UWorld Family Medicine Board
Questions With Complete Solutions
50 some yo woman with severe heartburn. with joint pain, skin hardening at fingertips, white lumps on
both forearms, small red blanching lesions over face. what's she at risk of developing? -
💕✔✔✔Pulmonary Hypertension. She most likely has systemic sclerosis (SSc). either limited and diffuse
forms depending on skin distribution. Limitedis restricted mainly to the hands and distal forearm and to
lesser extent on face and neck. Diffuse extends to abdomen and upper arms.
CREST Syndrome = a variant of limited form. anti-centromere-antibody positive and carry a more
favorable prognosis than diffuse form. They are more prone to developing pulmonary hypertension,
often without interstitial fibrosis. Diffuse form may develop severe forms interstitial lung disease.
What does CREST Syndrome stand form - 💕✔✔✔Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
What is the most common cause of epidemic gastroenteritis? - 💕✔✔✔Norovirus. Most common cause
of all gastroenteritis ina dust and children. Fecal-oral contamination. Vomiting is more prominent*. Can
be transmitted from food, water, fomites, airborne droplets from vomitus. Often at institutionalize and
travel settings (nursing homes, healthcare facilities, restaurants, cruise ships).
Fever, watery diarrhea, and in severe illness (fever, vomiting, headache and other systemic symptoms).
But can also be asymptomatic.
Which bacteria causes inflammatory diarrhea? (Mucus and blood)
Which bacteria causes watery diarrhea? - 💕✔✔✔Salmonella (both typhoid and non-typhi),
Campylobacter, Shiga toxin producing E. COli, Shgella, Enterobacter, Vibrio (usually parahaemolyticus),
Yersenia.
,Clostridium perfringens, Enterotoxic E. COli, Enteric viruses, Cryptosporiidium, Cyclospora, Intestinal
tapeworms
Which foodborne illness causes vomiting predominant (non-diarrhea)? - 💕✔✔✔Staphylococcus aureus,
Bacillus cereus, Noroviruses (e.g.,Norwalk).
What is the most effective way of differentiating Asthma and Chronic Obstructive Pulmonary Disease
(COPD)? - 💕✔✔✔SPirometry before and after administration of bronchodilator (albuterol). Reversal of
airway obstruction >= 12% increase in FEV1, or absolute increase in FEV1 of >= 200ml in response to
bronchodilator.
How to diagnose Asthma and COPD on spirometry? - 💕✔✔✔FEV1 decrease
FEV1/FVC decrease
Reversibility for asthma in FEV1
DLCO Diffusion Capacity of lung for carbon monoxide can be either normal or decrease in early COPD. In
late COPD, decrease in DLCO.
What are Chest X-ray changes in late COPD? - 💕✔✔✔Hyperinflation, loss of lung markings
What should you order for someone who you're suspecting to have pancreatic cancer? - 💕✔✔✔Hepatic
labs (bilirubin, alkaline phosphates, transaminases) and pancreatic (lipase) markers.
Imaging: transabdominal ultrasound or CT
55yo male comes in 3 month history of upper abdominal pain. Appetite decreased, 22lb weight loss. -
💕✔✔✔Suspect for pancreatic mass. CT abdominal
Biliary obstruction --> symptoms (jaundice, dark urine, elevated serum bilirubin and other hepatic
markers), back pain, ascites, steatorrhea, thrombophlebitis (Trousseau sign)
,What is Trousseau sign? When do you see it? - 💕✔✔✔Latent tetany, seen in patients with low Calcium.
Blood pressure cuff around patient's arm, and inflated to pressure greater than systolic pressure, held in
place for 3 minutes.
Very uncomfortable and painful carpopedal spasm (flexion at wrist, flexion at MCP joints, extension IP,
adduction of thumb and fingers)
What is the likely causative agent for Paronychia? What is Treatment? - 💕✔✔✔Infection and painful
inflammation around the nail. Due to bacterial infection (Staphylococcus aureus, Streptococcus
pyrogens) skin flora type, others being (Fusobacterium, streptococci in area exposed to oral flora.
Treatment warm compresses, antibiotics for more severe cases. Drainage if associated abscesses.
27yo female comes into office due to hair loss. Small clumps of hair come out when showers or brushes
hair. No pain or itching in scalp. Recently had uncomplicated vaginal delivery 3 months ago. Thyroid lab
normal. What's Dx and Tx? - 💕✔✔✔Telogen effluvium - one of the most common causes of hair loss in
adults, acute, diffuse, noninflammatory hair loss. Hair follicles has 3 phases: growth/Anagen phase 90%
follicles, transformative/catargen <1%, resting/shedding phase 10%. In telogen effluvium, widespread
shift into rest/shedding phase, with cessation of growth and subsequent shedding. Susually triggered by
Stressful event, such as severe weight loss, pregnancy, major illness/surgery, psychiatric trauma.
Dx based on clinical. Widespread thinning of hair, but scalp and hair shafts appear normal. Hair Pull Test:
small tracts of hair (50-60 fibers) pulled firmly, extraction > 10-15% fibers abnormal and suggests TE.
