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69 views159 pages(Medicalstudyzone - Com) Block 13
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Ons al
: ‘cohort study was conducted to ivesugue the impact of pst-waumall sues dstde (TSO) on asthma symproms wa
rs {rou of refer who worked at Grd Zavvi september 1 2000 teers tac nr Yr Yael
Gevloped asthma nthe aac’ aftermath The study compared paves Who had TED with those hod ot have PSO
researeners fund that patents wh FTSD hada grster number of hospitals fasta exacerbations RR = 2.0,
sk conidencemtenal= 4-25) ater adusing for medical comotbdes, soya cmarbues oe than PSD,
2 ana saceostion_ No aetna exacerbations
gs rsp 0 2
Be herrso 50 0
ape on thet eu, what peoportion oath horplzabons inpatients wth PTSD coud be atte to PSO?
ca
®
\®
©
050
IG
4 Omns al
a
oe ‘cone syn condcd ovate osc of post-rumate ues aoe (TSO) onastmasymotnsina ES
. freer teh shred ad sre it te spr 1,01 rt a ve Yr
Srslped nth inte sack math Th sy compared pas had FD th the i hae FS
a ‘turret pean FD a nat sumo oops essen =.
a SSecamoenc menal= 25) str agurng or mena comers yeh comers et an FD,
So eles comer eres
gs mo Py
Lol No PTSD 30 130
a
‘You do not eed to ue the 212 able to soe this question. The excess kin the eapoted group i the atrbutable
here percent which con be alate using herein
e 2a |
2.0 ek ORL, fp th PSD eng pean oat scars gn
e ‘err reana hxtaare or ahra race oie [Link] & cn eased dae te meer
eee Go nate crm peess re enter eae ee ee
Disgaea Aare oe
“exacerbations in pais wih TSO. Here, the aterbuable rik percent (ARP needs ob calculated estimate the proportion
‘festa hosptalatons in patent th PTSD.
10.25 se absolute sk eaucton Lethe erence bene the sk ofan exacerbaon he FISD gtoup andthe
‘roup of pais nthout PIS The AR lela by aking the abeoie rik of PSD pater and mbracting the absolute
‘sof paves without PTSD nhs eas, (0/160) (50/200 = 05-025) = 0.25 0 2% Tis means tat the absence of
[TsO reduces he i af honpazaton for athena exacerbation by 255, Om De at <1 + y40>
Taceoatons pavers wr #1SU- Here, me ateowaoie nk percent kr neeas 0 be CaLcusea Co esunate me popanion
fata Restarting tn pats wh PTSD.
‘oun of patients withou FSO. The ARR calculated by taking the absolute rsk of FTSD patents and subwacin the absolute
‘or pavems yeu PTSD. eis eas, (80/160) (50200) = (05 ~ 0.25) = 25 0 25m Ths ans at he abence of
[rso reduce he in of horpalaton for ath exacerbation by 258,
5.015 the rato (OR) Le he probabiyof a patient having FTSD If hel she has an asthma exacerbation tht eques
Iptalation. The OR canbe eluted athe a of deat n he exposed group ded bythe a of dean athe
‘unexposed group inthis ase: OR ~ (80/80),50/150)~1/(/3)~ 3. AMOR > I means that ters an creased oo of
tn wth eta exacerbation nang PTSD.
“Th proportion of sthmaHospelizationsacibtale oFTSD i the PTS grup is the arvibuble rik percent ARP, hich
an becalealited bed om the lative rk AR ARP = (BR. ~ 1) AR In th ave, ARP= 2.0 1) 2. = 1/2-= O50 ot SOK TH
‘means that 50% ofthe asthma exaceraetons nth TSO group canbe arbued 0 FSD.
Bi. fpitemitony
“4.015 he ruber nade te harm (NMG, De ruber of ndduals who need fo be exposed in is case, meaning he
[resees of 730) before ane parton dvalope ay asthma nearer, MMs ead astute ak Te
‘Setermine the aibuable Sk hee the ndence of asta exacerbauors in patents wth FTSDIssubaced fom the
Inetdence of asthma exacerbation in patents without FISD. In this ave, NN 1 (60160) (50/200) = 108-025) =
17025 = 4m other word, # people need devlen FISD order to eause a asthma exacerbation oe pADEM Ons al <2 +im>
‘55-year-old man comes ro the emergency daparimen because of Severe est pln er he pas NOW. Te aden =
dover he pana ested in the mile of ie cos, eng nuit, ar raditing oh bake has tory of
Inmetenston, nperipidema, and yp 2 aetes mals. He has smoked pack oF cigarettes daily for he pase 30 yas
Hc eta cay el ccs es eb racy eg er pct gs
IMeicatens include enalapi torvastatin, and metformin, He 52s tat he hs ot bee along hs mesiions on 2
regular basis He 174 cm 3 itll and weghs 98g (216 EM 22 Kg spl IO min ane blood
Prseurae 150/00:mm gin ight am and 0) 109 mmHg in i sm Cara examination shows 2
Fighepiteed blowing, crescendo sary solic murmur best head lng the ight steral border, an ECG shows no
“A facor forts pavents conation?
@) oiabeces mates
)) age
ypeipceria
obesity
perension
Taso ofebng ant
oss
Omns al <2 +>
pence ere |
dren the pln as fcc the meteor chs, earings, ara] He har ae of
Ineenston, nyperipidema, and yp 2 aetes mals. He has smoked pack of garetts daly for he pst 30 yas
Hee eta cay el cc as rh acy BE eh pS prs
IMeicatens include enalapi torvastatin, and metformin, He 52s tat he hs ot bee along hs mesiions on 2
regular basis He 174 cm 3 tal and weghs 98g (216 M22 Kg spl IO min ane blood
Pressure 150/00. gn i ight am and 80) 102 mm Hig in i sm Cara examination hows 2
est eat aong the ght sternal border. an ECG shows no
normalise, an ay of the chest Shows Tae a the flloning the ongetprecponng
facor forth patents conation?
“This pater resets wth vate chest pain symmetric Boos pressure readings, and amdenedmeslasomum on chest
scr. agatonaly, ne has high-z, Honng, dctsced cally dustoc mut along he ah tral Borde.
NU thee findings suggest ante secon compat by arte regurgitation, nesting that hs patent has 2 proximal
asset, which fe the ascncing core Sanford ype
2a
‘mca that dlabetesmelitus may have protecrve effects aganst rac aneurysm formation an arte secon There,
iaetes metus i note uergestpredsposing Taco for ts patent's aor secon.
Aor erection hata pos inedonce i mdse 0-00 years of ge. though the Patent eS years le ag ot he
‘Songest predisposing factor for his condition
“The nk of ceeoping an arc asecton 1 approx. 2-5 mes high men thn in women thn const 10 the rk fame
assecuon rupture, wich apeats to be sgh higher women), However, as paleas gender sno the srongest oma al <2 -im>
‘cocina use can cause abrop,svee hypertension due to Wresed sympathetic achat, wich fan nportant sk ator
Traore nection, However spate as not used cocaine fr the pat 1S yous A ary of ccsne suse sot 2|
sttong predsosina fecor for developing ara alsecnor.
