UWSA2

Question 1

woman gets soft subareolar mass from to weeks to months after cessation of breast feeding

Answer 1

galactocele

• benign milk retention cyst
• can get as large as 5cm
• dx made with ultrasound and needle aspiration

Question 2

explain the difference b/w primary and secondary adrenal insufficiency

Answer 2

primary- destruction of adrenal cortex (bilateral)
-all three layers affected

secondary- disruption of hypothalamic-pituitary axis

• cortisol (glucocorticoid) and ACTH decrease
• aldosterone (mineralocorticoid) will be normal

*Note: neither include anything with the adrenal medulla

Question 3

erythrasma

Answer 3

superficial skin infection affecting areas where skin touches or folds on itself

• well-demarcated, thin, red-brown plaques with wrinkling and fine scale
• coral-red appearance under woods lamp

Question 4

signs of congenital CMV

Answer 4

jaundice 
petechiae
hepatosplenomegaly 
periventricular calcifications 
microcephaly

Question 5

how to treat a gout flare in pts on anticoagulants

Answer 5

colchicine

Question 6

triad of acute liver failure

-there may be more symptoms but these three are the most specific

Answer 6

• elevated aminotransferases
• hepatic encephalopathy
• prolonged prothrombin time

*all of these in a pt without underlying liver disease

Question 7

patient with extensor vs flexor posturing when lying supine, what do you think of

Answer 7

flexor means problem is above red nucleus

extensor means problem is below red nucleus

Question 8

infarctions of this area impair motor functioning causing…

• hemiparesis
• dysarthria-clumsy hand syndrome

Answer 8

basis pontis (basilar pons)

Question 9

recurrent lapses into sleep or naps 3 or more times/week for 3 months
… what is this and what are the other criteria

Answer 9

narcolepsy and they must have 1 or more of the following as well

• cataplexy: brief loss of muscle ton precipitated by strong emotion
• low CSF levels of hypocretin-1
• shortened REM sleep latency

Question 10

patient randomly has ischemic ulcers and gangrene but also smokes

Answer 10

thromboangiitis obliterans (buerger disease) 
-inflammatory vaso-occlusive disorder to small and medium sized vessels 

-tx: stop smoking

Question 11

patient has asthma or cystic fibrosis that gets worse and leads to recurrent pulmonary infiltrates and bronchiectasis

Answer 11

allergic bronchopulmonary aspergillosis

-tx: long-term oral steroids and itraconazole

Question 12

treatment of hypercalcemia

Answer 12

severe > 14

• short term- hydration + calcitonin
• avoid loop diuretics unless heart failure exists
• long term- bisphosphonates (zoledronic acid)

moderate 12-14
-no treatment unless symptomatic, look above if needed

mild < 12

• no immediate treatment
• avoid thiazides, lithium, volume depletion, and prolonged bed rest

Question 13

what is the strongest risk factor for prosthetic valve thrombosis of a mechanical heart valve

Answer 13

inadequate warfarin anticoagulation

• goal INR for mitral valve: 2.5-3.5
• goal INR for aortic valve: 2-3

Question 14

bipolar I vs bipolar II

Answer 14

bipolar I
-manic episodes

bipolar II
-hypomanic episodes + 1 major depressive episode

Question 15

cyclothymic disorder

Answer 15

2+ years of fluctuating, mild hypomanic & depressive symptoms

Question 16

most common etiology of persistent nasal obstruction during childhood

Answer 16

adenoid hypertrophy

• presents with recurrent sinus and ear infections, mouth breathing, sleep disturbances/snoring due to apnea
• not seen on exam

Question 17

what disease are nasal polyps associated with

Answer 17

cystic fibrosis

-able to be visualized on exam

Question 18

positive fetal fibronectin test, next step?

Answer 18

give IM betamethasone if they are less than 34 weeks

-+ FFN is associated with delivery within the next week

Question 19

if someone has lambert-eaton, what is your next step

Answer 19

get a chest CT cause its associated with small cell lung cancer

Question 20

colonic pseudo-obstruction

Answer 20

aka ogilvie syndrome

• acute dilation of the colon only without any actual obstruction
• massive dilation of the cecum (diameter > 10cm)
• due to surgery, trauma, infection, electrolyte derangement (all decreased), medications, neuro disorders
• treat with npo, ng/rectal tube decompression
• use neostigmine if no improvement within 48 hours

Question 21

what is one thing required in most states regardless of consent?

