UWorld UWorld High-Yield Clinical Vignettes 2

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?

Accepted Answer

Transient ischemic attack (TIA)

Answer

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?

Accepted Answer

Non-seminomatous germ cell tumor (mixed)

Answer

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?

Accepted Answer

Wilms tumor (nephroblastoma)

Answer

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?

Accepted Answer

Primary hyperparathyroidism

Answer

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?

Accepted Answer

Amphotericin B plus flucytosine for induction, followed by fluconazole consolidation

Answer

Cryptococcal meningitis in HIV patients is treated with amphotericin B plus flucytosine for induction (2 weeks), followed by fluconazole for consolidation and maintenance.

UWorld Practice Test

UWorld Practice Test

UWorld UWorld High-Yield Clinical Vignettes 2