Uworld 7/2/13

Front 1

ABG findings in aspirin/salicylate tox?
What else seen?

Back 1

low pH (overall acidosis near neutral), low pCO2, low bicarb (mixed anion gap acidosis w/ resp alkalosis)
-Hyperpyrexia (hi temp from uncoupled ox phosph), tinitis, tachypnea

Front 2

Pt w/ severe abd pain and should pain after drinking and being punched in lower abdomen near pelvis.
ML Dx?

Back 2

Ruptured bladder dome (only part of bladder in contact w/ peritoneum)->chemical peritonitis->irritation of hemidiaphragm phrenic nerve C3,4,5->should pain

Front 3

Most common bladder injury outside of peritoneum?

Back 3

bladder neck rupture

Front 4

Pt w/ palpitation, lightheadedness, hx of weight loss, insomnia, fatigue, lid lag, fine tremor, found to have afib w/ RVR on ekg.
ML Dx?
TMT?

Back 4

Graves dz (w/ afib-complication of hyperthyroid)
-Beta blocker (propranolol) since hyperthyroid causes increased sensitivity beta receptors to sympathetic activity

Front 5

TMT of erysipelas?
Organism?

Back 5

penicillin
strep pyo

Front 6

first test in workup of monoclonal paraprotein?

Back 6

xray looking for punched out lytic lesions (metastatic skeletal scan)->if + think mult myeloma, if - think MGUS vs Waldenstrom's vs. amyloidosis
Followup w/ bone marrow bx to differentiate if unclear

Front 7

Differential of monoclonal paraprotein and unique features?

Back 7

1. MM: >10% plasma cells in bone marrow, serum monoclonal ptn>3 IgG or IgA spike on serum electrophoresis, hypercalcemia, lytic bone lesions on XR, renal failure (up BUN/Cr), anemia, rouleax on smear
2: MGUS: <10% plasma cells bone, serum mono ptn<3, no findings of MM (risk of MM transformation though)
3. Waldenstrom Macroglobulinemia: IgM from malignant B cell, hyperviscosity, lethargy, blurred vision, vertigo, engorged blood vessels in eye, mucosal bleeding, Raynauds

Front 8

TMT of waldenstrom macroglobulinemia?

Back 8

plasmapheresis to remove IgM and decrease hyperviscosity. Long term tmt w/ rituximab or cyclophosphamide

Front 9

Best test combo o ab and antigen for HepB?

Back 9

HBsAg and IgM anti-HBc (since IgM anti-HBc is the only thing that continues during window period and indicates acute phase of dz)

Front 10

Medical TMT of graves dz?
Side Effects?
Signs of side effects?

Back 10

Propythiouraci, methimazole
-agranulocytosis-appears as infxn w/ sore throat/fever/etc.

Front 11

CREST syndrome=

Back 11

calcinosis cutis (calcium pink/white nodules in upper extrem-"chalky"), raynauds phen, esophageal dysmotility, sclerodactyly, telangiectasias
-its limited sclerosis

Front 12

Most common causes of septic arthritis or osteo in neonates, infants<1?

Back 12

1. group B strep
2. e. coli

Front 13

Pt w/ recurrent pnas in same anatomic location lung by CXR=?
what to do?

Back 13

bronchogenic ca until proven otherwise (some obstruction)
-CT scan chest

Front 14

Change in child weight and height?

Back 14

weight doubles in 5mos, triples in 1yr
Height increases 50% in 1yr, doubles 4yr, triple 13yr

Front 15

State the developmental Milestones!

Back 15

2
4-5
6
9-10
12
2yr
3
4
5

Front 16

Most common glomerular dz in hodgkins?

Back 16

minimal change dz

Front 17

Most common glomerular dz in carcinoma?

Back 17

Membranous glomerulonephritis (nephropTHY)

Front 18

Type of nephrotic syndrome:
solid cancers=
children=
hodgkins=
injection drug use=
AIDS=
NSAIDS=
SLE=

Back 18

-membranous
-minimal change
-minimal change
-focal-segmental
-focal-segmental
-All but mostly membranous

Front 19

What type of rxn causes interstitial nephritis?

Back 19

IgE-mediated rxn

Front 20

What are concerning sexual behaviors in children 2-5yo?

Back 20

extensive sexual knowledge, stimulating foreplay, sexual intercourse, touching other's genitals

Front 21

Define IUGR
Causes of asymmetric vs/ symmetric IUGR?
Which has worse prognosis?

Back 21

IUGR=fetal weight <10th percentil
Symmetric has worse prognosis
Symmetric=chromosomal, congenital, TORCH (before 20wga, decreased brain weight like rest of body)
Asymmetric=maternal HTN, pree, uterine anomaly, antiphospholipid, collagen vasc dz, smoking (after 20wga, no change in brain weight, smaller abd)

Front 22

hi WBC w/ neutrophils predominant, splenomegaly, pruritis after hot shower=
Dx Test?
TMT?

