UWorld Review

Question 1

porcelain gallbladder

Answer 1

*a calcium-laden gallbladder wall with bluish color and brittle consistency, often associated with chronic cholecystitis
*pts can be asymptomatic, have RUQ pain, or firm nontender RUQ mass on exam
*CT scan shows a calcified rim in the gallbladder wall with a central bile-filled dark area
*associated with increased risk for gallbladder adenocarcinoma
*tx: cholecystectomy

Question 2

colorectal screening recs with hyperplastic polyps

Answer 2

*continue screening at the usual intervals, as small (<1cm) hyperplastic polyps do not increase risk for colon cancer:
1. repeat colonoscopy in 10 years for individuals at otherwise average risk
2. repeat colonoscopy in 5 years for individuals with high-risk FHx (first-deg relative w colorectal cancer age < 60)

Question 3

pulmonary contusion

Answer 3

*lung parenchymal bruising (due to transmitted kinetic energy) with resulting alveolar hemorrhage and edema
*clinical features: present < 24hrs after blunt thoracic trauma; tachypnea, tachycardia, hypoxia
*dx: rales/decreased breath sounds; CT scan > CXR with patchy alveolar infiltrate
*management: pain control, pulmonary hygiene, supplemental O2 & ventilatory support

Question 4

recurrent respiratory papillomatosis

Answer 4

*clinical presentation: hoarseness + laryngeal papillomas (finger-shaped lesions) on true vocal cords
*caused by HPV subtypes 6 and 11
*in children, commonly acquired via vertical transmission
*tx: surgical debridement

Question 5

acute pericarditis

Answer 5

*etiologies: viral, idiopathic, autoimmune, uremia (acute or chronic kidney failure), post-MI
*clinical features: pleuritic CP (improves when sitting) +/- fever, pericardial friction rub
*EKG: DIFFUSE ST-elevation & PR-depression
*echo: pericardial effusion

Question 6

steroid-induced ocular hypertension & open-angle glaucoma

Answer 6

*etiology: glucocorticoid use (topical eye drops)
*pathogenesis: glucocorticoids lead to decreased aqueous humor drainage, resulting in increased IOP
*sx: usually none until advanced disease leads to peripheral vision loss; rapid IOP increase can cause halos around lights, decrease visual acuity, eye pain, HA, corneal edema

Question 7

tonometry

Answer 7

*measures deformation of the cornea in response to applied (mechanical or pneumatic) pressure
*a test that estimates intraocular pressure (the pressure inside the eye)

Question 8

acute limb ischemia (ALI) - overview

Answer 8

*occurs when blood flow to a limb is significantly reduced or stopped, potentially leading to tissue damage / limb loss
*sx: pallor, absent lower extremity pulses

Question 9

acute limb ischemia - management options

Answer 9

1. viable limb: pulses detectable by Doppler, no motor or sensory deficits → CT angiography
2. threatened limb: pulses not detected by Doppler, partial motor/sensory loss → emergent surgical revascularization
3. nonviable limb: undetectable Doppler pulses and profound motor & sensory loss → amputation

Question 10

best intervention in minimize progression of AAA

Answer 10

*smoking cessation

Question 11

tarsal tunnel syndrome

Answer 11

*clinical presentation: burning pain, numbness, or paresthesia involving medial ankle, heal, sole, and toes
*pathology: compression of posterior tibial nerve under the flexor retinaculum in the medial ankle
*etiologies: trauma, overuse, inflammatory disorders