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CD.docxWhich soft tissues mass characteristic is most concerning for malignancy?
Discrimination Index: -0.01.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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4 cm in diameter, (Incorrect answer)4 cm in diameter |
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Not fixed to surrounding surfaces, (Incorrect answer)Not fixed to surrounding surfaces |
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Fluctuation in size, (Incorrect answer)Fluctuation in size |
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Sudden presentation, (Correct answer)Sudden presentation |
2. What is a primary indication for a pacemaker?
Discrimination Index: -0.08.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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Heart block, (Incorrect answer)Heart block |
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Bradyarrhythmia, (Correct answer)Bradyarrhythmia |
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Myocardial infarction, (Incorrect answer)Myocardial infarction |
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Tachycardia, (Incorrect answer)Tachycardia |
3. a 60 year old woman presents after her second presyncopal episode in 2 weeks. She was previously healthy. she reports mild fatigue and occasional shortness of breath. On her electrocardiogram every third P wave fails to conduct; however, the remaining P waves are normal. There is no evidence of ischemia.
Which of the following best describes her electrocardiogram?
Discrimination Index: 0.55.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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Third degree heart block, (Incorrect answer)Third degree heart block |
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Second-degree Mobitz type 2 block, (Correct answer)Second-degree Mobitz type 2 block |
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Wenckebach block, (Incorrect answer)Wenckebach block |
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First-degree block, (Incorrect answer)First-degree block |
4. As a clinician, you may ask yourself "If my patient has fatigue, malaise and a cough, and then a positive influenza test, what is the probability that this patient has Influenza?" This is an example of utilizing which of the following?
Discrimination Index: 0.43.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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Gold standard testing, (Incorrect answer)Gold standard testing |
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Bayesian reasoning, (Correct answer)Bayesian reasoning |
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Internal evidence, (Incorrect answer)Internal evidence |
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Fagan's nomogram, (Incorrect answer)Fagan's nomogram |
5. How is finding the AUROC of a test helpful in practice?
Discrimination Index: 0.1.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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Determining cut off values, (Incorrect answer)Determining cut off values |
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Identifying the overall performance of a test, (Incorrect answer)Identifying the overall performance of a test |
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Ruling in a diagnosis when the prevalence is unknown, (Incorrect answer)Ruling in a diagnosis when the prevalence is unknown |
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Comparing performance of several tests, (Correct answer)Comparing performance of several tests |
6. If the presence of a condition is not known ahead of time, which statistic will be most useful in determining the value of the test?
Discrimination Index: 0.13.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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LR, (Incorrect answer)LR |
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PPV, (Correct answer)PPV |
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ROC, (Incorrect answer)ROC |
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Specificity, (Incorrect answer)Specificity |
7. Which test has the best likelihood ratio?
Discrimination Index: 0.14.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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Negative LR of 0.3, (Incorrect answer)Negative LR of 0.3 |
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Positive LR of 8, (Correct answer)Positive LR of 8 |
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Positive LR of 1.4, (Incorrect answer)Positive LR of 1.4 |
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Negative LR of 0.95, (Incorrect answer)Negative LR of 0.95 |
8. Which of the following factors are not an unintentional factor that affects xray images?
Discrimination Index: 0.02.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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The patient's extremity is not perpendicular to the film or plate, (Incorrect answer)The patient's extremity is not perpendicular to the film or plate |
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Over-penetration of xrays when obtaining an image of a thin patient, (Incorrect answer)Over-penetration of xrays when obtaining an image of a thin patient |
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Temperature of the room changing the speed of the xray particles, (Correct answer)Temperature of the room changing the speed of the xray particles |
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A patient breathes during a chest xray, (Incorrect answer)A patient breathes during a chest xray |
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A deflection of the primary xray beams, or scatter, (Incorrect answer)A deflection of the primary xray beams, or scatter |
9. Which of the following tests should be considered in the evaluation of a patient with a suspected acute inflammatory condition?
Discrimination Index: 0.24.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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ESR, (Incorrect answer)ESR |
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CBC, (Incorrect answer)CBC |
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hs-CRP, (Incorrect answer)hs-CRP |
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CRP, (Correct answer)CRP |
10. Which urinalysis characteristic provides an assessment of the renal tubules ability to concentrate or dilute urine?
Discrimination Index: 0.43.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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Color, (Incorrect answer)Color |
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Ketones, (Incorrect answer)Ketones |
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pH, (Incorrect answer)pH |
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Specific gravity, (Correct answer)Specific gravity |
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Osmolality, (Incorrect answer)Osmolality |
11. A 15 month old patient presents to clinic with a history of sleeping concerns, difficulty with eating solid foods, and generalized motor delays. Which of the following additional pieces of information do not suggest the patient may have iron-deficiency anemia?
