What about this UW q....

[RussianJoo]

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12 y/o AA kid with Sickle Cell has fever, chills, cough, high WBC with bands. No bone pain, they ask what's the likely organism?


A) strep. Pneumo
B) Staph Aureus
C) pseudomonas aeruginosa
D) Salmonella

I picked Strep and it was the right answer.. because it's capsulated but i wasted like 1.5min cause pseudomonas is also capsulated.. so like it could be either one... they didn't give anything like he had sputum production or anything like that.. in the explanation they talk about the development of functional aspleenia in Sickle cell patients and thus capsulated organisms are more common. then they clump B,C,D together and say because of the aspleenia capsulated organisms are more common.

So did pseudomonas lose it's capsule while i was in 3rd year? or did UW just screw up...

 

[Nicholaus]

Maybe S. Pneumo is the MOST COMMON encapsulated organism affecting asplenic SCD patients?? Therefore, I would pick S. Pneumo over other encapsulated organisms as in this question.

 

[MSmentor018]

you're right, it's the encapsulated ones. step up says that and gives the example: H influ or strep pneumo. nothing about pseudomonas.

 

[Scaredshizzles]

12 y/o AA kid with Sickle Cell has fever, chills, cough, high WBC with bands. No bone pain, they ask what's the likely organism?


A) strep. Pneumo
B) Staph Aureus
C) pseudomonas aeruginosa
D) Salmonella

I picked Strep and it was the right answer.. because it's capsulated but i wasted like 1.5min cause pseudomonas is also capsulated.. so like it could be either one... they didn't give anything like he had sputum production or anything like that.. in the explanation they talk about the development of functional aspleenia in Sickle cell patients and thus capsulated organisms are more common. then they clump B,C,D together and say because of the aspleenia capsulated organisms are more common.

So did pseudomonas lose it's capsule while i was in 3rd year? or did UW just screw up...

For one I think strep is just a lot more likely to be the cause of any kind of sepsis, even in patients with a spleen, compared to pseudomonas. Secondly, I don't think pseudomonas has a significant capsule portion...probably more like a baby capsule...maybe some strains more so than others (like with e. coli's capsule...actually a number of gram negative rods have mucoid type variant strains...effecting their ability to stick to urothelium, etc).

 

[RussianJoo]

thanks guys.. i mean that's why i picked strep. pneu. cause it's more common.. but i think they should have at least addressed that in the explinations..

i just hope the real test doesn't do b s stuff like that..

 

[RussianJoo]

For one I think strep is just a lot more likely to be the cause of any kind of sepsis, even in patients with a spleen, compared to pseudomonas. Secondly, I don't think pseudomonas has a significant capsule portion...probably more like a baby capsule...maybe some strains more so than others (like with e. coli's capsule...actually a number of gram negative rods have mucoid type variant strains...effecting their ability to stick to urothelium, etc).

I learned it like this.. Some Killers Have Pretty Nice Capsules.
Strep Pneumo
Klebsiella
Haemophilus
Psuedomonas
N.meningitidis
Crytoccocus

I am sure there are exceptions but these are the biggies that should have capsules.

 

[astronomylover]

Here are two questions I'm confused about. Its about Achalasia. I dont remember the question but i have the educational objective written down. Tell me if these contradict eachother....


1) The Diagnosis of achalasia is made by Manometry, however, endoscopy is required to ensure that there is no malignancy. ( I put barium swallow which was wrong).

2) When a motility disorder of the esophagus is suggested by contrast studies, the next step is usually Esophagoscopy to excluse mechanical causes of dysphagia, such as stricture or esophageal cancer. (it can then be followed by manometry to confirm the diagnosis).

3) Barium Swallow is the initial test of choice for all patients with dysphagia.

I don't even know what my question is to be honest, I just dont understand which are the first tests you should order. I would assume achalasia would give you dysphagia yet barium swallow is not the correct answer. Maybe I am not seeing the bigger picture here.