Check CBC (and ferritin), TSH, CHem panel.
Tx: Address underlying cause. Reassurance.
What is treatment for alopecia areata?
What is treatment for Androgenetic alopecia? - 💕✔✔✔Alopecia areata (circumscribed patches of hair
loss): Topical corticosteroid (occasionally used).
Androgenetic alopecia (chronic, gradual thinning of hair, in women commonly vertex): Finasteride,
Minoxidil.
What is Hair Pull Tests? - 💕✔✔✔Hair Pull Test: small tracts of hair (50-60 fibers) pulled firmly,
extraction > 10-15% fibers abnormal and suggests TE
, USPSTF recommendation on breast cancer.
What's not recommended? What are the high risk family history? - 💕✔✔✔Mammogram every 2 years
for women age 50 - 74.
Genetic counseling & possible testing for women with evidence of high-risk family history
Breast self-exam at any age. Genetic testing for women without high-risk family history. Two first-degre
relatives with breast cancer (1 age < 50), three or more 1st- or 2nd-degree relatives with breast cancer,
1st- or 2nd-degree relative with breast & ovarian cancer, 1-st degree relative with bilateral breast
cancer. Breast cancer in male relative. Ashkenazi Jewish women with any 1st- or 2nd degree relatives
with breast or ovarian cancer.
What are risk factors for predispose patient to urinary kidney stones (neprholithiasis)? What
recommendation can you make to your patient? - 💕✔✔✔low urinary volume, idiopathic hypercalciuria,
hypocitraturia predisposes patient to develop stones.
Calcium undergoes passive reabsoprtion in proximal tubule along with sodium and water. A low-sodium
diet (<2300mg/24hours) lead to increased proximal tubule Calcium and Na reasborption, decreased
Calcium excretion, and a reduced overall incidence of Calcium stones.
High Na intake increases urinary calcium excretion and should be avoided.
Citrate can form a complex with calcium, thereby decreasing Calcium stone formation. Dietary sources
of citrate (e.g., 40x of lemon juice) can also increase urinary citrate excretion. However, lower-than-
normal 24-hour urinary citrate excretion (as seen in this patient) is a risk factor for calcium stone
formation; citrate supplementation would be indicated to decrease stone formation.
Dietary interventions for calcium stones
Increase on what
decrease on what - 💕✔✔✔Increase Calcium -- dec. oxalate absorption in GI tract.
Fluid - incr. urine flow (decreases solute concentration).
Citrate - behinds urinary Ca (makes soluble Cal Citrate).
Fruits & vegetables - (inc. citrate excretion in kidney)
Questions With Complete Solutions
50 some yo woman with severe heartburn. with joint pain, skin hardening at fingertips, white lumps on
both forearms, small red blanching lesions over face. what's she at risk of developing? -
💕✔✔✔Pulmonary Hypertension. She most likely has systemic sclerosis (SSc). either limited and diffuse
forms depending on skin distribution. Limitedis restricted mainly to the hands and distal forearm and to
lesser extent on face and neck. Diffuse extends to abdomen and upper arms.
CREST Syndrome = a variant of limited form. anti-centromere-antibody positive and carry a more
favorable prognosis than diffuse form. They are more prone to developing pulmonary hypertension,
often without interstitial fibrosis. Diffuse form may develop severe forms interstitial lung disease.
What does CREST Syndrome stand form - 💕✔✔✔Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
What is the most common cause of epidemic gastroenteritis? - 💕✔✔✔Norovirus. Most common cause
of all gastroenteritis ina dust and children. Fecal-oral contamination. Vomiting is more prominent*. Can
be transmitted from food, water, fomites, airborne droplets from vomitus. Often at institutionalize and
travel settings (nursing homes, healthcare facilities, restaurants, cruise ships).
Fever, watery diarrhea, and in severe illness (fever, vomiting, headache and other systemic symptoms).
But can also be asymptomatic.
Which bacteria causes inflammatory diarrhea? (Mucus and blood)
Which bacteria causes watery diarrhea? - 💕✔✔✔Salmonella (both typhoid and non-typhi),
Campylobacter, Shiga toxin producing E. COli, Shgella, Enterobacter, Vibrio (usually parahaemolyticus),
Yersenia.
,Clostridium perfringens, Enterotoxic E. COli, Enteric viruses, Cryptosporiidium, Cyclospora, Intestinal
tapeworms
Which foodborne illness causes vomiting predominant (non-diarrhea)? - 💕✔✔✔Staphylococcus aureus,
Bacillus cereus, Noroviruses (e.g.,Norwalk).
What is the most effective way of differentiating Asthma and Chronic Obstructive Pulmonary Disease
(COPD)? - 💕✔✔✔SPirometry before and after administration of bronchodilator (albuterol). Reversal of
airway obstruction >= 12% increase in FEV1, or absolute increase in FEV1 of >= 200ml in response to
bronchodilator.
How to diagnose Asthma and COPD on spirometry? - 💕✔✔✔FEV1 decrease
FEV1/FVC decrease
Reversibility for asthma in FEV1
DLCO Diffusion Capacity of lung for carbon monoxide can be either normal or decrease in early COPD. In
late COPD, decrease in DLCO.
