Step 3 UWSA Practice Exam

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• A patient with cirrhosis and ascites has increasing abdominal distention. What is the initial management?
• A patient with atrial fibrillation starting warfarin therapy. What baseline tests should be obtained prior to starting therapy?
• Which finding is highly suggestive of choanal atresia in a newborn?
• Administration of normal saline in hypovolemic hyponatremia predominantly leads to which effect on ADH?
• How is hereditary hemochromatosis diagnosed?
• A patient with suspected pulmonary embolism and hemodynamic stability. What is the initial diagnostic approach?
• If a patient with suspected PE has a low pretest probability and a negative D-dimer, what is the recommended next step?
• Which test best determines hepatitis B status in prenatal care?
• A patient in the second trimester has placenta previa on ultrasound. What is the recommended management?
• Polymyalgia rheumatica treatment is which of the following?
• In a renal transplant patient with worsening renal function and biopsy showing basophilic intranuclear inclusions, which virus is most likely responsible?
• In Crohn disease treated with azathioprine, which adverse effect is commonly monitored due to fatigue and abnormal liver tests?
• Which combination of iron studies is most consistent with iron deficiency anemia?
• A patient presents with RUQ pain, fever, and leukocytosis and cholecystitis is suspected. What is the initial management?
• Which agent is a long-term disease-modifying therapy for multiple sclerosis?
• Baby with cyanosis when eating that improves with crying and inability to pass an NG tube through the pharynx is highly suggestive of which condition?
• DiGeorge syndrome features?
• A patient presents with acute onset focal neurologic deficits and a CT scan without hemorrhage. What is the next appropriate management step?
• Which study design measures exposure and disease in a population at a single point in time?
• Course for Tourette syndrome in a child?
• Threshold for chelating agents for lead poisoning in children is which value?
• Normal iron transferrin saturation is which percentage range?
• In polymyalgia rheumatica, which of the following CK levels is typical?
• In acute ischemic stroke evaluation, which factors primarily guide the decision to pursue mechanical thrombectomy?
• What imaging study is most appropriate to evaluate possible vertebral osteomyelitis in a patient with Staphylococcus aureus bacteremia?
• In primary hyperparathyroidism, parathyroidectomy is indicated when serum calcium is above normal by how much?
• Which condition is described by erythematous plaques with central clearing and fever?
• In cirrhosis with ascites, what test should be performed early to evaluate for spontaneous bacterial peritonitis?
• In inflammatory arthritis, which synovial fluid leukocyte count range is typical?
• In pregnancy, Parvovirus B19 infection can lead to hydrops fetalis due to which mechanism?
• Which ABG pattern is typically seen in PCP-related respiratory decompensation?
• In a patient with chronic hepatitis B and a newly identified liver mass on imaging, which diagnosis is most likely?
• Entamoeba histolytica infection is classified as what type of infection?
• Which inflammatory markers are typically elevated in polymyalgia rheumatica?
• Which synovial fluid leukocyte count is most suggestive of infectious (septic) arthritis?
• At what GFR should renal replacement therapy be considered?
• A 58-year-old man presents with substernal chest pain lasting 45 minutes, diaphoresis, and shortness of breath. What is the most appropriate initial management step?
• Which of the following is a recommended next step after a positive STOP-BANG screen?
• Prostatitis treatment options: which antibiotic class is an appropriate option?
• A pregnant patient presents with severe preeclampsia at 34 weeks. What is the definitive management to prevent maternal complications?
• Statins can cause which muscle condition?
• To prevent febrile non-hemolytic transfusion reactions, which RBC preparation is recommended?
• In persistent vomiting, urine chloride is typically low.
• Which condition is typically associated with elevated urine chloride due to diuretic use?
• Fetal macrosomia is an indication for cesarean delivery at which gestational age?
• For reversal of anticoagulation in retroperitoneal hemorrhage, which treatment is indicated?
• What is the window for N-acetylcysteine administration after acetaminophen ingestion?
• Which scenario represents a secondary prevention indication for defibrillator therapy?
• Hepatocellular carcinoma arises from which liver cell type?
• Anti-centromere antibodies are most characteristic of which form of systemic sclerosis?
• Which study design begins with individuals who have a disease and looks back to determine prior exposures?
• Which screening frequency is recommended for diabetic retinopathy in a patient with diabetes?
• Patients 75 and younger with cardiovascular disease should be treated with which therapy?
• In the management of unstable upper GI bleeding, which immediate measures are appropriate?