 

[FutureInternist]

Here are two questions I'm confused about. Its about Achalasia. I dont remember the question but i have the educational objective written down. Tell me if these contradict eachother....


1) The Diagnosis of achalasia is made by Manometry, however, endoscopy is required to ensure that there is no malignancy. ( I put barium swallow which was wrong).

2) When a motility disorder of the esophagus is suggested by contrast studies, the next step is usually Esophagoscopy to excluse mechanical causes of dysphagia, such as stricture or esophageal cancer. (it can then be followed by manometry to confirm the diagnosis).

3) Barium Swallow is the initial test of choice for all patients with dysphagia.

I don't even know what my question is to be honest, I just dont understand which are the first tests you should order. I would assume achalasia would give you dysphagia yet barium swallow is not the correct answer. Maybe I am not seeing the bigger picture here.

I think it makes sense...i.e. Pt has dysphagia & the first thing you do is the swallow to determine the consistency of liq/solids he is having trouble with. There are many reasons for dysphagia & the barium swallow only confirms that there is infact some dysphagia (w/o giving any hints to the cause of it, unless Zencker's etc). The next step would be to go look for something that is blocking the way, hence the EGD. If you still do not have a cause, then achalsia is the dx (since at this point you have excluded the other causes) & you need manometry to confirm.

 

[FutureInternist]

From my UW notes. You may already have this

 

[RussianJoo]

Here are two questions I'm confused about. Its about Achalasia. I dont remember the question but i have the educational objective written down. Tell me if these contradict eachother....


1) The Diagnosis of achalasia is made by Manometry, however, endoscopy is required to ensure that there is no malignancy. ( I put barium swallow which was wrong).

2) When a motility disorder of the esophagus is suggested by contrast studies, the next step is usually Esophagoscopy to excluse mechanical causes of dysphagia, such as stricture or esophageal cancer. (it can then be followed by manometry to confirm the diagnosis).

3) Barium Swallow is the initial test of choice for all patients with dysphagia.

I don't even know what my question is to be honest, I just dont understand which are the first tests you should order. I would assume achalasia would give you dysphagia yet barium swallow is not the correct answer. Maybe I am not seeing the bigger picture here.

Yeah i remember that q and i put barium swallow too... I think they just fcked up... you need a road map before you go in there with a scope cause if it's a zankers or a cancer you might perforate the esophagus, unless you see the barium swallow first.

 

[FutureInternist]

Yeah i remember that q and i put barium swallow too... I think they just fcked up... you need a road map before you go in there with a scope cause if it's a zankers or a cancer you might perforate the esophagus, unless you see the barium swallow first.

But barium swallow doesn't lead to diagnosis. If the Q is "what is the first step" then Ba swallow, but if they ask how to diagnose then it has to be manometry.

 

[RussianJoo]

But barium swallow doesn't lead to diagnosis. If the Q is "what is the first step" then Ba swallow, but if they ask how to diagnose then it has to be manometry.

it asked what's the next best step.

 

[FutureInternist]

it asked what's the next best step.

Oh OK then....I agree w/ you on that 🙂

 

[astronomylover]

Lol thanks guys for your help! I understand your frustration RussianJew. I was thinking the same exact thing you were. I am too extremely frustrated and I'm getting to the point where I'm wishy washy on many of the "next step" thingies.

 

[SOUNDMAN]

Exactly it's not that you don't "know" what to do, but you have to be careful and read exactly what it's asking. Basically if it's saying you have achalasia what's the next step then Manometry would be right. If someone is just having difficult swallowing (dysphagia) then you would do Barium Swallow and then EGD. They are very sneaky in "what" they are asking, but if the stem mentions achalasia specifically I'd go with manometry in that case.

