WORLD questions discussion

[Poppy123]

Hey guys, I've been coming across some questions I where the answer still doesn't make sense despite world's explanations. If anyone else has ones of their own, post them here and let's discuss!

1. 40yo female complains of abdominal discomfort not associated with meals or fatty foods. No alarming symptoms. No relevant PMH. No abnormal labs. The next step?

World Answer: H. pylori breath test.
My answer: trial with H2 blocker.


2. 24yo male with tonic-clonic seizure, +cocaine and heroin use prior to seizure. CPK 11,000. Hepatitis C+, Hepatitis B negative and nonimmune. The next step?

World Answer: Hepatitis B vaccine.
My answer: FLUIDS!

Can anyone explain why I'm wrong? Thanks!!!!

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[jtre506]

The first step in management of a patient with dyspepsia who is Under 45 with out alarm symptoms is a non-invasive test for H. Pylori
Breath Test
Serologic Test



Not sure about number 2, but the logic is anyone who has Hep C must be vaccinated for Hep B and A...... that being said I think fluids is the correct managment to protect the kidneys form the myoglobin......

 

[waster]

since when were fluids indicated for seizure?

 

[cyclohexanol]

2. 24yo male with tonic-clonic seizure, +cocaine and heroin use prior to seizure. CPK 11,000. Hepatitis C+, Hepatitis B negative and nonimmune. The next step?

World Answer: Hepatitis B vaccine.
My answer: FLUIDS!

Can anyone explain why I'm wrong? Thanks!!!!

I think if you go back and carefullly re-read the answer choices you will see why you were wrong. The answer you picked actually said fluid restriction, something you obviously don't want to do with a CPK of 11k. I'm sure you knew that, but just saw "A. Fluid ____" and clicked it. Something I do far too much of as well.

Of the other answer choices: b-blocker, life-long phenytoin, or nothing, none of them are appropriate.

 

[medInUSA]

Hey guys, I've been coming across some questions I where the answer still doesn't make sense despite world's explanations. If anyone else has ones of their own, post them here and let's discuss!

1. 40yo female complains of abdominal discomfort not associated with meals or fatty foods. No alarming symptoms. No relevant PMH. No abnormal labs. The next step?

World Answer: H. pylori breath test.
My answer: trial with H2 blocker.




You do the H. pylori breath or serologic testing for H pylori in this situation. If that's not in the answer choices then you pick PPI. Finally if even that is not one of the answers you can pick H2 blocker

 

[medInUSA]

since when were fluids indicated for seizure?

The seizure caused rhabdomyolisis. Thats why the CPK is so elevated. That's why the poster wanted to pick fluids.


I don't remember this question and I have done all the UWorld questions.
I cann't believe that if in fact fluids were one of the answers, then that indeed is the correct answer.

 

[medInUSA]

I just came upon this same question

the answer choice definitely says fluid restriction not just fluids.

 

[astronomylover]

Does anybody know what are the standards of lab values to determien Exudative fluid vs. Transudative Fluid. USMLE World is confusing me. In one question they state if the glucose level is between 30-50 that it indicates a malignant process...a.k.a. transudative. In another question they said if glucose levels are < 60 then it is exudative. I'm super confused. Also this whole Light's Criteria is annoying. Does anybody know the standard LDH, GLucose and Protein Levels for both situations?

 

[medInUSA]

Does anybody know what are the standards of lab values to determien Exudative fluid vs. Transudative Fluid. USMLE World is confusing me. In one question they state if the glucose level is between 30-50 that it indicates a malignant process...a.k.a. transudative. In another question they said if glucose levels are < 60 then it is exudative. I'm super confused. Also this whole Light's Criteria is annoying. Does anybody know the standard LDH, GLucose and Protein Levels for both situations?

according to master the boards step 3 by conrad Fischer page 110

Exudate:
protein level >50 % of serum level
LDH level > 60 percent of serum level
ph<7.3
if ph<7.2 it is highly suggestive of infxn and requires chest tube aspiration to prevent empyema!!!!!

Transudate
protein <50 % of serum level
LDH <60% of serum level
ph>7.35

best initial test: CXR decubitus film and upright film to see if it changes with position

most accurate test: thoracentesis
Order gram stain
acid fast stain
total protein
ldh
glucose
cell count
pH

if effusion is recurrent pleurodesis is indicated
if pleurodesis fails surgical decorticaion is done

 

[medInUSA]

Does anybody know what are the standards of lab values to determien Exudative fluid vs. Transudative Fluid. USMLE World is confusing me. In one question they state if the glucose level is between 30-50 that it indicates a malignant process...a.k.a. transudative. In another question they said if glucose levels are < 60 then it is exudative. I'm super confused. Also this whole Light's Criteria is annoying. Does anybody know the standard LDH, GLucose and Protein Levels for both situations?

I just did one of the questions you're referring to.
The UWorld explanation basically says the same thing as Fischer (what I quoted above)

additionally glucose <60 suggests a parapneumonic effusion, TB or RA

 

[astronomylover]

I just did one of the questions you're referring to.
The UWorld explanation basically says the same thing as Fischer (what I quoted above)

additionally glucose <60 suggests a parapneumonic effusion, TB or RA

Thank you for all that helpful information. The only thing is that Conrad refers to percentages and in world they don't give you percentages, they just give lab values. It's hard to take a percentage of something when you don't know what the original value is in the first place. I cant seem to find it anywhere.

 

[medInUSA]

Thank you for all that helpful information. The only thing is that Conrad refers to percentages and in world they don't give you percentages, they just give lab values. It's hard to take a percentage of something when you don't know what the original value is in the first place. I cant seem to find it anywhere.

In the question stem they will give you the patient's serum LDH or protein or both

and then they will give the pleural effusion LDH and protein.

then, just calculate the percentage and you will know exudate from transudate!!!

or else they will make it easy and give you the pH of the pleural fluid, if so we can give thanks to god for making our life so easy