1 | P a g e UWorld Internal Medicine Queries and Solutions Promising Academic Success, Verified and Valida ted Ring enhancing lesion on CT head, with known infx elsewhere - Answer Brain abscess. MC organisms are aerobic and anaerobic strep and Bacteroides Stable angina: long term tx? - Answer 1. Beta blockers. 2. CCB or long -acting nitrates Uncomplicated cyst itis in young woman: Tx? - Answer Bactrim or nitrofurantoin. (Complicated - tx with cipro or levofloxacin) Skin lesion that is suspicious for melanoma: next step? - Answer Excisional biopsy w/ narrow margins (so you can dx Breslow depth of invasion). Acute ascending cholangitis: Tx? - Answer 1. Broad Spectrum Abx's, 2. ERCP, then 3. cholecystOSTOMY and eventual 4. CCectomy Statin -induced myalgias: mechanism? - Answer Statins: decreases HMG CoA reductase, also coenzyme Q10 synthesis (leads to mya lgias?) Scabies: distribution and Tx? - Answer Fingers, heels of palms, wrist creases, penis, scrotum, areolae. 2 | P a g e Tx: Permethrin cream overnight Porcelain gallbladder: at risk for? - Answer Gallbladder carcinoma (adenocarcinoma). Remove! Tumor lys is syndrome: MCC's, and electrolyte abnl's? - Answer Burkitt's lymphoma, ALL; High Phos, High K, High Uric acid, Low Ca (binds to Phos). Tx = allopurinol Isoniazid: effects on liver, and tx? - Answer 1. Mild hepatic injury in 10 -20% (ALT/AST less than 100): no tx, keep using and monitor; 2. Hepatitis in 2% of high risk (higher ALT/AST): d/c drug Pellagra: vitamin deficiency and classic Symptoms - Answe r Niacin (B3): Diarrhea, Dementia, Dermatitis #1 risk factor for lacunar strokes - Answer Hypertension CREST syndrome: stands for... - Answer Calcinosis cutis, Raynaud's, Esophageal Dysmotility, Sclerodactyly, Telangiectasias 6 dx criteria for OsteoArthritis in painful knee - Answer Age > 50, crepitus, 3 | P a g e bony enlargement, bony tenderness, lack of warmth, lack of morning stiffness (> 3 = 69% specific) Pulmonary nodule in peripheral lung field of non -smoker Most likely? - Answer Adenocarci noma (MC in smokers and non -smokers, most often peripheral) Pseudogout: RF causing hyperCa, and fluid shows? - Answer RF: Primary Hyperparathyroidism Fluid: rhomboid shaped, positively birefringent crystals Normal Pressure hydrocephalus: triad? - Answer Gait disturbance, dementia, urinary incontinence "wet, wacky, wobbly" Pig farmer with headaches, autopsy shows cysts: dx? - Answer Neurocysticercosis (T. soleum) Cardiac auscultation: which maneuvers decr ease preload? - Answer Valsalva, standing. (squatting, recumbency, leg raise inc preload) (handgrip inc afterload) Antihistamines --> urinary retention. MOA? - Answer First generation H1 -antihistamines also have anticholinergic effects. Failure of detrusor contraction 4 | P a g e Myasthenia gravis: MOA - Answer Auto -antibodies to Ach receptors at NMJ Acute hyponatremia: tx? - Answer 3% saline (NS for CHRONIC hyponatremia or asymptomatic/mild) Increased or normal FEV1/FVC ratio, with decreased DLCO - Answ er restrictive; dec DLCO = interstitial lung disease VZV shingles: progression of Symptoms? - Answer Pain precedes rash by 48 hours Hyperthyroid untreated --> risk of? - Answer Bone loss - increased osteoclastic activity. Tachyarrhythmias (afib) but NOT CAD To check for Hemolysis, what labs do you order? - Answer Bilirubin (increased) LDH (increased) Haptoglobin (decreased bc it binds to free Hg), MS: CSF examination shows? - Answer Oligoclonal bands (in 85 -90%); Opening pressure, protein, cell count are all wnl. Nephrotic syndrome --> sever abd pain, fever, hematuria. Dx? - Answer Renal vein thrombosis. MC is membranous glomerulonephritis Symmetric arthritis, minimal am stiffness, nl inflammatory markers, resolves w/in 2 months - Answer Viral arthritis Pt with GERD, dysphagia to solids, symmetric stricture on MBS with no weight loss - Answer Peptic stricture (adenocarcinoma would be asym metric, and pt would lose weight) Transfusion --> immediate f/c, flank pain. MOA? - Answer ABO mismatch:
