Thursday, May 3, 2012

Answers to the Sample Questions from 5/2/12

Yesterday I posted 4 sample questions - Here are the answers...

Sample Q1: What is the most common infectious etiology of septic arthritis?
Staph aureus, which in my estimation is everybody's favorite gram positive bacterium.

Sample Q2: What are the Centor Criteria, and what do they assess for?
These criteria can be used to assess the likelihood of bacterial infection in patients with a sore throat. It was studied in adult patients, and assigns 1 point to each of 4 criteria:

History of fever
Tonsillar exudate
Tender anterior cervical adenopathy
Absence of cough

The modified Centor Criteria added age into the mix
<15 years add 1 point
>44 years subtract 1 point

<2 points: Risk of GAS infection <10% - no antibiotics or testing necessary2 points: Risk of strep 15%3 points: Risk of GAS 32%>4 points: Risk if GAS 56% with a throat culture PPV of 40-60%

If you lack any of the 4 variables the NPV is 80%. Though not implicitly stated in the criteria these criteria can be extrapolated to help rule out strep throat and enable you to avoid swabbing for a rapid strep.

Sample Q3: What type of fracture is depicted here? 
This is a Monteggia fracture (It was on my Peds boards) and is a combination of a fracture of the proximal third of the ulna and a radial head dislocation.

Sample Q4: A pt. w/ fever, hopping tenderness, RLQ pain, & ANC 8,200 has a Pediatric Appendicitis Score of what?
Doing the math nets a score of 6 - This is an 'equivocal' value and merits further testing (labs like a CBC, Urine in girls, and an ultrasound).

PAS: Pediatric Appendicitis Score
1 point  anorexia
1 point  fever
1 point  nausea/vomiting
1 point  migration of pain
2 points  pain w/ cough,   percussion or hopping
2 points  RLQ tenderness
1 point   WBC >10,000
1 point  ANC >6750

Tuesday, May 1, 2012