

Question 71

Review the initial mangagement of chronic cough.

Answer 71

* Asthma: PFTs with bronchodilator response, methacholine challenge *  UACS: H1 antagonist *  GERD: PPI trial *  ACE inhibitor: stop the ACE

Question 72

In addition to Sertoli-Leydig tumors of the ovaries, ___________ can also lead to virilization.

Answer 72

adrenal tumors secreting DHEAS

Question 73

What are Light's criteria?

Answer 73

*  PE protein : S protein > 0.5 *  PE LDH : S LDH > 0.6 *  PE LDH > 2/3 the upper limit of normal

Question 74

In tumor lysis syndrome, two electrolytes are increased and one is decreased: ________________.

Answer 74

phosphate and potassium are increased and calcium is decreased (due to binding to intracellular anions) Uric acid is not an electrolyte, but it is also elevated in TLS.

Question 75

If they give you a stem that looks like heart failure (edeam, JVP, ascites) but they bend over backwards to tell you that the ventricles, valves, and lungs are normal, then the answer is likely ______________.

Answer 75

constrictive pericarditis Look for a past heart surgery or radiation.

Question 76

Burr cells are seen in ____________.

Answer 76

those with advanced liver disease or ESRD

Question 77

How does renal crisis in diffuse scleroderma present?

Answer 77

*  Hypertensive crisis *  AKI * MAHA

Question 78

What does peeling of the hands and feet indicate in a neonate?

Answer 78

Adaptation to the extrauterine environment (i.e., a totally normal finding)

Question 79

A patient with mitral-valve prolapse develops fever, leukocytosis, LUQ pain, and left pleural effusion. What's going on?

Answer 79

This is likely infective endocarditis with subsequent splenic abscess. The triad of LUQ pain, fever, and leukocytosis suggests splenic abscess. (CT could show perisplenic fluid.) This is most commonly due to some form of bacteremia, either endocarditis or IV drug use.

Question 80

The preferred initial diagnostic for suspected kidney stones is _______________.

Answer 80

ultrasound Although non-con CT is better at detecting kidney stones, US has almost no risk and can detect dilations in the ureter and kidney that would suggest a stone.

Question 81

Zollinger-Ellison presents with multiple duodenal ulcers, elevated gastrin, and _______________.

Answer 81

steatorrhea due to acidic inactivation of pancreatic enzymes

Question 82

Low Ig levels (all of them) and absent CD3 indicates ____________.

Answer 82

SCID CD3 is the receptor for T cells.

Question 83

The treatment for SCID is _____________.

Answer 83

stem cell transplant

Question 84

Why does complete molar pregnancy lead to ovary enlargement?

Answer 84

ß-hCG leads to growth of the corpus lutea

Question 85

How do you treat rheumatic fever after the JONES symptoms have resolved?

Answer 85

Penicillin G Even in those with no symptoms should be given Q4W penicillin G to eradicate any remaining GAS as well as to prevent future attacks. It is important to prevent future infections because repeat GAS infections lead to worsened rheumatic heart disease.

Question 86

Hypotonic hyponatremia with urine osmolarity < 100 indicates what two potential disorders?

Answer 86

* Beer potomania | *  Primary polydipsia

Question 87

True or false: SAAG < 1.1 indicates SBP.

Answer 87

False SBP, because it results from cirrhosis, usually has a SAAG > 1.1.

Question 88

Once again, loss of peripheral vision with increased cupping?

Answer 88

Open angle glaucoma

Question 89

Primary autoimmune adrenalitis is common in what demographic?

Answer 89

Postpartum women

Question 90

``` EBV can cause these symptoms and lab findings: • Fever • Tonsillar exudate • Cervical lymphadenopathy • _________________ • _________________ • _________________ ```

Answer 90

Thrombocytopenia; Transaminitis; Autoimmune hemolytic anemia

Question 91

Recall that contact dermatitis includes both the immune and ____________ subtypes.

Answer 91

irritant So healthcare workers with dermatitis on their hands – like you – have contact dermatitis.

Question 92

If they give you an HIV esophagitis story but note that (1) the pain is severe and (2) the patient has no thrush, they are telling you that _______________.

Answer 92

the patient has viral esophagitis, eithe HSV or CMV

Question 93

Fever 1-6 hours after an RBC transfusion most likely was caused by ________________.

Answer 93

failure of leukoreduction Febrile nonhemolytic reactions are caused by WBCs in the donor RBCs that release cytokines after they die.

Question 94

Urticarial reactions to blood are usually due to ______________.

Answer 94

IgE attacking proteins in the blood

Question 95

Bloody diarrhea and diffuse pneumonia in a post-organ transplant patient?

Answer 95

CMV