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3 Cards in this Set
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Toss Up: A 38-year-old female patient presents with pain in her right calf of 3 days duration. She had a lap cholecystectomy 8 weeks ago and a cervical conization for carcinoma-in-situ 6 years ago with no recurrence. No one in her family ever had a DVT. She has 2+ bilateral pitting ankle edema. Choice for initial diagnostic test would be? (D-dimer)
Immediate Bonus: What is the patient's Wells' pretest probability score? (0 - hence if negative d-dimer may exclude DVT)
Bonus: A) To the nearest 5%, if an individual scores 3 or greater (high probability) according to Well's criteria, what is the likehood that they will test positive for DVT on u/s? B) Identify if the following are part of the Well's criteria for DVT: 1) Active cancer with treatment within last 6 months 2) Swelling of entire leg 3) Major surgery requiring regional or general anesthetic within past 16 weeks C) D-dimer can be used to rule out a DVT because the test has a high specificity. T or F. |
A) 53% likelihood - for moderate 17% and 5% for low probability B1) Yes B2) Yes B3) No - Within 12 weeks C) False - SNOUT - High sensitivity |
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Toss Up: (ENT)
What three criteria must be present to diagnosis otitis media because not all red ears are otitis media? (Acuity - onset within 48 hours {Severe pain, fever >39, tugging at ears in nonverbal}, middle ear effusion seen with pneumatic otoscopy or tympanometry, inflammation seen as bulging/fullness, bullae or purulent otorrhea not from externa)
Immediate bonus: In patient with effusion present without signs of inflammation, what would be the Dx? (OME with effusion)
Bonus: 1) What are the three primary pathogenic targets in children with AOM? 2) According to AAFP, in what type of child with AOM could observation be an option rather than treatment with antibiotics 3) In the patient with concurrent conjuctivitis and AOM, what medication should be initial therapy/why? 4) Duration of effusion can persist for how long post AOM treatment? 5) In recurrent AOM, what is the treatment of choice? |
1) Strep pneumo, H flu and Moraxella catarrhalis 2) Child greater than 6 months with unilateral AOM that is not severe 3) High suspicion for H flu which has higher resistant to Amox 4) 8 to 12 weeks 5) Minimize risk factors - eliminate smoke exposure, pacifier and bottle feeding and limit daycare attendance |
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