Uworld 8/17/15

Front 1

flushing, throbbing HA, palpitations, abd cramps, after eating fish=?

-how long after do they get?

Back 1

Scombroid poisoning (improper stored seafood, temp >15C)

-10-15min after (may have bitter taste and oral burning/spicy), self limited go away

Front 2

Patient afraid that genetic results will affect her job- what tell patient?

Back 2

genetic information is prohibited for use as discrimination by health insurers or employers, inform patients

Front 3

best questions to screen for unhealthy ETOH use?

Back 3

single-item screening: "how many times in past year have you had 5 (4 for women) or more drinks a day?"

Front 4

76yo F w/ diffuse achy pain mostly in shoulder and pelvic girdle for 6wks, malaise, on simvastatin, HCTZ, normal creatinine kinase=?

Other sx and findings?

Labs?

TMT?

associated condition? and tmt?

Back 4

Polymyalgia rheumatica

-age>50, bilat pain +morning stiff>1mo, involve 2 or more of neck/torso/shoulder/thigh/hip/constitutional sx, decrease ROM shoulder/hip/neck

-ESR>40, elevated CRP

-Glucocorticoids lo dose

-giant cell arteritis (HA, jaw claudication, vision loss)-hi dose steroid

Front 5

Risk of offspring of parents with type 1 DM given baby DM1?

Back 5

3% if mom, 6% if dad

Front 6

Sx of lead intoxication?

When to test?

TMT?

Back 6

-lead colic (abd pain/constipation), anemia w/ basophilic stippling

-houses built before 1978, international adoptees, immigrants

-if mild (<45): none

-if mod (45-70): po DMSA/meso-2-3dimercaptosuccinic acid/succimer

-if severe(>70): po dimercaprol AND EDTA (ca disodium edetate)

Front 7

colonic ischemia vs. mesenteric ischemia?

Back 7

Mesenteric: pain out of proportion t findings from emboli, no peritoneal signs, no blood in stool

Colonic: from hypotn state in watershed area, lateralized pain, BLOODY diarhea

Front 8

Symptoms of urethral diverticulum?

Best dx test?

Back 8

3Ds : dysuria, post void dribble, dyspareunia

-transvaginal u/s

Front 9

contraindications to kidney donation?

Back 9

age<18

coercion

HIV

pregnancy

active substance abuse

active infxn

active suicidality or uncontrolled psych illness

active/incompletely treated ca

Front 10

Patient with unpleasant leg senation waking up in night/worse at night, relieved with movement, worse on lying down

-Dx test?

-possible causes?

-tmt?

Back 10

Restless Leg syndrome

-check ferritin level (associated with iron deficiency)

-iron deficiency, DM, uremia (ESRD), MS, parkinsons, pregnancy, antidepressants

-mild sx (supplement iron, heat pads), persistant sx(dopamine agonists: ropinirole/pramipexole, 2nd line : gabapentin)

Front 11

Family with dizziness, HA, nausea, malaise

-ML Dx?

-when most common?

-Dx test?

Back 11

Carbon monoxide poisoning (CO)

-cold winters/cold climates, vented fuel-burning device/ kerosene heater

-carboxyhemoglobin level

Front 12

vaginal lesion (warty) turn white with acetic acid=?

Method transmission?

-TMT?

Back 12

Condyloma acuminata (anogenital warts via HPV) turn white w/ acetic acid

-sexually transmitted

-Trichloroacetic acid, ablative or surgical tmt if fails acid

Front 13

When to start cervical ca screening?

What if start sex at 17?

How frequent to screen?

-what if ASCUS and will return?

-what if ascus and unsure followup?

-what if CIN1?

-what if CIN2 or 3

-what if recurrent CIN 2 or 3

Back 13

-age 21

-still age 21

-q3 yrs only cytology <30, q3 yrs only cytology or q5 cytology +HPV DNA >30yo

-rpt PAP in 3-6mos w/ HPV - if again colpo + bx

-colpo + bx

-rpt pap, colpo + pap, or hpv q4-6mos for 2yrs

-cryo, laser, LEEP, cold knife

-hysterectomy

Front 14

Elderly with hip fracture=mgmt?

Back 14

surgery in under 48 hours (unless advanced dementia/nonambulatory/medically unstable)

Front 15

what abx for dog bite?

Back 15

amoxicillin/clavulonate (in addition to tetanus and rabies ppx if dog not being held under obs)

Front 16

Patient with STEMI, now with hypotension acutely, clear lung fields, JV distention=?

TMT?

Back 16

Cardiogenic shock from Right ventricular MI(seen in 50% pts w/ inferior MI)

-optimize preload (IVF bolus), avoid nitrates/diuretics/opioids (decrease RV preload), after bolus, thrombolytic vs. PCI

Front 17

Patient with SOB, tachy, hypoxic, xray with white out/pulm edema=?

first step tmt?

second step?

Needed dx tests?

