UWorld 5

Question 1

nitrates

Answer 1

primary anti-ischemic and anti-anginal effects are d/t systemic vasoDILATION rather than coronary vasodilation
-systemic venodilation lowers preload and LVEDV reducing wall stress and myocardial oxygen demand

Question 2

thoracentesis

Answer 2

use it to evaluate undiagnosed pleural effusion except in pts with clear-cut evidence of CHF

Question 3

ASA intoxication

Answer 3

• should be suspected in a pt with triad of: fever, tiniitus, tachypnea
• adults with ASA toxicity develop a mixed resp alkalosis and anion gap metabolic acidosis
• a nml pH in an acid-base disturbance typically signifies a mixed respiratory and metabolic acid-base disorder

Question 4

herpes simplex keratitis

Answer 4

characterized by corneal vesicles and dendritic ulcers

Question 5

mitral regurg

Answer 5

classically results in a holosystolic murmur heard best at the apex with radiation to the axilla
-common clinical features: exertional dyspnea, a fib, signs of HF

Question 6

pt with severe renal dz in need of anticoagulation

Answer 6

unfractionated heparin is preferred over lmzh, findaparinux, and rivaroxaban in pts with severe renal insufficiency (eGFR <30mL/min/1.73^2) as reduced renal clearance increases anti-Xa activity levels and bleeding risk

Question 7

what is the most common vaccine-preventable dz among travelers

Answer 7

Hep A

Question 8

biliary colic

Answer 8

occurs d/t increased intra-gallbladder pressure thats created when the gallbladder contracts against an obstructed cystic duct

• pain is exacerbated by fatty meals, usually lasts <6h and resolves completely between episodes
• there is no fever, abdominal tenderness on palpation, or leukocytosis

Question 9

VTE

Answer 9

acquired RF include: immobilization, sx, malignancy, and meds

• recommended testing for occult malignancy includes age-appropriate screening (colonoscopy, mammo) and CXR in most pts with a first episode of unprovoked VTE
• more detailed testing is indicated for pts with findings concerning for malignancy or for recurrent or multiple-site (cerebral, hepatic vein) VTE

Question 10

peritonsillar abscess

Answer 10

• potential complication of tonsillitis and requires both iv abx therapy and urgent drainage of the abscess
• deviation of the uvula and unilat LAD can be helpful in distinguishing a peritonsillar abscess from epiglottitis

Question 11

medication induced esophagitis

Answer 11

• tetracyclines
• ASA and many NSAIDs
• Alendronate and Risedronate
• K-Cl and Fe

Question 12

single photon emission CT scan

Answer 12

• useful took to evaluate for CAD and indicates inducible ischemia when a reversible defect is noted on stress and rest images
• antiplatelet therapy is the preferred treatment to prevent CAD in these pts

Question 13

analgesic nephropathy

Answer 13

• m/c form of drug-induced chronic renal failure
• papillary necrosis and chronic tubulointerstitial nephritis are the m/c pathologies seen
• pts with chronic analgesic abuse are also more likely to develop premature aging, atherosclerotic vascular dz, and urinary tract ca

Question 14

primary inciting event of acute cholecystitis

Answer 14

gallstone obstructing the cystic duct with subsequent inflammation and infection

Question 15

which meds confer a survival benefit in CHF

Answer 15

ACEI, ARBs, BB, spironolaction

Question 16

dermatofibromas

Answer 16

nontender firm hyperpigmented nodules that are usually <1cm in diameter

• d/t fibroblast proliferation and most commonly occur on the LE
• the lesions have a fibrous component that causes the ctl area to dimple when pinched

Question 17

GC

Answer 17

can cause a leukocytosis mainly through mobilization of marginated neutrophils and an increase in the number of circulating neutrophils