W5 mock SB (-5)

Question 1

what is nonresponse bias?

Answer 1

a type of selection bias that occurs when study participants fail to respond to surveys/ questionnaires

Question 2

a study called into question due to high % participants lost to f/u could have what kind of bias?

Answer 2

attrition bias (selection bias) occurs if lost pts differ significantly from the remaining participants

Question 3

why do studies try to achieve incr f/u rates?

Answer 3

decr potential for attrition bias and thus the chance for over/underestimating the assoc btwn exposure and dz

Question 4

what % of observations will fall w/in 1, 2, and 3 SD respectively?

Answer 4

1 SD = 68%
2 SD = 95%
3 SD = 99.7%

Question 5

what term describes a pts chance of not truly having a dz after testing negative for the dz?

Answer 5

negative predictive value

Question 6

what term describes a pts chance of truly having a dz after testing positive for the dz?

Answer 6

positive predictive value

Question 7

NPV will vary w/ what and what does this mean?

Answer 7

• will very w/ pre-test probability of a dz
• high prob = low NPV
• low prob = high NPV

Question 8

what are ROC curves used to show?

Answer 8

the trade off between sensitivity and specificity @ various cutoff points

Question 9

a test exhibits what sensitivity and what specificity if it falls on the R end of a ROC curve vs the L end?

Answer 9

R end = high sens + low spec
L end = low sens + high spec
(this is opp the charts w/ 2 overlapping bell curves)

Question 10

what is a hazard ratio?

Answer 10

the chance of an event occurring in the tx group compared to in the control group

Question 11

how do you interpret HR?

Answer 11

< 1 - tx has decr risk
> 1 - tx has incr risk
close to 1 = little difference in risk btwn groups

Question 12

what is risk and how do you calculate it?

Answer 12

= the chance of getting a dz over a set period of time

R = #dz / #total @ risk

Question 13

what measures the added risk attributable to a specific RF?

Answer 13

attributable risk % (ARP)

Question 14

how do you calculate ARP?

Answer 14

ARP = (RISKexp - RISKun) / RISKexp
ARP = (RR - 1) / RR

Question 15

a urethral meatus located at the coronal margin (ventrally displaced) is characteristic of what condition?

Answer 15

hypospadias

Question 16

in addition to ventral meatus, what other 2 s/s can be seen in hypospadias?

Answer 16

• dorsal hooded foreskin

- chordee (curved penis)

Question 17

what must be done once clinical dx of hypospadias has been made?

Answer 17

urology consult/eval

Question 18

how does granuloma inguinale present?

Answer 18

• extensive PAINLESS ulcers w/o lymphadenopathy
• ulcer bases may have granulation tissue
• G-neg staining Donovan bodies

Question 19

how does 1* syphilis present?

Answer 19

+single painless papule –> nonexudative ulcer w/ indurated borders
+/- mild-mod bilat lymphadenopathy

Question 20

which test for syphilis is commonly neg in early dz?

Answer 20

nontreponemal serology (RPR and VDRL)

Question 21

pt presents w/ lesion suggestive of 1* syphilis but tests RPR and VDRL neg. what do you?

Answer 21

tx emperically w/ IM benzathine penicillin G

Question 22

what pts should not receive metformin and why?

Answer 22

• acutely ill pts w/ AKI, liver failure or sepsis

- incr risk for lactic acidosis

Question 23

what is the BG goal in acutely ill pts?

Answer 23

140-180 mg/dL

Question 24

what insulin management plan is recommended for acutely ill pts and why?

Answer 24

• short acting insulin regimen

- long acting plans w/ insulin ggt –> incr risk of hypoglycemia + adverse outcomes

Question 25

what is diabetes insipidus the leading cause of?

Answer 25

euvolemic HYPERnatremia

Question 26

what meds commonly cause nephrogenic DI?

Answer 26

- litium - demeclocycline - amphotericin B - foscarnet - cidofovir

Question 27

how does nephrogenic DI present?

Answer 27

- polyuria - polydipsea - euvolemic hyperNa - low u. OSM - incr s. OSM

Question 28

how do you tx nephrogenic DI 2/2 lithium use?

Answer 28

Na restriction + D/C lithium

Question 29

how can you distinguish stroke 2/2 L atrial thrombus from stoke 2/2 L atrial myxoma?

Answer 29

low F + incr ESR + wt loss = MYXOMA

Question 30

how will myxomas present?

Answer 30

- 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

Question 31

what is the MC 1* cardiac neoplasm?

Answer 31

cardiac myxoma

Question 32

what is PCWP and when will it be incr?

