UWorld Tidbits 2

Question 1

Workup for UTI: in diapers vs. not in diapers

Answer 1

Workup for UTI

• not in diapers: can do clean catch mid stream
• if in diapers: need to do straight catheterization for a sterile specimen b/c of frequent contamination of stool and skin flora

Question 2

Effect of the following on HOCM murmur intensity

(a) Squat
(b) Sustained hand grip
(c) Valsalva

Answer 2

HOCM murmur

• murmur intensity increases w/ decreased preload
• murmur intensity decreases w/ increased preload or increased afterload

(a) Squatting increases afterload and increases preload => decreases murmur intensity
(b) Sustained hand grip increases afterload => decreases murmur intensity
(c) Valsalva decreases preload => increases murmur intensity

Question 3

Trendelenburg sign

(a) What is it
(b) Indicates weakness in what muscle?

Answer 3

(a) Trendelenburg sign = drooping of contralateral hemipelvis during monopedal stance (aka if stand on left foot, right hip/pelvis tips downwards)
(b) Weakness or paralysis of gluteus medius/minimus

Question 4

Huge laboratory distinction btwn HUS and HSP

Answer 4

HUS = thrombocytopneia

HSP = purpura w/ normal platelet count

Question 5

Bone tumor w/ pain quickly relieved by NSAIDs

Answer 5

Osteoid osteoma

Question 6

Workup for simple febrile seizure

Answer 6

Reassurance- no EEG needed

Question 7

5 major criteria for acute rheumatic fever

(a) Etiology

Answer 7

JONES

J- joints (migratory arthritis)
O (shape of a heart)- carditis
N- nodules
E- erythema marginatum (rash)
S- sydenham chorea 

(a) Etiology = strep pyogenes

Question 8

Serum sickness-like reaction

(a) What is it
(b) Features
(c) How to distinguih from ARF

Answer 8

(a) Type III hypersensitivity 1-2 weeks after starting beta-lactam or bactrum abx
(b) Features = fever, uticaria, polyarthralgia
(c) ARF extremely rare after proper abx tx of strep pharyngitis

Question 9

Physical exam finding of coarctation

Answer 9

Upper extremity hypertension

Question 10

Explain why there is a single S2 in TOF

Answer 10

Stenotic pulmonic valve

Question 11

Effect of squatting on ToF murmur

Answer 11

Squatting decreases r –> l ventricular shunting => improves cyanosis but increases murmur intensity b/c of the increased blood flow thru the RVOT

Question 12

Next step in evaluation of primary amenorrhea if

(a) Uterus present
(b) Uterus absent

Answer 12

Primary amenorrhea workup if

(a) Uterus present- FSH levels
- if FSH high: karyotype
- if FSH low: cranial MRI
(b) Uterus absent- karyotype

Question 13

Bugs of CF pneumonia

(a) GNR
(b) GN coccobacilli
(c) GP cocci in chains
(d) GP cocci in clusters

Answer 13

CF pneumonia

(a) GNR: pseudomonas, B. cepacia, strenotrophomonas maltophilia
(b) GN occcobacilli = H influenza
(c) GP cocci in chains = strep pneumo
(d) GP cocci in clusters = staph aureus

Question 14

Describe the murmur heard from a large VSD

Answer 14

Pansystolic murmur best heard over LLSB + diastolic rumble at apex (due to increased flow across the mitral valve)

Question 15

Features in addition to inspiratory stridor

(a) Laryngomalacia
(b) Vascular ring

Answer 15

Inspiratory stridor +

(a) Layrngomalacia = worse when supine, improves when prone
(b) Vascular ring- improves w/ neck extension, aways presents before 1 yoa, associated w/ presence of other cardiac abnormalities

Question 16

Musty/mousy body odor

Answer 16

Mousy body odor- buzzword for PKU

Question 17

5 mo old w/ 2 days of projective vom, diarrhea, one GTC seizure
-eczematous rash

Answer 17

Musty odor of urine- think PKU

Question 18

First line pharma tx for Tourette’s

Answer 18

Antipsychotics

-Haloperidol, pimozide, risperidone

Question 19

Next step:

Child w/ ALL, parents refusing chemotherapy

Answer 19

Obtain court order for chemo

-non-emergency by fatal medical condition

Question 20

Best bet for abx choice for 3 yo CF pt w/ pneumonia

Answer 20

Staph aureus = most common cause of bacterial pneumonia in young kids w/ CF => tx for IV Vanc

Question 21

First line tx for pinworm

Answer 21

Pinworm (scotch tape test on anus) tx = Albendazole

Question 22

Acute stroke sydnrome in child after foreign body injury to soft palate

Answer 22

Internal carotid artery dissection

-confirm dx w/ brain MRI

Question 23

5 yo w/ difficulty swallowing, copious drool, facial grimacing

• fever, chills, malaise, muscle aches
• refusing water

(a) Dx
(b) Reservoir
(c) Tx

Answer 23

(a) Rabies: hydrophobia/aerophobia (feeling of water or air triggers involuntary pharyngeal muscle spasms) pathognomonic

(b) Racoon
(c) Post-exposure rabies prophylaxis = both rabies immune globulin and rabies vacine to prevent progression to life-threatening encephalitic or paralytic disease

Question 24

Hydrophobia/aerophobia

Answer 24

Refuses to drink fluids, pathognomic for rabies b/c feeling or air/water triggers involuntary pharyngeal muscle spasms

Question 25

of words for a (a) 24 month old (b) 30 mo old

Answer 25

(a) 24 month old: 150-300 words - correct use of pronouns - stranger understands about 1/2 of the child's speech (b) 30 mo: about 1,000 words - 3-4 word sentences

Question 26

Next step: 25 hr old CF pt w/ bright green vomitting - hasn't passed BM - distended abdomen - Xray showing dilated bowel loops w/ no rectal air and no free air

Answer 26

Next step: contrast enema to assess for level of obstruction. After determining level of obstruction => surgery

Question 27

14 yo F w/ irregular menstrual periods -oral progesterone => withdrawal bleeding for 3 days Cause?

Answer 27

HPG axis immaturity = common cause of irregular menstrual cycles in women shortly following menarche = insufficient gonadotropin secretion

Question 28

Bony prominences of the costochondral junctions and genu varum

Answer 28

Vitamin D deficency rickets -costochondral joints = rachitic rosary

Question 29

Most common cause of nephrotic syndrome in teenager w/ HepB

Answer 29

MCD is the most common in younger children and children overall, but teenager + active Hep B infection = membranous nephropathy