UWorld Step 2 CK Form 2

Question 1

Differentiate galactocele and plugged duct.

Answer 1

A galactocele is a milk-filled cyst that arises in the subareolar area typically a month or two after women stop breast feeding. It is usually large (> 4 cm) and fluctuant.

A plugged duct is a focal occlusion of a breast duct that can happen anywhere in the breast and is small (< 2 cm). Because plugged ducts are caused by deposition of protein, they are firmer than galactoceles.

Question 2

In primary adrenal insufficiency, you need to treat with ______________.

Answer 2

hydrocortisone and fludrocortisone

Question 3

Bile leak can present with what somewhat surprising lab pattern?

Answer 3

Obstructive biliary labs (elevated alkaline phosphatase and direct bilirubin)

This can present even with no bile obstruction (as proved by absence of bile duct dilation on US).

Question 4

How are confidence intervals calculated?

Answer 4

Mean +/- 1.96 x the standard error of the mean

Standard error of the mean = SD / square root N

This formula shows why an increased N leads to a narrower CI.

Question 5

Don’t forget that early Lyme disease can present with ______________.

Answer 5

lymphocytic meningitis

Question 6

If you witness a colleague have impairment (medical, psychiatric, or substance-use-related) that endangers patients, you first need to _____________.

Answer 6

report them to your hospital or practices physician health program (PHP)

Only contact the state licensing board when the physician fails to comply with the PHP’s recommendations

Question 7

Spermatoceles (cystic collections of sperm) typically arise where?

Answer 7

In the epididymis

Question 8

Describe the themes in managing intimate-partner violence.

Answer 8

• Validate (“You were right to seek help.”)
• Support (“I will do whatever I can to help you. Know that I am always here for you.”)
• Do not suggest a specific option (e.g., don’t say “You need to confront you husband about this.”)

Question 9

Deceleration in head growth is suggestive of _____________.

Answer 9

Rett syndrome

Question 10

In which cases of intense cancer pain should you add a long-acting opioid?

Answer 10

• When the pain awakens the person overnight

* When the pain is not controlled with Q4H doses

Question 11

A woman has an intertriginous rash beneath her left breast. Microscopic exam is likely to show?

Answer 11

Pseudohyphae with budding yeast

Candida appears as the above description on microscopy.

Note Tinea appears as segmented hyphae on KOH prep.

Question 12

Petechiae are common in which congenital infections?

Answer 12

Most of them (it is a nonspecific finding)

Many infections cause some degree of defective hematopoiesis.

Question 13

True or false: congenital CMV causes macrocephaly due to hydrocephalus.

Answer 13

False

CMV actually causes microcephaly more commonly.

Question 14

True or false: instead of NSAIDs, you should use colchicine in those with gout and renal failure.

Answer 14

False

Colchicine is contraindicated in those with renal failure.

Question 15

In which cases should you avoid NSAIDs in those with gout?

Answer 15

Those who are on multiple blood-thinners should be given colchicine instead of indomethacin.

All NSAIDs are blood thinners, so be cautious if someon is already on multiple anticoagulants (like clopidogrel and apixaban).

Question 16

Blepharitis is ___________.

Answer 16

eyelid swelling

Question 17

What is a chalazia?

Answer 17

A benign swelling in the eyelid caused by a blocked meibomian gland

Question 18

What is a serious form of rosea?

Answer 18

Ocular rosea

Think of this is a person presents with rosea on their nose and cheeks (telangiectasias and small pustules) and complains of “something in my eye” for the last couple weeks.

It is serious because it can cause blindness. Ophthalmology workup is indicated.

Question 19

The triad of acute liver failure is _______________.

Answer 19

AMS, prolonger INR, and transaminitis

Question 20

Carbamazepine causes NTD by what mechanism?

Answer 20

Folate antagonism

Question 21

What is lochia?

Answer 21

The normal postpartum uterine discharge

It can last up to 28 days. Rubra, serosa, and alba are the three stages.

Question 22

A long-time smoker with COPD desires elective surgery. What two things can you do in the preoperative period to decrease the risk of post-operative pneumonia?

Answer 22

• Smoking cessation > 8 weeks prior to surgery

* Physical therapy to increase respiratory strength (e.g., aerobic exercise, pulmonary PT)

Question 23

Buerger disease is also called ____________.

Answer 23

thromboangiitis obliterans

Remember, the ONLY treatment is smoking cessation.

Question 24

Allergic bronchopulmonary aspergillosis (ABPA) typically occurs in those with _______________.