‘eyperipierns can ein he Farmation of plage ithe nes ta of trl walle The lagu can contbue tthe
evelopment of atherosclerosis which nteases the Sk of aor secon However, pepe snot he svonges
predisposing factr forth condo,
‘Obesty im pacar euncl obey) sank factor for atherosclerosis which 5 asocaes wh Zor asseton, Homever
Suais sugges mat obese no assocated wh an eases Yk af aor sector
“ori essecton mst commonly cus Secondary to hypertension, mote tah 7ON of patients with 2c essectn have
‘te blood pressure, nd ypertenion routs for more thn SO the population ark of arte dasecton.
‘Uncontolenypertension ads prosepaten of ore dssecton and ieee the isk of ruptUe
By Aerie dineation
‘motig i sk aco or ateresceoss, which 5 assocated with aor ssecon, and an dependent rk fcr or are
a a ee parte ee ene eee rere
‘redspasing factor for ths conion OW Fa at <2 a>
‘iyperiperta ca ein the Farmaton of plage the inca tira of ater! walle. This plague can conte tthe
‘evelopment of etheroscerest, whieh ntetes the rk of ore dsecton Hower, MperDIdEMI Snot SERGES
prekspasing fact for is conto.
‘Chetty in patcaarranel obey ie tk factor or atherosclerosis, which atocaed wth sorte detection, Hone,
Studies suggest hat obey sot assocate with an creased vik of sre deco
‘Aerie essecon most conmenly acu secondary to hypertension: more than 70% of patents wh 2 essecton have
‘vated ood pressure, and hypertension acounsfor more than S08 of he population a ak of sree aac
ete pen er ering se deat el pee cr
Bo
“smoking rh fcto fo atheresceoss, which assocated with zor secon, and an independent risk fc or aor
ee reeds nat pte cee Fe eae een toe eat aree
relsposing factor ors cnation.
SS
[tents <0 years of age These srdes are vey ae in let pallens wth sot Section, Morcoey, this paler has no
ay story, personal Matory. or pei etures eg. long ger, hyperexenibe oto ypeeantc kn tht would
‘ae Suslcon for these condions. Ons al <3 +im>
45-year-old ma comes tothe pysicantecause ofa S-monh history of creasing fatigue an reduced I. He aso
orlans of fom pain n bth of ands He hs aro of hypertension hat canta wa enlapi edoes ho
"Soke or se lc drugs fe dike 2-3 bees onthe weekands is al ss re within nal irs Physi
ceri hea care red pene cement eee ls angel
Joins ot both has are ener palion an range of tions lite. The vere plntea 2 ro 3 em el te a
Costa margin. aboratty suds Sh
‘saris amsnornsterase 700
“his ptin i at retest nk or developing whith ofthe flening complications
4a
=) 0
on Hodan ymphoma
Hepat carcinoma
HO}
OG
Progress cenral abesty
=) (5)
a
BO o
a
es
2
oss
Omns al <2+>
‘A4s-year-old man comes othe psican Decase ofa 6-manth history zesing FU an |
compte bth of hand. ears rary hypateion t cnles
Se etis amt bes oes oa pes tral wae
i
aor E
“his ptin i at retest nk or developing whith ofthe flening complications
“Thain presents wth tig, los of ibid, and etal, Analy hs aboratory sis revel elevated Fert
Ay asteana att 2s wales sabes melts random serum alocose measurement of > 200 ma/ aU In conjunction wth
NC nyptpemenatin of te sin estcularaophy, and heparomegay these features are suggestive of PemecNomass,
2a
Non-Hodsinmpoms can occurin atceation wth infections (a. EBV, HCV, Helcobcter pf), atsimmune dines
(eg, nashimoto trois and cermatomyosts However anasscten between nor-Hodgin phoma and
emociomatose eee ly.
eieiay sysiomes sich ail adenomatous polyposis and HAREC are genic sk airs for ove
serocardrams. slough some studies suggest an erased oko eleecal cast hemoctromatons hs asecition
rot wel established ane other complcation re mere Waly 0 orc omnes a <2 8 >
‘epaocluat carcinoma (HCO is ne ofthe most SeousComplcatos and he mos commen Case of death in patents with
IeredtayRamorbromaose. Theil of HCE in hee patent esate 200 fa omar tothe gore population. HCE
{aes om pogessve kon deposton in he hepatic parenchyma hat ests hos, Paves wth ered
Iemactromutons and confer chess should be atey steed or HCC
Boers
‘Petinsonims «complication of wisn deus, which can preset with nepatomegay and elevated ensmiases AST and
ALD, ar soem thi patent. Howover, the patent aks oor pial fetre f Won sat, char Behavirl anges
‘earlosicl srmproms (9, emo dsartval end KayserFlescher igs
Progressive cetal bes associated nt Cushing syndrome, shen could aa cause fatigue, hpepigmentaten and
Inyperaiiceria. However, hvpeameraion general ny curs aeas hat ae not normaly exposed othe Sun alm
‘crass, ofa cavity Furthermore, pownal Muscle wares thnning hn, weg ut aa sleep dsturbances would be
‘ipected. Cushing syndrome nou loot expla he patie hepatomegahy, tertclar strphy,o elevated wanraminaseé
“nd fein oes,
‘Arough smmetnc arvalgas and sofines of metzcarpopalangeal NCP Jos and fatigue are common ndings patents
‘oo heumatos ari, wis conan would typcaly aso afc WSs ar proximal nephalngeal (AP Jos, and
pretnt nth naar (eg saan neck form) Moreover, Ravould not expla i pale shi
Iypepiamentaton, diabetes mths, and reduced ido, making a efeen dagnoss mere ley.
eee eer veered heed encapsulant ope ROD
‘mule endocrine neoplasia ype 1. Hemeve, he Ine beeen pancreatic CaN” and hemecWomatss Isnt wel eased omnes a <2 8 >
‘epaocluat carcinoma (HCO is ne ofthe most SeousComplcatos and he mos commen Case of death in patents with
IeredtayRamorbromaose. Theil of HCE in hee patent esate 200 fa omar tothe gore population. HCE
{aes om pogessve kon deposton in he hepatic parenchyma hat ests hos, Paves wth ered
Iemactromutons and confer chess should be atey steed or HCC
Boers
‘Petinsonims «complication of wisn deus, which can preset with nepatomegay and elevated ensmiases AST and
ALD, ar soem thi patent. Howover, the patent aks oor pial fetre f Won sat, char Behavirl anges
‘earlosicl srmproms (9, emo dsartval end KayserFlescher igs
Progressive cetal bes associated nt Cushing syndrome, shen could aa cause fatigue, hpepigmentaten and
Inyperaiiceria. However, hvpeameraion general ny curs aeas hat ae not normaly exposed othe Sun alm
‘crass, ofa cavity Furthermore, pownal Muscle wares thnning hn, weg ut aa sleep dsturbances would be
‘ipected. Cushing syndrome nou loot expla he patie hepatomegahy, tertclar strphy,o elevated wanraminaseé
“nd fein oes,
‘Arough smmetnc arvalgas and sofines of metzcarpopalangeal NCP Jos and fatigue are common ndings patents
‘oo heumatos ari, wis conan would typcaly aso afc WSs ar proximal nephalngeal (AP Jos, and
pretnt nth naar (eg saan neck form) Moreover, Ravould not expla i pale shi
Iypepiamentaton, diabetes mths, and reduced ido, making a efeen dagnoss mere ley.
eee eer veered heed encapsulant ope ROD
‘mule endocrine neoplasia ype 1. Hemeve, he Ine beeen pancreatic CaN” and hemecWomatss Isnt wel eased omns a <2 19>
‘PEnnsonsm sg compneation ot vison seas, wri Can aesent wh nepAtOMEGEN 2 leva VaNSaMnases AS! ano
{ALD a seem (5 patent. However, hs pant lacks ote pial Teas of Won aseas, sch as Behavioral anges,
‘surlogel symptoms emo, sata and ayer ngs.