Back 17

-acute decomp heart failure

-IV furosemide/lasix

-IV vasodilator (nitrog vs. nitroprusside) to provide sx relief

-cardiac biomarkers, echo (in any patient with pulm edema)

Front 18

clinical signs of pancoast tumor?

-which has worse progrnosis?

-most common?

what type of ca?

Back 18

shoulder pain (most common), horner's, weakness/atrophy hand muscle, pain/parasthesias arm/forearm, lower extrem hyperreflexia (worse prog since spinal cord compression)

-non small cell lung ca

Front 19

Who gets a statin?

Back 19

LDL>190, atherosclerotic dz (MI, ACS, angina, revascularizaiton procedure, stroke, TIA), DM >40yo

Front 20

CXR shows pneumoperitneum in patient with h/o GERD and peritonitis?

1st step mgmt?

other steps?

Back 20

-peptic ulcer perf

-IV abx w/ fluid resuscitation, IV ppi

-surgical intervention

Front 21

asymptomatic pt with 8mm lesion raised on optho exam w/ irregular borders, densely pigmented on R choroid =?

next step?

if painful or larger?

Back 21

ocular melanoma

-rpt exam in 3 months (since less than 1cm)

-radiation therapy

Front 22

15yo F w/ lower abd pain intermittent with menses in low thigh and back with nausea and vomit=?

T

Back 22

Primary dysmenhorrhea

-NSAID (2nd line is OCP)

Front 23

erythema of central face with flushing, telangiectasias worsened with spicy food, ETOH, hot temp, emotional distress=?

TMT?

associated conditions?

Back 23

Rosacea

-topical metronidazole

-ocular manifestations (chalazion, blepharitis, keratitis, corneal ulcers)-optho consult

Front 24

Patient with silvery scaly plaques with mild itching=?

TMT?

Back 24

Psoriasis

-localized mild-to-mod: betamethasone .05% on extensors (hi-potency)

-facial or groin: topical tacro or low potency steroids (hydrocortisone 1%)

-severe(all over): methotrexate systemic or phototherapy

Front 25

Patient with hi Calcium - steps workup?

Back 25

1. measure PTH

->if hi (PTH dependent condition): measure urinary calcium

-->if>250/24hr: primary or tertial hyperPTH

-->if <100/24hr: familial hypercalcemic hypocalciuria

->if low: measure PTHrP, 25(OH)D, & 1,25(OH)D

-->up PTHrP: evaluate solid tumor

-->up 1,25(OH)D: CXR for possible lymphoma/sarcoid (granulomatous dz)

-->elevated 25(OH)D: vit D toxicity)

-->normal: check mult myeloma, adrenal tumor, immobilization, milk-alkali

Front 26

Fatigued patient with anemia, MCV 70: (Dx and TMT)

1. lo Fe, lo ferritin, hi TIBC, hi RDW

2. lo Fe, hi ferritin, lo TIBC

3. normal Fe studies, target cells

4. hi Fe, ETOH, isoniazid, lead

Back 26

1. Fe deficiency: ferrous sulfate

2. Anemia of chronic dz: correct underlying

3. Thalassemia: dx by hgb electrophesis with hi HgA2 and HgF, normal alpha Hg, no tmt

4. Sideroblastic anemia: if minor: pyridoxine replacement

Front 27

22yo soccer player tried to run around player on R, felt popping senation R knee then sudden pain with swelling, aspiration shows gross blood, ambulation is awkward and painful=?

Dx test?

TMT?

Back 27

ACL injury

-MRI (+anterior drawer test/lachman test)

-RICE (rest, ice, compression, elevation +/- surgery

Front 28

Patient with chronic locking or catching of knee, doesn't remember specific injury, slowly swelling=?

Back 28

meniscal tear

Front 29

Acute stress Disorder vs. PTSD?

Back 29

PTSD >1mo

Acute stress 3 days to 1mo and may resolve

Front 30

24yo M w/ periodic constipation x2 yrs and periumbilical pain better w/ BMs. Colonoscopy shows innumerable polyps=?

genetic info?

Next step?

Back 30

Familial Adenomatous Polyposis (FAP)

-aut dom (will have 1st degree relative w/ colon ca), test for APC gene to confirm

-upper GI endoscopy to r/o gastric and duodenal carcinomas

Front 31

12yo boy failing school, coughs repeatedly, blinks requently, shakes head repeatedly/randomly=?

Differentiate from other similar dz?

TMT?

Back 31

Tourette disorder (<18yo w/ multiple motor tics and at least one vocal tic)

-Autism disorder: have tics but are regular rhythmic with early onset and stop with distraction, impaired social/verbal communication

-TMT risperidone, pimozide, haldol, fluphenazine

Front 32

Patient with OCD-1st step TMT?

2nd step TMT?

3rd?

Back 32

CBT with exposure therapy

-SSRI (fluvoxamine, sertraline, escitalopram, paroxetine, citalopram)

-clomipramine

Front 33

TMT of herpes zoster?

What after tmt?

Has some lesions not yet crusted over - wants to go to dinner party?

