How would you answer these 7 most popular clinical questions of 2022 on Pearls4Peers??

Peers, just turned 7 with 2022 poised to become its best year ever in viewership  (>30,000 views so far)!  To mark this “momentous” occasion, I thought I would share with you, loyal viewers and subscribers, the 7 most viewed posts  of 2022 at its midway point.  Imagine rounding on the wards with your team and someone asks you one or more of these questions.  Take a crack at answering them and compare your answers with those of P4P (Ctrl+Click)! Have fun!

  1. What is the significance of teardrop cells(dacrocytes) on the peripheral smear of my patient with newly-discovered pancytopenia?
  2.  My elderly patient developed a flare-up of her gout few days after receiving covid-19 vaccine. Is there a connection between immunization and gout flare? 
  3. What is the clinical relevance of the “SPICE” organisms? 
  4. What does an “indeterminate” result in QuantiFERON Gold in-Tube Test for latent tuberculosis really mean? 
  5. What is the difference between “moderate” and “high complexity” medical decision making under the Centers for Medicare and Medicaid Services (CMS) rule? 
  6. The urine culture of my female patient with urgency is growing Lactobacillus. Should I treat it?
  7. Why is serum AST levels generally higher than ALT in alcohol-induced liver injury?

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Disclosures: The listed questions and answers are solely the responsibility of the author and do not necessarily represent the official views of Mercy Hospital-St. Louis, Massachusetts General Hospital, Harvard Catalyst, Harvard University, their affiliate academic healthcare centers, or its contributors. Although every effort has been made to provide accurate information, the author is far from being perfect. The reader is urged to verify the content of the material with other sources as deemed appropriate and exercise clinical judgment in the interpretation and application of the information provided herein. No responsibility for an adverse outcome or guarantees for a favorable clinical result is assumed by the author. Thank you!

How would you answer these 7 most popular clinical questions of 2022 on Pearls4Peers??

200 pearls and counting! Take the Pearls4Peers quiz #2!

Multiple choice (choose 1 answer)
1. Which of the following classes of antibiotics is associated with peripheral neuropathy?
a. Penicillins
b. Cephalosporins
c. Macrolides
d. Quinolones



2. The best time to test for inherited thrombophilia in a patient with acute deep venous thrombosis is…
a. At least 1 week after stopping anticoagulants and a minimum of 3 months of anticoagulation
b. Just before initiating anticoagulants
c. Once anticoagulation takes full effect
d. Any time, if suspected



3. All the following is true regarding brain MRI abnormalities following a seizure, except…
a. They are observed following status epilepticus only
b. They are often unilateral
c. They may occasionally be associated with leptomeningeal contrast enhancement
d. Abnormalities may persist for weeks or months



4. Which of the following is included in the quick SOFA criteria for sepsis?
a. Heart rate
b. Serum lactate
c. Temperature
d. Confusion



5. All of the following regarding iron replacement and infection is true, except…
a. Many common pathogens such as E.coli and Staphylococcus sp. depend on iron for their growth
b. Association of IV iron replacement and increased risk of infection has not been consistently demonstrated
c. A single randomized-controlled trial of IV iron in patients with active infection failed to show increased infectious complications or mortality with replacement
d. All of the above is true


True or false

1. Constipation may precede typical manifestations of Parkinson’s disease by 10 years or more
2. Urine Legionella antigen testing is >90% sensitive in legionnaire’s disease
3. Spontaneous coronary artery dissection should be particularly suspected in males over 50 years of age presenting with acute chest pain
4. Urine dipstick for detection of blood is >90% sensitive in identifying patients with rhabdomyolysis and CK >10,000 U/L
5. Diabetes is an independent risk factor for venous thrombophlebitis




Answer key
Multiple choice questions:1=d; 2=a;3=a;4=d;5=c
True or false questions:1=True; 2,3,4,5=False


200 pearls and counting! Take the Pearls4Peers quiz #2!

Take the P4P Quiz (#1)!

With over 100 pearls posted, I thought it would be fun to take a quiz on topics covered to date!

Multiple choice questions

  1. Your patient with hypertensive crisis is admitted with yellow discoloration of skin but not sclera. Which of the following might explain your finding?
    1. Hypothyroidism
    2. Excessive ingestion of squash or carrots
    3. Liver disease
    4. Nephrotic syndrome
    5. All of the above
  2. Your patient with COPD is admitted with acute exacerbation of his disease without a clear trigger or explanation.  Based on published literature, his risk of concurrent pulmonary embolism is approximately
    1. 0-10%
    2. 15-20%
    3. 30-40%
    4. 50%
    5. > 60%
  3. Your diabetic patient has developed hypoglycemia while being treated with trimethoprim-sulfamethoxazole for a urinary tract infection. A potential explanation for this finding include:
    1. Trimethoprim serving as an insulin secretagogue
    2. Sulfamethoxazole serving as an insulin secretagogue
    3. Reduction of insulin renal clearance by sulfamethoxazole
    4. Increased renal excretion of glucose due to sulfamethoxaole
    5. All of the above
  4. Your patient with urosepsis and E.coli bacteremia presents with new-onset direct hyperbilirubinemia (4.0 mg/dl). His ultrasound of the liver and biliary tree is normal. The most likely explanation for his hyperbilirubinemia  is…
    1. Hemolysis due to sepsis
    2. Gilbert’s syndrome
    3. Common bile duct obstruction due to stone
    4. Cholestasis due to sepsis-induced cytokines
    5. None of the above
  5. Your 55 y old patient is admitted for alcohol withdrawal. You note “Frank’s sign” on his exam. All of the following is true of this sign except…
    1. It was first discovered by a surgeon
    2. It describes a diagonal earlobe crease
    3. It may be a potential marker of coronary artery disease, especially in those 60 y of age or younger
    4. It is associated with alcoholic cirrhosis
    5. It’s pathogenesis may be related to the breakdown of type I collagen due to oxidative stress in atherosclerosis


True or false questions

1. Patients with reported shellfish allergy have a significantly higher rate of allergic reactions to iodinated contrast media than those without shellfish allergy.     T              F

2. The new AABB guidelines recommend using a hemoglobin threshold of 7.0 g/DL for all hospitalized patients in the absence of active hemorrhage.    T             F

3. Vitamin D deficiency may present as proximal muscle weakness before any biochemical signs such as hypocalcemia develop.  T         F

4. “SPICE” organisms include multi-drug resistant Staphylococcus aureus and  Pseudomonas aeruginosa.   T            F

5. Prophylactic subcutaneous heparin can be associated with hyperkalemia.

T             F


For answers: Scroll down past the bonus picture quiz below….

pepper Continue reading “Take the P4P Quiz (#1)!”

Take the P4P Quiz (#1)!