Answer 24

asthma or cystic fibrosis

Question 25

Describe the presentation of prosthetic valve thrombosis.

Answer 25

Usually caused by inadequate anticoagulation (the INR needs to be 2.5 - 3.5 in those with mechanical mitral valves and 2.0 - 3.0 in those with mechanical aortic valves), prostehtic valve thrombosis presents with acute-onset heart failure and emoblic stroke.

Question 26

Bronchiectasis can be caused by even _______________.

Answer 26

one severe pulmonary infection A severe, necrotizing pneumonia can lead to significant tissue damage that impairs bacterial clearance.

Question 27

Discuss the differences in hypomania and mania.

Answer 27

* Mania is characterized by > 1 week of DIGFAST symptoms along with marked impairment in social functioning (like calling out of work or getting into legal trouble). Any psychotic features or hospitalizations are diagnostic regardless of timing. * Hypomania is characterized by < 1 week of DIGFAST symptoms with no appreciable impairment in function.

Question 28

The recommended management of preeclampsia with severe features is ____________.

Answer 28

induction of labor C-section is done only for eclampsia and any sign of non-reassuring FHT.

Question 29

True or false: the adenoids are smallger lymph glands embedded on the posterior side of the tonsils.

Answer 29

False The adenoids are lymph glands superior to the soft palate of the oropharynx. They are not visible on physical exam.

Question 30

The most common cause of recurrent AOM and rhinosinusitis is ______________.

Answer 30

adenoidal hypertrophy, which blocks the drainage of the sinuses and the Eustachian tubes

Question 31

In addition to the nitrazine test, ___________ can also be used to determine if a woman will start labor within one week.

Answer 31

fetal fibronectin This is a protein found at the placenta-uterus junction. Labor disrupts this junction and causes fetal fibronectin to leak into the vagina.

Question 32

In whom do you skip GBS testing and go straight to treatment?

Answer 32

* Women with past pregnancies complicated by GBS | * Women with a recent UTI caused by GBS

Question 33

In which cases should you opt for a copper IUD and in which cases should you opt for a progesterone IUD?

Answer 33

*  Copper IUDs can cause menorrhagia, so avoid these in women with heavy periods. * Progesterone IUDs cannot be given to women with breast cancer or liver disease. *  Active PID is a contraindication to both. * Both can be given while a woman is menstruating.

Question 34

The most common reason patients don't take medicines is ______________.

Answer 34

being asymptomatic (particularly common with antihypertensives and diabetes meds!)

Question 35

Describe the diagnosis and treatment of mastoiditis.

Answer 35

* Mastoiditis is diagnosed clinically. History of inadequately treated AOM, PE showing displacement of the ear, and systemic infectious signs (fever, tachycardia, increased RR) all point to a diagnosis. *  Treat with IV antibiotics. *  If IV antibiotics fail, then consult surgery for T-tube placement or debridement of necrotic bone.

Question 36

What is colonic pseudo-obstruction?

Answer 36

A syndrome that looks like large intestine obstruction (tympany, obstipation) without evidence of anatomic obstruction on x-ray.

Question 37

Gas in the rectum on an x-ray showing SBO indicates ______________.

Answer 37

partial obstruction

Question 38

How should you manage SBO?

Answer 38

*  Diagnosis with history, PE, and x-ray. *  For patients with signs of peritonitis or strangulation, take for laparotomy immediately. *  For patients without the above signs, manage with NG decompression and water-soluble contrast.

Question 39

True or false: achild born to woman with no history of STIs or risk factors does not need prophylactic erythromycin.

Answer 39

False Because erythromycin is so safe and the potential consequences of gonorrheal conjunctivitis are so severe, erythromycin is given to all infants.

Question 40

Livedo reticularis can be a sign of ____________.

Answer 40

antiphospholipid antibody syndrome

Question 41

True or false: the PTT and PT are prolonged in those with APLAS.

Answer 41

False! Only the PTT.

Question 42

A patient s/p thyroidectomy 8 years prior presents with with tremor and instability. CT shows massive calcifications in the basal ganglia. What happened?

Answer 42

Calcifications in the basal ganglia are a complication of high phosphate-calcium product (typically greater than 55). In this case, this patient likely stopped taking their hypoparathyroidism meds, leading to a high phosphate.

Question 43

Why is there afferent dilation and efferent constriction in diabetic nephropathy?

Answer 43

Afferent dilation occurs due to HTN. Efferent vasoconstriction occurs due to increased renin activity due to mesangial proliferation.

