Unidentified flying fever
random
"I won’t consider myself to be in trouble until I start coughing blood."
"I Hate You, Don't Leave Me"
MODY, Oh my
When the Sandman Goes on Strike
100

Name two co-morbid conditions which would warrant empiric abx if dx w/ FUO.

  • Immune compromised, neutropenic, critically ill
  • Consider both broad spectrum abx and antifungals
100

In stable patient’s whom had completed dual-antiplatelet therapy after DES placement, ongoing monotherapy with this agent led to fewer events in the 2 years after transitioning to single agent therapy.

  • Clopidogrel (vs ASA monotherapy)
  • Fewer strokes, fewer hospitalizations, less major bleeding
  • No differences in all-cause mortality or nonfatal MI
  • Study did take place in South Korea
100

In cases of hemoptysis requiring intervention, the source of the bleed is most commonly from the ___.

  • Bronchial arteries (90%)
  • Pulmonary arteries (5%)
  • Non-bronchial systemic arteries (5%)
100

Exhibited by patients with borderline personality, this is the term used to describe when a person rapidly with over or de-value a relationship.

  • Splitting
  • Ex: in one moment the patient can highly appreciate a clinician and then reverse this opinion when an appointment needs to be reschedule or another perceived rejection occurs
100

if you suspect MODY and have already ordered autoantibodies and C-peptide, order this test for confirmation

targeted genetic testing.

100

This is the first line treatment for obstructive sleep apnea in childhood.

  • Adenotonsillectomy, works in 70% of normal weight children, <30% of obese children
  • 2nd line is CPAP
  • According to a 2012 AAP guideline, all children should be screened for OSA at WCC.
  • PSG is required for the diagnosis of OSA, which peaks in incidence in childhood between ages 2 and 8. Smoke exposure and obesity are risk factors, amongst other considerations.
200

Due to good diagnostic yield and an evidence rating of B, name one of the two tests suggested to be performed if non-invasive diagnostic testing is unrevealing for FUO.

  • Tissue biopsy guided by hx and exam (relatively high diagnostic yield)
  • 18-F fluorodeoxyglucose positron emission tomography scan with computed tomography (for pt’s w/ elevated inflammatory markers whom don’t have a dx after initial testing)
200

According to this issue of AFP, this test has higher sensitivity but advanced adenomas than it’s other stool based counterparts, but comes with the cost of more false-positives, higher likelihood of negative results on follow-up colonoscopy, and is less cost-effective.

  • Cologuard, i.e. FIT-DNA testing. Cost 680$ (colonoscopy costs 1700$)
  •   Sensitivity 92% (74% with colonoscopy)
  •   Specificity 87% (vs 95% w/ colonoscopy)
  • Number needed to screen to detect 1 colon cancer: 154 w/ colonoscopy; 166 with cologuard; 208 with FIT
  • 3 times as many false positive results compared w/ FIT (455 vs 162 positive tests w/ negative colonoscopy)
  • Test does NOT report which part of the test turned positive (FIT or DNA component)
  •   Patients w/ positive FIT-DNA often undergo more aggressive short term surveillance, though no evidence guides this
  • Article cites 2 follow-up studies on pts w/ false + FIT-DNA testing w/ a mean f/u of 4 years who did not show increased rates of colorectal cancer.
  • https://www.aafp.org/afp/2018/0515/hi-res/afp20180515p658-t3.gif
200

In deciding if a patient has massive hemoptysis, and thus needs emergency care, certain clinical factors are considered. Name 3.

  • Rate of bleeding
  • Patient’s ability to maintain a patent airway (which is dependent on the rate of blood clearance, internalized bleeding, airway obstruction (like from a clot) and respiratory status)
  • Patient’s physiologic reserve (fucntino of hemodynamic stability, cardiopulmonary reserve, risk fo recurrent bleeding)
200

The article lists 3 dimensions of clinical features of borderline personality disorder. Name 2.