‘Progressive cera bes is associated th Cushing syrrome, which could also cause fae, hypeplgmenaton, and
Iypeglceria However, hyperpigrestaton generally any ccs mares hat ae hot normaly exposed tothe sum al
rss, fal cv Furthermore, proximal muscle weaeress, thing 3r wlght 3m ra sleep csurbances would be
‘expected. Cusning syndrome woul aso Wo expla is patents hepatomegaly, testcla arophy, elevate wansamiases
attnough symm arthalpas ad tres of metacarpaphalanges! NCP joints and atigue ar common ndings pte
‘wen heumatoa artes, ts conten would pc aso affect wsson and proximal ntephalangeal (Pons and
resent within ceormies (eg san neck form Moree, Ra ould not expla hs patents Ski
Iypersreetaton, dabaies tiny aed reduced Helo, making ferent mor ay
‘Pancreatic cancer is associat with sera nhered genetic synome, such as Feutzeghessynome, HRECC, and
‘mule endoerne neoplasia type 1. Howaver, he nk beeen pancreas caer and hemtromaons srt well exaished
‘Adrenal css can occur patents wih primary arenl asic, hich causes Wyperplemenaton abgu, an joa pur,
{essen the patent Howcvr the hyperplgmentaton general only ocats in ater tat ae not normally exposed fo
Sinigh eg, palm cieases, mucous membrane ofthe ofl cu) 30, paint with primary arena suey,
creased ide general only secur im women and eter sg, such weight los, intestinal compas hypotension,
and/or nypoalvemis would Ge present ‘ne dulson chit of general ireral niin at an caer mesial cones ines I ecucing 20-20y
‘easton for atl katozedons (DRA) ls patents. her eae tam ced tfllow 7 patents over the
‘9605 who have acely been ada the hosp or DK for a 3-day period the nid of 30 days he
an ap ee em
rman resus ofr study ae summarzedn te table below.
Rnoswey Pas
sade oF OKA nthe past year 00
one Reference
12 1250108138)
a4 1a8e-155)
Se zuoisezsy
Which fhe following aspects of the es would support a cauial reins between astery of OKA andl 30-ay
Feasmisson nse or OKA
45 im
Bm pra
(©) conence wena that o wet as 10
©) cave-contal ty dong
(ig sao
(©) Pose respone reuters
F snow anoier o
a
es
2
oss
Omns al <1 +>
“ne duson cto genera eral niin a a cae medical center eines in educing 20-day ES
‘easton for atl katzedons (DRA) ly patents. her ear fam sce to fllow a patents over the
{520 5 who have ecey been adie. the Hostal for DES fora 30-day period. Cte end of 30 das he
rman resus ofr study ae summarzedn te table below.
RR iosncy Fae
pine A thf ea aaa)
one Retrence
2 000136
25-159)
reer
lhc of the ftloning specs ofthe resus would support a abl elon Bebe a Ht of Kan 30-2,
‘eadmission ik for OKA?
‘ome of the Key tena for aust inde) exposure preceding the cuzome, ( srenath of ssociton increased
_amourts of exzosue fading to creased rk) canssefsuRs whan epee a atert sets, pleusie
4a «
“The p-value sa measur of sansa siontficance, butt as no beanng on cust, One ofthe ceri for causaly
‘rng of sation whic ees wo the magnitude of he stud outcome measure (ate sk o fae, Sependng
‘the sy design), nt tthe pve,
“The confidence intra ges he estimated range of alues hats SS ely 1 cade te unknown "ue walue im heady
opus. this sy the conten eal forte rte rk valer donot cree 0 The miles tht thee are
Rascal slgnficant arenes between the ak of eadmiclon pasts th o hon Of DKA and the vk of OU at si + + 40>
“The confidence interval gies the etmated range of ales hats SSK ely once the unknown ue’ wae inthe sd
‘epulatn, this study the coniencenrvals forthe relate nk ales do rot oss 1.0, Ts mpl tat here ae
Rascal sgntican drenes betaeen teak of eadisclon pasts wh 0 ty Of DKA and the vk ot
{esdnisan patos aha ory of KR. The ple tat aigieaes but a ho eating on ea
“This nota case-control stay but rather a prospective coor study, a case-control sy, the cases of an outcome of
Interest oul stb slected followed by sutabe con. The messute hold be reported aba ede rato, ot ete
sk T because, a case-conel sway, acal sk cannot be esate because 2 smal number of conto and cases
‘Scte rom te population af being stu ate tha ah ene populon. a Ws pospecve chor sua, $87 pats
‘igh rati i cotect beaut the tay sa prospective coho sty which pe lative rk as measure of
"assertion rather than he 065 a, Arch would be Used m2 ca5e-conre) study Actua KAY caot be esate n 3
‘ase-conlstuaybecaee a sler number of cmos and cases selcea tom te popula are being sued ater than
“avenue population.
‘The lane risk (8) fradmsson nea a5 he name of previous episodes of DKA creases, which means hater
4 ove-responte elaoroip Inceaned amounts af exposure ith case, ior episodes of DXA) lading to am neesred
‘ofthe outcome in ths cas, fezdmission) 1s one of he eterareqred a eszbish causaltym epéemilogcl sae.
Bo Ons al
‘A npaepoychaist cen had wo ptems who developed serous saswoiesia ntecions whe ing
‘ozapne Hs was concerned that hi patent had developed apranulocyon 2 lave rar but dangerous adverse
ferent assocated wih clozapine Wher the pyelatist decked the abst netiophl cunt ANC) of both patent
‘se 450 mm? he the other was 700/mmN = 500m. According ote clozapine REMS (Rak fulton and
Iegaton svaeny program, severe neuvopena in clozapine ellen has offen ben defined as an absolute neuvoph
‘court (ANG) ethan 300m, Changing theca value wo 750"mm? wou ec the et performance of ANG with
‘eoatd aprons meh ofthe flloning way
20
| meveased rue nesatves
(© Decreases ue pontues
(@) unchanged soecry
merase ase posties|
GF) Decreases sent Omns al
‘An inpcen poy rece had mo ptems who developed serous gatoiestial intecions whe aking Gs
‘lozapne He as concerned that hi pants hal developed apraulocyonszelately fre but dangerous adberse |
“event associated wah clozapine Whe the ps}hiatist checked the absohite neutopi Cour ANC) of Bah patent, one
‘se 450 mm? he the other was 700/mmN = 1500 |r. According ote clozapine REMS (Rak fulton and
easton ste poarem in clozapine ecient has ote ben
wou fect the et perfomance of ANC with
Feoard we apraulcons mich of he falling ways)
“ang the cutoffram S00 750mm means thatthe patente nhahaveagranuocyon are mors ly ta be eid
F_sSsuci: However, broadesing the teri for stanley has a disadvamage.
