UWorld Sample Cases

Question 1

vomiting hx

Answer 1

projectile, blood, how often, sick contacts/food
abdo, back pain
diarrhea, constipation

b sx: fever, chills, headaches
gu sx: burning with urination, menstrual period, preggers

Question 2

vomiting ex

Answer 2

orthostatic hypotension (vitals)
heent (fundi for increased icp, orophyrx for dry mucous membranes)
cardio: m/g/r
abdo: denstension, +bs, percuss for bowel gas pattern, tenderness/rebound, cva tenderness

Question 3

vomiting ddx

Answer 3

gastroentero, obstruction (sbo), pregs, med/tox, meningitis, pancreatiis, hepatitis, cholecystitis, pyelonephr

Question 4

vomiting ix

Answer 4

cbc (w/differential), euc, preg test/urine hcg, ua, urine culture

axr after neg preggers, amylase, lipase, liver function panel (alt, ast, ggt, alp), abdo u/s, stool studies

Question 5

diarrhea hx

Answer 5

times/day, how often, volume amt, acute v chronic, continuous v intermittent (normal mvmts in between?), blood/pus/mucus in stool, greasy diarrhea/clay colored/dark,

abdo pain (ibd, ibs), weight loss (malabsorption, cancer), milk or lactose intolerence, increased stress
better/worse factors, recent ravel, sick contacts, fever, chills, radiation exposure

Question 6

diarrhea ex

Answer 6

heent: lesions orophayrnx (ie bulemic eating diet pills), enlarged cervical lymph nodes, thyromegaly, masses ie lipomas/dermoid cysts

heart, lungs, abdo (+bs, percuss for bowel gas patterns, palpate superficial and deep)

Question 7

diarrhea wu

Answer 7

cbc, fobt, cmp/euc, tsh, stool (wbc, o&p)

Question 8

diarrhea ddx

Answer 8

secretory diarrhea (bacteria/toxins, ileal bile acid malabsoprtion, endocrine diarrhea)
osmotic diarrhea(laxatives, carb malabsorption)
inflam diarrhea (ibd, giiardia)
fatty dirrhea (celiac, short bowel syndrome)

Question 9

vag bleed hx

Answer 9

gradual/sudden, bright red / dark, clots, tissue ish (molar pregnancy), continous flow/spotting, triggers (sex, sleep, trauma), assoc sx (n&v, abdo pain, fever), drugs (cocaine can cause bleeds)

preggers before/ g/p/a, lmp, heavy flow, pads per day, period length, irregular/reg, abortions, stds, PMHx bleeding/hospitalization due to that, bleeding disorders, multiple abortions

sexual hx: marriage/relationship state, contraception, last sexual contact (& protection)

Question 10

vag bleed ex

Answer 10

nose, gums etc bleeding; orthostatic hypothension
abdo: hepatospleno, +bs, palpate, rebound

state: will do pelvic ex

Question 11

vag bleed wu

Answer 11

pelvic ex, preg test, cbc, transvaginal us, serum r-hcg, tsh

Question 12

vag bleed ddx

Answer 12

regular menses, abortion, preg, ectopic, hyadatiform mole

Question 13

dark urine hx ex

Answer 13

blood, same color throughout day, decrease/increase, pain with urination, abdo/back, b sx, diarrhea, food (beets/ artificial colors/berries), trauma, heavy exercies (rhabdo), sore throat (poststrep glom), kidney probs

heent, cardiac, abdo including cva tenderness

Question 14

dark urine wu

Answer 14

ua, cbc, cpk, bmp/euc, cystoscopy (bladder), ct abdo

Question 15

dark urine ddx

Answer 15

glomerulo, benign familial hematuria, exercise-induced / rhabdo, atn, med or food induced, KUB stones, UTI, kidney/bladder tumors

Question 16

abuse

Answer 16

look for bruises, palpate tenderness. hx suicide, weapen, children, sexual abuse, emergency plan (friends/family)

assure confidentiality (no records released without her permission), assure your role in her safety, encurage to get away
Before she goes, ASK if safe for her, offer domestic violence counselor

Question 17

confusion hx ex

Answer 17

hx: weak/tingle/numb, dizziness, jerky mvmts, seizures, headaches, trauma, systemic, adls
ex: lymphadeno, thyroid, pallor, heart, lungs, abdo (masses for ca). neuro: MSE, cranial nerves, reflexes, power&sensory super quick, gait, balance

Question 18

confusion ix

Answer 18

cbc, ua, bmp, tsh, ecg, ct head, carotid doppler, cxr

Question 19

confusion ddx

Answer 19

tia, multiinfarct dementia, alz, euc abnormalities, med side effects (polypharmacy)

Question 20

depression hx ex

Answer 20

sig e caps, weight change/apetite. thyroid: cold, hair loss, constipation/bowel movements, sob. hallucinations. counselor (& if they want one)

ex: thyroid, hla, reflexes (delayed relaxation phase of hypothyroid), MMSE.

Question 21

depression ix ddx

Answer 21

tsh, cbc, cmp, peripheral smear (anemia types)

depression, hypothyroid, anemia

Question 22

diziness

Answer 22

fall to specific side, feelings of panic, hearing difficulty/ringing/buzzing, double/blurry vision, weak/numb in face/arm/leg, bowel and bladder, loss of consciousness, warning signs, headaches, n&v, sob, palps

vitals-orthostatic hypo, heent-gross/rinne/weber & otoscopic (esp if tinnitus, ear discharge), thyroid, carotid bruits. neuro: dix-hallpike nystagmus, gait /romberg, dysmetria/dysdiadocho etc for cerebellar

Question 23

diziness ddx

Answer 23

bpv, tia/stroke, postural/orthostatic hypo, arrhythmia, cns tuors/meniere’s, polypharmacy/meds, peripheral neuropathy, thyroid abnormal, anemia, hypoglycemia or other metabolic, nonspecific dizziness

Question 24

dizz ix

Answer 24

cbc, euc, tsh/t4, ecg/24 hr holter monitor, carotid doppler for stroke/mr, mri brain for acoustic neuroma etc

Question 25

forgetting hx ex

Answer 25

onset, timecourse, sleeping, walking, adls, depression (sad/lonely), dizzy spells/falls, hypothyroidism (cold), weight loss. diarrhea/constipation, urination

ex: fundi, mmse. full neuro: power, reflex, sensation (touch, position, vibration), rombergs/get up n go
counsel: home environ, stairs, bathroom safety, support

Question 26

forget ddx

Answer 26

alz, vascular dementia, nph, vita b12, hypothyroid, depression (atypical), chronic subdural

Question 27

forget ix

Answer 27

cbc, ncct, tsh/b12/thiamin, bmp, syphilis (rpr/vdrl)

Question 28

passout

Answer 28

hx: seizure qs (jerky, tongue biting, bowel/bladder incontinence), n&v, cardio & neuro stuff, blurry vision.
ex: orthostatic hypo, carotid bruits ,neuro

ddx: arrythmia, vasovagal syncope, orthostatic hypotension, heard dz (aortic, ie coarctation, takayasus), seizures, tia/stroke
ix: cbc, bmp/euc, ecg, echo, holter/event monitor, get up n go, tilt table, ct/mri/eeg

Question 29

terminal ca

Answer 29

hx: socrates, weight/appetite, morphine and other pain meds, all systemic, mood/sleep/depression. ex: edema, pallor. discuss: home situ, hospice, advanced directives

Question 30

smoking cessation

Answer 30

assess motivation to quit, awareness of dz, why (stress, depression, social/triggers with etoh), cough, sob, previous attempts and with what methods