Stats/Ambulatory Flashcards
(38 cards)
When a percentage of subjects from two group are lost to follow-up and not included in final analysis, it is this type of bias.
Selection bias (inappropriate selection or poor retention)
This bias is common in retrospective studies where subjects with negative outcomes are more likely to report exposures than controls
recall bias
This bias has subjects over or underreporting exposure history due to perceived social stigma
reporting bias
exposures that happen long before disease assessment can cause study to miss dx pts that die early or recover
prevalence bias
Incidence represents this.
measure of appearance of new cases.
Prevalence represents this.
measure of those with the disease in the population at a particular point in time (P = Incidence x Time)
A 62-year-old Caucasian woman complains of a several month history of pain and stiffness in the
shoulder and pelvic girdle that is worse in the morning and lasts at least 30 minutes. She has
occasional fevers, night sweats, fatigue and weight loss. Her erythrocyte sedimentation rate is
elevated, but the rest of her labs are normal. She is given oral prednisone 10 mg daily and her
symptoms completely resolve within 48 hours. What is the likely diagnosis?
Polymyalgia rheumatica (due to over age 50, bilateral, proximal morning stiffness more than 30 minutes, and rapid improvement in symptoms with oral steroids)
A 9-year-old boy is brought to the clinic because of complaints of fatigue. Though he sleeps 10 hours
per night he continues to complain of sleepiness during the day. While sleeping the patient does snore
consistently. On examination he has tonsillar hypertrophy and polysomnography shows moderate
obstructive sleep apnea. What is the next best step in the treatment of this patient if adenotonsillectomy isn’t applicable?
can use CPAP like in adults
A 52-year-old post-menopausal woman is being placed on long-term (> 3 months) prednisone
treatment for severe rheumatoid arthritis. In regards to bone health, what is the next best step for this
patient?
For men over 50 and any postmenop. woman, its recommended that use Ca 1200 mg, Vit D 800 IU, and biphos
A 78-year-old man with a history of type 2 diabetes and hypertension presents with progressively
worsening shortness of breath, lower extremity edema and paroxysmal nocturnal dyspnea. His
medications include lisinopril, pioglitazone, glipizide and saxagliptin. His creatinine is 1.0 mg/dL. An
echocardiogram shows an ejection fraction of 30%. Which of his medications is likely contributing to
his symptoms?
pioglitazone (cause fluid retention)
A 6-month-old male infant is brought to the clinic for diarrhea and vomiting for the past 24 hours. He
has had low grade fever and has been acting fussy. He is primarily breastfed but has been tolerating
solids. He has a 3-year-old brother with similar symptoms. On examination he has moist mucus
membranes, good skin turgor and is active. What is the treatment for this patient?
Continue age appropriate diet and continue breastfeeding (virus most likely)
A 76-year-old man complains of pruritic lower extremities. Though no rash seems to be present the
pruritic areas become dry and scaly. This occurs only during the winter months and tends to be worse
after bathing. He has no history of eczema and takes no medications. On examination he has normal
extremity pulses, no lower extremity edema and the affected area has no obvious rash but does
appear dry. What is the most likely diagnosis and treatment?
xerosis (seen in older pts in winter); skin hydration with topical emollients
A 62-year-old man with a history of lung cancer has a serum calcium of 15.1 mg/dL with a normal
serum albumin. The patient complains of polyuria and weakness. What is the next best step in the
management of this patient?
saline hydration (help excrete Ca and keep hydration) and calcitonin
An 8-month-old male infant is brought to the clinic for a rash that has been present for several weeks.
The infant has been eating well and has had no ill-like symptoms. On examination the rash appears dry
and located bilaterally over the antecubital and popliteal fossae. The affected skin is mildly thickened
but no scaling is present. No tenderness or surrounding erythema is present. The parents report a
family history of eczema and are asking if they can use the pimecrolimus that they were given for their
other older child. What do you tell the parents?
No; Pimecrolimus can’t be used in kids under 2 years so have to use topical emollients then if not effective, low topical steroid
A 42-year-old woman is diagnosed with rheumatoid arthritis. Her rheumatologist wants to start her on
infliximab. What tests need to be performed prior to starting this medication?
Hep B surface Ag and TBD
A 65-year-old man has progressive memory loss over the past several months. He has waxing and
waning alertness and even has audio and visual hallucinations. He has had several falls over this time
period. On examination he has a resting tremor and moderate rigidity of his trunk and face. He has
normal labs and a normal CT of the head. What is the most likely diagnosis?
Dementia with Lewy bodies (dementia, fluctuating cognition, visual hallucinations, and parkinsonism)
A 22-year-old sexually active woman complains of gradually worsening dysuria and urinary frequency
for one week. She denies fever, flank pain or gross hematuria. A urinalysis reveals pyuria but the
culture did not grow any bacteria. After 3 days of nitrofurantoin the patient reports no improvement in
symptoms. What is the likely cause of these symptoms?
chlamydia or gonorrhea
A 52-year old homeless man is hospitalized for community acquired pneumonia. The patient had been
improving quickly but then on day-of-admission three the patient becomes agitated, starts to
hallucinate and become very tremulous. The patient is afebrile, is not hypoxemic and his chest x-ray is
slightly improved from admission. A D-dimer is negative. His white blood cell count is normal. What is
the most appropriate treatment for this patient?
Benzos (EtOH withdrawal becuz DTs happen 3-4 days where get shaky and hemodynamic issues)
A 23-year-old man has asthma. He admits to needing to use his short-acting β-agonist 3 times per week during the day. What is the most appropriate initial treatment for this patient?
Low dose inhaled corticosteroid daily plus short-acting beta agonist PRN (if patient uses beta agonist more than 2x a day, then it is at least mild persistent asthma)
What are the U.S. Preventative Services Task Force recommendations for abdominal aortic aneurysm screening?
All men 65-75 who have ever smoked
A 42-year-old woman complains of gnawing mid-epigastric pain for the past 3 weeks. The pain improves with eating and radiates to her back. She reports darkly colored stools for the past 4 days. She has a long history of alcohol abuse and occasionally uses ibuprofen for headaches. What is the most likely cause of these symptoms?
H.pylori (peptic ulcer
A 42-year-old woman complains of sore areas on the proximal nail folds of several fingers over the past several months. She works as a dish-washer at a local restaurant. She has no other complaints or medical problems. What is the most appropriate treatment for this condition?
wear gloves or topical medium to high potent corticosteroid (for chronic paronychia)
A 21-year-old pregnant woman at 26 weeks gestation complains of frequent migraine headaches. What migraine medications should be avoided in pregnant patients?
ergotamines and triptans (cause vasoconstriction of the placenta and uterine vessels)
A 22-year-old man is diagnosed with meningococcal meningitis. His only close contact is his roommate. What measures should be taken with the roommate?
rifampin, cipro, or IM ceftriaxone