Discrimination Index: 0.09.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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The child drinks about 30 oz of cow's milk daily, (Incorrect answer)The child drinks about 30 oz of cow's milk daily |
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The child had abnormal newborn screening results, although mom cannot remember specifics, (Correct answer)The child had abnormal newborn screening results, although mom cannot remember specifics |
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The family lives in a home built in 1965, (Incorrect answer)The family lives in a home built in 1965 |
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The child has tachycardia on exam, (Incorrect answer)The child has tachycardia on exam |
12. When educating a patient about the care of their lesion post-cryotherapy, it is necessary to inform them that:
Discrimination Index: 0.3.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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Hemorrhage at the site is a common effect, with no treatment necessary., (Incorrect answer)Hemorrhage at the site is a common effect, with no treatment necessary. |
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Blisters at the site are not common, and should prompt follow up in clinic if they present., (Incorrect answer)Blisters at the site are not common, and should prompt follow up in clinic if they present. |
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Edema of the site can form within minutes, and may be severe depending on the site of treatment., (Correct answer)Edema of the site can form within minutes, and may be severe depending on the site of treatment. |
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Treatment sites should be covered with an antiseptic bandage., (Incorrect answer)Treatment sites should be covered with an antiseptic bandage. |
13. What is a special consideration when utilizing mattress suturing?
Discrimination Index: 0.53.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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The clinician should not use mattress sutures on concave surfaces of the body, (Incorrect answer)The clinician should not use mattress sutures on concave surfaces of the body |
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Instruct patient to return for early suture removal, (Correct answer)Instruct patient to return for early suture removal |
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These sutures should never be alternated with other types of sutures, (Incorrect answer)These sutures should never be alternated with other types of sutures |
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Patient should see a plastics specialist for follow up, (Incorrect answer)Patient should see a plastics specialist for follow up |
14. Keeping cryotherapy freeze times under 30 seconds per treatment reduces the risk of:
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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burns, (Incorrect |
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secondary malignant lesions, (Incorrect |
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scarring, (Correct answer) |
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hyperpigementation, (Incorrect answer) |
15. A 16-year-old male presents to your urgent care clinic with severe hip pain after running in a track race. He noted a pop after starting his race, and subsequently developing sharp pain, swelling and limited ROM. He is ambulating, but with a limp. On exam, you note tenderness, swelling and crepitus over his left anterior pelvis. He is a sprinter, and has had no history of injury or chronic pain until today. You obtain a radiograph of his pelvis. What diagnosis do you suspect based on your assessment?
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Strained sartorius muscle |
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Acetabular fracture, (Incorrect answer)Acetabular fracture |
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Avulsion fracture of AIIS, (Incorrect answer)Avulsion fracture of AIIS |
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Avulsion fracture of ASIS, (Correct answer)Avulsion fracture of ASIS |
16.
What is the notable difference between these two chest xrays?
Discrimination Index: -0.08.
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A table of answers and brief statistics regarding student answer choices. |
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Answer Text |
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One has more prominent hepatosplenomegaly, (Incorrect answer)One has more prominent hepatosplenomegaly |
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One is AP and one is PA, (Correct answer)One is AP and one is PA |
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One demonstrates poor inspiration, (Incorrect answer)One demonstrates poor inspiration |
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One shows cardiac enlargement, (Incorrect answer)One shows cardiac enlargement |
AN EXAMPLE
Which of the following considerations for cryotherapy is correct?
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A provider must never remove the fine spray nozzle from a cryospray container to treat lesions |
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Cryospray should be applied at a distance of 3-4 cm from the target lesion, (Incorrect answer)Cryospray should be applied at a distance of 3-4 cm from the target lesion |
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Malignant lesions require a larger margin than premalignant or benign lesions, (Correct answer)Malignant lesions require a larger margin than premalignant or benign lesions |
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The confined spray technique is best for hyperkeratotic lesions, (Incorrect answer)The confined spray technique is best for hyperkeratotic lesions |
ANSWER:
The fine spray nozzle can be removed from a cryospray, to perform the technique, the the standard spray tip is removed from the handheld cryosurgery canister nozzle (Clebak et al, 2020)
Cryospray should be applied at a distance of 1 to 2 cm from the target perpendicular to the surface of the skin (Clebak et al, 2020)
Malignant lesions require a larger margin of about 4 to 5 mm than premalignant or benign lesions to ensure adequate depth of freeze (Clebak et al., 2020)
·The confined spray technique is best when treating sensitive areas or when spraying near nearby structures, (Clebak et al., 2020)
References
Clebak KT, Mendez-Miller M, Croad J. Cutaneous Cryosurgery for Common Skin Conditions. Am Fam Physician. 2020 Apr 1;101(7):399-406. PMID: 32227823.