• Average-risk individuals should begin colorectal cancer screening at what age, and what is the typical interval if results are normal?
• Which supplement can cause a false-positive fecal occult blood test?
• A patient with chest pain has a non-diagnostic ECG and negative initial troponin. What should be the next step in evaluation?
• A child presents with splenomegaly, anemia, thrombocytopenia, bone pain, and failure to thrive. Which disease is most likely?
• Which test is used to determine current pregnancy status?
• Acquired hemophilia is caused by inhibitors against which coagulation factor?
• Does placement of a PEG tube in patients with dementia improve outcomes?
• A patient with major depressive disorder presents with suicidal ideation. What is the immediate safety plan?
• In a patient with hypertension and CKD, which class of medications provides renal and cardiovascular protection and is preferred unless contraindicated?
• In a patient with diabetes and nonproliferative retinopathy, what is the recommended annual screening test?
• Which treatment is the choice for QRS prolongation in TCA overdose?
• PCP treatment with antibiotics can cause which complication, potentially requiring steroids and arterial blood gas assessment?
• Which dosing regimen is considered high-intensity statin therapy for secondary prevention in patients 75 or younger?
• Focal seizures should raise suspicion for which condition?
• A patient postpartum with heavy uterine bleeding. What is the most immediate step in management?
• A patient with episodic headaches and hypertension has elevated plasma metanephrines. What is the next step in management?
• A patient presents with elevated transaminases and unclear etiology. What is the essential initial evaluation step?
• Which statement correctly identifies a disease-modifying therapy for multiple sclerosis?
• Which statement about thymic involvement in DiGeorge syndrome is correct?
• RDW is increased in which microcytic anemia?
• Postoperative prophylaxis for DVT includes which combination of measures?
• What is the standard interval before declaring infertility in couples under 35 and over 35 years old?
• A patient with a traumatic knee injury. What is the first-line imaging to evaluate fracture?
• In iron-deficiency anemia with positive guaiac stool, what is the recommended diagnostic step to identify the bleeding source?
• A 72-year-old man with community-acquired pneumonia started on a standard regimen has no clinical improvement after 48–72 hours. What is an appropriate next step?
• For latent TB infection, isoniazid is given for how long?
• A child with a history of seizures has poor adherence to antiseizure meds. What is an important management step?
• Which test is typically used first when hereditary hemochromatosis is suspected?
• Which test is used for syphilis screening in prenatal labs?
• In acute otitis media, persistence of symptoms beyond two weeks implies which of the following about the causative organism?
• Hypercalcemia manifestations include which of the following?
• Which of the following is a contraindication to estrogen/progesterone therapy for menopause?
• Acute otitis media symptoms in 2 weeks: If symptoms persist beyond two weeks, which is most likely?
• In a cross-sectional study, which measure is primarily estimated?
• A late complication of Entamoeba histolytica infection is a liver abscess; which symptom is typically present?
• Which vaccine is recommended for patients 50 years and older with normal immune function?
• In suspected meningitis, what is the correct sequence of management steps?
• In community-acquired pneumonia with penicillin allergy, which antibiotic is an appropriate alternative?
• Before starting warfarin for atrial fibrillation, which set of baseline tests is recommended?
• In iron deficiency, which pattern is typical for iron studies?
• Pulsatile mass in popliteal fossa with necrotic toe indicates what?
• A patient presents with fever and purulent skin infection; which antibiotic covers MRSA?
• Time interval between Entamoeba histolytica infection and liver abscess formation is typically which weeks?
• Postoperative prophylaxis for DVT typically includes which pharmacologic option?
• What is the strongest indicator for obstructive sleep apnea?
• A patient with acute decompensated heart failure presents with pulmonary edema and hypotension. What is the initial management?
• An otherwise healthy 6-month-old infant presents with fever and irritability and a red bulging tympanic membrane. What is the first-line antibiotic for acute otitis media?
• In a second-trimester placenta previa diagnosed on ultrasound, which procedure should be avoided?
• A newly diagnosed type 2 diabetic patient with BMI 32, what is the recommended first-line pharmacotherapy and target HbA1c?
• TPMT testing is used to assess risk of which adverse effect in Crohn disease patients starting azathioprine?
• Hypercalcemia can present with which of the following renal-related disorders as a manifestation?
• Which step is essential if symptoms persist after serial troponins during evaluation for chest pain?
• Which statement about ferritin in iron deficiency anemia is true?