  • Emotion dysregulation (intense moods, sudden mood shifts, outbursts of anger, self-harm, increased risk of suicide)
  • Interpersonal problems (chronic lonliness and emptiness, recklessness and impulsivity, fear of being abandoned, persistent efforts to avoid feeling unaccepted and/or unloved)
  • Self-identity disturbance (aggressive impulses, lack of an integrated sense of self, persistent unstable self-image, transient paranoia, and/or severe dissociated symptoms)
200

True/False: MODY patients typically respond well to metformin

False - consider MODY if poor response to metformin in suspected Type 2

200

This is a common cause of restless legs syndrome, and should be corrected before using other pharmacologic treatment for this syndrome.

  • Iron deficiency, treat to be above a ferritin of 50
  • May be misdx as growing pains
  • Often co-morbid w/ ADHD
  • “an unpleasant sensation in their legs”; “need to kick, spiders, tingly, wiggly, funny in legs”
300

Name 3 broad categories of disease which are commonly implicated in FUO.

300

The age at which the USPSTF recommends starting colorectal cancer screening, with a B recommendation.

45

300

Give an example of pseudohemoptysis.

  • Bleeding from a source outside the pulmonary vasculature resulting in the patient coughing up blood. Epistaxis, GI bleed, upper airway bleed, bleeding from dental disease.
  • Or, a red expectorant that is not blood, such as w/ Serratia marcescens nfection
300

True/false: suicidality is no more increased or decreased from the general population in patients suffering from borderline personality.

300

This is the preferred pharmacologic treatment for MODY 1 and 3. 

Sulfonylureas

300

Name the range of recommended sleep time for a child age 5-12 years old.

400

Define fever of unknown origin.

  • A clinically documented temperature of 101 degrees F (38.3 C) or higher on several occasions, coupled with an unrevealing diagnostic workup.
  • “Previous definitions have provided suggested minimal time frames for investigation; however, these were acknowledged to be artibrary and are not included in the current consensus definition.”
400

Neither death nor the need for respiratory support was prevented when this IV medication was administered to adults hospitalized with moderate to severe COVID-19.

remdesivir

- endpoint was all-cause mortality and need for respiratory support (HFNC, non-invasive or invasive mechanical ventilation) at up to 28 days.

- did not reduce duration of mechanical ventilation, quality of life, duration of hospitalization, ICU admission, or duration of ICU stay

- low certainty of evidence, but did seem to reduce the need for new invasive mechanical ventilation

400

This is the initial imaging modality recommended for either non-massive and massive hemoptysis.

  • CXR PA and lateral
  • Follow either either: bronch, CTA, or CT w/ IV contrast
400

This form of CBT integrates groups and personal sessions to help pts manage their emotional lability and impulse behavior.

  • Dialectical behavior therapy
  • Reduces BPD severity, self-harm, and increased psychological functioning
  • Reduces suicide attempts and psych hospitalizations in pt’s w/ BPD
  • Supposedly can start seeing positive effects within just a few months
  • Mentalization therapy: increase an individual’s udnerstanidn go fhow actions are influence dby mental states, thereby decreasing impulsiveness and emotional lability.
  • Can also do standard CBT if these are not available.
  • Therapy dropout rates are about 1 in 5
400

compare and contrast pathophysiology / cause of MODY vs Type 2 diabetes

Type 2 diabetes is due to insulin resistance and progressive loss of beta cell function.

MODY is due to impaired insulin secretion

400

This is the term used to describe undesirable physical events or experiences during sleep onset, within sleep, or during arousal from sleep.

500

Due to their high sensitivity for infection and inflammation and high negative predictive value for inflammatory causes, these two tests should be ordered early on in a FUO w/u.

500

Name 4 common causes of hemoptysis.

500

Which medication class has high-quality evidence for its use in treating borderline personality disorder?

  • Trick question: no medications posess this quality of evidence
  • Low qualifty evidence for mood stabilizers
  • Maybe buph and naltrexone to reduce suicidal behavior?
500

The article states testing for MODY can be considered in patients <30 yo with diabetes and these 5 attributes (name 3 out of 5)

-is not obese

-lacks signs of insulin resistance (acanthosis nigricans, skin tags, metabolic syndrome)

-lacks beta cell autoantibodies

-fasting C-peptide level greater than 0.6

-has family hx of diabetes in young, non-obese family members

500

The Choosing Wisely recommendation in the article stated to NOT do this when treating childhood insomnia, which usually develops from parent-child interactions and resopnds to behavior interventions.

Prescribe medications

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