Question 44

Why does proteinuria develop in those with diabetic nephropathy?

Answer 44

Mesangial proliferation leads to stretching of the glomerulus which lets out protein through stretched fenestrations.

Question 45

The increased efferent constriction in diabetic nephropathy leads to ______________.

Answer 45

ischemic damage There are distal arteries from the efferent arteriole that perfuse the kidney. Constriction of the efferent arteriole leads to ischemic death.

Question 46

List the negative and positive prognostic factors associated with schizophrenia.

Answer 46

• Positive: - Positive symptoms • Negative: - Early onset - Negative symptoms - Family history - Intrusive family - Prodromal phase with slow onset - No precipitant

Question 47

Lack of placental delivery and increased vaginal bleeding are features of ______________.

Answer 47

retained placenta Bleeding can be quite profuse (up to 500 mL!).

Question 48

With psych questions, if they didn't tell you about a symptom, it ___________.

Answer 48

isn't there This is really important. There are a lot of questions in which the person they're describing seems depressed or anxious, but unless they tell you that the person endorsed the DSM-V criteria for those disorders then they don't have them!

Question 49

What disorder can resemble tophaceous gout?

Answer 49

Chronic bursitis In chronic bursitis, repetitive use leads to fluid accumulation in the bursa. This is common on the elbow, particularly in those who work with their elbows on a surface (like carpenters). Chronic bursitis lesions will be softer and more fluctuant than gouty tophi. Also, there will not be a history of gout.

Question 50

What is pulmonary cachexia?

Answer 50

A disorder in those with advanced COPD in which the increased respiratory drive leads to atrophy of the respiratory muscles This is a diagnosis of exclusion, so it is important to rule out infection, malignancy, and adrenal insufficiency (in those taking high-dose steroids repeatedly).

Question 51

Inadequate post-procedural compression can lead to what abnormality in those who have undergone femoral catheterizations?

Answer 51

* Hematoma * Pseudoaneurysm These can be distinguished from each other with physical exam: pseudoaneurysms will be pulsatile and have a bruit.

Question 52

The UWorld first-line therapy for borderline personality disorder is _______________.

Answer 52

psychotherapy

Question 53

Before surgery and steroid injection, you need to recommend these interventions in osteoarthritis: _______________.

Answer 53

NSAIDs, weight loss, moderate activity, and PT to strengthen the quadricep muscles

Question 54

Review the causes and presentations of chalazia and sty.

Answer 54

*  Chalazia: blocked meibomian tear glands (the glands along the eyelid) that is non-infected; this is a more chronic, less painful presentation of an eyelid swelling; typically rubbery swelling that is farther from the lid margin; treat with warm compresses *  Sty (hordeolum): S. aureus infection of a eyelash follicle

Question 55

What is the technical name for a fetus that is < 10th percentile weight but otherwise completely normal?

Answer 55

Consitutionally small infant This is just the small range of normal and does not predispose the child to any future morbidity.

Question 56

True or false: needle aspiration is the next diagnostic step when you discover a suspicious cyst/mass on mamogram or US.

Answer 56

False Core biopsy is the next step. Needle aspiration can be done to exclude malignancy in simple cysts.

Question 57

What is susceptibility bias?

Answer 57

A type of selection bias in which those who have a more severe presentation are susceptible to being selected for different treatments This would be in an RCT without intention-to-treat analysis or in an observational trial.

Question 58

True or false: Cushing syndrome from pituitary ACTH secretion leads to suppressed cortisol on low-dose dexamethasone suppression test.

Answer 58

False Pituitary tumors are suppressed with HIGH-dose dexamethasone. This distinguishes them from ectopic ACTH production, which will not suppress on high-dose dex testing.

Question 59

Open-angle glaucoma causes what kind of vision loss?

Answer 59

Peripheral vision loss

Question 60

What is the diagnostic feature of open-angle glaucoma on fundoscopic exam?

Answer 60

Optic disc cupping This is an increase in the cup:disc ratio, meaning the disc (the surrounding rim) will stay the same size, but the cup will increase to greater than half the disc diameter.

Question 61

What CBC abnormality is often seen in babies born to diabetic mothers who have not treated their diabetes?

Answer 61

Polycythemia The high levels of glucose lead to a hypermetabolic state in the developing fetuses, which in turn leads to hypoxemia from increased metabolic demand. The chronic hypoxemia leads to reactive erythrocytosis.

Question 62

Both colonic pseud-obstruction and opiod ileus can occur after surgery. How can you differentiate the two?

