Aquifer Case Study Questions

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Questions and Answers

What is the most appropriate next step in diagnosis for a 45-year-old female with left calf pain and swelling?

D-dimer (correct)

Lower extremity Doppler

CT angiography

MRI

What is the most appropriate next step in the care for a 65-year-old male with right calf redness and swelling?

Initiate treatment with antibiotics. (correct)

Order a lower extremity Doppler.

Initiate treatment with Low molecular weight heparin.

Check a D-dimer

What might you do differently when counseling a 56-year-old male with an increased HbA1C of 7.5%?

Recommend he follow a more strict dietary protocol including elimination of meat from his diet.

Suggest he get a personal trainer.

Tell him you are disappointed that he was not able to adhere to your previous recommendations.

Find out from the patient whether barriers exist to his adherence to your previous suggestions. (correct)

What is the most appropriate initial counseling for a 55-year-old man experiencing knee pain and stiffness?

Develop a weight loss plan with the patient. Signup and view all the answers

What is the next best step in management for a 13-year-old female presenting with flu-like symptoms?

Ibuprofen Signup and view all the answers

What is the next best step in management for a 4-year-old male with sore throat and fever during a flu epidemic?

Tamiflu (oseltamivir phosphate) Signup and view all the answers

What is the most appropriate next step for a 7-year-old male with fever and sore throat symptoms?

Rapid Strep Test Signup and view all the answers

What is the next best step for a 48-year-old female with sore throat and exudate?

Rapid Strep Test Signup and view all the answers

What is the greatest risk factor for complications in a 9-year-old male suspected of having influenza?

Long-term aspirin therapy Signup and view all the answers

What is the most likely pathogen in a 5-year-old girl with a vesicular rash, high fever, and mouth ulcers?

Coxsackie A virus Signup and view all the answers

What classic signs might you discover in a 2-year-old with symptoms suggestive of Kawasaki disease?

Erythematous tongue and erythema/edema of the extremities Signup and view all the answers

What is the most likely diagnosis for a 3-year-old boy with fever, conjunctival injection, and a rash?

Kawasaki disease Signup and view all the answers

What is the next best step in management for a boy with suspected Group A strep?

Rapid strep test with back-up culture if negative Signup and view all the answers

What is the most important follow-up for a girl diagnosed with Kawasaki disease?

Echocardiogram to look for coronary artery aneurysm Signup and view all the answers

What is the most appropriate diagnosis for a 65-year-old female with blood pressure readings of 146/96 mmHg and 148/92 mmHg?

Elevated blood pressure Signup and view all the answers

Which medication is most appropriate to begin for a patient with a blood pressure of 156/94 mmHg?

Thiazide diuretic Signup and view all the answers

Which lifestyle change is least likely to improve cardiovascular risk for a 54-year-old male?

Alcohol cessation Signup and view all the answers

Which medication is most likely to cause an adverse event in a patient with a history of gout?

Hydrochlorothiazide Signup and view all the answers

What is the most appropriate management step for a 62-year-old female with hypertension and not at treatment goals?

Add amlodipine 5 mg daily Signup and view all the answers

What does Kernig's sign indicate?

Sign of meningitis Signup and view all the answers

What does Brudzinski's sign indicate?

Sign of meningitis Signup and view all the answers

Which characteristic is most typical of cluster headaches?

They are associated with rhinorrhea, lacrimation, miosis, and ptosis Signup and view all the answers

Which characteristic is most typical of migraine headaches?

Patients with them often complain of a pulsating quality of pain Signup and view all the answers

Which of the following is most typical of tension headaches?

They are associated with occipital tenderness Signup and view all the answers

What is the best treatment for a patient with rebound headaches?

Discontinue use of ibuprofen and Tylenol Signup and view all the answers

What is the best next step in management for a patient presenting with red flags for headaches?

Neuroimaging Signup and view all the answers

What is the most appropriate next step in diagnosis for a patient with right calf pain and swelling?

Lower extremity Doppler Signup and view all the answers

Study Notes

Pediatric Infections

Coxsackie A virus causes herpangina, presenting with fever, vesicular rash on palms/soles, and oral ulcers; symptoms resolve spontaneously within three days.
Kawasaki disease is characterized by prolonged fever and signs like strawberry tongue, rash, and unilateral cervical adenopathy; early echocardiogram is recommended to assess for coronary artery aneurysms.

