W5 mock SB (-5) Flashcards
W5 blocks (86-94) Missing blocks 90-94
what is nonresponse bias?
a type of selection bias that occurs when study participants fail to respond to surveys/ questionnaires
a study called into question due to high % participants lost to f/u could have what kind of bias?
attrition bias (selection bias) occurs if lost pts differ significantly from the remaining participants
why do studies try to achieve incr f/u rates?
decr potential for attrition bias and thus the chance for over/underestimating the assoc btwn exposure and dz
what % of observations will fall w/in 1, 2, and 3 SD respectively?
1 SD = 68%
2 SD = 95%
3 SD = 99.7%
what term describes a pts chance of not truly having a dz after testing negative for the dz?
negative predictive value
what term describes a pts chance of truly having a dz after testing positive for the dz?
positive predictive value
NPV will vary w/ what and what does this mean?
- will very w/ pre-test probability of a dz
- high prob = low NPV
- low prob = high NPV
what are ROC curves used to show?
the trade off between sensitivity and specificity @ various cutoff points
a test exhibits what sensitivity and what specificity if it falls on the R end of a ROC curve vs the L end?
R end = high sens + low spec
L end = low sens + high spec
(this is opp the charts w/ 2 overlapping bell curves)
what is a hazard ratio?
the chance of an event occurring in the tx group compared to in the control group
how do you interpret HR?
< 1 - tx has decr risk
> 1 - tx has incr risk
close to 1 = little difference in risk btwn groups
what is risk and how do you calculate it?
= the chance of getting a dz over a set period of time
R = #dz / #total @ risk
what measures the added risk attributable to a specific RF?
attributable risk % (ARP)
how do you calculate ARP?
ARP = (RISKexp - RISKun) / RISKexp ARP = (RR - 1) / RR
a urethral meatus located at the coronal margin (ventrally displaced) is characteristic of what condition?
hypospadias
in addition to ventral meatus, what other 2 s/s can be seen in hypospadias?
- dorsal hooded foreskin
- chordee (curved penis)
what must be done once clinical dx of hypospadias has been made?
urology consult/eval
how does granuloma inguinale present?
- extensive PAINLESS ulcers w/o lymphadenopathy
- ulcer bases may have granulation tissue
- G-neg staining Donovan bodies
how does 1* syphilis present?
+single painless papule –> nonexudative ulcer w/ indurated borders
+/- mild-mod bilat lymphadenopathy
which test for syphilis is commonly neg in early dz?
nontreponemal serology (RPR and VDRL)
pt presents w/ lesion suggestive of 1* syphilis but tests RPR and VDRL neg. what do you?
tx emperically w/ IM benzathine penicillin G
what pts should not receive metformin and why?
- acutely ill pts w/ AKI, liver failure or sepsis
- incr risk for lactic acidosis
what is the BG goal in acutely ill pts?
140-180 mg/dL
what insulin management plan is recommended for acutely ill pts and why?
- short acting insulin regimen
- long acting plans w/ insulin ggt –> incr risk of hypoglycemia + adverse outcomes
what is diabetes insipidus the leading cause of?
euvolemic HYPERnatremia
what meds commonly cause nephrogenic DI?
- litium
- demeclocycline
- amphotericin B
- foscarnet
- cidofovir
how does nephrogenic DI present?
- polyuria
- polydipsea
- euvolemic hyperNa
- low u. OSM
- incr s. OSM
how do you tx nephrogenic DI 2/2 lithium use?
Na restriction + D/C lithium
how can you distinguish stroke 2/2 L atrial thrombus from stoke 2/2 L atrial myxoma?
low F + incr ESR + wt loss = MYXOMA
how will myxomas present?
- stroke (2/2 tumor fragment embolization)
- middiastolic rumble + decr CO w/ SOB & syncope (2/2 mitral valve obstruc)
- constitutional s/s = F + wt loss + incr ESR
what is the MC 1* cardiac neoplasm?
cardiac myxoma
what is PCWP and when will it be incr?