• Which of the following is a reasonable initial diagnostic approach for suspected appendicitis in patients with vague symptoms?
• In patients with Staphylococcus aureus bacteremia, which evaluation is commonly recommended due to risk of metastatic infection such as endocarditis or vertebral osteomyelitis?
• Postpartum, an enlarged boggy uterus is most consistent with which condition?
• Which autoantibody is commonly associated with scleroderma and is linked to interstitial lung disease and esophageal hypomotility?
• The rash described with the 4 P's that commonly affects the flexor surfaces is which condition?
• A patient presents with wheezing, shortness of breath, and use of accessory muscles. What is the initial treatment in the ED for a moderate asthma attack?
• In postpartum hemorrhage, what is the most immediate step?
• Which mode of transmission is most characteristic for Parvovirus B19?
• A postmenopausal patient with a vertebral compression fracture. What class of drugs reduces vertebral fracture risk?
• Persistent pelvic bleeding during labor with a contracted uterus is most consistent with which diagnosis?
• Which test is used to assess rubella immunity in prenatal care?
• Which timing is recommended for surgical repair of a pediatric inguinal hernia to prevent incarceration?
• In hyponatremia with euvolemia, which tests help differentiate SIADH as a cause?
• A patient on a TNF inhibitor with lower lobe consolidation and rapid deterioration is most suggestive of which type of infection?
• Which chromosomal microdeletion is associated with DiGeorge syndrome?
• A patient with long QT syndrome is taking multiple QT-prolonging medications. What is the essential clinical step?
• A patient presents with severe dehydration from diarrhea. What is the first-line fluid management?
• A patient presents with fever, neck stiffness, and photophobia. What is the immediate management?
• A patient develops a blue toe after cardiac catheterization, with rising creatinine and BUN. The most likely diagnosis is:
• A patient with generalized anxiety disorder is started on an SSRI. What common side effects should you counsel about and what monitoring is required?
• What is the typical natural history of an umbilical hernia in an infant?
• In hyponatremia with euvolemia, what is the initial management approach?
• A patient with chronic back pain using NSAIDs develops epigastric pain. What is a major risk and recommended alternative strategies?
• In pregnancy, Parvovirus B19 infection can cause which complications?
• Factor V Leiden MOA is associated with which mechanism?
• Lichen planus commonly involves which mucosal surface with Wickham striae?
• Initial test for hip fracture is which imaging modality?
• A patient with latent TB infection tests positive on PPD but has a normal chest X-ray. What is the recommended management?
• A patient with atrial fibrillation and rapid ventricular response is hemodynamically stable. What is the preferred initial agent for rate control if no contraindications exist?
• Which synovial fluid leukocyte count range is typical for inflammatory arthritis such as rheumatoid arthritis or gout?
• Recurrent cellulitis is typically associated with which underlying condition?
• What is the initial treatment for hypovolemic hyponatremia?
• Where is a femoral hernia located in relation to the inguinal ligament and the VAN (vein, artery, nerve)?
• What is the recommended RBC preparation to prevent febrile transfusion reactions?
• In the context of fibroids vs malignancy, fibroids typically cause which pattern of uterine bleeding?
• Patellofemoral syndrome management includes which of the following?
• Stroke treatment within 3 hours?
• Hairy cell leukemia is commonly treated with which regimen?
• In synovial fluid analysis, which range indicates non-inflammatory arthritis?
• A patient presents with unilateral leg swelling and tenderness. What is the initial diagnostic test for suspected DVT?
• Fetal anemia is diagnosed by which test?
• Which procedure is used to evaluate suspected primary sclerosing cholangitis in a patient with ulcerative colitis?
• Ulcerative colitis is associated with primary sclerosing cholangitis. Which diagnostic procedure is commonly used to evaluate biliary disease in this context?
• First-line diagnostic test for Pneumocystis jirovecii pneumonia is which of the following?
• In NSAID-related acute kidney injury, what is the initial management?
• A patient with suspected community-acquired pneumonia has a documented penicillin allergy. What is an appropriate alternative antibiotic?
• In an incapacitated patient needing surgery but with a DNR, can a guardian suspend the DNR for surgery?
• A patient with suspected upper GI bleeding is unstable. What is the immediate management?
• In management of STEMI diagnosed on ECG, what is the recommended approach regarding lab confirmation?
• Which medication class is an established disease-modifying therapy for multiple sclerosis?
• For COPD without evidence of infection on imaging or labs, which treatment is appropriate?
