UWorld UWorld High-Yield Clinical Vignettes 2 — Questions and Answers
Question 1: A 62-year-old woman with a history of atrial fibrillation on warfarin presents with sudden onset left-sided weakness and facial droop lasting 2 hours that fully resolved. What is the most likely diagnosis?
- Transient ischemic attack (TIA) (Correct answer)
- Completed ischemic stroke
- Todd's paralysis following a seizure
- Hemiplegic migraine
Correct answer: Transient ischemic attack (TIA)
A TIA presents with focal neurological deficits that resolve completely within 24 hours (typically minutes to hours) without evidence of infarction on imaging.
Question 2: A 25-year-old male presents with painless testicular swelling. Ultrasound shows a solid intratesticular mass. Tumor markers reveal elevated AFP and beta-hCG. What is the most likely diagnosis?
- Non-seminomatous germ cell tumor (mixed) (Correct answer)
- Pure seminoma
- Testicular lymphoma
- Epididymo-orchitis
Correct answer: Non-seminomatous germ cell tumor (mixed)
Elevated AFP is not produced by pure seminomas, so its presence indicates a non-seminomatous component; elevated beta-hCG can be seen in both but combined elevation suggests mixed NSGCT.
Question 3: A 3-year-old girl presents with a painless abdominal mass that does not cross the midline. CT shows a large intrarenal mass. What is the most likely diagnosis?
- Wilms tumor (nephroblastoma) (Correct answer)
- Neuroblastoma
- Renal cell carcinoma
- Hepatoblastoma
Correct answer: Wilms tumor (nephroblastoma)
Wilms tumor is the most common renal malignancy in children, typically presenting as a smooth, unilateral abdominal mass that does not cross the midline.
Question 4: A 50-year-old woman presents with recurrent calcium oxalate kidney stones. Labs show hypercalcemia, hypophosphatemia, and elevated PTH. What is the most likely underlying cause?
- Primary hyperparathyroidism (Correct answer)
- Vitamin D toxicity
- Milk-alkali syndrome
- Sarcoidosis
Correct answer: Primary hyperparathyroidism
Primary hyperparathyroidism causes hypercalcemia with inappropriately elevated PTH and low phosphate, and is the most common cause of hypercalcemia in outpatients with calcium nephrolithiasis.
Question 5: A 40-year-old male with HIV (CD4 count 50 cells/µL) presents with headache, fever, and neck stiffness. CSF India ink stain shows encapsulated yeast. What is the treatment of choice?
- Amphotericin B plus flucytosine for induction, followed by fluconazole consolidation (Correct answer)
- Fluconazole monotherapy immediately
- Acyclovir IV for viral meningitis
- Ceftriaxone plus vancomycin for bacterial meningitis
Correct answer: Amphotericin B plus flucytosine for induction, followed by fluconazole consolidation
Cryptococcal meningitis in HIV patients is treated with amphotericin B plus flucytosine for induction (2 weeks), followed by fluconazole for consolidation and maintenance.
Question 6: A 32-year-old woman in her third trimester presents with severe hypertension (180/110), proteinuria (4+ on dipstick), and headache. Labs show elevated LFTs, low platelets, and hemolytic anemia. What is this condition?
- HELLP syndrome (Correct answer)
- Preeclampsia without severe features
- Gestational hypertension
- Thrombotic thrombocytopenic purpura
Correct answer: HELLP syndrome
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia requiring prompt delivery regardless of gestational age.
UWorld UWorld High-Yield Clinical Vignettes 2
A 62-year-old woman with a history of atrial fibrillation on warfarin presents with sudden onset left-sided weakness and facial droop lasting 2 hours that fully resolved.
What is the most likely diagnosis?