Test 56 Flashcards
Suicide
Decisions regarding discharge from the ED should not be based on an intoxicated patient’s statements. Patients with suicidal threats or behavior must be reassessed when they are clinically sober.
Carpal tunnel syndrome
Carpal tunnel syndrome presents as pain or paresthesias in the median nerve distribution. reproduction of symptoms by hyperflexion of the wrists (Phalen test), tapping over the median nerve (Tinel sign), and hand elevation above the head can help to confirm the diagnosis.
Carpal tunnel syndrome
Nerve conduction studies can confirm the diagnosis and assess the severity of carpal tunnel syndrome. They are used in preparation for surgery or when the diagnosis is uncertain.
Superior vena cava syndrome
Superior vena cava syndrome must be suspected in any patient who has a high risk of malignancy (family history or smokers) and presents with dyspnea, orthopnea, neck pain and swelling, and has cervical and upper extremities venous dilation. The best diagnostic test to perform is computerized tomography of the neck and chest.
Ischemic stroke
Consent for thrombolysis in acute ischemic stroke should be obtained from the patient when possible. However, because time to treatment is critical (“time is brain”), thrombolysis can be given on an emergency basis without consent.
Perioperative medical management
Assessment of a patient’s perioperative cardiac risk depends on the risk associated with the proposed surgery as well as the patient’s underlying comorbidities and functional capacity. Low-risk surgeries (breast or cataract surgery) carry less than or equal to 1% risk of significant cardiac events and, in the absence of acutely active cardiac disease (decompensated heart failure, unstable angina), do not require preoperative cardiac work up regardless of underlying comorbidities.
Confounding, effect modification, bias, errors
Recall bias results from the inaccurate recall of past exposure by participants in a study. It applies mostly to case-control designs and leads to misclassification of exposure.
Professional conduct
Pediatricians should maintain appropriate professional boundaries in their relationships with family members of patients. Romantic relationships between physicians and parents of patients are ethically problematic.
Life expectancy and survival statistics
The Kaplan-Meier survival curve is a commonly used graphical representation of the probabilities that subjects survive in a study without an event. The event-free survival rates of greater than or equal to 2 study groups can be compared; they are statistically different only if the p-value is <0.05.
Pneumocystis pneumonia
Patients with suspected Pneumoncystis pneumonia require fiberscopic bronchoscopy with bronchoalveolar lavage if induced sputum samples do not yield a diagnosis.
Asthma
A short course of systemic corticosteroids is indicated for outpatient treatment of patients with mild acute asthma exacerbations unresponsive to bronchodilator therapy. It reduces the need for hospitalization and improves long-term control. Prednisone 40-60 mg daily for 5-7 days is a widely adopted regimen.
Study designs
Studies that use a crossover design usually require smaller sample sizes and yield more precise estimates of treatment effects than studies that use a parallel arm design (because each subject receives all treatments). However, they may take longer to complete and may be affected by the carryover effect.
Spinal cord compression
Suspected epidural spinal cord compression should be treated as an emergency with empiric high-dose corticosteroids. An MRI should be ordered to confirm the diagnosis and assess spinal stability. Patients with highly radiosensitive tumors and those with an unstable spine should undergo surgical evaluation.