Hypertension Management

Hypertension is diagnosed with two readings above 130/80 mmHg, with Stage 1 defined as 130-139/80-89 mmHg and Stage 2 as ≥140/90 mmHg.
Elevated blood pressure should first be confirmed; a second similar reading is needed to diagnose stage appropriately.
First-line treatments for Stage 2 hypertension include thiazide diuretics, ACE inhibitors, or calcium channel blockers; thiazide diuretics are preferred.

Gout and Medication Considerations

Hydrochlorothiazide can exacerbate hyperuricemia, a concern in patients with gout, making it a less ideal first-line treatment for hypertensive patients with this condition.
Regular review of current medications and their impact is crucial, particularly in patients with multiple comorbidities.

Headache Types and Diagnosis

Cluster headaches present with severe unilateral stabbing pain and autonomic symptoms (like rhinorrhea and lacrimation).
Migraine headaches are pulsating and associated with sensitivity to light and sound.
Tension headaches typically exhibit a squeezing pain and can involve the occipital area without food triggers or exacerbation by activity.

Diagnostic Approaches

Neuroimaging is critical in patients with red flag symptoms indicating possible intracranial pathology; age, headache changes, and neurological exam findings guide decision-making.
Doppler ultrasound is the preferred method for diagnosing DVT; D-dimer can help reduce unnecessary imaging in lower-probability cases.

Key Findings in Clinical Scenarios

A two-part Red Flags for headaches: age over 50, headaches worsening, and abnormal neurological exam warrant immediate neuroimaging.
Assessment of calf pain and swelling requires careful evaluation of patient history and symptoms, and appropriate next steps may involve D-dimer testing or Doppler depending on pretest probabilities.

General Recommendations

Lifestyle modifications can significantly benefit cardiovascular health; however, certain changes like alcohol cessation may not always lead to lower blood pressure in moderate consumers.
Reinforcement of patient adherence to treatment plans, including forthcoming drug prescriptions, is important for effective management of chronic conditions.### Treatment Protocols
Initiate treatment with antibiotics for suspected cellulitis; further anticoagulation with heparin is unnecessary.
In cases of fever with tenderness, assess for cellulitis rather than deep vein thrombosis (DVT) signs with Doppler or D-dimer.

Diabetes Management

Patient with Type 2 Diabetes Mellitus (DM) had initial HbA1C of 7.0%, which increased to 7.5% at follow-up.
Effective counseling should include exploring potential barriers to adherence rather than imposing stricter dietary protocols or expressing disappointment.

Osteoarthritis in Obesity

A 55-year-old man with knee pain displays no inflammatory signs but has crepitus and narrowed joint spaces on X-ray.
Initial counseling should focus on developing a weight loss plan as obesity significantly impacts joint health and overall mortality.

Influenza Symptoms

A 13-year-old female presents with flu-like symptoms; rapid strep test is negative.
Supportive care including rest and ibuprofen for fever/pain is indicated, antiviral medications are less effective outside the 48-hour symptom onset window.

Pediatric Flu Management

A 4-year-old boy shows flu symptoms during a flu epidemic; rapid strep test is negative.
Management includes prescribing Tamiflu within 48 hours of symptom onset as testing is unnecessary during an outbreak.

Pediatric Pharyngitis Evaluation

A 7-year-old male has fever and sore throat, presenting with tender lymphadenopathy.
Use of a rapid strep test is essential to confirm or rule out streptococcal pharyngitis before empiric antibiotic treatment.

Strep Throat Assessment in Adults

An adult with fever and erythematous throat should be evaluated using the Modified Centor Criteria.
A score of 3 indicates the need for a rapid strep test to guide treatment decisions, leading to appropriate antibiotic therapy if positive.

Complications of Influenza

A 9-year-old male with a history of Kawasaki disease on aspirin therapy is at increased risk for complications from influenza.
Long-term aspirin therapy is a significant risk factor, while a splenectomy poses other infection risks but not specifically against influenza.

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Description

This quiz focuses on a specific case study involving a 5-year-old girl with a notable rash and fever. Participants will identify the most likely pathogen based on clinical presentation and case details. Improve your understanding of infectious diseases and their indicators through these targeted flashcards.