Uworld Mix 10/7/18

Question 1

74 year old woman is brought in because she had an unprovoked fall last year, and another 6 months ago. She is mildly forgetful, has mood swings, and is depressed. She also has htn and stress urinary incontinence. She has weakness and deficits on the right side. She has low volume of speech and flat affect. what would neuroimaging show.

Answer 1

Cortical/cubcortical infarctions. Has vascular dementia

Question 2

What condition is associated with MEDIAL temporal lobe atrophy on imaging?

Answer 2

Alzheimers

Question 3

What metabolic conditions do you see with Hepatic Encephalopathy

Answer 3

Hypokalemia, Metabolic Alkalosis from elevated bicarb, which promotes NH3.

Question 4

What is the immediate treatment for Hepatic Encephalopathy with hypokalemia

Answer 4

Potassium repletion, THEN IVF with lactulose

Question 5

80 year old woman is in the ED for lethargy and confusion. She has HTN, T2DM, CAD, Peripheral Vasc Disease, and Previous stroke. She had an MI 10 years ago. BP 74/48, pulse is 124/min, resp 24. She has a sacral ulcer with purulent drainage. Slight hyponatremia. Cr 2.2, glucose 250. She has a low normal PCWP, and an increased Mixed Venous O2 sat level. What is the PATHOLOGICAL reason she has Hypotension

Answer 5

Reduced Cardiace Afterload - they have septic shock from the infected ulcer, which is characterized by normal to low PCWP, RA, Increased Cardiac Output, Decreased SVR, and INCREASED McO2!!

Question 6

What kind of MvO2 is with Septic Shock?

Answer 6

Increased

Question 7

What kind of shock is seen with decreased MvO2

Answer 7

Hypovolemic and Cardiogenic.

Question 8

Why do you see increased MvO2 with Septic shock

Answer 8

Hyperdynamic circulation, as CO is increased, there is an inability of of tissues to adequately extract O2

Question 9

Describe Cardiogenic Shock

Answer 9

Cool extremities, hypovolumia, increased PCWP, increased RA, Increased SVR, decreased CO, and decreased contractility.

Question 10

What do you see when theres a lesion BELOW the pons with a patient with bells palsy.

Answer 10

CN 7 lesion - in the affected side, cant raise the eyebrow, cant close the eye, drooping of the mouth, and no nasolabial fold.

Question 11

What facial features do you see when the CNS lesion is ABOVE the facial nucleis, aka above the pons

Answer 11

contralateral lower facial weakness that spares the forehead, dysarthria, hemiparesis

Question 12

Patient has vision problems in the right eye. When he covers his left, and looks at a line grid, the lines look bent and wavy. What is the dx

Answer 12

Macular degeneration.

Question 13

What is the dx if the patient is complaining of a “enlarging blindspot”

Answer 13

Papilledema, with mass effect.

Question 14

Patient has RUQ pain, that radiates to the scapula, that gets worse with inspiration. Bilirubin is 1.2, alp is 110, ASt is 48, ALt is 65. Theres leukocytosis and a fever. with a history of asymptomatic gallstones. What is the MOST INITIAL EVENT that lead to this cause.

Answer 14

Impaction of gallstone in cystic duct.

Question 15

34 female has swelling redness and pain in the RLExtremity, specifically the right carlf. She has elevated plasma homocystein level. She started on heparin and warfarin. What other therapy is indicated

Answer 15

Pyridoxine - the increased homocystein level is indicative for a lack of B6 which would be a cofacter for cytathionine B Synthase.

Question 16

What labs/UA do you find in a possible cholesterol embolism

Answer 16

Elevated serum creatining, low complements, Eosinophilia, eosinophiluria, WBC/RBCs in urine.

Question 17

27 female has joint pain that is bilateral, on the hands, Pips, wrists, knees and ankles. Its worse in the morining. She has had few episodes of loose bowel movements with skin itching. The joints arent red or swelling. She is an elementary school teacher with 2 kids. . What is it, and what anitbody is most likely elevated

Answer 17

Ani-parvovirus B19 IgM antibodies. Pb19 show flu like symptoms, with Erythema INfectiosum symptoms in Kids.

Question 18

Describe Pb19 infection SxS

Answer 18

Flulike, Erythema infectiousmum, Arthiritis that LOOKS like RA, and pure red cell aplasia in Sickle Cell

Question 19

How can you tell RA from Pb19 in adults?

Answer 19

Pb19 is very acute, and joints lack swelling and stiffness. theres just pain.

Question 20

What antibiotic do you give for a patient who is under chemo and suddenly has Febrile Neutropenia (high fever with dramatic decrease in WBCs)

Answer 20

Pip Tazo to protect against Psudomona. The priority is antipseudomonal coverage.