{tang the cat vale 0 730? wou decree the sumer of ue meats (2, dda whut agranuoryot|
iho conect est negate
Raining the catof valu 0750 would enim adecreaed postive preci value (PV = tae posts tue postes
fs postoves. The reason te PPV ceccases stat the numero fae posites would cease mere tan the Number of
‘tue poses
‘asing the ccf valu to 750mm? woul increase te numberof ue posthes Ge, niduals with aranulacyosis who
corel tet poste Om ns al
‘atng the ato valu 0750 /rm!would inerese te numberof te poetnes (=, duals with aranslocnie who
cone et postive)
Rasing the tof valu 0750 would decrease the spec of the tent 50 ewer indi aha do ot uly hase
agranulocytosis true negates would crecty be Were 35 negate,
‘ating the tof value 0 730/re ue, Brenig the nelson eran fe agranlocytowe)neuld etl nam mceate @
‘ive a fase positives wie wus and fle negatives would decease, nother words, increasing the musi crea esd 0
‘mote patents ith the dineae bing identified a auch, ie a the sre time eulting a there big an eresed mur OF
‘aida under uspt0n for agreuley.s's who de rat actualy have the seas, Ths woul make te et mre SenStNe
Duttess specie it woul aso eas wo a ceased psivepreicve lu ahd an Wreasea negative prea ale.
Ax
Bo
Raining the ato valu 0750 woul inerene te semi (epidemiology ofthe fea, 0 more ds wh ray
Inve soranuocjtosis (ue posts) would e nae a having te conation ge
8
Ons al
‘A nemattoist has founda stoic emacyomete used ding the 1960S. Cu of urs, he dcdes 0 obama
fours fom hs bother ho Nas patie rombacenpenc purpura) with bot the stareal hemocytometer and =
‘modern automated C8 analyze, The ltl cous Of reps mass erens ae shown in acendng order
551000 571909 62000 76,000 7,000 92,000 92,000 mean: 72,000
Historical hemocytometer
oder automated x anayzer 71,000 71,009 72209 73,000 72.000
be craw about he hstoncl Remecometer
20
(Gee aciaey
| Testlacs vay
(© | Tet aks epecticny
(©) Tet aks precion
(©) Testa seascney
*
BO Omns al <5 +>
‘A nemattoist has founda soil hemecyromete used ding he 19605. uo csi, he decides oct plat
outs fom hs rather, who hat patie rombocytopenc purpura TP, wth both the tonal hameryometer and 2
‘modem automated C8 analyzer. The ltl counts of repested meas erent ee shown i ascending order
sswtavenmna $8 So Gow Row Tape RE BON Hanae
eee ee ee
be craw about he histoncal Remecromater
‘Wile te mean of he ses of asarerint the same te range RSs}, varanc atts ana Standard
Fe Gesen ate maner wise sonal pemocrometes
2a «
‘Over he nsonclhemacvorete seems tobe acuate at measur what Ms suposed to measur ltlt counts
‘tak of scuacy would probaby have resuRed in a Serene mean compared ote modern avamates Cc aaa,
‘Our estonia hemceyoneer seems obe acute at measuring what is syppostd ta masture (, low plat
‘count fom TP lack ofvaly would have reste in a Sllerant mean tha the modem automated CC ane
Specs a measure of et vay andres othe aby of atest to correc deny tose whe donot have cena
‘dseas hte low platelet counts om ITP AS there ae no Standard values or nemal or IT-ateed plate count ee hk
ase
Ww
OWBs al <5 >
(Gel i fetid teers st ta br alec eee int upped meee Le pe oe
‘ack of accuracy would probably have resuted in a erent mean compared tote moder automated Cc ena
‘Grrl hs loved fencer see ob act at mesg wha te spe ts meee Uo apa
‘coum fom MP lack of aly would have reste in a ilerant mean han the modem automated CBC analyzer.
Specify sa measure of estat and efers othe abit of testo correct deny thse who donot havea certain
seas hr ow platelet counts om IT AS there ae no Standard values or normal or TP-aeredpllet count feed
ete no conlsions abou pen canbe rau
‘ase on te resus presentd, he strc! hemocyromatr lacks preion Ge rabity)The testi unrabl 8 oes
tet cc cy oe ser sts opened eect. ge Gta ro te stil error
15 55,000-52:000,wnde te range of resus of the mod automated CBC anaes much alle (71000-74000, ies
‘tat its more precise Random ers result i Sigiealus airing signa om te ean Suing
teat ratert menarerent whieh radues the precison of at
By eoicemictoy
‘Sersoity epldemilogy isa measure of est ality an fers tote aby of testo cnet ieny tose whe have 2
ertain espe here lo platelet count or IP) there ae no standard values for ntl or IT-akeed platelet aunt
‘ales offered here, no conclsions abou senstvty canbe drew. ‘62-year-old man comes othe prysican because oa prstet cough fone ps2 weeks. Dring ti me, he as
Slee had ecessonldsorfre im chet. Thre weeks ago ea ore thes headache, spd low-grade fee,
“shen were eatea with acetaminophen andres, He hs stor of hyperersion and myperipiema His father ded of
‘nyse infarcion atthe age of 57 yeas Hess smoked s pack of iar cai forthe past #0 years Curent
‘meseatons incu eal and toriastao, His temperatures 37C (98.67), pulse 70) nd bled pressures
"Ts/90 mm Hp. Physical examination sows no abhormatig nc ofthe Chest i show, Which Othe flow
‘he most aproprat nxt spin management”
Feadeack
« ee ag erence Omns al <7 +>
‘SY man cones prs bec apestert cash pst ues Dug iste. ne mas
‘sion were Vested with acetaminophen and est He has istoy of HPAES ad hperipdemia Ms ater ied of
‘myocardial infarction at the age of 57 yet He has sed a pack of igure iy forthe past #0 years. Cutent
‘meseatons incu eal and atortastao, His temperature 37 (9.67), pulse 70mm an bled pressures
145/90 mg Physi examination shows no abnormal, an Kay GFENEEE SOME, Which of te allowing
eet a ea aero
“This pate’ chest ray sons blging of the ar aoc nob cr prominent Shadow ofthe aor ch, widened
P_edetiumand ace devaton athe mgt sie These ings ae aggeste of «three a anes 88)
2a
Esophageal manomeny is used to iagnse esophageal moi disorders such a achalasia While achalasia can abo present
vith nest coca, patents more comeronyreparsjophagia to Seth solide an hud, a wll a regugtauan and weight
Toss, noe of whi s present ere, The melas wdenng In his pale snot due to aaiateaesoprans,
‘A conratt- enhance CT (C7) an ofthe chet the prefered maging medal for merigatng mediastinal abnormalities
‘ated on chest ty (meds wiering 25 een hs pa, or medasinal ss a es acura api and
srow-imusie Ths patent» ray ndings ae sragly suggertve aa TAA, which can presen uth chest Scone ad
‘ough ae to compression of te vacteabronchal wee lfough most TAAS ae asymptote, and ms pater COugh May
bea sequela tis ecent upper rspatry vac nfeccon), Homer, a est ray cea acute tem the uneing