- estimate of LV end diastolic pressure
- incr in pts w/ LV systolic and/or diastolic dysf(x)
incr pulmonary artery systolic pressure is diagnostic for what?
pulmonary HTN
when is incr portal venous resistance (portan HTN) seen?
- hepatic cirrhosis
- extrahepatic portal vein thrombosis
renal bx confirms clinical dx of minimal change dz. when do you do this confirmatory test?
no response to steroid tx
when do you get a real bx in a kid?
- age > 10 yo + nephrotic synd
- suspected min change dz that didn’t respond to steroid
how do you tx minimal change dz?
corticosteroids
what is giant cell tumor of bone?
- benign, locally destructive neoplasm
- MC site = epiphysis of long bones
what do giant cell tumors of bone look like on xray?
eccentric lytic lesion = “soap bubble” lesions
what is osteoid osteoma?
benign bone tumor that causes nighttime bone pain that is relieved w/ NSAIDs
how does osteoid osteoma appear on xray?
sm round radiolucency
how do giant cell tumors of bone present?
- local pain, swelling, stiffness and pathologic frx
- uncommon lung mets/malig transformation
when do you use PO ABX and/or isotretinoin for acne?
severe or recalcitrant acne only
how does diaphragmatic rupture appear on CXR?
+elevated hemidiaphragm or migration of abd contents into the thoracic cavity
-pleural effusion (won’t see)
how does empyema typically present and how long does it take to form?
- F + pleuritic chest pain + sputum production
- unlikely to develope w/in 1 d of hospitalization
when might you find gastric contents in the thoracic cavity despite an intact diaphragm?
esophageal rupture
how do you tx inflammatory acne?
- topical retinoid + benzoyl peroxide wash
- add topical ABX
- consider PO ABX (very severe only)
what post-void residual vol is expected in significant bladder outlet obstruc?
usually > 50mL
does BPH typically cause significant proteinuria?
no
pts w/ DM > 10 yr are @ incr risk of developing what?
diabetic microangiopathy, nephropathy and glomerulosclerosis
what are the clinical findings of diabetic microangiopathy, nephropathy, and/or glomerulosclerosis 2/2 longterm DM?
- mild/mod proteinuria
- CKD w/ incr Cr
how does acute irritant contact dermatitis present?
pruritis, erythema, local edema and vesicles
how does chronic irritant contact dermatitis present?
excoriations, fissuring, hyperkeratosis
what causes molluscum contagiosum?
pox virus
when should you consider HIV testing in a pt w/ molluscum contagiosum?
if lesions are widespread and/or involve the face
pleural effusion is + for LIGHTs criteria. is it a transudative or exudative effusion?
exudative
what are some common causes of exudative effusion?
- empyema
- chylothorax
- malig
- TB
what are the distinguishing features of exudative pleural fluid 2/2 chylothorax?
-milky white
-incr TG
-pH < 7.45
(will meet lights criteria)
what are the distinguishing features of exudative pleural fluid 2/2 empyema?
-purulent fluid
-PMN-predominance
-POS G stain/culture
-pH < 7.45
(will meet lights criteria)
what are the distinguishing features of exudative pleural fluid 2/2 TB?
-acid-fast bacterium on stain/culture
-pH<7.45
(will meet lights criteria)
when is thrombolytic tx indicated for DVT when there is no PE?
massive proximal DVT + significant symptomatic swelling and/or limb ischemia
when is thrombolytic therapy typically reserved for?
hemodynamically unstable pts w/ PE
what are the indications for IVC filter placement?
- anti-coag C/I (actively bleeding)
2. anti-coag failure (rpt or expanding DVT despite full anti-coagulation)
how do you dx intra-amniotic infx (chorioamnionitis)?