Answer 21

neonatal prophylaxis against gonococcal conjunctivitis

-topical erythromycin

Question 22

what is the most common dermal manifestation of antiphospholipid syndrome

Answer 22

livedo reticularis

• transient latticelike rash caused by impaired blood flow in superficial venules
• prolonged aPTT due to lupus anticoagulant

Question 23

what does doxorubicin do to the heart

Answer 23

cardiac myocyte necrosis and death

• cardiomyocyte replacement by fibrous tissue
• not reversible

Question 24

trastuzumab cardiotoxicity

Answer 24

myocardial stunning/hibernation without myocyte destruction

-reversible

Question 25

delusional disorder

Answer 25

persistent delusions lasting 1+ months with no other psych symptoms

Question 26

behcet syndrome

Answer 26

genital aphthous ulcers - recurrent and painful - heal w/i 1-3 weeks

Question 27

liver mass with central stellate scar

Answer 27

focal nodular hyperplasia

Question 28

patients with hyperemesis gravidarum are more likely to have what type of pregnancy

Answer 28

pts with hydatidiform mole or multifetal gestation are at increased risk for HG -get pelvic u/s if they have it

Question 29

loss of peripheral vision in a pt with normal visual acuity | -usually elderly pt

Answer 29

open-angle glaucoma | -enlarged cup/disc ratio > 0.6

Question 30

DRESS syndrome

Answer 30

Drug- most commonly due to allopurinol and antiepileptics (phenytoin, carbamazepine) Reaction (rash)- morbilliform eruption starts on face or upper trunk and becomes diffuse and confluent, with facial edema Eosinophilia Systemic Symptoms- fever, malaise, diffuse lymphadenopathy with some sort of organ involvement (liver, kidney, lung) - can happen 2-8 weeks after drug initiation - offending drug should be stopped immediately and usually pts recover completely

Question 31

what should you worry about if someone gets malaria from a non-African country

Answer 31

its likely vivax and you need to worry about dormant hepatic infection that can reactivate if you dont use primaquine to get rid of the hepatic hypnozoites -can cause a persistent dormant infection

Question 32

what are the three vaccinations a mother should get during the third trimester

Answer 32

Tdap inactivated influenza Rho(D) immunoglobulin- if indicated

Question 33

choriocarcinoma

Answer 33

- secretes hCG, following any type of pregnancy - very aggressive - uterine mass that most commonly metastasizes to the vagina and lungs (on vagina presents as red, friable lesions) - can cause bloody purulent vaginal discharge - pelvic pressure and enlarged uterus

Question 34

patient presents with microscopic colitis - frequent watery bms - fecal urgency - incontinence - classically: nocturnal diarrhea - workup for pretty much everything else is negative what do you see on biopsy of the colon?

Answer 34

mononuclear predominant infiltrate -risk factors: > 50, women, smoking, possibly NSAIDs

Question 35

which medications can cause akathisia

Answer 35

-inner restlessness meds - antipsychotics - antiemetics (prochlorperazine, promethazine, metoclopramide) *these can cause all the different types of extrapyramidal symptoms

Question 36

how to differentiate myelodysplastic syndrome and myelofibrosis

Answer 36

both have pancytopenia - myelodysplastic syndrome has dysplastic cells- PMNS with decreased segmentation and decreased granulation/anything where the cells dont look normal. also insufficient reticulocytosis - myelofibrosis has pretty huge splenomegaly due to extramedullary hematopoiesis

Question 37

what to give pts with recurrent hepatic encephalopathy if they are already compliant with their meds

Answer 37

nonabsorbable abx | -give rifaximin on top of lactulose

Question 38

patient comes back from a trip with gi symptoms, fever, relative bradycardia, and a pulmonary infiltrate, what do you think

Answer 38

legionella pneumophilia pneumonia - dx with urine legionella antigen - treat with respiratory fluoroquinolone or newer macrolide

Question 39

what is the aortic valve area in severe aortic stenosis

Answer 39

less than 1cm and if they have symptoms | -refer them for valve replacement

Question 40

whatre uterine fibroids made of

Answer 40

aka leiomyomata uteri | -abnormal proliferation of the myometrium

Question 41

how to dx uterine fibroids

Answer 41

sonohysterography | -saline infusion u/s which improves sensitivity of the dx

Question 42

patient has blurred vision, raynauds, headaches, confusion, possibly ataxia... what do you think of if they also have tons of IgM

Answer 42

waldenstrom macroglobulinemia - hyperviscosity syndrome - do serum IgM plasma exchange to reduce viscosity

Question 43

how to treat codylomata acuminata (presents in clusters)

Answer 43

HPV induced anogenital warts - may worsen due to pregnancy due to physiologic immunosuppression - give topical trichloroacetic acid