{aint of medastnl weaning. CECT can te dna te soe aed long of the TAA ard detect completers fs,
ay - OM Dw <7 + 10>
‘A conratt- enhance CT (C7) an ofthe chet the prefered maging medal for merigatng mediastinal abnormalities
‘erected on chest ry, elas iden, a8 seen in this pati, or a edastinal mas a8 cs acura, a and
srow-imusie Ths patent» ray ndings ae sragly suggertve aa TAA, which can presen uth chest Scone ad
‘ough ae to compression of te vacteabronchal wee lfough most TAAS ae asymptote, and ms pater COugh May
bea sequela tis ecent upper rspatry vac nfeccon), Homer, a est ray cea acute tem the uneing
‘aut of medactnal wednng. CECT cant dala te son aed eng othe TAA and det cmmpeatons (eh,
‘thrombus formation, fee onaied TAA ror! thereby providing valable infomation fr planing management
aera
_aenograpy can accurately delineate the branches ing from he ated aegrent of te thrai ota, hich maybe
Useful mplming surgical Feament of TAA Homer, a ts performed under fuorescopy oss-sctoral mages cannot Be
‘tine, which ears ta the amet of he aneurysm canMer Be aseSsed Ment Es anise procedure that can
‘aurea averse efacs,tuch sot irection dung the wad ofthe needle 2dr Paphototy from the
Injected contrasts therfore not prefered est meastnl widening detected on hes 23,
Reassurance san appropnate option if he cause forthe widened mecstinum ona chest x-rays aortc unfolding, which
‘the mst common cause ofa dened medasinur on ehes1a} the ee Home! aoc unfold eppeas as
‘Speed up mrt acon chet way does ant cane a tates shy seen here. Tvs pate ha tay cing har
Stvonghy Suggest ofa 784, wich Shuld be fre imesigted and cond orld ot
Emergency surgical rep is neat for arte eekingthorcc arte aneuryom a aor dasecton, bath of which ca
‘appear 2 a iced mediastinum o chest ry, as Seen tts case, However, both condoms cause severe trace Dah
(orten inastrgushabe om a acute Mana henodynamicasabyCachyara,hypetesin, sometimes Pypetesion
typlly proto. Ae there stirs ae abront nth pat, emerge suis reps at an Sparopriate management
pt. Omms al <7 10>
“Avpoximately 20% of thorai cor aneurysms (AAS ar ered, occuring ether alone o a5 par of snsrome (ea
astan synrome, ies-DaniosSyacrome, Tuer syatomeh Cenc eng shouldbe Conse wee concer Tora
heredity etilgy ofthe Tad, eg cevarance at young age or #fomly Retry o ciel etree atone with any of here
synromes. Honea, inthis 62-year-ld pair wha does no ave sigs or symptoms of hereditary TA, gana tig
‘oul ot be nested Moreover a confor testo defintely agee TAA swarated
‘Apathoogy ef any ofthe sructres inthe mesastrum can sppes as medastnal widening on ches xa Some examples
Include enlarged ilar fph nodes (eg de To pneumona, wberaloss, Hodgian Nmghoma, achalasia, cardomegale
thrare one aur detection, tumors (ay teratoma, thynams,stragonada germ cal tor weet Rot lof
‘these condons req conimation on biopsy, and biopsy of arovasculrstuctures would be sacs. Theeore,
‘asm esophagram used nthe cagnoss of esophageal sores, including esophageal diverticula eg, Zenker
[Suersclam)Erphages vert can cause chest dacorfort and nthe eave regurgitation of food, cough However the
{absence of eysohagi als andregratation of uragete food makes ts clegness unlike The medason! widening
Ins pete no ue to an esophageal Gherccuum,
Endovascular neuryem repair x maeatad im patent ah symptomatic tora sore aneurysm (TARY ap aeymptomate
‘Teitwthaclameter= 5.5m n the acenng sot ofa ameter = 6 em nthe descening sort oF 2 TAA has
“apancing = I em per yar, though the paens xr findings tongy suggest TAA he agnor nee be ee ree)
ore enicy OM a ul Ku? i>
syctomes However, th 62-yet-ld patent ho dose have ign or symptoms of hereditary TAA gone teh
woul ot be nate Moteover, a confmaor testo deftly iagrose TAA swarerted
“tog of any ofthe rcs inthe messin can pps! rearing on chen mS sep
Include enlarged rm nots eas sue preuron, eres, Hodgkin hmphons, chal, caromeaa,
‘ora crue aneurysm zen of tums ge eetom, tymoma,eagonaal gum cel une Homer, nt OF
Biopsy s nore et Ds step afer Sting meatal wining on ces :
“A banum ssophanram used the eagnocs of erophagal dards, ncludingssphagea ders, Zanker
‘ier Esphages divert cen cause chest confor ard the ase of vegurgaton of ood cough Howes the
sbience of cyphgia, alte andregrptatin of undigested food metas ts Sagnons nies. The eda! widening
‘mais patent snot cue tan esophageal chereculum.
Endovascular aneurin repas macated im patents lth a symztomanc tora aor aneurysm (TA an asymptomatic
“expanding > em arya. tough his patents x1 fndngs song Suggest TAB, he dagnesis fst ree tobe
‘onfimed andthe iareer assessed before planing s surgical itesenbon. These ndings canot be deduced from 2
ferest say alone. Ons al <5 >
a
‘A reseaten group designed a study onestigte re epdemilogy of syphis nhe Unted States, me levesugators =
renew teamined tha ttl number of eare fens and gonurnary cya the ited Saeco antral beth
"Suv of anatonly representative sample of US ces condctedin 2012, Telmvestigatorsukimaay Found hat
[story of penton Hanya norton is asoited with spi Ths stad abst described x whch othe
follwing?
a
ge
8
Mea-anlss
Sinale-bina sins! na
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‘ross secuonl stay
case-control sty
Prospective coor study Omns al
‘A reseaten group designed a study omestigte re epdemilogy of syphi inhe Uned States. me lvesugators ES
‘examined the total number of case of epi and gsournayclamyea inthe United sates Gamera EHR
‘Hijo nana representative sample of US chzers€ONdUEKEGIN2DIR. Te investigators limately found tat =
stor of gentouinary cima nforon aso with ayphin Th suas best described he ofthe
follwing?
(air ee
2a “
tmameta-anass, data rom multe sues spooled ences statistical power and oer discepances andor
‘common tects among tus. Te tesearn toupee conducted ah oul SAG
‘observational nature, Homever, and dno involve adminisaton or testing ofa weatment
tn a double-bnd circa! mal nether he researcher nor the ty partipants know whe Is a contol or weatment cardia.
‘This sty was ofan observanal rate, noweve, and dd fot ioe abhinlsvaton oF testhg Of a UesIMen.
‘a ecole dy steer whole ppulaon or communty for xpoturs ard outcomes Het, dats rm 2 sey of
‘iter india was collected ater than aggregate data atthe populton lev (eg, coun ll agnosia cy or
=. omnes wf Rie wD!