Back 22

CML (basophils release histamine=pruritis, splenomegaly described as abd fullness, b sx)
-BCR-ABL test w/ PCR or FISH
-Imatinib (tyr kinase inhibitor) initial tmt

Front 23

5q deletion=

Back 23

myelodysplastic syndrome (think sideroblastic anemia + pancytopenia)

Front 24

pelger-huet cell=

Back 24

myelodysplastic syndrome

Front 25

reed-sternberg cells=

Back 25

hodgkins lymphoma

Front 26

Pt w/ hodgkins lymphoma
What test to do to determine amount of chemo?

Back 26

MUGA or nuclear ventriculogram (since adriamycin/doxorubicin is cardiotoxic and need to know LV EF%)

Front 27

Adverse toxic effects of chemo:
Doxorubicin?
vincristine?
bleomycin?
cyclophosphamide?
cisplatin?

Back 27

-cardiomyopathy
-peripheral neuropathy
-lung fibrosis
-hemorrhagic cystitis
-renal and ototoxicity

Front 28

TMT of abscence seizures?

Back 28

ethosuximide or valproate

Front 29

TMT iniitally of all partial seizures?

Back 29

phenytoin

Front 30

Name physiologic changes of pregnancy in
Cardio-
GI-
Kidney-
Heme-

Back 30

-increased cardiac output/HR, slight down BP
-Morning sickness (naus/vom during day from estrogen/prog/hcg levels), GERD, constipation (decreased large intestine motility)
-increased size kidney/ureter (chance pyelo from uterine compression), up GFR->down BUN/Cr
-anemia (from increase plasma vol 50%), hypercoagulable (no change PT/PTT/INR, increase fibrinogen)

Front 31

4 complications of tetralogy of fallot

Back 31

Pulm stenosis->crescendo/decrescendo murmur at 2nd L
RVH
Overriding Aorta
VSD->holosystolic murmur at LLsternal border

Front 32

What improves tet spell?

Back 32

knee to chest position (increases SVR and preload decreasing R to L shunt of VSD and diverting blood to pulm artery increasing oxygenation)

Front 33

TMT of tet of fallot?

Back 33

surgery

Front 34

What conditions have VSD and what is chrom abnormality?

Back 34

Down (trisomy 21)
Edward (trisomy 18)
Patau (trisomy 13)
Tet of fallot (associated w/ chrom 22)

Front 35

Hep E is concerning in what population?

Back 35

Pregnancy (3rd trim) and east asians, middle-aged
-can progress to fulminant hepatitis (in 15% pregnant cases)

Front 36

Pt w/ SLE w/ 2+ptn on U/A and rising BUN/Cr.
Next Step?

Back 36

Biopsy Kidney (need to determine stage of SLE nephritiss prior to treating)
TMT is w/ steroids and cyclophosphamide/mycophenalate

Front 37

Sx of hyperestrogenism in cirrhosis?

Back 37

spider angiomata, gynecomastia, palmar erythema, testicular atrophy, decreased body hair in males

Front 38

EKG findings anterior MI? Vessel involved?

Back 38

LAD, some to all of V1-V6 ST elevation

Front 39

EKG findings inferior MI? Vessel involved?

Back 39

RCA or LCX, ST elevations II, III, AVF

Front 40

EKG findings posterior MI? Vessel involved?

Back 40

LCX or RCA, ST depression V1-V3, ST elevation I & AVL (LCX), ST depression leads I & AVL (RCA)

Front 41

EKG findings lateral MI? Vessels involved?

Back 41

LCX or diagonal, ST elevations I, AVL, V5, V6 and ST depression leads II, III, AVF

Front 42

EKG changes right ventricle MI? Vessels involved?

Back 42

RCA, ST elevations V4-V6 on RIGHT

Front 43

What findings in RCA occlusion?

Back 43

inferior wall MI, RV infarction, AV block (from lack blood to AV node thru AV nodal artery), bradychardia (from lack blood supply to SA node)

Front 44

Pt w/ diarrhea, abd pain, scaly pigmented skin rash malar face, neck, back of hands worse w/ sunlight, depressed mood and decreased memory.
ML Dx?
Cause?
Hints?

Back 44

Pellagra
-niacin deficiency->dermatitis, diarrhea, dementia (4th is death)
-from india, africa, china (corn based diet) (differentiate from porphyria cutanea tarda which lacks other findings)

Front 45

Obese woman recently pregnant w/ periodic visual loss when standing up or leaning forward abruptly. Also frequent morning HA.
ML Dx?
Describe findings in ocular exam.

