Step3 24 Flashcards
Size of sample needed in each case
Magnitude of effect
P-value
Power
SD
The magnitude of effect:
The Bigger the magnitude of the effect, the smaller the sample you will need
P-value:
If you set a P value of 0.5 vs 0.1, you will need a bigger sample for the latter
Power:
The bigger the power you want your study, the bigger the sample you will need
Standard deviation:
If SD is smaller than expected, it will be easier to detect the difference, the smaller sample will work
Validity vs. Reliability
Validity (accuracy) is the ability of a test to provide correct results
Reliability: the ability of a test to always reproduce the same result. Doesn’t matter if it is right or wrong
What is the kappa statistic?
Kappa statistics measure inter-rater reliability, AKA inter-rater concordance
Value -1 to +1
0= results due to chance alone
<0= disagreement
>0= agreement
0-0.2: negligible
- 21-0.4: minimal
- 41-0.6: fair
- 61-0.8: good
- 81-1: excellent
Criteria for endometrial biopsy
>45 yoa with anovulatory bleeding <45 with risk factors: -unopposed estrogen (obesity, PCOS) -failed medical management -persistent abnormal bleeding
Ancillary statistical analysis
It is done to compare a cohort of one study to a similar population
Sometimes, the workforce is healthier than the general population and things like all-cause mortality can be biased (healthier people die less) (The healthy worker effect)
How do you adjust for confounders in a clinical study
Use a multiple regression analysis
How do people that do not respond to questionnaire in a study, can affect the study
They can differ in a big way from respondents
Mechanism of COPD cachexia (3) and management
Increase work of breathing (calorie consumption)
Systemic inflammation (decreases appetite and increases muscle breakdown)
Muscle hypoxia
Disease optimization
Exercise
Nutritional supplementation
Centor criteria for pharyngitis and treatment
Tonsilar exudate
Anterior lympadenopathies
Fever
Absence of cough
If positive for GAS
Penicillin V or amoxicillin for 10 days
1st gen cephalosporin for 10 days
Non-anaphylactic allergy to penicillin: azithromycin 5 days
Postoperative atrial fibrillation
Common after cardiac surgery
Most patients convert to sinus in a few days
Still at risk of common complications of Afib
Etiology of pediatric septic arthritis
<3 months:
S. aureus
GBS
Gram-negative bacteria
> 3 months:
S. aureus
GAS
AV blocks
1st degree: PR >0.2
2nd degree:
Mobitz type 1: PR get longer and longer until a beat drops
Mobitz type 2: R-R are the same except for the beat that is absent (need pacemaker)
3rd degree:
No relation between P and QRS
Somatic symptom disorder
Illness anxiety disorder
SOMATIC SYMPTOM:
>1 symptom, excessive thought and behaviours related to symptoms. Reassurance does not help. Affects normal functioning
ILLNESS ANXIETY DISORDER:
Minimal or no symptoms, preoccupation with the idea of having serious symptoms
Malingering vs. Factiocious disorder
Malingering: secondary gain
Factitious disorder: primary gain or by proxy (Munchausen)
Suspicion of spinal cord compression management
High dose systemic steroid (eg. dexa) to reduced inflammation
MRI of the spine
+/- Surgery consult
Radioresistant tumor and/or spinal instability: surgery
Radiosensitive tumoe: radiation
Tumors that commonly metastasize to bone
Adrenal
Lung
Breast
Non-Hodgkin
Indication for catheter removal in a patient with apparent infection
Severe sepsis
Pus coming out of insertion site
Fever >72hrs after atb initiation
Hemodynamic instability
Metastatic infection (eg. endocarditis, septic arthritis/osteomyelitis)
Culture positive or S. aureus, Pseudomona or fungi
Empiric antibiotic for catheter-related infection
Vanco + cefepime or genta
Common organisms
Coagulase negative staph
S. aureus
Gram negative
Add antifungal medication if high risk: caspofungin
High risk for fungal bloodstream infection
Add caspofungin to empiric atb (vanco+cefepime)
TPN
Prolonged use of broad-spectrum antibiotics
Hematologic malignancy
Solid tumor transplant
Femoral catheter
Multiple sites with Candida colonization
Organs affected with Turner syndrome
Aortic coarctation
Bicuspid aortic valve
Horseshoe kidney
Streak ovaries, amenorrhea, infertility
Physical features of turner sd.