-maternal F + >= 1 of the following:
fetal tachy for at least 10 min (HR > 160bpm)
maternal incr WBC
purulent amniotic fluid
management of PPROM @ < 34wks is typically expectant (steroids + ABX + tocolytics). when would you deliver immediately?
suspect chorioamnionitis
what i the MCC of anaphylacti transfusion rxn?
giving pt w/ IgA def packed RBC unit that has not been depleted of IgA
how will anaphylactic transfusion rxn present?
resp distress + low BP + s/s of anaphylaxis
how does TRALI typically present?
-acute hypoxemic resp distress + bilat pulm infiltrates w/in hours of receiving RBC transfusion
how do you distinuish TRALI from transfusioni-associated circulatory overload?
nL BNP + NO JVD = TRALI
which GERD pts get EGD instead of PPI trial?
- alarm s/s
- men age > 50yo + >= 5yr s/s + Ca risk (tobacco use)
what are the alarm s/s prompting EGD?
- dysphagia
- odyophagia
- wt loss
- anemia
- GI bleed
- recurrent emesis
how does ogilvie synd. present?
- severe abd distension and pain
- vomiting
- obstipation
what are some common causes of ogilvie synd?
- electrolyte abn (decr K, decr Mg)
- sx
- neuro dz
- anti-cholinergic meds
how does median n. entrapment @ forearm present?
+forearm pain
+sensory loss over entire lat palm and thenar eminence
chronic HepC dx is a 2 step process. what are the 2 steps?
- serologic Ab test
2. confirmatory test = PCR for HepC viral RNA
what is the pathophys of carpal tunnel synd 2/2 hypothyroidism?
soft tissue enlargement
mucopolysaccharides = mucinous infiltration
how do MS s/s present?
episodic and affecting multiple, non-contiguous domains
how do B-agonists (albuterol) cause intracellular K shift?
- stimulate NaKATPase and NaKCl2 cotransporter
2. stimulate incr insulin release –> K shift
what are some causes of low K?
- intracellular shift
- GI loss
- renal K wasting (diuretics and hyperaldosteronism)
what is tachycardia-mediated cardiomyopathy?
cardiomyopathy 2/2 sustained tachyarrythmia (afib, aflutter, vtach, re-entrant tachy) + prolongued RVR
what structural changes can you see in the setting of chronic tachy?
LV dilation and myocardial dysf(x)
if prednisone use is affecting K levels what will they be?
decr
bactrim can cause what met derangement 2/2 its effects on the kidney?
incr K
what is Leriche synd?
aortoiliac occlusion
how does Leriche synd (aortoiliac occlusion) present?
hint: classic traid
- bilat hip, thigh and buttock claudication
- impotence
- absent/diminished femoral pules (can –> symmetric LE atrophy 2/2 chronic ischemia)
what conditions can cause ankle edema?
- venous insufficiency
- renal insufficiency
- RHF
- hepatic dz
when gas is seen w/in the GB wall, what is the dx and what do you do?
- emphazematous cholecystitis
- emergecy cholecystectomy
what is recommended got acute cholecystitis but not emphazematous cholecystitis?
ERCP
what are the MCCs of delirium in a hospitalized pt?
- toxic metabolic etiology
- infectious etiology
what pts are @ incr risk of developing agitated delirium in the hosp?
pts w/ dementia
what are teh s/e of high dose B-2 agonists?
- tremor
- palpitations
- HA
- weakness, arrhythmia and EKG changes 2/2 hypokalemia
in pre-renal AKI 2/2 sepsis + dehydration, what do you expect to see on U/A and why?
- u. Na < 20 (body is retaining Na and H2O)
- FENA <1% (body is retaining Na and H2O)
- bland urine sediment (b/c no intrinsic damage or infx)
what is not seen in bland urine sediment on U/A?
-NO casts, RBC and WBC
how/why do nitrates relieve angina and MI pain?
systemic vasodilation –> decr preload and decr LVED volume –> decr wall stress –> decr O2 demand –> decr pain
what can nitrates do to HR and how do you compensate?
- cause reflex tachycardia
- coadmin w/ BB
