Usmle World Test 3

Front 1

Dx 22 yo patient with breast nodule that is firm moveable rubbery mass, that when aspirated, disappears.

Back 1

In a young person, this is an example of fibrocystic disease, which when treated, results in resolution of the lesion. You observe the patient for 4-6 weeks afterwards.

Front 2

Tx for someone w Pagets disease of the bone whos bones havent been affected yet

Back 2

If bone scan doesnt show active disease, then no treatment is needed. Conditions for treatment are bone pain, hypercalcemia of immobolization, neuro deficit, high output cardiac failure, prep for ortho surg, involving weight bearing bones. Bisphosphonates are treatment of choice, decreasing bone resportion. Calcitonin is second line drug.

Front 3

Dx a gardener who persents with painless ulcer on the finger of right hand, and w numerous non tended sub cutaenous nodules on his right forearm.

Back 3

Key is gardener, and he has sporothrix schenkii, or otherwise known as Sporotrichosis. Initial lesion is a nodule that later ulcerates.

Front 4

Greatest diagnostic utility of bronchoalveolar lavage

Back 4

Done to sample lung cells, either when suspecting malignancy or opportunistic infections. Do it to evaluate PCP.

Front 5

Main side effect of amiodarone

Back 5

Pulmonary toxicity is he main side effect, leads to pulmonary fibrosis. Also thyrodi dysfunction, hepatotoxicity, corneal deposits, skin changes.

Front 6

Characteristics of an Anterior cerebral artery stroke vs a left middle cerebral artery stroke

Back 6

The more anterior you are, the more likely you are to affect contralateral feet than upper limbs, and the more middle you are, the more you have arm involvement rather than feet.

Front 7

Dx patient with SOB who has an elevated left main bronchus

Back 7

Something that causes Left atrial involvement, such as mitral stenosis leading to atrial enlargment. Most common cause of MS is rheumatic fever.

Front 8

Dx patient with pallor, jaundice, positive coombs test, and spherocytes wo central pallow

Back 8

AIHA

Front 9

Tx of patient with suspected primary hyperparathyroidism

Back 9

Need to get a setamibi scan to evaluate where you need to be cutting.

Front 10

Define a retrospective cohort study

Back 10

Must have some kind of exposure, then you follow until some kind of outcome.

Front 11

Define a case control study

Back 11

Case control is also a retrospective study, and it begins by looking at a certain outcome, and are defined as cases or controls based on outcome. Then you look back for risk factors.

Front 12

Dx patient with polyarthralgia, tenosynovitis, and painless vesiculopustular skin lesions.

Back 12

Disseminated gonoccocal infection. Treat w ceftriaxone.

Front 13

Dx Test for someone with suspected vasovagal syncope

Back 13

Tilt table test. You can use isoproterenol to induce the syncope .

Front 14

Tx for bacillary angiomatoses

Back 14

These look like bright red, firm, friable, exophytic nodules, that are caued by Bartonella, a gram negative bacillus. Use oral erythromycin.

Front 15

Most common causes of epiglottitis

Back 15

Usually haemophilus influenze and strep pyogenes.

Front 16

Dx patient with a brief period of impaired conciousness, automatisism, but no post icta state.

Back 16

This a typical absence seizure. An atypical one is oen that last longer. You can induced this with hyperventilation.

Front 17

Dx patient with brief period of impair conciousness, fialure to respond to stimuli, staring spells, and post ictal confusion. Hyperventilation during EEG cannot stiumlate the seizure.

Back 17

Complex partial seizure.

Front 18

Dx child with multiple types of seizures, impaired cognitive function, and slow activie on EEG

Back 18

Lennox Gastaut syndrome.

Front 19

Elderly patient with bone pain, renal failure and hypercalcemia

Back 19

Multiple myeloma.

Front 20

Tx for someone with a symptomatic right renal bruit

Back 20

This person needs angioplasty with stent placement.

Front 21

Pt with a microcytic anemia with GI bleeding, hepatomegaly, liver enzymes representative of cholestatic disase, small pleural effusion.

Back 21

Patient with possible metastatic disease.

