AFP journal review

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AFP journal review

• Jiyo Shin M.D.
• Emory Family Medicine

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May 15 2010

• Nursing Home Care Clinical Aspects
• Diagnosis and Initial Management of Acute HIV
  Infection
• Primary Care of Adult Survivors of Childhood
  Cancer

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Nursing Home Care
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Tai Chi
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Cont
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Level of evidence
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Cont
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Cont
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Review Question

• 1. Methicillin-resistant Staphylococcus aureus
  (MRSA) infection is diagnosed in a nursing home
  resident. Which one of the following statements
  about infection control is correct?  (check one)
• A. Handwashing is the most important measure for
  controlling infection.
• B. Resident-to-resident contact is a major mode
  of MRSA transmission.
• C. Cultures should be performed in all residents
  for surveillance purposes.
• D. The residents room should be thoroughly
  decontaminated.
• Answer A

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Review Question

• 2. Which of the following are goals of palliative
  care for nursing home residents in the early
  stages of disease ?  (check all that apply)
• A. Discussing prognosis.
• B. Discussing the patients expectations for
  treatment.
• C. Providing educational material.
• D. Encouraging focus on completing important
  tasks.
• Answer A,B,C

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Review Question

• 3. Which of the following statements about
  advance directives in a nursing home are correct?
   (check all that apply)
• A. Most residents have an advance directive in
  place when admitted to a nursing home.
• B. Nursing homes are required to offer residents
  information about advance care planning.
• C. Advance directives should include discussions
  about hospital transfers.
• D. A surrogate can be selected to make health
  care decisions if the resident is unable to do so
• Answer B,C,D

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Review Question

• 4. Which one of the following situations warrants
  antimicrobial treatment for urinary tract
  infection in a nursing home resident?
   (check one)
• A. Bacteria identified in the urine of an
  asymptomatic patient.
• B. Negative urine culture results in a
  symptomatic patient with a white blood cell count
  of greater than 10,000 cells per mm3 (10.00 x 109
  per L).
• C. Positive urine culture results in a
  symptomatic patient with positive leukocyte
  esterase test result.
• D. Positive nitrite test result in an
  asymptomatic patient who has not received urine
  culture.
• Answer C

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Review Question

• 5. A woman with noninsulin-dependent diabetes
  mellitus and dementia is admitted to the nursing
  home. She has little interest in food. Which of
  the following are the best interventions to
  ensure weight maintenance and optimal nutritional
  status?  (check all that apply)
• A. Strict American Diabetes Association diet.
• B. Liberal, culturally appropriate diet.
• C. Feeding tube placement.
• D. Frequent, small feedings.
• Answer B,D

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Review Question

• 6. A nursing home resident with normal cognitive
  function has had several incontinence episodes
  and is willing to cooperate with therapy. Which
  of the following interventions are appropriate?
   (check all that apply)
• A. Scheduled toilet habit training.
• B. Check-and-change program.
• C. Prompted voiding.
• D. Catheterization
• Answer A, C

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Acute HIV infection
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Acute HIV infection
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• R

Rash erythematous maculopapular exanthem
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Quick Review

• Likelihood ratio for a positive result (LR)
  tells you how much the odds of the disease
  increase when a test is positive.
• Likelihood ratio for a negative result (LR-)
  tells you how much the odds of the disease
  decrease when a test is negative.
• The likelihood ratio of a positive test result
  (LR) is sensitivity divided by 1- specificity.
• The likelihood ratio of a negative test result
  (LR-) is 1- sensitivity divided by specificity.

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Review Question

• 7. Which one of the following tests is considered
  the most useful diagnostic marker for acute human
  immunodeficiency virus (HIV) infection?
   (check one)
• A. p24 antigen.
• B. CD4 lymphocyte count.
• C. HIV RNA viral load.
• D. Enzyme-linked immunosorbent assay (ELISA).
• E. HIV genotype.
• Answer C

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Review Question

• 8. A 28-year-old patient presents with symptoms
  of myalgias, lymphadenopathy, and mucocutaneous
  ulcerations. The ELISA is negative, and the
  patients HIV RNA viral load is above 100,000
  copies per mL. Which one of the following
  statements about the patients condition is
  correct?  (check one)
• A. The results likely represent a false positive.
• B. The patient has a long-standing HIV infection.
• C. The patient has an acute HIV infection.
• D. A transient increase in CD4 lymphocyte count
  would confirm the diagnosis
• Answer C

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Review Question

• 9. Which of the following statements about
  management of acute HIV infection are correct?
   (check all that apply)
• A. Patients should be counseled on effective risk
  reduction strategies.
• B. Current evidence suggests that combination
  antiretroviral therapy initiated during acute
  infection leads to long-term improvement in
  HIV-related outcomes.
• C. HIV antibody and RNA viral load testing should
  be repeated within four to six weeks in patients
  with low viral loads to rule out a false-positive
  result.
• D. Short-term hospitalization for monitored
  induction therapy is recommended in most patients
• Answer A,C

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Primary Care of Adult Survivors of Childhood
Cancer
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Late Effects
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Cont
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Cont
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Cont
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Take home point

• The Childrens Oncology Groups long-term
  followup
• guidelines are available at
• http//www.survivorshipguidelines.org

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Review Question

• 10. A 25-year-old woman who was diagnosed with
  Wilms tumor at four years of age had previously
  received a chemotherapy regimen that included
  doxorubicin (Adriamycin) for six months. Which
  one of the following secondary morbidities would
  most likely occur in this patient?  (check one)
• A. Cataracts.
• B. Osteoporosis.
• C. Cardiomyopathy.
• D. Peripheral neuropathy
• Answer C

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Review Question

• 11. A 47-year-old childhood cancer survivor comes
  to the office as a new patient for a routine
  examination without any medical records. Which of
  the following would be important in the care of
  this patient?  (check all that apply)
• A. Work with the patients previous physicians to
  create a Summary of Cancer Treatment form.
• B. Consult the long-term follow-up guidelines
  from the Childrens Oncology Group to determine
  proper screening tools for future management.
• C. If the patient does not recall prior
  treatments, just proceed with routine health
  maintenance.
• D. Use patient risk factors (e.g., age, sex,
  lifestyle choices) to help create a future
  follow-up and monitoring plan for the patient
• Answer A,B,D

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Finally Tomato Tomato !
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References

• 1. Jones AL, Dwyer LL, Bercovitz AR, Strahan GW.
  The National Nursing
• Home Survey 2004 overview. Vital Health Stat 13.
  2009(167)1-155.
• 2. American Academy of Family Physicians.
  Practice Profile I Survey.
• June 2008. http//www.aafp.org/online/en/home/abou
  tus/specialty/
• facts/5.html. Accessed February 16, 2010.
• 3. Unwin BK, Porvaznik M, Spoelhof GD. Nursing
  home care part II. clinical
• aspects. Am Fam Physician. 201081(10)1229-1237.
• 4. Dimant J. Roles and responsibilities of
  attending physicians in skilled and more in AFP
  journal 2010 May 15