Answer 32

- estimate of LV end diastolic pressure | - incr in pts w/ LV systolic and/or diastolic dysf(x)

Question 33

incr pulmonary artery systolic pressure is diagnostic for what?

Answer 33

pulmonary HTN

Question 34

when is incr portal venous resistance (portan HTN) seen?

Answer 34

- hepatic cirrhosis | - extrahepatic portal vein thrombosis

Question 35

renal bx confirms clinical dx of minimal change dz. when do you do this confirmatory test?

Answer 35

no response to steroid tx

Question 36

when do you get a real bx in a kid?

Answer 36

- age > 10 yo + nephrotic synd | - suspected min change dz that didn't respond to steroid

Question 37

how do you tx minimal change dz?

Answer 37

corticosteroids

Question 38

what is giant cell tumor of bone?

Answer 38

- benign, locally destructive neoplasm | - MC site = epiphysis of long bones

Question 39

what do giant cell tumors of bone look like on xray?

Answer 39

eccentric lytic lesion = "soap bubble" lesions

Question 40

what is osteoid osteoma?

Answer 40

benign bone tumor that causes nighttime bone pain that is relieved w/ NSAIDs

Question 41

how does osteoid osteoma appear on xray?

Answer 41

sm round radiolucency

Question 42

how do giant cell tumors of bone present?

Answer 42

- local pain, swelling, stiffness and pathologic frx | - uncommon lung mets/malig transformation

Question 43

when do you use PO ABX and/or isotretinoin for acne?

Answer 43

severe or recalcitrant acne only

Question 44

how does diaphragmatic rupture appear on CXR?

Answer 44

+elevated hemidiaphragm or migration of abd contents into the thoracic cavity -pleural effusion (won't see)

Question 45

how does empyema typically present and how long does it take to form?

Answer 45

- F + pleuritic chest pain + sputum production | - unlikely to develope w/in 1 d of hospitalization

Question 46

when might you find gastric contents in the thoracic cavity despite an intact diaphragm?

Answer 46

esophageal rupture

Question 47

how do you tx inflammatory acne?

Answer 47

1. topical retinoid + benzoyl peroxide wash 2. add topical ABX 3. consider PO ABX (very severe only)

Question 48

what post-void residual vol is expected in significant bladder outlet obstruc?

Answer 48

usually > 50mL

Question 49

does BPH typically cause significant proteinuria?

Answer 49

no

Question 50

pts w/ DM > 10 yr are @ incr risk of developing what?

Answer 50

diabetic microangiopathy, nephropathy and glomerulosclerosis

Question 51

what are the clinical findings of diabetic microangiopathy, nephropathy, and/or glomerulosclerosis 2/2 longterm DM?

Answer 51

- mild/mod proteinuria | - CKD w/ incr Cr

Question 52

how does acute irritant contact dermatitis present?

Answer 52

pruritis, erythema, local edema and vesicles

Question 53

how does chronic irritant contact dermatitis present?

Answer 53

excoriations, fissuring, hyperkeratosis

Question 54

what causes molluscum contagiosum?

Answer 54

pox virus

Question 55

when should you consider HIV testing in a pt w/ molluscum contagiosum?

Answer 55

if lesions are widespread and/or involve the face

Question 56

pleural effusion is + for LIGHTs criteria. is it a transudative or exudative effusion?

Answer 56

exudative

Question 57

what are some common causes of exudative effusion?

Answer 57

- empyema - chylothorax - malig - TB

Question 58

what are the distinguishing features of exudative pleural fluid 2/2 chylothorax?

Answer 58

-milky white -incr TG -pH < 7.45 (will meet lights criteria)

Question 59

what are the distinguishing features of exudative pleural fluid 2/2 empyema?

Answer 59

-purulent fluid -PMN-predominance -POS G stain/culture -pH < 7.45 (will meet lights criteria)

Question 60

what are the distinguishing features of exudative pleural fluid 2/2 TB?

Answer 60

-acid-fast bacterium on stain/culture -pH<7.45 (will meet lights criteria)

Question 61

when is thrombolytic tx indicated for DVT when there is no PE?

Answer 61

massive proximal DVT + significant symptomatic swelling and/or limb ischemia

Question 62

when is thrombolytic therapy typically reserved for?

Answer 62

hemodynamically unstable pts w/ PE

Question 63

what are the indications for IVC filter placement?

Answer 63

1. anti-coag C/I (actively bleeding) | 2. anti-coag failure (rpt or expanding DVT despite full anti-coagulation)

Question 64

how do you dx intra-amniotic infx (chorioamnionitis)?

