Quiz 33 Flashcards
DM
uTI
TMP-SMP
A week later improves but then fever and flank pain again.
Perinephric abscess is an elusive diagnostic problem that is defined as a collection of pus in the tissue surrounding the kidney, generally in the space enclosed by Gerota’s fascia. Mortality rates as high as 50% have been reported, usually from failure to diagnose the problem in a timely fashion. The difficulty in making the diagnosis can be attributed to the variable constellation of symptoms and the sometimes indolent course of this disease. The diagnosis should be considered when a patient has fever and persistence of flank pain.
Most perinephric infections occur as an extension of an ascending urinary tract infection, commonly in association with renal calculi or urinary tract obstruction. Patients with anatomic urinary tract abnormalities or diabetes mellitus have an increased risk. Clinical features may be quite variable, and the most useful predictive factor in distinguishing uncomplicated pyelonephritis from perinephric abscess is persistence of fever for more than 4 days after initiation of antibiotic therapy. The radiologic study of choice is CT.
preoperative evaluation prior to cataract surgery.
No testing
routine preoperative testing prior to cataract surgery does not decrease intraoperative or postoperative complications (SOR A). The American Heart Association recommends against routine preoperative testing in asymptomatic patients undergoing low-risk procedures, since the cardiac risk associated with such procedures is less than 1%.
evaluation of her asthma
wheezing 3–4 times per week,
Mild-occurring more than 2 days per week, but not daily, and use of her albuterol inhaler more than 2 days per week, but not daily.
Intermittent is less than 2 per week
mild is less than 1 per day
moderate and severe is more than 1 per day
intermittent is less than 2 per month night
mild is more than 2 per month night
mod and severe is more than 1 per week
int and mild is 80%
mod is 60-80
severe is less than 60
int is rescue inhaler mild add low ICS mod add LABA severe at high ICS refractory is PO steroids
DM screening
The ADA recommends screening for all asymptomatic adults with a BMI >25.0 kg/m whohave one or more additional risk factors for diabetes mellitus, and screening for all adults with no risk factors every 3 years beginning at age 45.
Current criteria for the diagnosis of diabetes mellitus include a hemoglobin A1c≥6.5%, a fasting plasma glucose level ≥126 mg/dL, a 2-hour plasma glucose leve l≥200 mg/dL, or, in a symptomatic patient, a random blood glucose level ³200 mg/dL
A 42-year-old African-American male recently traveled to the Caribbean for a scuba diving trip. Since his return he has noted brief intermittent episodes of vertigo not associated with nausea or vomiting. He is concerned, however, because these episodes occurred after sneezing or coughing and then a couple of times after straining while lifting something. He has had no hearing loss, and no vertigo with positional changes such as bending over or turning over in bed. The most likely cause of this patients vertigo is
A perilymphatic fistula between the middle and inner ear may be caused by barotrauma from scuba diving, as well as by direct blows, heavy weight bearing, and excessive straining (e.g., with sneezing or bowel movements.)
Vestibular neuronitis is a more sudden, unremitting syndrome. Menieres disease is manifested by episodes of vertigo, associated with hearing loss and often with nausea and vomiting. Benign paroxysmal positional vertigo is more likely in older individuals, and is associated with postural change. Multiple sclerosis requires symptoms in multiple areas and is not thought to be provoked by climate change.
An 8-year-old female is brought to your office because she has begun to limp. She has had a fever of 38.8°C (101.8°F) and says that it hurts to bear weight on her right leg. She has no history of trauma.
On examination, she walks with an antalgic gait and hesitates to bear weight on the leg. Range of motion of the right hip is limited in all directions and is painful. Her sacroiliac joint is not tender, and the psoas sign is negative. Laboratory testing reveals an erythrocyte sedimentation rate of 55 mm/hr (N 0–10), a WBC count of 15,500/mm 3 (N 4500–13,500), and a C-reactiveprotein level of 2.5 mg/dL (N 0.5–1.0).
Which one of the following will provide the most useful diagnostic information to further evaluate this patient’s problem?
U/S
This child meets the criteria for possible septic arthritis. In this case ultrasonography is recommended over other imaging procedures. It is highly sensitive for detecting effusion of the hip joint. If an effusion is present, urgent ultrasound-guided aspiration should be performed.
Bone scintigraphy is excellent for evaluating a limping child when the history, physical examination, and radiographic and sonographic findings fail to localize the pathology.
MRI provides excellent visualization of joints, soft tissues, cartilage, and medullary bone. It is especially useful for confirming osteomyelitis, delineating the extent of malignancies, identifying stress fractures, and diagnosing early Legg-Calvé-Perthes disease
Plain film radiography is often obtained as an initial imaging modality in any child with a limp. However, films may be normal in patients with septic arthritis, providing a false-negative result.
A 17-year-old female sees you for a preparticipation evaluation. She has run 5 miles a day for the last 6 months, and has lost 6 lb over the past 2 months. Her last menstrual period was 3 months ago. Other than the fact that she appears to be slightly underweight, her examination is normal.
To fit the criteria for the female athlete triad, she must have which one of the following? (check one)
A. A formal diagnosis of an eating disorder
B. Amenorrhea for 1 year
C. A Z-score on bone-density testing of –2.5 or less
D. Withdrawal bleeding after progesterone administration
E. A history of a stress fracture resulting from minimal trauma
E. A history of a stress fracture resulting from minimal trauma
The initial definition of the female athlete triad was amenorrhea, osteoporosis, and disordered eating.
Primary amenorrhea is defined as lack of menstruation by age 15 in females with secondary sex characteristics. Secondary amenorrhea is the absence of three or more menstrual cycles in a young woman previously experiencing menses. For those with secondary amenorrhea, a pregnancy test should be performed. If this is not conclusive, a progesterone challenge test may be performed. If there is withdrawal bleeding, the cause would be anovulation. Those who do not experience withdrawal bleeding have hypothalamic amenorrhea, and fit one criterion for the triad.
Athletes who have amenorrhea for 6 months, disordered eating, and/or a history of a stress fracture resulting from minimal trauma should have a bone density test. Low bone mineral density for age is the term used to describe at-risk female athletes with a Z-score of –1 to –2. Osteoporosis is defined as having clinical risk factors for experiencing a fracture, along with a Z-score
Which one of the following is the most common cause of recurrent and persistent acute otitis media in children?
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid of children with acute otitis media. Penicillin-resistant S. pneumoniae is the most common cause of recurrent and persistent acute otitis media.
A 65-year-old asymptomatic female is found to have extensive sigmoid diverticulosis on screening colonoscopy. She asks whether there are any dietary changes she should make.
In addition to increasing fiber intake, which one of the following would you recommend?
Patients with diverticulosis should increase dietary fiber intake or take fiber supplements to reduce progression of the diverticular disease. Avoidance of nuts, corn, popcorn, and small seeds has not been shown to prevent complications of diverticular disease.
