UWorld 2017

Question 1

Congenital torticollis

Answer 1

Noted at age 2-4 weeks
Child prefers to hold head tilted to one side
Result of malposition of head in utero or birth trauma
Most resolve w/ conservative therapy + stretching exercises

Question 2

Hormones in Klinefelter syndrome

Answer 2

Primary hypogonadism
Low testosterone
High FSH, LH
High estradiol

Question 3

Postpartum hemorrhage

Answer 3

Obstetric emergency
Can be from abnormal placentation
Prior uterine surgery: impaired decidualization, myometrial invasion by villi
Placenta accreta: abnormally adherent to myometrium

Question 4

Preeclampsia

Answer 4

HTN onset after 20wg + proteinuria or signs of end-organ damage
Abnormal placentation then infl factors then endothelial damage then end-organ damage

Question 5

1 cause of decreased AFP + 3 causes of increased AFP

Answer 5

Aneuploidies

Open neural tube
Ventral wall defect
Multiple gestation

Question 6

Ttt of PCOS if wish of pregnancy + if not

Answer 6

Wish pregn: clomiphene (selective estrog recept modulator that increase LH+FSH + ovulation)
No wish: estrogen-progestin OCPs (minimize endom prolif, reduce androg sympt, prevent unwanted pregn)
Progestin-only: minimize endom prolif, no effect on fertility, no improv of androg sympt

Question 7

Empiric ttt of cervicitis (N. gonorrhoeae or C. trachomatis)

Answer 7

Ceftriaxone +

Azithromycin or doxycycline

Question 8

HPV oncogenicity

Answer 8

E6 + E7 inhibit cell cycle regulatory proteins p53 + Rb

Infected cell undergo unchecked cellular prolif + evasion of apoptosis

Question 9

Histology of fibroadenomas

Answer 9

Cellular or myxoid stroma around epithelium-lined glandular + cystic spaces

Question 10

Diagnosis confirmation of Trichmonas vaginitis

Answer 10

Saline (wet mount) microscopy of vaginal discharge

Question 11

Granulos cell tumor

Answer 11

Sex-cord stromal tumor of ovary
Secrete estrogens (endometrial hyperplasia)
Call-Exner bodies (microfollicular)
Yellow tumor (lipid in theca cells)

Question 12

Histology of Epithelial ovarian cancer

Answer 12

Anaplasia of epith cells w/ invasion into stroma
Multiple papillary formations + cellular atypia
CA-125

Question 13

First-line ttt for prolactinoma

Answer 13

Dopamine agonist (Bromocriptine)

Question 14

8 risk factors for cervical cancer

Answer 14

HPV 16, 18
History of STDs
Early sexual activity
Multiple or high-risk sexual partners
Immunosuppression
Oral contraceptive
Low socioeconomic status
Tobacco use

Question 15

Higher cancer risk in adolescent girls

Answer 15

Cervical: intercourse before 18 (x2 than after 21), tobacco. Not alcohol, not family history
Breast: menarche before 12
Endometrial: menarche before 12, anovulatory cycles in nulliparous

Question 16

HPV infection of basal cervical cells

Answer 16

Cervical intraepithelial neoplasia (atypical squamous cells)
Low-grade: <1/3 of epith
High-grade: beyond
Invasive: basement membrane

Question 17

Histology of Ductal carcinoma in situ

Answer 17

Ducts distended by pleomorphic cells
Prominent central necrosis
Basement membrane not affected

Question 18

Flutamide

Answer 18

Nonsteroid anti-androgen
Competitive inhibitor of testo recept
Combined w/ long-acting GnRH agonists to ttt prostate cancer

Question 19

Neonatal abstinence sd

Answer 19

Neuro, GI, autonomic symptoms
Tremors, irritability, diarrhea, poor feeding
Ttt: opiate, dose titrated to ptt’s symptoms then slowly weaned

Question 20

Fetopathy due to ACE inh or ARBs

Answer 20

Blockade of Ang II (necessary for renal dev)

In pregnancy: fetal anuria, oligohydramnios, pulm hypoplasia, limb contractures, calvarium defects