Front 22

Patient with hepatomegaly and elevated LFTs with obesity, DM, and hypertriglyceredemia

Back 22

NASH

Front 23

Tx for a patient with suspected squamous cell who has a negative CT scan

Back 23

Panendoscopy, which consists of esophagoscopy, bronchoscopy, and laryngoscopy.

Front 24

Dx. patient w progressive dyspnea on exertion, and a dry non productive, with velcro like inspiratory crackles, no fever and chest pain.

Back 24

IPF.

Front 25

X ray findings of sarcoidosis

Back 25

Bilateral lymphadenopathy but also interstitial infiltrates. 1/4 of patients have anterior uveitis. Some only present w interstitial infiltrates.

Front 26

Dx patient w recurrent epistaxis, with ruby colored papules on lips that blanch with pressure, digital clubbing.

Back 26

Osler-weber-rendu syndrome, hereditary telangetctasis, which also have widespread AVM, sometimes in the lungs, leading to chronic hypoxemia and secondary polycythemia.

Front 27

Tx of myasthenia gravis

Back 27

Three treatments. Anticholinesterases, immunosuppresive agents, and thymectomy. Pyridostigmine is drug of choice. Edrophonium is also an anticholinergic but is only used for diagnostic purposes.

Front 28

Dx patient with a palpable mass 4 weeks after onset of acute pancreatitis

Back 28

Pancreatic pseudocyst. Comprised of inflammatory fluide, tissue, and debris, also seen is a high serum amylase. Ultrasound to diagnose.

Front 29

Patient w recurrent bilateral trigeminal neuralgia in her 30s

Back 29

MS. Focal neurologic dysfunction is key here, transient in nature, can occur 20-30 times a day.

Front 30

Largest risk factor for malignancy in a mole

Back 30

If it has recently changed, with a relative risk of 10

Front 31

Dx patient with increased intraocular pressure, with cupping of the optic disc and loss of peripheral vision. Tunnel vision.

Back 31

This is primary open angle glaucoma. It is different from angle closure glaucoma as these patients have severe eye pain, nausea, vomitting, and a rey eye with hazy cornea and dilated pupill.

Front 32

Dx patient with decreased central vision and old age.

Back 32

Macular degeneration

Front 33

Dx patient w progressive thickening of lens, oxidative damage to the lens w blurred vision, problems w nighttime driving and glare.

Back 33

Cataract.

Front 34

Cause of hyperkalemia in DKA

Back 34

Not true hyperkalemia, as the patient actually has decreased total body potassium. Usually caused by the metabolic acidosis leading to a shift, and a volume contraction.

Front 35

Best way to monitor respiratory function in a patient w GBS

Back 35

you use vital capacity. better than ABG? Dubious. People GBS usually get it due to respiratory tract infection of GI infection usually campy.

Front 36

Dx patient with a lesion in left forearm wo any sensation, w general malaise, headache or cough.

Back 36

This is leprosy, which affects the periperhal nerves and skin, caused by mycobacterium leprae, presents as a hypopigmented plaque with muscle atrophy and cirppling of hands. Need to do skin biopsy.

Front 37

Dx pregnant woman who presents with SOB and inability to lie flat, and recurrent sore throats as a child, w A fib

Back 37

Acute onset MS, secondary due to rheumatic fever. ALso patients will have a diastolic rumble at apex or opening snap.

Front 38

Dx patient with left sided varicocele that does not empty when patient is recumbent.

Back 38

Pt probably has renal cell carcinoma. Classic triad is flank pain, hematuria, and palpable abdominal mass.

Front 39

Dx patient w low back pain w that is worse w standing and relieved by sitting, and pain is more severe walking uphill than downhill.

Back 39

Spinal stenosis, need to get an MRI.

Front 40

Type of metabolic acidosis in chronic renal failure

Back 40

Patients classically present with a hypochloremic gap acidosis, due to a failure to excrete acid as NH4+ and accumulation of organic anions.

Front 41

Renal insufficiency with a non gap acidosis associated wtih hyperkalemia

Back 41

Type 4 RTA, due to aldosterone deficiency, leading to K retention and a failure to secrete acid as NH4+. (no sodium H exchange, retaining H).

Front 42

Causes of restrictive cardiomyopathy

Back 42

Infiltrative (sarcoid, amyloid), storage (hemochromatosis), endomyocardial fibrosis. Hemochromatosis is the only reversible one.