UWorld_7.18

Question 1

Analgesic overuse ==> kidney dz?

Answer 1

chronic interstitial nephropathy w/WBC casts

Question 2

glomerulonephritis ==> UA results?

Answer 2

• hematuria/RBC casts

- +/- proteinuria

Question 3

Most important risk factor for stroke

Answer 3

HTN

Question 4

Complications of wilson’s dz.

Answer 4

• cirrhosis

- hepatolenticular degeneration (basal ganglia) ==> neuropsych changes

Question 5

Tx of wilson’s dz.

Answer 5

• copper chelators: d-penicillamin or tientine
• oral zinc
• liver transplant if needed

Question 6

Renal tubular acidosis ==> acid/base disturbance?

Answer 6

metabolic acidosis

Question 7

Metabolic alkalosis evaluation

Answer 7

1. urine chloride
   - low urine cl ==> vomiting/aspiration vs. diuretic use
   - high urine cl ==> examine vol. status
2. volume status
   - hypervolemia ==> excess MC activity, e.g. hyperaldo, cushings, ectopic ACTH
   - hypovolemia/euvolemia ==> bartter & Gitelman syndromes

Question 8

Management of torsades de pointes

Answer 8

1. defib in hemodynamically unstable patients

2. IV magnesium sulfate @ conscious/stable patients + removal of offending causes (e.g. medication induced prolonged QT)

Question 9

Drugs that prolong QT

Answer 9

• diuretics ==> electrolyte imbalances
• zofran
• antipsychotics (haloperidol, quetiapine, risperidone)
• TCAs
• SSRIs: citalopram
• Antiarrhythmics: amiodarone, sotalol, flecainide
• antianginal: ranolazine
• antibiotics: macrolides, fluoroquinolones, antifungals

Question 10

Electrolyte imbalances ==> prolonged QT

Answer 10

• hypoK
• hypoMg
• hypoCa

Question 11

Thyroid storm presentation

Answer 11

• fever
• tachycardia/arrhythmias
• HTN
• tremor
• AMS
• lid lag

Question 12

Dermatitis herpetiformis association/presentation

Answer 12

• pruritic papules/vesicles @ elbows, knees, buttocks, etc.

- assoc. w/gluten-sensitive enteropathy

Question 13

Porphyria cutanea tarda presentation

Answer 13

• painless blisters, hypertrichosis, hyperpigmentation
• assoc. w/hep C
• can be triggered by ethanol, estrogens

Question 14

Acute Hep B infection

Answer 14

• icterus
• urticarial rash
• flulike sx
• elevated LFTs

Question 15

Indications for carotid endarterectomy

Answer 15

• @ men: 60-99% stenosis w/out sx or >50% if sx

- @ women: 70-99% stenosis

Question 16

RA skeletal risks

Answer 16

• osteopenia
• osteoporosis
• bone fx

Question 17

Sensorineural hearing loss vs. conductive hearing loss

Answer 17

• Rinne test: bone > air conduction ==> dx = conductive hearing loss
• Weber: @ conductive ==> affected ear; @ sensorineural ==> unaffected ear

Question 18

Common cause of conductive hearing loss in adults

Answer 18

otosclerosis = remodeling of otic capsule w/stapes fixed to oval window

Question 19

Abx ototoxicity ==>

Answer 19

sensorineural hearing loss

Question 20

Imaging of pancreatitis

Answer 20

RUQ ultrasounds

Question 21

Artifical heart valves/severely calcified valves ==> heme-related complication?

Answer 21

macrovascular hemolysis ==> microcytic anemia

Question 22

Fear of public speaking/performance ==> dx?

Answer 22

social anxiety disorder

Question 23

hyperactive bowel sounds + dilated loops of bowel ==> dx?

Answer 23

ileus

Question 24

Albumin impact on calcium

Answer 24

• most Ca2+ bound to albumin/plasma proteins

- decreased albumin ==> decreased total Ca2+; ionized Ca will stay stable

Question 25

Cause of low platelets in HIT

Answer 25

autoantibodies

Question 26

Tx of acute dystonia 2/2 anti-psych

Answer 26

- benztropine | - diphenhydramine

Question 27

Tx of acute parkinsonism 2/2 anti-psych

Answer 27

- benztropine | - amantadine

Question 28

PPx of cluster H/A

Answer 28

- verapamil - prednisone - ergotamine - indomethacin

Question 29

Tx of cluster H/A

Answer 29

100% O2

Question 30

Wartlike lesions + violaceous nodules + skin ulcers ==> dx?

Answer 30

blostomycosis

Question 31

Histoplasmosis infx presentation

Answer 31

- mycosis @ Miss./OH river valley - asx vs. mild pulmonary - diss. @ immunocompromised

Question 32

Coccidioidmycosis infx presentation

Answer 32

- mycosis @ SW united states/CA | - pulmonary

Question 33

Evaluation of hypocalcemia

Answer 33

1. corrected Ca (is albumin low?) 2. low Mg? drugs? blood transfusion? 3. measure PTH - normal/low: (para)thyroidectomy/radical neck surgery, wilson's dz, hemochromatosis - high: Vit D deficiency/CKD, pancreatitis, sepsis, tumor lysis

Question 34

Tetralogy of Fallot murmur

Answer 34

harsh, systolic ejection murmur @ LUSB

Question 35

VSD murmur

Answer 35

- holosystolic murmur @ LLSB | - diastolic rumble 2/2 increased blood flow across mitral valve

Question 36

Risk factors for acalculous cholecystitis

Answer 36

- severe trauma, burns, recent surgery - prolonged fasting or TPN - critical illness