“The use ofa hencae survey wo determin ne prevalence of syphilsané genzurnaty clave ata single pon ne
consistent witha cor seconal sy. A tore sectional sy determines te prevalence of varabler of eert,
Simukaneous, at #pscicpoinn tne saps dy). allows concsions tobe taun about assocatons between an
‘aporategentourinary ehamyci) and cuore ay) bat unl ot about easaty (enna shan thet
‘enourrarychlamyol infection anay precedes Syphils ifecton.
By toitemitosy
‘Case-contol stols ar ipl or determining the presence of sk Fosfor Ware) sass I tas With im oups ne
‘eth the dear of tern (ave group: pil) aed owe wot te anaes emia grow. noes). The a ef experre
Te ask ecrof wrest, genourary clamyaanfeon then dette Her, he esearch Gouploked at data
2 ng point in tive,
‘A pospecve conor study sas win aguas who ae eter expos o ot exposes to a pare kao hte
‘gentounarychamyéi infeton, There ta groupe ae than flowed fr = prog of ime ose ihe eae of iret
{Grpis) eons I this study, however, data was calleted ata single point in tne and wot in longitu study ov me,
(Great ison we akc abel cae enc beeen crane
‘case sens 3 quartatv compton of simlarnGidual ass, Ts research grou used a heatcare survey, 2 SStEME
‘olecuon of data forte Sud.
‘Areuospectve cohort study stat th indus who ate eer exposed o ot exposed to «particu isk factor here
(pentournary chlamydia infection ave of medical ecrssof patents in ath groups a then condictedt determine the
‘ease oF nteres er sys Mas developed Int tay, homer, cata was calleted at single pontine and notin 3 ge
8
Ons al
‘A researen group designed a stu omestigte re epdemilagy syphi imhe Uned States, me levesugators
‘eamine por apt ome and rats of ype n Rew York ay, Lo Angels, hago, and Houton ats ony de
Soh ates was pone by each sys heath agency. Mhevestigatos ultimately Fund thatthe numberof new cases
‘apps wes higher in low ocome neighborhood This stay abet dearned nich ofthe fling?
Prospective coor study
NO)
eerste
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Srl biea incall
clog cl study
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‘ion-sectonal study
@
‘aan
BO Omns al
‘A reseaten group design a stu oimestigte re epdemilagy fsyphis inhe Unted States. me levesugators res
carey Sas oncnyouce
Syphilis ates was ponded by each xy Neath agency. Mhevestigtors ultimately Found thatthe numberof new Ses
‘apps wes higher in low ocome neighborhood This stay abet dearned nich ofthe fling?
a
| potpocve conor sid sats wth indule ho ae ther expotd or not pone to a parla rik Factor hr ow
Income neighborhood. These wo groups ete followed for ptod af ume ose he dase of test hee SyphiS)
develops nthe study, However, t-mide yp ates were gathered fom several ey health agencies a he population
lev no nah eater were seeree.
‘A rerospecive conor: uy stat indus who are eer exposed or ot exposed to «particu ik factor dow
Income nelghbochod). & rave of medal records af patents both goupe eek conducted to detrmine te ara of
Increst hee syphil has aeveloped lo this study, however, uid yp ates ware gathered om Svea yeah
‘Case-contolstols ar ep or determing the presence of sk Taos fr lar) asases. They vole so goups one
seth te dese of eres (ave group: pi), aed oon wot te anaes cme gro. ao eye) The tel ef exporre
{es ecrof terest, ow ince neighberhood then dterined Here, the vesearch gloup coleced data at he
‘opultion lel iy bye ate han ooking at induces of enone Omns al < o>
‘a singe-bnd cimcal al ony researchers know wh sa conto or eat anda, This study was ofan
‘bierabonal nate, noweve, ad ld neti admaisvaion of esting oa wearer
‘cause the esate relied on data rom cy heath agence oases the incidence of syphilis ad pr cap ncome, they
Planned an ecalagia tua An ecologist san berate ud that szenesaggegete data cles at he
Population lvl. popultion of aeret counties, te, oF Socecanom pfUos for exposures andor MCE
‘coop! stuies af wel suted othe nial ivesugaton of causal hypetneses Hower, they do not alow corcusins
{said to nda t be dam (ey persed rako developing ey tpn omc,
By. eoatematoay
‘case sures ia quantitate compilation of sila india ass, This research group engaged in a sytem sty of
Sia tire Cpe
a duble-ting cic wa star te researner nor teste paFUCpars Know who I cotil ar Ueament cance,
“The sty sofa servations mcs ome, acid mot cee crit or ating of ete
‘Acrossseconal study determines the prevalence of vals of ttest simultaneous, at speci pin tne napshot
udp Here, hesmvestigatrsanaized the mere ty By ey, heh cheaters ofa erent typeof ty deagh
1 a etaanais at om mull tus spooled to crease sac power an to deny ascrepancisbetnen
ndjor common facts among suse, Hes, he roearch group conducted at nds ge
8
Ons al < ur >
‘A researen group degre a stu omestigte re epdemilogy osyphis nhe Uned States, Te lvesugators
Subsequecy examined wheter patients wth active cocie ue were moe thle Cevelop sypsin the past 5 months
“ve mestigators uate found net the rte of spa was 30 higher patients with sce cacane ube compared
stent witout cocaine use. Ts ud bes cesrbed a which of te fll?
a
Prospective chon study
Meta-anes
‘lagal ey
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eospectve coher study
‘Gone-sectonal sad
‘ase-contal sty
BO Omns al <0 >
‘A researen group degre a stu omestigte re epdemilogy osyphis nhe Uned States, Te lvesugators ES
arte pater who wre weg coc va rv of rect rcerd td ot teeny fe Ty S
subsequent
“ne metgators uta found hat the rte of np was 305 higher pens wth arte cocaine wb compared
stent witout cocaine use. Ths ud bes cesrbed as which of te fll?
‘Note that he mvestgstors have conducted a chart review of meal record, The dented patents wth an excosure
(coca ue and assessed whether they deloped a outcome ph)
‘A rospecve conor study also examines indus who are eer exposed or not exposed fo a parc nk factor hare
‘ocane ue) However, hee two groups ate then folowed or a period ome te seeifthey develope seat feast
(Gere sph dat re wns eolaced Fo pat eal eed
‘na metaanay' ata fom mut studless pooled ro increase static power and to idey cscrepancis beeen
nd/or common effects among suse, Here, the research group condurted ancl.
