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UWorld ABIM questions with complete solutions rated A+
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UWorld ABIM questions with complete solutions rated A+
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UWorld ABIMCOPD Classification and Management - correct answer ✔✔FEV1/FVC <70% predicted
mild- FEV1 80+%
-short acting bronchodilator PRN
moderate- FEV1 50-80%
-long acting bronchodilator, prn short acting bronchodilator
severe- FEV <50%
-same as moderate + ICS for frequent symptoms or frequent exacerbations
pulmonary rehab for moderate/severe severity, moderate/severe symptoms, high risk
low risk (0-1 exacerbation and no hospitalizations per year)
-minimal symptoms- short acting bronchodilator (SABA, SAMA or combo) PRN
-moderate/severe symptoms (SOB while on level surface or assessment score 10+)- long acting
bronchodilator (LAMA or LABA), PRN short acting bronchodilator
high risk (2+ exacerbations or 1+ hospitalization per year)
-minimal symptoms- LAMA, PRN short acting bronchodilator; if frequent exacerbations- LABA +/- ICS
-moderate/severe symptoms- LAMA + LABA, PRN short acting bronchodilator; frequent exacerbations-
ICS
ICS recommended for symptomatic COPD with frequent exacerbations who don't respond to treatment
with inhaled bronchodilators, pulmonary rehab and smoking cessation; may also help if asthmatic
component
,azithromycin and roflumilast decrease COPD exacerbation risk in patients with frequent exacerbations
IgG4 Related Disease - correct answer ✔✔-most commonly middle age men
-suspect in anyone with idiopathic pancreatitis, sclerosing cholangitis, bilateral salivary/lacrimal gland
enlargement (w/o dry mouth/eyes)
-generalized LAD, type 1 autoimmune pancreatitis, sclerosing cholangitis, bilateral salivary and/or
lacrimary gland involvement w/o significant symptoms (eg. dry mouth/eyes), thyroid (eg. riedels
thyroiditis), interstitial pneumonitis/pulmonary pseudotumors, tubulointerstitial nephritis,
retroperitoneal fibrosis
-diagnosis- tissue infiltration of mainly IgG4 positive plasma cells and small lymphocytes, high serum
IgG4, high eosinophils
-treatment- steroids; refractory- possible azathioprine, mycophenolate, rituximab
HUS - correct answer ✔✔-prodromal abdominal pain, vomiting, diarrhea
-MAHA (anemia, negative coombs, schistocytes, high LDH/bilirubin, low haptoglobin), low platelets
-diagnosis clinically, evaluate with peripheral smear and serology for EHEC (stool cultures not as
sensitive)
Parkinsons - correct answer ✔✔-bradykinesia + resting tremor or cogwheel rigidity
-suggestive- unilateral onset, craniofacial (hypophonia, decreased blink rate, masked facies), vision
(impaired upward gaze, blurred vision), MSK (myoclonus, dystonia, micrographia), shuffling stooped gait,
postural instability, autonomic dysfunction, neuropsych (depression, psychosis, disturb sleep, dementia),
anosmia, constipation
-levodopa/carbidopa- most effective, preferred in severe disease and age >65
-dopamine agonist (bromocriptine, pramipexole, ropinirole)-preferred in age <65 with mild/mod disease
-anticholinergics- can be used in age <70 with tremor and no significant akinesia or gait disturbance
Serotonin Syndrome - correct answer ✔✔-SSRI/SNRI, TCA, tramadol, MDMA, dextromethorphan,
amphetamines, MAOI, linezolid
-AMS (eg. anxiety, agitation, delirium), autonomic (eg. sweat, high BP/HR/temp, vomiting, diarrhea),
tremor, myoclonus, hyperreflexia
-treatment- supportive, sedation with BZDs, stop med
,-if supportive measures fail-->cyproheptadine
-immediate sedation, paralysis and intubation if temp >106
Gout - correct answer ✔✔-RF- hyperuricemia, HTN, diuretics, alcohol, obesity
-1st MTP, ankle, knee
-needle shaped negatively birefringent uric acid crystals, synovial fluid 2k-100k WBCs
-XR- subcortical bone cyst with possible bony erosions
-target uric acid <6
-losartan and CCB decrease risk of gout flare
-if have acute attack while taking allopurinol, continue dose and adjust 3-4 weeks after acute
inflammation subsides
-allopurinol prophylaxis with colchicine in recurrent gout, tophaceous gout, radiographic evidence of
gouty arthritis, or urinary uric acid excretion >1100 mg/day
Lyme Disease - correct answer ✔✔-early localized (days to 1 month)- erythema migrans, fatigue,
headache, myalgia/arthralgia
-early disseminated (weeks-months)- multiple EM, unilateral/bilateral CN palsy, meningitis, encephalitis,
carditis (eg. cardiomyopathy, AV block), migratory arthralgia, conjunctivitis, regional/generalized LAD
-late (months-years)- arthritis, encephalomyelitis, peripheral neuropathy
-admission with IV rocephin recommended for symptomatic carditis and those with 2nd/3rd degree AV
block or 1st degree AV block with PR interval >300 ms; oral antibiotics continued at discharge for total
21-28 days
-complete AV block require temporary pacing as blocks self limited and usually improve within 1 week;
lesser conduction disturbance may take up to 6 weeks for resolution
IgA Vasculitis (HSP) - correct answer ✔✔-palpable purpura, arthralgia/arthritis, abdominal pain, GI bleed,
glomerulonephritis +/- proteinuria
-diagnosis- IgA deposits on skin or kidney biopsy
-treatment- supportive (hydration, NSAID); steroid for kidney failure and severe abdominal pain
, Depression Treatment Duration - correct answer ✔✔-should continue antidepressant for at least 6
weeks at therapeutic dosage before consider med augment or switch
-single episode should continue med for at least for additional 6 months following acute response
-history of multiple episodes of MDD, chronic episode (2+ years) or severe episode (eg. suicide attempt)
should continue med for at least 1-3 years following remission
-consider indefinite treatment for highly recurrent (eg. 3+ episodes) and very severe/chronic major
depressive episodes
Hyperprolactinemia - correct answer ✔✔-physiologic cause- pregnancy, breastfeed, stress
-pathologic cause- prolactinoma, hypothalamic disease (eg. cancer, sarcoid), drugs (eg. antipsychotic,
reglan), hypothyroidism, chest wall injury, CKD, after seizure
-prolactin normalize 1-2 months after delivery even with continued breastfeeding
-prolactin in CKD usually modestly elevated (<100), doesn't respond to dialysis
-decreased libido, erectile dysfunction, infertility, gynecomastia, galactorrhea, menstrual irregularity
-significant high prolactin (>200) usually indicate prolactinoma
-in any hyperprolactinemia and not taking causative med should have MRI head
-prolactinoma with hypogonadism or neuro symptoms treated with dopamine agonist and followed with
serial MRI; surgery reserved if fail medical therapy
Cardiovascular Effects of OSA - correct answer ✔✔HTN
pulmonary HTN
CAD
nocturnal cardiac arrhythmia (low HR, sinus pause, asystole, afib, NSVT, tachyarrhythmia)
CHF
obese patient with difficult to treat HTN, nocturnal arrhythmia or nocturnal angina- should have eval for
OSA with PSG and EKG monitoring
Hypersensitivity Pneumonitis - correct answer ✔✔-chronic allergen inhalation (birds, hay, hot tubs)
-acute- flu like, fleeting infiltrate
-subacute/chronic- develop over weeks-months; cough, SOB, weight loss, clubbing
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