Back 45

Papilledema from pseudotumor cerebri (idiopathic intracranial HTN)
-enlarged blind spot

Front 46

Optic neuritis pathomnemonic for=?
describe?

Back 46

Multiple sclerosis
unilateral eye pain and vison loss

Front 47

Child to ED w/ fall on head, LOC, vomited once, and HA.
What do you do?

Back 47

mild traumatic brain injury w/ GCS 15: do CT scan and send home if normal w/ as long as someone can monitor him for 24hrs

Front 48

What is the most sensitive test in detecting hypovolemia?

Back 48

BUN/Cr

Front 49

Tennis player w/ shoulder pain, worsened by passiver internal rotation and flexion of shoulder, pain when he lifts his arm over head.
ML Dx?

Back 49

Subacromial bursitis (from repeated overhead movement causing rubbing of supraspinatus tendon btwn acromonion and humeral head leading to temp vascular supply compromise)

Front 50

Alternate name for tennis elbow?

Back 50

lateral epicondylitis (since that's where it occurs!)

Front 51

What clonal proliferation occurs in CLL?
What is a poor prognostic factor?
Primary cause of death?

Back 51

small mature B lymphocytes
thrombocytopenia (worst)->tmt w/ prednisone (different from other stages delt w/ cyclophosphamide)
infxn

Front 52

Hansel or Wright Stain for?

Back 52

acute allergic interstitial nephritis to detect eosinophils

Front 53

What combo of pts get papillary necrosis?
Presentation?
Initial Dx Test? Best Test?

Back 53

NSAID use or sudden vascular insufficiency in pt w/ SICKLE CELL, DM2, urinary obstruction, pyelo
-SUDDEN (w/in hrs whereas pyelo takes a few days) onset flank pain, fever, hematuria
-U/A w/ rbcs and wbcs and maybed necrotic tissue, best CT scan w/ bumpy egg in cup contour of lost papillae

Front 54

HIV pt w/ red eye painful w/ discharge, multiple skin lesions on face, eyelid, inner thigh, penis, pubis, CD4 <100, are pale.
ML Dx?
describe lesions?
Cause?

Back 54

Molluscum Contagiosum
pale, pearly shiny dome shaped papule w/ central umbilication (can also cause conjunctivitis)
-poxvirus in HIV pts CD4 <100

Front 55

What is pseudocyesis?

Back 55

pt wants to be pregnant so mimicks it but not really ->its a strong psych conversion disorder

Front 56

How do fibroids change over time?

Back 56

increase w/ size w/ OCPS or pregnancy, regress after menopause (estrogen dependent)

Front 57

Sx of pelvic congestion syndrome?

Back 57

dull ill defined pelvic ache worse prior to menses relieved by it, associated w/ hx of sexual problems

Front 58

TMT of MS?
ppx of MS?
Dx test for MS?
Most common order of sx MS?

Back 58

Hi dose steroids
-glatiramer, beta interferon, immonuspressives (aza, cyclophosph)
-MRI w/ multiple white matter lesions
-1 ataxia/focal prob, 2 optic neuritis, 3 motor/sensory

Front 59

anticholinergic drug + retro-orbital pain=?

Back 59

acute angle glaucoma

Front 60

side effect of levodopa?

Back 60

naus/vom, anxiety, agitation

Front 61

Brain area effected in parkinsons?
type of gait?
TMT of mild dz?
TMT of severe dz?

Back 61

substantia nigra
-shuffling gait
-anticholinergics (benzrtopine trihexyphenidyl) and amantadine (increases dopamine release, use especially when old pt intolerant of anticholinergic)
-Levodopa/carbidopa, dopamine antagonist (pramipexole/ropinerole), COMT inhibitors (tolcapone and entacapone->prevent breakdwon dopamine, use to prevent on/off phenomena of levo/carbi), MAOi(rasagiline/selegiline, block dopa metabolism)

Front 62

TMT restless leg syndrome?

Back 62

pramipexole (dopamine agonist)

Front 63

What causes hypoxia in pna?

Back 63

alveolar and interstitial inflammation->V/Q mismatch->increase in A-a gradient

Front 64

TMT placenta previa?

Back 64

emergent c-section

Front 65

What causes TTP?
What occurs in it?
Lab findings?
TMT?

Back 65

HIV, SLE, ticlopidine, clopidogrel, cyclosporine
Pentad: microangio introvasc hemolysis, thrombocytopenia, renal failure, neuro sx (confusion/seizures), Fever
-schistocyte, helmet cells, fragmented RBCs, normal Pt/PTT, negative coombs
-Plasmapheresis if severe (DO NOT GIVE PLTS) or FFP infusion

Front 66

Triad of HUS?

Back 66

IV hemolysis, thrombocytopenia, renal failure

Front 67

1st line for specific phobias tmt?

Back 67

CBT