• Postpartum thyroiditis prognosis?
• A patient with CKD stage 3 has a serum potassium of 6.2 mEq/L without ECG changes. What is the initial management?
• In suspected acute coronary syndrome, which initial antiplatelet therapy is recommended if not contraindicated?
• In a femoral hernia, which is the correct relation to the femoral vein, artery, and nerve (VAN) and the inguinal ligament?
• A 65-year-old woman with long-standing hypertension and CKD stage 3 has a blood pressure of 158/92. Which first-line agent provides renal and cardiovascular protection and is preferred unless contraindicated?
• In a patient with acute otitis media who has a history of penicillin allergy, which antibiotic is an appropriate alternative?
• Which oral antibiotic with activity against MRSA is commonly used for furuncles and carbuncles (abscess)?
• In severe preeclampsia, what prophylaxis is indicated to reduce seizure risk during delivery?
• Which condition is an indication for primary prevention implantable cardioverter-defibrillator placement?
• A patient with sudden unilateral facial weakness and arm weakness. What finding helps distinguish stroke from Bell palsy?
• When initiating an SSRI for generalized anxiety disorder, what is the recommended monitoring plan?
• In severe acute pancreatitis with hypotension and tachycardia, what is the primary management focus?
• What is the most significant risk factor for stroke?
• A patient with suspected HIV infection; what is the immediate management step?
• Tetracyclines, NSAIDs, bisphosphonates, potassium chloride, and iron supplements can cause which condition?
• Elevated aPTT is typically seen in which disorders?
• Which statement best describes qualification for physicians participating in organ donation processes?
• MI on EKG: The recommended management is immediate PCI with MONA-BASH; do not wait for positive labs. Which option best reflects this approach?
• In a 16-year-old with diabetes mellitus and an A1C of 12%, which complication is at greatest risk?
• Which electrocardiographic change is associated with hypercalcemia?
• Which supplement is associated with a false-positive fecal occult blood test?
• After myocardial infarction, which medication should be added to the patient's regimen to improve long-term outcomes?
• Tx for recurrent pleural effusion includes which of the following?
• In metabolic acidosis with anion gap, what is the initial approach?
• Which statement best describes the primary prevention indication for ICD?
• What type of bleed is potentially life-threatening with anticoagulation therapy?
• In a woman presenting with hematuria, flank pain, and a palpable mass, which diagnosis is most likely?
• Which statement describes an indication for parathyroidectomy?
• If a child with acute otitis media has had amoxicillin recently, which antibiotic would be an appropriate alternative?
• Which medication class is appropriate for migraine prophylaxis besides beta-blockers?
• In epidemiology, cohort studies are used to calculate which measure of association?
• T-lymphocyte deficiency is a feature of which syndrome?
• In iron deficiency anemia, ferritin level is typically:
• For prevention of diabetic foot ulcers, which strategy is emphasized?
• Synovial fluid leukocyte count thresholds are used to classify arthritis. Which value indicates non-inflammatory arthritis?
• In a patient with thunderclap headache and nuchal rigidity, what imaging is indicated first?
• Gaucher disease is caused by deficiency of which enzyme?
• Which statement best describes the management of retroperitoneal hemorrhage due to anticoagulation?
• A patient suspected of having obstructive sleep apnea in primary care. What screening tool and next steps?
• If a pregnant woman with uncertain Rh status has a positive anti-D antibody titer, what is the recommended course regarding anti-D immunoglobulin prophylaxis?
• DiGeorge syndrome involves abnormal development of which pharyngeal arches?
• Which option represents a chemotherapy regimen used for hairy cell leukemia?
• Thromboembolic risk in atrial flutter compared with atrial fibrillation is...
• Abdominal aortic aneurysm surgical repair is generally recommended at which diameter?
• Atrial flutter: before cardiac ablation or pharmacologic or electrical conversion, what is recommended due to clot risk?
• A patient with suspected appendicitis and vague symptoms. What is the recommended initial diagnostic test?
• Target cells are pathognomonic for which microcytic anemia?
• Which range is most suggestive of septic arthritis based on synovial fluid leukocyte count?
• A patient with iron-deficiency anemia and positive guaiac stool test. What is the appropriate next step?
• For pheochromocytoma, once stabilized and biochemical confirmation is obtained, what is the definitive treatment?
• Before initiating azathioprine therapy, which tests should be considered?
• A patient on a sulfonylurea presents with recurrent hypoglycemia. Which management change is appropriate?