Webbed neck Low hairline Broad chest, spread nipples Short stature Narrow, high arched palate Angioedema
Workup for suspicion of Turner on a newborn and later in life
Urgent karyotype
If the diagnosis was confirmed
4 extremity blood pressure
Echocardiogram
Abdominal ultrasound
During childhood:
Evaluate for thyroid and celiac disease
Neurocognitive evaluation (higher risk for learning disability) Intelligence is normal
What increases the risk of recurrence in
Trisomy 21
Age: Klinefelter and trisomy 21
Robertsonian translocation: increases risk by 10%
Other name for quantiferon test
Interferon-gamma release assay
Sulfasalazine side effects
Hepatotoxicity
Stomatitis
Hemolytic anemia
Hydroxychloroquine side effects
retinopathy
Leflunomide side effects
Hepatotoxicity
Cytopenias
Methotrexate
Hepatotoxicity
Stomatitis
Hemolytic anemia
(Also… Sulfasalazine)
Metabolic complications of renal transplant
High risk patient
NEW-ONSET DIABETES
- Secondary to medication side effects (glucocorticoids and calcineurin inhibitors (destruction of pancreatic cells))
- Improved renal function increases causes insulin excretion and gluconeogenesis
Higher risk in BMI> 30 and >45 yoa
SUBCLINICAL HYPOTHYROIDISM
OSTEOPOROSIS
After prolonged use of corticosteroids
Reversible causes of Asystole/PEA
5 H's Hypotension Hypoxia Hydrogen: acidosis Hyper/Hypo Kalemia Hypothermia
5 T's Tension pneumothorax Tamponade Toxins Thrombosis Trauma
Clinical features and management of functional abdominal pain
Chronic (>2months) Poorly localized No vomiting, diarrhea, weight loss Normal exam Stool guaiac negative
Reassurance
Symptom management
Diper rash vs. Candida dermatitis
Diaper rash: does not involve skin folds
Treat with zinc oxide or petrolatum
Candida is more “beefy-red” and involves the skin folds
satellite lesions
Recent antibiotic use increases the risk
Treat with topical antimycotics: nystatin or clotrimazol
Normal response of caloric irrigation of the ear
transient, conjugate, slow deviation of gaze to the side of irrigation followed by saccadic correction to the midline
CSWO
Cold same, warm opposite (for the first part of the eye movement)
Pancreatic inflammatory collection presentation and complications
Symptoms related to mass effect
Abdominal pain
Pancreatic or biliary obstruction
Necrosis
Fistula
Infection
Aneurysm
Management of Spontaneous splenic rupture
Fluid resucitation (cristaloid/blood)
CT
Ideal management is not operatively
Management of asthma exacerbation
Mild-Moderate: PEF or FEV1 >40% of expected
SABA inhaled (3 doses)
PO corticosteroids if no response
O2 if Sat. <90%
Moderate-Severe: PEF or FEV1 <40%
SABA + ipratropium for one hour
PO or IV corticosteroids
O2 if Sat. <90%
Impeding or actual respiratory distress SABA + ipratropium Steroids + Magnesium sulfate Terbutaline (IV B2 agonist) or Epinephrine O2 if Sat. <90% Intubate if necessary
Admission vs. discharge with asthma exacerbation
Good response: >70% PEF or EFV1
Send home
Moderate: PEF or EFV1 40-70%
Hospitalized
Bad response: PEF or EFV1 <40 or pCO2 >42
ICU
Clinical presentation of spontaneous peritonitis and diagnosis
Abdominal pain
Fever (37.8)
Altered mental status (connect the dot test)
If severe: hypotension, hypothermia, ileus
DIAGNOSIS OF ASCITIC FLUID >250 PMN SAAG: >1.1 Positive culture: E coli, Klebsiella Protein: <1