What are Chest X-ray changes in late COPD? - 💕✔✔✔Hyperinflation, loss of lung markings
What should you order for someone who you're suspecting to have pancreatic cancer? - 💕✔✔✔Hepatic
labs (bilirubin, alkaline phosphates, transaminases) and pancreatic (lipase) markers.
Imaging: transabdominal ultrasound or CT
55yo male comes in 3 month history of upper abdominal pain. Appetite decreased, 22lb weight loss. -
💕✔✔✔Suspect for pancreatic mass. CT abdominal
Biliary obstruction --> symptoms (jaundice, dark urine, elevated serum bilirubin and other hepatic
markers), back pain, ascites, steatorrhea, thrombophlebitis (Trousseau sign)
,What is Trousseau sign? When do you see it? - 💕✔✔✔Latent tetany, seen in patients with low Calcium.
Blood pressure cuff around patient's arm, and inflated to pressure greater than systolic pressure, held in
place for 3 minutes.
Very uncomfortable and painful carpopedal spasm (flexion at wrist, flexion at MCP joints, extension IP,
adduction of thumb and fingers)
What is the likely causative agent for Paronychia? What is Treatment? - 💕✔✔✔Infection and painful
inflammation around the nail. Due to bacterial infection (Staphylococcus aureus, Streptococcus
pyrogens) skin flora type, others being (Fusobacterium, streptococci in area exposed to oral flora.
Treatment warm compresses, antibiotics for more severe cases. Drainage if associated abscesses.
27yo female comes into office due to hair loss. Small clumps of hair come out when showers or brushes
hair. No pain or itching in scalp. Recently had uncomplicated vaginal delivery 3 months ago. Thyroid lab
normal. What's Dx and Tx? - 💕✔✔✔Telogen effluvium - one of the most common causes of hair loss in
adults, acute, diffuse, noninflammatory hair loss. Hair follicles has 3 phases: growth/Anagen phase 90%
follicles, transformative/catargen <1%, resting/shedding phase 10%. In telogen effluvium, widespread
shift into rest/shedding phase, with cessation of growth and subsequent shedding. Susually triggered by
Stressful event, such as severe weight loss, pregnancy, major illness/surgery, psychiatric trauma.
Dx based on clinical. Widespread thinning of hair, but scalp and hair shafts appear normal. Hair Pull Test:
small tracts of hair (50-60 fibers) pulled firmly, extraction > 10-15% fibers abnormal and suggests TE.
Check CBC (and ferritin), TSH, CHem panel.
Tx: Address underlying cause. Reassurance.
What is treatment for alopecia areata?
What is treatment for Androgenetic alopecia? - 💕✔✔✔Alopecia areata (circumscribed patches of hair
loss): Topical corticosteroid (occasionally used).
Androgenetic alopecia (chronic, gradual thinning of hair, in women commonly vertex): Finasteride,
Minoxidil.
What is Hair Pull Tests? - 💕✔✔✔Hair Pull Test: small tracts of hair (50-60 fibers) pulled firmly,
extraction > 10-15% fibers abnormal and suggests TE
, USPSTF recommendation on breast cancer.
What's not recommended? What are the high risk family history? - 💕✔✔✔Mammogram every 2 years
for women age 50 - 74.
Genetic counseling & possible testing for women with evidence of high-risk family history
Breast self-exam at any age. Genetic testing for women without high-risk family history. Two first-degre
relatives with breast cancer (1 age < 50), three or more 1st- or 2nd-degree relatives with breast cancer,
1st- or 2nd-degree relative with breast & ovarian cancer, 1-st degree relative with bilateral breast
cancer. Breast cancer in male relative. Ashkenazi Jewish women with any 1st- or 2nd degree relatives
with breast or ovarian cancer.
What are risk factors for predispose patient to urinary kidney stones (neprholithiasis)? What
recommendation can you make to your patient? - 💕✔✔✔low urinary volume, idiopathic hypercalciuria,
hypocitraturia predisposes patient to develop stones.
Calcium undergoes passive reabsoprtion in proximal tubule along with sodium and water. A low-sodium
diet (<2300mg/24hours) lead to increased proximal tubule Calcium and Na reasborption, decreased
Calcium excretion, and a reduced overall incidence of Calcium stones.
High Na intake increases urinary calcium excretion and should be avoided.
Citrate can form a complex with calcium, thereby decreasing Calcium stone formation. Dietary sources
of citrate (e.g., 40x of lemon juice) can also increase urinary citrate excretion. However, lower-than-
normal 24-hour urinary citrate excretion (as seen in this patient) is a risk factor for calcium stone
formation; citrate supplementation would be indicated to decrease stone formation.
Dietary interventions for calcium stones
Increase on what
decrease on what - 💕✔✔✔Increase Calcium -- dec. oxalate absorption in GI tract.
Fluid - incr. urine flow (decreases solute concentration).
Citrate - behinds urinary Ca (makes soluble Cal Citrate).
Fruits & vegetables - (inc. citrate excretion in kidney)