TMT of post herpetic neuralgia?

Back 33

-acyclovir or valacyclovir for 7-10 days within 72hrs of skin rash onset (hastens resolution of lesions)

-immunization with VZV for adults >60 (will reduce risk post-herpetic neuralgia), unlikely to recur tho

-cover up affected parts (contact precautions as only contact causes transmission where as chickenpox is airborne and highly contagious)

-TCA (amitryptiline), topical capsaicin, gabapentin, oxycodone

Front 34

26yo M w/ HA, blurry vision over weeks, multiple sex partners w/o condoms, HIV+, RPR+, confirmatory trepenomal ab test +

-most sensitive test?

-other sx?

-next step?

-TMT?

-what if pregnant?

-what if allergic?

-has severe HA and shaking with fever several hours after TMT=?

-TMT of this?

Back 34

1. Lumbar puncture to r/o neurosyphilis

2. darkfield microscopy, then VRDL/RPR

-tabes dorsalis, argyll robertson pupil, general paresis

-if primary/2ndary/or early latent <12mos: benzathine penicillin G IM 1 dose

-if late latent>12mos OR UNKNOWN, cardiovasc or gummatous: penicillin IM weekly x3 weeks

-neurosyphilis: aqueous pen IV q4hrs x10-14days

-congenital: aqueous pen iv q8hr x10days

-desensitize if pregnant or allergic

-doxycycline if primary or secondary syphilis (chancre vs. rash/alopecea/condyloma)

2. Jarisch-Herxheimer rxn (from lysis spirochetes)

-no TMT

Front 35

Patient on statin therapy (for 1 year) with thigh pain and elevated CK 500 (normal 25-90) after long distance walk, discontinued. Now pain improved but LDL 132. Next step?

Back 35

Recheck serum CK and restart if normal sicne had significant myopathy that resolved and likely due to excercise

-only have to stop if CK >10x normal or symptomatic myopathy

Front 36

38yo M w/ diffuse joint pain, fatigue, skin rashes, no morning stiffness, is current smoker, ETOH use and IV heroin, multiple red,nonblanching nontender lesions lower extrem, mild hepatometaly, decreased serum C3, CH50, C4. Urine w/ RBC, WBC, proteinuria and RBC casts. up LFTs

-ML Dx?

-What test to dx?

-most acc test?

TMT?

Back 36

Mixed Cryoglobulinemia (arthralgias, lymphadenapathy, HSM, periph neuropathy, PALPABLE PURPURA, renal injury w/ asymtpomatic hematuria/proteinuria) - associated with HEPATITIS C

-check cryoglobulin (also C4 low)

-biopsy

-Ledipasvir/Sofosbuvir/Ribavirin

Front 37

Patient with cough, hemoptytis, decreased Cr, rbc cases on u/a=?

Initial test?

most accurate?

tmt?

Back 37

Wegeners Granulomatosis (resp/lung problems and systemic vasculitis with glomerulonephritis)

-C-Anca

-biopsy kidney

-Cyclophosphemide and steroids

Front 38

48yo F w/ hypoTH, elevated LFTs, on thyroxin, mild painless hSM, negative hep C=?

Other sx?

-dx test?

-most acc test?

-TMT>

Back 38

Autoimmune hepatitis

-progressive liver damage, middle age women, autoimmune manifestations (arthritis, E nodosum, thyroidits, pericarditis, anemia, sicca), elevated LFTs, aka lupoid hepatitis

-ANA and Anti - smooth muscle (Anti-SM) ab (serum electrophoresis shows hypergammaglobulinemia)

-liver bx

-Prednisone

Front 39

Patient with emotional/attention seeking behavior, inappropriate sexual/seductive behavior, dramatic emotions, shifting, vague speech, easily influenced, considers relationships more intimate than they are=?

Back 39

Histrionic Personality Disorder

Front 40

What vaccines for HIV patients? and when?

Back 40

HAV-for chronic liver dz, gay, iv drug use

HBV-all unless already immune

HPV-men and women 9-26

flu-yearly

Meningococcus-age 11-18, large group proximity (college, military, prison), asplenia/complement deficiency

Pneumococcus-PCV13 x1, PPSV23 8wks later and every 5 yrs

TDap: Tdap x1, rpt Tdap in pregnancy, Td q10 years after

Front 41

When to start treating ADHD with methylphenidate/amphetamines?

What to do before starting?

When do you expect it to work?

Back 41

after age 5 (in preschool chilrend try behavior therapy first, and then meds when fail)

-Cardiac hx and exam (no ekg needed)

-titrate up med every week or so until max dose, if not effective, stop and immediately start a different med

Front 42

Sx of lithium toxicity?

What drugs can it interact with to cause this?

TMT?

Back 42

confusion, ataxia, neuromuscular excitability, confusion, slurred speech, tremor

-thiazide diurettics (chlorthalidone most), ACEi, NSAIDS

-hemodialysis, IV hydration, check levels q2-4hrs