UWorld

Question 1

What is unique about ulcers caused by the following:

• arterial insufficiency
• venous insufficiency
• poor blood sugar control
• pressure necrosis:

Answer 1

• arterial insufficiency: these tend to occur at the most distal portions of extremities
• venous insufficiency: these typically occur in the setting of lower extremity edema and stasis dermatitis and they are most common pre-tibially or above the medial malleolus
• poor blood sugar control: these occur due to chronic micro trauma and are most common under the metatarsal heads or at the tops of the toes
• pressure necrosis: these occur over bony prominences

Question 2

The hepA vaccination is indicated for what adult populations?

Answer 2

IV drug users, men who have sex with men, and those with chronic liver disease

Question 3

What happens to breath sounds and tactile fremitus in those with lung consolidation and in those with a pleural effusion?

Answer 3

• consolidation conducts sounds thus breath sounds and tactile fremitus are increased
• an effusion insulates sound and thus breath sounds and tactile fremitus are decreased

Question 4

What is AVNRT?

Answer 4

• a form of SVT characterized by abrupt onset, regular tachycardia that resolves with vagal maneuvers
• due to a fast and slow conduction pathway through the AV node; if a premature atrial contraction occurs when the fast pathway is refractory, a re-entry mechanism exists with anterograde conduction through the slow pathway and retrograde conduction through the fast
• vagal maneuvers increase parasympathetic tone, which increases the refractory period of the AV node

Question 5

Fifth Disease

Answer 5

• a viral infection with parvovirus B19
• most commonly affects adults who have frequent contact with children
• patients often have flu-like symptoms, a “slapped cheek” rash, and acute, symmetric arthritis resembling the distribution of RA
• an acute infection is diagnosed based on the finding of anti-B19 IgM antibodies

Question 6

Which diseases are the following associated with:

• ANA antibodies
• anti-cyclic citrullinated peptide antibodies
• anti-dsDNA antibodies

Answer 6

• ANA antibodies: highly sensitive for SLE
• anti-dsDNA antibodies: highly specific for SLE
• anti-cyclic citrullinated peptide antibodies: RA

Question 7

What is a diastolic decrescendo murmur indicative of?

Answer 7

aortic regurgitation

Question 8

Which paraneoplastic syndromes are associated with small cell carcinoma of the lung and with squamous cell carcinoma of the lung?

Answer 8

• small cell: ectopic ACTH and SIADH

- squamous cell: PTH-like

Question 9

What are the side effects of B2 agonists?

Answer 9

• hypokalemia with resulting weakness, arrhythmias, and ECG changes
• tremor, headache, and palpitations

Question 10

How do closed and open angle glaucoma differ in clinical presentation?

Answer 10

• open angle tends to be asymptomatic early, eventually leading to gradual peripheral vision loss
• closed tends to have abrupt onset pain, n/v, and blurred vision

Question 11

What kind of pneumonias are immunocompromised patients at greater risk for?

Answer 11

PCP and CMV

Question 12

At what age does diabetes screening begin?

Answer 12

45 years old

Question 13

Why does supplemental oxygen increase carbon dioxide retention in those with COPD?

Answer 13

• reversal of hypoxia reduces vasoconstriction in poorly ventilated areas of the lung increasing VQ mismatch
• increased oxyhemoglobin reduces CO2 uptake form peripheral tissues
• decreased respiratory drive reduces minute ventilation