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You are told that test X has a sensitivity of 85% and a specificity of 70%.

63F with RA and is taking prednisone and methotrexate. She has a failed R hip arthroplasty and tells you her surgeon is interested in doing a revision. On exam, she has weakness of R grip, generalized hyperreflexia and hypertonia, and synovitis. What is the next step?

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You are told that test X has a sensitivity of 85% and a specificity of 70%.

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  1. 63F with RA and is taking prednisone and methotrexate. She has a failed R hip arthroplasty and tells you her surgeon is interested in doing a revision. On exam, she has weakness of R grip, generalized hyperreflexia and hypertonia, and synovitis. What is the next step? A. Obtain ANA, anti-DNA, and anti-Sm ab B. Test for cryoglobulins C. Add tumor necrosis factor alpha inhibitor D. Obtain images of cervical spine

  2. 35F on OCPs for 10 y develops a PE and is found to be heterozygous for prothrombin g20210A mutation. She was anticoagulated for 6 months. How should she be counseled? • Take a daily aspirin • Continue life-long anticoagulation • Offer genetic counseling for family members • Do nothing further

  3. You are told that test X has a sensitivity of 85% and a specificity of 70%. • Calculate the positive likelihood ratio. • Is this a good test?

  4. 26F marathon runner present to clinic with fatigue and mild dyspnea with exertion. You check a hgb and find that it is 7.8 g/dl. All the following might explain her anemia except: A. Dilutional pseudoanemia B. Intravascular hemolysis C. Iron deficiency anemia D. Splenic sequestration

  5. Type I Type II Type III Type IV mast cell-mediated reaction Immune complex mediated T-cell mediated Antibody-mediated reaction Match sensitivity reaction with type

  6. Breast Prostate Lung Kidney Myeloma Thyroid Melanoma Blastic Lytic Blastic and Lytic Match cancer and bone lesion

  7. 35M presents with Hep C with cirrhosis presents with general malaise for last week. On exam, he has an open skin lesion on R arm, no hepatosplenomegaly or signs of decompensated liver failure. Blood cultures are drawn and grow out a gram negative rod. You suspect he became infected through close contact with his dogs. What is the best next step? • Start a fluoroquinolone • Start a penicillin • Start a tetracycline • Initiate contact isolation

  8. 50M presents with hematuria, fatigue. Initial labs show a normocyctic anemia, nl RBC’s on urine microscopy. Because of worsening renal function, a kidney biopsy was performed which showed. • All of the following can be associated with this condition except: • MicrocyticAnemia • Hypertension • Hypercalcemia • Secondary amyloidosis • SIADH

  9. 55F with CKD on HD presents with progressive pain in RUE. Also with itching, burning. No trauma to this region. Ca x Phos is 35. Picture is shown on R. What is the most like cause of her condition? • Calciphylaxis • Nephrogenic systemic fibrosis • Stevens-Johnson’s syndrome • Secondary amyloidosis due to HD

  10. 35M with HIV presents with severe HA and vomiting x 2 days. Fevers at home and in ED. No complaints on mental status changes. You are worried about a meningitis, so you perform a lumbar puncture. OP 35 mmhg. CSF stain shown. What is the next best step? A. Start vancomycin, ampicillin, ceftriaxone B. Start antifungals C. Start dexamethasone D. Consult neurosurgery

  11. 45F life-long nonsmoker presents to clinic with progressive DOE and RUQ pain. She works in an office setting, no recent travels. On exam, she has decreased B sounds at her bases, panniculitis of her abdomen. She is not anemic. Because of suspicious lesions on CXR, a CT chest was done and is shown. What is the next best step? • Consult pulm for bronchoscopy and biopsy • Consult CT surgery for open lung biopsy • Start bronchodilators, steroids, oxygen • Put patient on airborn precautions and check AFB’s in sputum

  12. 80M with NICM, EF 30% presents with increasing of SOB. Has been taking diuretics as prescribed and has adhered to dietary restrictions. On exam, he has JVD to his ear at 30 degrees, crackles to mid-lung, and B LE edema- symmetric. His labs: serum Na 127, Cr 1.1, Urine Na 5, U P/C ratio 0.1. What is the most likely cause of his hyponatremia? • CHF exacerbation • Renal salt wasting • SIADH • Nephrotic syndrome

  13. 78M presents with ataxia for 2 weeks. He reports one episode of urinary incontinence 3 days ago. His family brings him in to clinic saying, “He is becoming more forgetful.” You obtain a CT head and await the results. What is the next best step? • Lumbar puncture • Consult neurology for concerns of evolving CVA • Start antibiotics • Obtain a CTLS MRI and start dexamethasone

  14. 35M with CKD stage V on HD presents with severe HA. In the ED, his BP is 230/120. He has a seizure and a brain MRI is obtained and shown. Blood cultures drawn and were negative. What is the most likely diagnosis? • Septic emboli • Hypertensive encephalopathy • Toxoplasmosis • Nocardia infection

  15. You are preparing for EBM and come across an RCT with a power calculation. You find out that the trial did not enroll enough people to reach power. What is the major concern with this trial? • There is a chance of missing a true difference. • There is a chance that the results show that the treatment is effective when it is not. • We will not be able to calculate the number needed to treat.

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