‘an ecologial stud san observational study that assesses aggrepate at collected tthe population ee. aopulaton ot
“ferene ounte, tee orsoceeearamie gaupe) fr exporter or outcomes. For ineanen, ther than aleting dats
{rom inal paterson acne se and NStor of SpIis fection an ecological say might isle the clecton of Sats om os al <0+ 0>
ov tiwbo paes on cate use a yO Sys ean a en SULT ue UC at
‘Acase sens sa quartatve complston of snr india cases and doesnot lw concsions about causal eatonships
{ote ora, Ac besa ypothese might be sugested bace on several observed cae cae sees tere ar 0
Te i ae ete ony ese a ef idl Resonate Tse ef
‘bsenatonal nature, Roweve, and inet move admmiszation or esting oa tresrert.
na double-ting cic wa ear te researner nor we Stuy parcpars Know who I corttl a Heat cance,
“Thi study at of an eberatoal mtr, awe, ae lho aie amiizeatin of ating of trate
‘sca the researcher followed idl patient witha ceran tra cosine at] to determine hey had developed
syphilis wa char reve ke etrospectali, the conducted a revospecove conor study. TMs OF Sud BeBMS wh Me
‘Sdecion of aduaswno ate dtemared to have ether ban exposed of nt exposed Wo ask aco fies based on
‘ha aod are than atceed retronpectely fo te fthey ve ot have not developed scram eae ot
‘outcome, Retrospective chor studies te tinensving a lat iexpenie 5 they rele the analysis of data at has
‘Stedy been collected. Cohort sues we wel autedta determining the nedence of dese and allo forthe lative sk
(98) of developing acissseof erst o be cleustea Here, the of cevelopina sph S13 nace cocaine ers
‘compare o puters wou his ik act
BB coitemicln
‘Azrot-cecuonal study detec tha prevalence of ables of ttet smultanesuy t pei pintn tne Gnaprhot
‘Suh would not allow concusons tobe drawn abou colton oe time: could, or mstance, show that ccaine Om ns al < 00>
tna double-bind cial al nether he researcher norte ty partipants know who sa contol or eaten anda.
‘This stay was ofan observatonal nanue, oweve, and dd fot ioe admiisuation or esting Of a UesImen.
‘cause the researches followed ialdul patie wth 2 cen vat cocaine use) deerme hey had developed
Epis achat ee (ie erage they conducted a reoapectve coker sud. Ths pe o td begs wth he
Selection of incnals whe ae setermiad to hate ear been exposed or rot exoseato ask ocr of rest based on
‘hart een duals are then asessea especie fo se ithe have of have rot developed acer asease ot
‘cutee. Rernpectve coor sans tine-cvin aed ly Wengen at Uy ech the ag of data at
‘eady been collected. Cohort sues ae we suited to determining the ncderce ofa dsease ad allow forthe lative tsk
(G2) of developing acineae of mlrest tobe clesied Here the ff developing mpi 1.2 native ocnne wera
‘compare to pavers wrhou ths isk factor.
BB festeclosr
‘Acros-ceconal su detemines he prevalence of variables of terest simutaneous, specie pint n ume Gnapenet
Sindy Wald oo al concooore to bu ert at cralatons ev ioe cul ot, fr etre, show at eocane
se preceded a sypilsinetion.
‘Case-contol stcies are hepfl for determining the presence of sk factors for rare) sas. The ivole re gous: one
se ne aseas of ees (as tou: yp) and one WiBNGU te seas CnUD Gfup. he SHS) The sk of exGESUE
toa ak faa of trot eaca ute than detrmoned, Hare; he resistors ad dy ind et fac of
rarest (te cocaine use) ad wanted 025855 he cco ew aS of sph Case-cona Stes report the ods
fat (OR), wach reflects whether peers witha ceran outers ar mare Hey tohee eon exposed tothe ik ior
(@osineassonation, FOR > 1 Ons al
fo-yu-otman ones hepa foment ad sare Wak 2 ems THe
stkohadsveral episodes of het pounding and palpitations. Two washe ago, head anny nose and productive
ugh Hehe pe 2 abets ees and pererl arterial aeareehas ever moked He mks ane 840 ee
foccsionaly He as 2 story of ivavenous she rugs use but has nt used in eer 25 ya's. Cue meactons
Ineude asi, atorasat d meormn. Vil igs are tan tml mts. Ceaminaon Shows Asta asa rs.
Cardiac auveuaton shown, Which the following the mart Mel dgness?
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(Mia wave equation
Pence
“ewspit eve eouraton
BO Oma s al <->
a
° ‘.co-yr-ld man comes oe pcan veces | or 2 morte The Eg
Seeiiew ‘dyspnea occurs on moderate |and “gasping for ar.” He has a
‘otad sera pode wo es fee Ra mn nore rds rode
eich espe 3 aetna perpen He hen skeen eo te eae
a cessionay eas hrory fvaeno en sug a ut anova nove 5 yar Carne maaan
wl Inet spin asa, ad metre wn nae amiaton Sos
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ee ee ee
ee eee eee eee eee ee ey ee eee
1 murmur a racist the ela and hear est the ape, here te manicure ecostl space (CS,
Tata ne mest aly nding cause
2a
& head bes uring expiration and ie te patios les onthe let ide, Causes of primary mitral ragutaion nude
fecmet degenerative mil vie diese (rl vale prolapse, itl anlar caeson ruptured horde eines), ete
“endcarns, ae heumste er
By tu requaiato a
|
|
; Om Ds a
‘This ase presems wth some features of percarcts including fate, palptations, and exertional dysone, whch ae often
preceded by fie symptoms But he lack the pel Snags, such a fever, and sharp, ler ehest pia does Pt
fave a gn-pced sata sound (penal fetion rub.
hough capi eguittion elt haloes murmur, tie bard best athe lousr paternal raion, doe it adate
{othe ala apd doesnot have a blow quay teal iah-sied heart murmur is ese dig deep isp ton.
In contrast this patent's murmur intense on expration Noresver, tcp vate regurgitation is extrema ae and
woul tpl resent wth symptoms of riht-sidea ear fare, Such s peripheral ting edema and Jug Venous
Falmonary sterols marly prasents during at childhood as 3st crascand-decrscenco mura heard beta the
eft. nalts, common causes include cco Syndrome abd Crone Meumai fev Le al igh-sded eae
rrurmars, sintered during dep nptation rates than dug expan asin this putert. Moree, pulmonary valve
Steresis sare ang woul play present wth symotoms of right-sided heart are, such a prohera pana edema and
gular venous distention
although ths patent’ letstded heart are could be explained by arc regurgitation, would preset 5 ahigh- Frequency,
bore
et hy
hy,
| Hit —
| ‘Alough hs avn’ erste Meat ale could te explained by mia stenosis, wou pest a alow -requeney,
‘rida ot yale rumble an lauds) herd best athe apes pay the Sh eft Cs the mae ie).
‘Hl { .
{af — ge
8
Ons al
‘cra are row is nteestes in wheter oh uscutaory fining of pulmonary as can acura pric
Iyperseme state. He condarte +s In 100 patents with volume overloaded tte confirmed 3 Swan Can at
inhi hospaseariac cnc care unit. He lo racruts 100 pas with evolamic state confi by Sean Gare
‘theo, He sbesucm examines al patents nthe une fr als and stat 80 pats nthe hyperemic group
have rales n comoanson o 50 stents nthe ewolamic grup. Which of te flowingis te peso preserve vale oF
‘ales forte presence of hypetema?
©) sons0 Omns al <2 >
ee ee ees =a
‘hypervolamic stats. He conducts a study in 100 pationts with volume overloaded stata confirmed by a Swan Canz cath a
In is hosp acc crcl care unit. He 50ers 100 pees with ewolemic sate conimed by Suen Caz
_ Catheter. He subsequent examines ll patents inthe unt fr ales and finds that
a ‘naeralsm comvarson to Spates ithe eBVIRMIE CUB. Wich of me following tre
Fale forthe prazence of ypenlema?