Answer 62

Colonic-pseudo obstruction presents with more severe colonic dilation often with a normal-appearing distal rectum, whereas opioid ileus leads to milder dilation of the colon with symmetically dilation.

Question 63

Explain the framework for declining patient requests for unnecessary procedures.

Answer 63

Explain the risks and benefits that are the reason why you're declining the test/medicine in a nonjudgmental way. Instead of saying "this test is unnecessary," explain why it is unnecessary (the high risks and low benefits).

Question 64

Onycholysis is the _______________.

Answer 64

separation of the distal nail from the nail bed

Question 65

These are the side effects of lithium: - Tremor - GI upset - Nephrogenic DI - _____________

Answer 65

hypothyroidism Think of this if a person with well-controlled psychiatric symptoms presents with weight gain, fatigue, cognitive slowing, and constipation.

Question 66

True or false: viral tenosynovitis commonly presents with mild fever.

Answer 66

False Fever, leukocytosis, and elevated ESR are uncommon symptoms.

Question 67

Recurrent watery diarrhea – particularly at night – in an elderly woman will classically show a ___________ infiltrate on colonic biopsy.

Answer 67

mononuclear

Question 68

The best way to prevent genital herpes transmission is _______________.

Answer 68

consistent condom use

Question 69

What migraine medicine can cause akathisisa?

Answer 69

Prochlorperazine

Question 70

Describe MDS.

Answer 70

Myelodysplastic syndrome is a hematopoietic neoplasma that interferes with all bone marrow cell lines, leading to pancytopenia and dysplasia. Common smear signs are hyposegmented neutrophils and oval RBCs.

Question 71

Which patients should be referred for valve replacement in aortic stenosis?

Answer 71

Any patients with symptoms Recall that aortic stenosis has a long asymptomatic phase with a quick decline once symptoms start. Thus, any increased SOB, syncope, decreased exercise tolerance, or heart failure should be referred for aortic valve replacement.

Question 72

True or false: progesterone implants (Nexplanon) is more effective than IUD.

Answer 72

False I thought it was, but UWorld says IUD and implants are both >99% effective. IUD lasts longer, so in those with "busy schedules" – who may not want to come back for Nexplanons – choose IUD.

Question 73

Review the birth control requirements for isotretinoin.

Answer 73

* Two negative pregnancy tests * Two forms of contraception (barrier and pill) *  Monthly pregnancy tests while on the medication

Question 74

Testicular torsion is caused by ____________.

Answer 74

failure of the tunica vaginalis to connect with the testes

Question 75

When an older child acts out against the younger child – with, for instance, hitting the younger child or behavioral regression – the recommended treatment is ____________.

Answer 75

to have the parent spend more time with the older child

Question 76

Those with chronic diarrhea are at increased risk for which type of kidney stone?

Answer 76

Uric acid Loss of bicarbonate through the GI tract acidifies the urine, which predisposes to uric acid crystal formation.

Question 77

When they ask you "what is the most likely reason an adolescent is doing X?" The answer is ____________.

Answer 77

their friends are doing it

Question 78

What are phimosis and paraphimosis?

Answer 78

* Phimosis: foreskin stuck to the glans *  Paraphimosis: foreskin stuck around the base of the glans when retracted – an ischemic emergency that requires immediate reduction of the foreskin

Question 79

If they say "this guy's never had abdominal surgery" and then ask what kind of obstruction he has, the answer is most likely ___________.

Answer 79

not SBO due to adhesions but rather sigmoid volvulus, which can occur due to chronic constipation with resultant redundant colon

Question 80

Discomfort during the rectal exam of a patient with bowel obstruction indicates ___________.

Answer 80

sigmoid pathology

Question 81

A kid has limb ataxia following a viral illness. This is _____________.

Answer 81

acute cerebellar ataxia, a post-viral syndrome in which kids develop limb ataxia, usually one-sided, that resolves on its own

Question 82

Cocaine withdrawal can last ___________.

Answer 82

weeks If symptoms persist for longer than one month, though, this is abnormal and suggests something else.

Question 83

What type of headache is often accompanied by decreased level of consciousness?

Answer 83

Subarachnoid hemorrhage

Question 84

Weakening of the floor of the inguinal canal causes which type of hernia?

Answer 84

Direct Indirect inguinal hernias are caused by laxity of the deep inguinal ring.

Question 85

Genital warts are treatable with ______________.

Answer 85

trichloroacetic acid

Question 86

Elevated LDH in a person with a mechanical valve may indicate _____________.

Answer 86

hemolysis from valve dysfunction