 

[RussianJoo]

Exactly it's not that you don't "know" what to do, but you have to be careful and read exactly what it's asking. Basically if it's saying you have achalasia what's the next step then Manometry would be right. If someone is just having difficult swallowing (dysphagia) then you would do Barium Swallow and then EGD. They are very sneaky in "what" they are asking, but if the stem mentions achalasia specifically I'd go with manometry in that case.

yeah but they're not going to say.. i have been to dr. x and he diagnosed me with achalasia and now i want to do something about it... they're going to say the pt has difficulty to swallowing liquids and solids. which could be a huge cancer, a peptic stricture or achalasia. I think it's always best to see where you're going or have a "road map" as they say... so barrium is first, then take a look and some biopsies with EGD and then once you ruled out cancer and peptic stricture do manometry to confirm the diagnosis of achalasia. of course if they ask what's the best test then it would be manometry, if they ask what's the first test it would be barrium or EGD i think. achalasia presents with dysphagia.....

 

[MSmentor018]

I learned it like this.. Some Killers Have Pretty Nice Capsules.
Strep Pneumo
Klebsiella
Haemophilus
Psuedomonas
N.meningitidis
Crytoccocus

I am sure there are exceptions but these are the biggies that should have capsules.

I thought it was.....Some Strange Killers Have Pretty Nice Capsules....
Salmonella

is that right?

 

[RussianJoo]

I thought it was.....Some Strange Killers Have Pretty Nice Capsules....
Salmonella

is that right?

Salmonella might have a capsule too..and maybe that's how your mnemonic goes, but strep pneumo definitely has a capsule and is a lot more common than any of those other bugs...

 

[SOUNDMAN]

yeah but they're not going to say.. i have been to dr. x and he diagnosed me with achalasia and now i want to do something about it... they're going to say the pt has difficulty to swallowing liquids and solids. which could be a huge cancer, a peptic stricture or achalasia. I think it's always best to see where you're going or have a "road map" as they say... so barrium is first, then take a look and some biopsies with EGD and then once you ruled out cancer and peptic stricture do manometry to confirm the diagnosis of achalasia. of course if they ask what's the best test then it would be manometry, if they ask what's the first test it would be barrium or EGD i think. achalasia presents with dysphagia.....

Aren't we saying the same thing? I'm not disagreeing with the management/dx of dysphagia and understanding the underlying etiology and what route to take to get there, I'm saying that they are sneaky in how they ask the question, etc.

For example the question may say...blah blah blah problems swallowing liquids...blah...dysphagia. then the last line is "The diagnosis of achalasia is confirmed by?...." In a sense, a giant paragraph before is just meant to throw a person off from what they are "actually" asking.

Or the question would be..."How would you rule out secondary causes or achalasia?"

Or what is the initial test in evaluating dysphagia?

The answers to those questions are all different and that's how they are sneaky little biatches.

 

[RussianJoo]

Aren't we saying the same thing? I'm not disagreeing with the management/dx of dysphagia and understanding the underlying etiology and what route to take to get there, I'm saying that they are sneaky in how they ask the question, etc.

For example the question may say...blah blah blah problems swallowing liquids...blah...dysphagia. then the last line is "The diagnosis of achalasia is confirmed by?...." In a sense, a giant paragraph before is just meant to throw a person off from what they are "actually" asking.

Or the question would be..."How would you rule out secondary causes or achalasia?"

Or what is the initial test in evaluating dysphagia?

The answers to those questions are all different and that's how they are sneaky little biatches.

i agree they are sneaky.. and i hate how they use different names of the same diseases.. or try to screw you up by using the lesser known medical terminology terms that aren't as common.. it's like if you know it you know it.. why try to screw people by confusing the hell out of them.. and also in real life we'll have a lot more than 1 min to answer the question...

 

[SOUNDMAN]

i agree they are sneaky.. and i hate how they use different names of the same diseases.. or try to screw you up by using the lesser known medical terminology terms that aren't as common.. it's like if you know it you know it.. why try to screw people by confusing the hell out of them.. and also in real life we'll have a lot more than 1 min to answer the question...

Amen to this brother!!👍👍