7 ‘emay ai to create a wo-by-tvo able whee vlues mendoned inte sem ard then culate sna, spec,
ie ‘pote prod valu PV) ad negative practi alue (PL). The PV ithe liatRood that = paven hs pore
ae ONC ese he, presence of aes on euscutaon) cul este condton i, hypeolemia
2a «
80/100 reese sens elcemiogy a te ts, he probably that he Les aes) spose He conten
(ryperclmifprsen Seen epidemiology} cle a 918+ FM) or Tl patente wth ta condton, hare
= ‘Tris we postives and FW fae negetves In this case senstty = 80/(60~ 20)= 50/100 = SON Based on hs study, SON
St hypenclemc patent il ave rls om easel,
& 50/100 elects the sper the texte arobably hat the tale) regve fhe conten ype
fecmet ‘beet Te sey cle a TMAH + FoF TN/al gues witout he onan where Tepes ue
ogee an F sate posts. ith carespucfety = (50 = 4) = 3) 109 = 508 fated on he tay hee e250
Chance or ewoemic pies to hav ales on sscuaion, making his est appropiate wo ffecely chide 15 Condon
ireuleme patents Aten wth such alow spe causes high rate ol ale posties eg. res duet congestive heat
fate preumons, At05,
150/130 reflects the Pv. The PV icles a 1 /(1F = or Tal patent who tested pose, whore T operons he
‘ve poses ad Pte fale poses, nts cate PPV = 60/80 ~ 50) = 80/130 ~ 62K Sasad nh ty, he PP
fn ini as aes on auscuatn,thethelinoed of that pten tly being «hype sate OM Da at
Fypervtemc aunts wi rave rales on auscunatee.
50/100 rele the speceny of theta, the probably that he tale) x nagatne fhe cancion (ypeslemia) =
bse. The spe Is calelted a5 TW/CN =F) or Tal patents witout he Condition ehere TN epesers woe
egrve and Fane pontes ithaca spacey = 50)(50 + 5) = 0) 100 = 50 fated on his say, heea 2 SO
hance or ewvolemic pater to nav ales on auscultation, making ns est mappropnate to eecrvly exclude ths condition
Ir etvlem patents. aes ih such alow Seeciicy causes nigh aes als poste (eas due wo congesove heat,
{alr proumons, R29,
180/120 reflects the Pv. The POV icles as TP/TP = Fo Tal patent who teste poste, where TP epresets he
‘rus poses pa Pte fae ponte, n tis ate Fv ~ 50 (89 = 50) ~ 0139 = 52% Sars on ths stuy, he PL
‘Suggests that an tidal as rales om eusculso, te kelNood of hat paler wuy being Wa hypenolemi sae
BB eoitemotony
50/70 ete the NPL. thelihehood tat a pte wth 2 negative est eit oes} ly oss not have the disease
(Ge vice) MPVs called an TN(TN- Por Tal patents na tested negative, here TN tae negtves snd
letle nostnes. nthe cae NPv~ 50 (50 ~ 20)~ 50 70 = 71-s4-Eared one ody, if paeN es not ave ales on
auscultation the ienood of beng an ewolamic aes approx. 71%.
100/200 it prevalence of cases with hyperlemia in the oral popltion of 200 pies, The prevalence calcul
the numberof pele th a contin ttl numer of pple tc Inthe case prevalence =
SON ofthe Stuy popustn arena stat ot hypenclemie
00/200 = 5% Aecanng, ge
8
Ons al < 10>
A 2weth-old newborns brought 1 oe emergency deparmentby hs parents DEcase of 4 episodes of vomiting that
fected hat moming The patents pert fat he vom as Yllansh- gear wth ao aod ni The pan wat Btn at
58 weeks gestation wa vaginal delney and has generally ben heaty He hs assed Normal stoos each dy. There >
fami story of eri iens, He appets table an pal seperate 70 (8.57) ules 146 /min and
ood pressure 5 90/55 mm Ha examin shows a sof mlly tended abdomen wh no mses organomeaal A
rasogaswc tubes sered and vivaenous Ti esse taton I Wated A Xray Shows Mo Gus tl othe denn.
(can ofthe soon
BO
Emergent explorer lparnomy
Apcominaluraeouna oma a <>
a
oo, Aaemect ania rouge me eegte epeter bys puts ease ot epsotesoromengnt
ceca rrmng The pepo te ar sce epee
Serccs guar val everyones gerbe heal, es esed Poa tl ch yee
tami ay frais, he apes ea and ale Ha tempera 37 O68 SP pase
a Shoe eure 90 5 rm i amnaton show 0 eh croruomesnh &
tasguii ube seta wane ha tsucaton tes Ara
6 “Tis naonate presents with acate-ontat lous vomiting, a ly distended abdomen, and no gas inthe distal small
bank Festi on x-ray which highly suspicious fr midgut obstruction most ey due to esa marta,
=
oats
‘Computed omagrspy (CF) maging shuld not be performed in hc patent. The patent hae Festus that ae mot!
= “oncrrng fran anatoriclebstacton i the midgut i other dagnost ets provide Bee Sulza0n oF 5 rain,
& Lupsorcopy nl nese further eleanor wrk ad no esblBN a deine agro or wes ages oF
fecmet Iaoaton witout a compieaing vous, nhs eonate tet Ses sould be perme sto cantar he
for cagross oF nesta malta wth midgut [Link] obvious signs of maroraoon ae a misplaced igen of Ter
‘nd duodenojejunal uncon onthe igo he [Link] and thus cokecreu-keapgesranc tthe Quod and Om Ds al
‘Waet-solubl const enemas used 2 a confimatoy tes and therapeu oo for mussusception ich also presen in
Inara wth vemting, However, mont cases of itsnuneption ae leoecal lous vemting occurs ony mpage
‘seas, On andominal x-ray, ltd laps and a Fuld levels wots be also expected in the smal este rth than &
‘ses andomen. Addnionaly, pues tpl gresantbeween 3-12 months a age anc usual aso have ute JCA
{Sedona pain (every 13-39 mits) and paasy 3 palpable mass on abdominal nam one of whch ae seen ah e6
Emergent exploratory laparotomy i nates cases of hemodynamic inetaby and/or bowel cher or perforation. The
pater femogyramicly sabe, Is afer, and fas sf abdomen, inccatng that further alzgreste workup safe shou
the decompensee ana develop profound cya, hypotension sls ef peloton (ele a under We apa on
Abdorinalukrasound is an imporan imaging modality fr diferentating between causes of abdominal sin n chien. is
feel lable te ear eres wl oer eae elise ect cee il acd pe
‘lasscay ah olve-stapea mass cn be ftom abdominal evar tis petentsabdornal exams netabe for mld lstenton
‘atmo mat evden Morave, the patent desc hare naslov vor, aiding at woud ot be expected wh an
‘sbrseon caved by a Hypervaphe plo, whichis proximal he arpa of Vater ani theafore uso wth
‘onbitovsvoming
Flenble spmoioscopy sued treat sigmoid vohulus patents who have no signs or symptoms ofpetonts (a
‘eoouna tendemes,nemeaynanic stabi) ime ous mast common Seah ede aus and presents wth
‘lbdominal pam, nase vomiting and blotng. Ths yung patent mos aly has are proximal ist pathology,
meaning that sigmoidoscopy would nt be appropriate
