UWorld Q Bank: Final Stretch!

Question 1

______________ presents like Henoch-Schonlein purpura in an adult who has a history of IV drug use.

Answer 1

Mixed cryoglobulinemia

They both present with purpura, arthralgias, malaise, hematuria, and proteinuria. Other than a history of HCV, the only big difference is that MC presents with low complement.

Question 2

____________ may present after rhinoplasty.

Answer 2

Septal perforation

Question 3

Rigors after pregnancy may signify ___________.

Answer 3

nothing

While they could be a sign of fever, rigors in the postpartum period are common. They are thought to occur secondary to poor thermal regulation.

Question 4

In addition to hirsutism, those with PCOS can actually have ______________.

Answer 4

male-pattern baldness

Question 5

Those with IBD are at increased risk of what ophthalmologic concern?

Answer 5

Anterior uveitis

Question 6

What is the uvea?

Answer 6

The tissue between the cornea and the retina

Question 7

Hereditary spherocytosis can present as early as ____________.

Answer 7

the neonatal period

Question 8

Postprandial hypoglycemia in a long-time diabetic can indicate what disorder?

Answer 8

Gastroparesis

If someone gives themselves a preprandial bolus of insulin and then their meal is stalled in their stomachs, then they will become hypoglycemic.

Question 9

Which antibiotics are CYP inhibitors?

Answer 9

• Ciprofloxacin

* Clarithromycin / erythromycin

Question 10

What synthetic cannabinoid is often given for weight gain in those with HIV cachexia?

Answer 10

Dronabinol

Note: it has not been shown to be effective in other types of anorexia, so megesterol is preferred for non-HIV cachexia.

Question 11

Explain how severe B12 deficiency can cause hemolytic anemia.

Answer 11

B12 deficiency leads to megaloblastosis. Those large RBCs can actually break when leaving the bone marrow, leading to intramedullary hemolytic anemia.

Question 12

Upper-lobe cavitation, hyponatremia, and hyperkalemia indicate _________________.

Answer 12

tuberculosis with adrenal destruction

Question 13

How can you prevent uric acid stones?

Answer 13

• Hydration

* Potassium citrate (this alkalinizes the urine and prevents stone formation)

Question 14

True or false: the best initial diagnostic in those with suspected diverticulitis is x-ray.

Answer 14

False

Abdominal CT with oral and IV contrast is the proper initial diagnostic.

Question 15

Untreated, genital herpes has what usual course?

Answer 15

Decreasingly frequenty relapses

In the first year after infection, those with genital herpes will typically have five relapses. Frequency usually decreases after that.

Question 16

Diagnose diabetes with ___________ in those with PCOS.

Answer 16

oral glucose tolerance test

It is more sensitive than the A1c.

Question 17

Describe the presentation of sporotrichosis.

Answer 17

• Starts at distal extremities
• Papule that then ulcerates into non-purulent, odorless vesicle
• Spreads along lymphatics
• Vital signs normal

Question 18

Atrial fibrillation most commonly arises from which site in the heart?

Answer 18

Pulmonary veins

Question 19

The dermatitis of pellagra is ______________.

Answer 19

sun-sensitive (look for malar rash and rash on forearms)

Question 20

Minimal change disease is seen in children and those with _______________.

Answer 20

Hodgkin lymphoma

Recall the association with cytokines.

Question 21

Membranous nephropathy is seen in those with HBV, HCV, and ___________.

Answer 21

solid malignancies

Question 22

Although many people think that OCPs cause ____________, several studies have shown this not to be true.

Answer 22

weight gain

Question 23

Describe the differential for fetal growth restriction.

Answer 23

•Note if it has occurred throughout pregnancy or started later.

• Early FGR is either infectious (with multiple anomalies on US) or aneuploidy (fewer anomalies).
• Late FGR is likely due to maternal HTN or uteroplacental insufficiency.

Question 24

In addition to diarrhea, dementia, and dermatitis, pellagra can also cause ______________.

Answer 24

glossitis

Question 25

How does contraction alkalosis affect the urinary chloride?

Answer 25

It leads to high urinary chloride. The increased bicarb absorption leads to a need for another anion to be peed out.

Question 26

Discuss how vitamin D can be used to differentiate between hyperparathyroidism and PTHrp.

Answer 26

PTHrp does not lead to as much conversion of vitamin D, so 1,25-Vitamin D will be normal or even low in hypercalcemia of malignancy.

Question 27

A young woman has pulsatile tinnitus. What is the likely cause?

Answer 27

Fibromuscular dysplasia of the internal carotid

Question 28

Discuss how the choice to do US for DVT differs based on presentaiton.

Answer 28

Those with suspected DVT only (that is, no PE symptoms) should have compression US done prior to anticoagulation. Those with PE symptoms go straight to anticoagulation.

Question 29

“Pain out of proportion to the abdominal exam” is Step 2 code for ________________.

Answer 29

mesenteric ischemia

Question 30

Hypoplastic thoracic cavity and multiple fractures at birth are consistent with _____________.

Answer 30

osteogenesis imperfecta

Question 31

Matching patients to similar controls (like neighbors or those with the same comorbidities) controls for ____________.

Answer 31

confounding

Not selection bias!

Question 32

Doing ______________ can trigger a thyroid storm in someone with Graves disease.

Answer 32

a contrast CT

The iodine load can induce a surger of thyroid hormone.

Question 33

“Straight lines that appear wavy” on a visual exam are consistent with _______________.

Answer 33

macular degeneration

Question 34

An enlarging blind spot is suggestive of _____________.

Answer 34

papilledema

Question 35

Low levels of __________ can cause severe hypocalcemia.

Answer 35

magnesium

Question 36

In addition to HOCM, murmurs from ____________ may increase with squatting.

Answer 36

MVP

Question 37

In addition to macrosomia, babies who are post-term are at risk for ______________.

Answer 37

oligohydramnios (thought to be due to placental fatigue)

Question 38

Although women give urine at each prenatal visit, culture is done only on ___________.

Answer 38

the initial one

Question 39

Although it is recommended that the 13-valent PNA be given first in those 65 and older, the ___________ is given first in those with medical comorbidities.

Answer 39

23-valent

Question 40

Although SCC more commonly ulcerates, BCC can, too. How can you tell them apart?

Answer 40

BCC has a pearly ring around its ulcer.

Question 41

People with profuse watery diarrhea and recent travel hiking in streams may have _____________.

Answer 41

Cryptosporidium infection

Parasitic infections like Strongyloides usually present with additional symptoms (like pulmonary and derm stuff), so think of Crypto if all they have is diarrhea.

Question 42

Distal neuropathy, hypo- and hyperpigmentation, transaminitis, and anemia are features of which toxidrome?

Answer 42

Arsenic poisoning

Look for the exposure to antique wood!

Question 43

Remember, you need to wait ______________ before testing for G6PD.

Answer 43

3 months after the hemolytic attack

Testing during the attack will show up as normal.

Question 44

True or false: give doxycycline for someone with headache and fatigue from Lyme.

Answer 44

True

Ceftriaxone is reserved for cardiac involvement (myositis or AV block), encephalitis, or nerve palsy. Fatigue and headache don’t count.

Question 45

Osteitis deformans is seen in _______________.

Answer 45

Paget disease of the bone

Question 46

Those with RA are at elevated risk for what orthopedic problem?

Answer 46

Osteoporosis

The chronic inflammation seen in RA stimulates increased bone resorption.

Question 47

Discuss the three groups of therapy for hyperthyroidism and how to decide which to do.

Answer 47

• Mild disease: PTU, methimazole

* Moderate/severe disease: RAI, thyroidectomy