UWSA 3 Comprehensive
Questions and Solutions
Graded A+
Sports-related groin pain - Answer: (sometimes inaccurately referred to as a "sports hernia") is a
common condition in athletes. It is thought to be due to repetitive stress to the
musculotendinous portions of the groin (most commonly the external oblique aponeurosis).
Symptoms include chronic, intermittent groin pain that is reproduced on Valsalva or sit-ups.
This patient has a headache that worsens with increased pressure (eg, bending forward), is
associated with minor epistaxis, and began after a trip involving scuba diving - Answer:
Barotrauma affecting the paranasal sinuses is common in divers and occurs because changes in
barometric pressure generate mucosal edema, which causes obstruction of the sinus outflow
tracts and an inability to equalize pressure. It presents with headache and sinus pressure/pain;
sinuses are often tender to palpation.
This patient takes a tumor necrosis factor (TNF) inhibitor for rheumatoid arthritis (RA) lives in
Indiana has systemic sx - Answer: Patients on anti-tumor necrosis factor therapy for rheumatoid
arthritis who live in endemic areas for histoplasmosis are at high risk for disseminated infection.
They usually present with nonspecific symptoms, pulmonary infiltrates, hepatosplenomegaly,
and pancytopenia. Infection risk is also particularly increased for bacterial pneumonia, zoster,
and tuberculosis.
In children, the most common cause of neutropenia (absolute neutrophil count [ANC]
<1,500/mm3) is - Answer: an acquired, transient, postinfectious etiology
, A confidence interval (CI) for a difference between means that excludes 0 - Answer: (ie, null
value for a difference) is statistically significant, and a CI for a difference between means that
includes 0 is not statistically significant.
This patient with a history of severe malnutrition has symptoms of bowel obstruction (eg,
postprandial epigastric pain and fullness relieved with emesis) following reintroduction of
nutrition (ie, refeeding). Imaging demonstrates narrowing of the angle between the superior
mesenteric artery (SMA) and the aorta. This presentation is consistent with - Answer: Superior
mesenteric artery (SMA) syndrome results from depletion of the fat pad separating the SMA
from the aorta (eg, due to severe malnourishment or hypermetabolic state). This can lead to
compression of the duodenal segment traveling through the fat pad, causing small bowel
obstruction. Initial management is often conservative (eg, slow nutritional rehabilitation).
Dyspepsia in a 60 year old woman - Answer: Dyspepsia is characterized by epigastric
pain/burning, postprandial fullness, and early satiety. Management of dyspepsia is largely
determined by malignancy risk. Older patients (ie, age ≥60) and those with alarm symptoms (eg,
dysphagia) concerning for malignancy should be considered for esophagogastroduodenoscopy.
CT not helpful
When should palliative care be initiated? - Answer: as soon as life-threatening illness is
diagnosed for symptom management and easier transition to hospice
telephone counseling for smoking cessation - Answer: Proactive phone counseling, in which a
counselor calls a patient at prearranged times, is an effective method for smoking cessation. It is
more effective than reactive phone counseling, in which the patient calls the counselor when
the patient feels like talking.
Indications for statin therapy in prevention of ASCVD - Answer: Statin therapy (eg, rosuvastatin)
is indicated for the primary prevention of atherosclerotic cardiovascular disease in all patients
age ≥40 with diabetes mellitus, regardless of baseline lipid levels. Statins should also be
Questions and Solutions
Graded A+
Sports-related groin pain - Answer: (sometimes inaccurately referred to as a "sports hernia") is a
common condition in athletes. It is thought to be due to repetitive stress to the
musculotendinous portions of the groin (most commonly the external oblique aponeurosis).
Symptoms include chronic, intermittent groin pain that is reproduced on Valsalva or sit-ups.
This patient has a headache that worsens with increased pressure (eg, bending forward), is
associated with minor epistaxis, and began after a trip involving scuba diving - Answer:
Barotrauma affecting the paranasal sinuses is common in divers and occurs because changes in
barometric pressure generate mucosal edema, which causes obstruction of the sinus outflow
tracts and an inability to equalize pressure. It presents with headache and sinus pressure/pain;
sinuses are often tender to palpation.
This patient takes a tumor necrosis factor (TNF) inhibitor for rheumatoid arthritis (RA) lives in
Indiana has systemic sx - Answer: Patients on anti-tumor necrosis factor therapy for rheumatoid
arthritis who live in endemic areas for histoplasmosis are at high risk for disseminated infection.
They usually present with nonspecific symptoms, pulmonary infiltrates, hepatosplenomegaly,
and pancytopenia. Infection risk is also particularly increased for bacterial pneumonia, zoster,
and tuberculosis.
In children, the most common cause of neutropenia (absolute neutrophil count [ANC]
<1,500/mm3) is - Answer: an acquired, transient, postinfectious etiology
, A confidence interval (CI) for a difference between means that excludes 0 - Answer: (ie, null
value for a difference) is statistically significant, and a CI for a difference between means that
includes 0 is not statistically significant.
This patient with a history of severe malnutrition has symptoms of bowel obstruction (eg,
postprandial epigastric pain and fullness relieved with emesis) following reintroduction of
nutrition (ie, refeeding). Imaging demonstrates narrowing of the angle between the superior
mesenteric artery (SMA) and the aorta. This presentation is consistent with - Answer: Superior
mesenteric artery (SMA) syndrome results from depletion of the fat pad separating the SMA
from the aorta (eg, due to severe malnourishment or hypermetabolic state). This can lead to
compression of the duodenal segment traveling through the fat pad, causing small bowel
obstruction. Initial management is often conservative (eg, slow nutritional rehabilitation).
Dyspepsia in a 60 year old woman - Answer: Dyspepsia is characterized by epigastric
pain/burning, postprandial fullness, and early satiety. Management of dyspepsia is largely
determined by malignancy risk. Older patients (ie, age ≥60) and those with alarm symptoms (eg,
dysphagia) concerning for malignancy should be considered for esophagogastroduodenoscopy.
CT not helpful
When should palliative care be initiated? - Answer: as soon as life-threatening illness is
diagnosed for symptom management and easier transition to hospice
telephone counseling for smoking cessation - Answer: Proactive phone counseling, in which a
counselor calls a patient at prearranged times, is an effective method for smoking cessation. It is
more effective than reactive phone counseling, in which the patient calls the counselor when
the patient feels like talking.
Indications for statin therapy in prevention of ASCVD - Answer: Statin therapy (eg, rosuvastatin)
is indicated for the primary prevention of atherosclerotic cardiovascular disease in all patients
age ≥40 with diabetes mellitus, regardless of baseline lipid levels. Statins should also be