Answer 64

-maternal F + >= 1 of the following: fetal tachy for at least 10 min (HR > 160bpm) maternal incr WBC purulent amniotic fluid

Question 65

management of PPROM @ < 34wks is typically expectant (steroids + ABX + tocolytics). when would you deliver immediately?

Answer 65

suspect chorioamnionitis

Question 66

what i the MCC of anaphylacti transfusion rxn?

Answer 66

giving pt w/ IgA def packed RBC unit that has not been depleted of IgA

Question 67

how will anaphylactic transfusion rxn present?

Answer 67

resp distress + low BP + s/s of anaphylaxis

Question 68

how does TRALI typically present?

Answer 68

-acute hypoxemic resp distress + bilat pulm infiltrates w/in hours of receiving RBC transfusion

Question 69

how do you distinuish TRALI from transfusioni-associated circulatory overload?

Answer 69

nL BNP + NO JVD = TRALI

Question 70

which GERD pts get EGD instead of PPI trial?

Answer 70

- alarm s/s | - men age > 50yo + >= 5yr s/s + Ca risk (tobacco use)

Question 71

what are the alarm s/s prompting EGD?

Answer 71

- dysphagia - odyophagia - wt loss - anemia - GI bleed - recurrent emesis

Question 72

how does ogilvie synd. present?

Answer 72

- severe abd distension and pain - vomiting - obstipation

Question 73

what are some common causes of ogilvie synd?

Answer 73

- electrolyte abn (decr K, decr Mg) - sx - neuro dz - anti-cholinergic meds

Question 74

how does median n. entrapment @ forearm present?

Answer 74

+forearm pain | +sensory loss over entire lat palm and thenar eminence

Question 75

chronic HepC dx is a 2 step process. what are the 2 steps?

Answer 75

1. serologic Ab test | 2. confirmatory test = PCR for HepC viral RNA

Question 76

what is the pathophys of carpal tunnel synd 2/2 hypothyroidism?

Answer 76

soft tissue enlargement | mucopolysaccharides = mucinous infiltration

Question 77

how do MS s/s present?

Answer 77

episodic and affecting multiple, non-contiguous domains

Question 78

how do B-agonists (albuterol) cause intracellular K shift?

Answer 78

1. stimulate NaKATPase and NaKCl2 cotransporter | 2. stimulate incr insulin release --> K shift

Question 79

what are some causes of low K?

Answer 79

- intracellular shift - GI loss - renal K wasting (diuretics and hyperaldosteronism)

Question 80

what is tachycardia-mediated cardiomyopathy?

Answer 80

cardiomyopathy 2/2 sustained tachyarrythmia (afib, aflutter, vtach, re-entrant tachy) + prolongued RVR

Question 81

what structural changes can you see in the setting of chronic tachy?

Answer 81

LV dilation and myocardial dysf(x)

Question 82

if prednisone use is affecting K levels what will they be?

Answer 82

decr

Question 83

bactrim can cause what met derangement 2/2 its effects on the kidney?

Answer 83

incr K

Question 84

what is Leriche synd?

Answer 84

aortoiliac occlusion

Question 85

how does Leriche synd (aortoiliac occlusion) present? | hint: classic traid

Answer 85

1. bilat hip, thigh and buttock claudication 2. impotence 3. absent/diminished femoral pules (can --> symmetric LE atrophy 2/2 chronic ischemia)

Question 86

what conditions can cause ankle edema?

Answer 86

- venous insufficiency - renal insufficiency - RHF - hepatic dz

Question 87

when gas is seen w/in the GB wall, what is the dx and what do you do?

Answer 87

- emphazematous cholecystitis | - emergecy cholecystectomy

Question 88

what is recommended got acute cholecystitis but not emphazematous cholecystitis?

Answer 88

ERCP

Question 89

what are the MCCs of delirium in a hospitalized pt?

Answer 89

- toxic metabolic etiology | - infectious etiology

Question 90

what pts are @ incr risk of developing agitated delirium in the hosp?

Answer 90

pts w/ dementia

Question 91

what are teh s/e of high dose B-2 agonists?

Answer 91

- tremor - palpitations - HA - weakness, arrhythmia and EKG changes 2/2 hypokalemia

Question 92

in pre-renal AKI 2/2 sepsis + dehydration, what do you expect to see on U/A and why?

Answer 92

- 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)

Question 93

what is not seen in bland urine sediment on U/A?

Answer 93

-NO casts, RBC and WBC

Question 94

how/why do nitrates relieve angina and MI pain?

Answer 94

systemic vasodilation --> decr preload and decr LVED volume --> decr wall stress --> decr O2 demand --> decr pain

Question 95

what can nitrates do to HR and how do you compensate?

Answer 95

- cause reflex tachycardia | - coadmin w/ BB