In a 45 year old with a finger laceration what is the risk of digital ischemia if using epinephrine with a local anesthetic? If the risk is minimal are there any benefits? (prognosis 7.06)
Endocrine
In a 45 yo man with hypertension and a negative renal artery duplex done for refractory hypertension, what is the value of an aldosterone-renin ratio in the diagnosis of primary hyperaldosteronism? (diagnosis 1.07)
In a Type 2 diabetic requiring insulin therapy, does the addition of oral hypoglycemic agents improve glycemic control? (therapy 5.06)
In patients with diabetes requiring insulin, does the addition of metformin improve outcomes (endpoint: death, non-fatal MI, CVA, revascularization, etc.)? (therapy 1.05)
In patients with diabetes and painful peripheral neuropathy, does treatment with gabapentin reduce pain? (therapy 9.04)
In Type II diabetics without amputation (primary prevention), does the use of a screening program and foot care specialist reduce the risk of amputation? (therapy 7.04)
In patients with clinically suspected chronic pancreatitis, what is the diagnostic value of serum amylase and lipase? (diagnosis 2.05)
What is the diagnostic value of hypokalemia in predicting hyperaldosteronism in hypertensive patients? (diagnosis 1.05)
In a patient with Type II diabetes and persistent hyperglycemia (A1C of 10), what is the risk of cardiovascular symptoms? (prognosis 9.04)
ENT
GI
In a 48 y.o. woman with episodic elevations in transaminases, what is the utility of anti smooth muscle Ab to dx autoimmune hepatitis?(diagnosis 2.08)
In a 59 yo man with history of heavy alcohol use and hospitalization due to cirrhosis, what is the risk of death with or without abstinence from alcohol? (prognosis 11.06)
In a 30 yo man w/ hx of IVDU, elevated ALT, heavy alcohol use, and newly diagnosed chronic hepatitis C, what is the risk of progression to cirrhosis and how does alcohol use affect that risk? (prognosis 9.06)
In a patient with cirrhosis, what is the utility of screening annually with alpha fetoprotein to diagnose HCC (i.e. does screening improve mortality from HCC)? (diagnosis 4.06)
In a 51 year-old African-American woman with HCV, increased AST and ALT, but without cirrhosis, what's the benefit of interferon vs. placebo in preventing progression to cirrhosis?(therapy 11.05)
In a patient with Barrett's esophagus on a proton pump inhibitor, what's the risk of developing esophageal cancer? (prognosis 12.05)
In patients with ascites due to chronic liver disease, what is the benefit of primary prophylaxis with weekly ciprofloxacin in reducing the risk of SBP?(therapy 8.05)
In adult patients with tense ascites undergoing large volume paracentesis, does the concomitant administration of albumin improve morbidity and mortality over placebo? (therapy 5.05)
In patients with known NASH, diagnosed by biopsy, what is likelihood of the development of cirrhosis?(prognosis 4.05)
In a 56-year old female with diarrhea and risk factors for C. difficile, what is the diagnostic utility of c. diff antigen/toxin A done 3 times versus once in diagnosing Clostridium Difficile colitis? (diagnosis 3.05)
What is the diagnostic utility (sensitivity, specificity, likelihood ratio) of a positive NG tube aspirate in the diagnosis of upper GI bleed? (diagnosis 8.04)
Genitourinary
In a 45 yo man w/ urinary hesitancy, what is the efficacy of doxazosin (vs no treatment) in the relief of urinary symptoms? (therapy 1.07)
Hematology
In a 50-year old woman with an indwelling central venous catheter for chemotherapy, does the use of low dose coumadin prevent complication from line related thrombosis? (therapy 3.05)
In an anti-coagulated patient, what is the likelihood of significant bleeding complications with the placement of a central line? (prognosis 6.05)
For patients with essential thrombocytosis, what is the risk of vascular complications (eg. stroke, MI) at a platelet count > 1,000,000? (prognosis 8.04)
Infectious Diseases
In a 64 year old woman with genital herpes, does chronic suppressive therapy will valacyclovir decrease the rate of transmission? (therapy 8.06)
In a 55 yo male with gram negative bacteremia, what is the benefit of double covering vs. single coverage on mortality (or hospital days)? (therapy 3.06)
Do oral antibiotics improve time to recovery in patients with soft tissue abscesses treated with incision and drainage? (therapy 5.05)
In adult patients with severe sepsis, what is the effect of activated protein C (drotrecogin alfa) in reducing mortality? (therapy 2.05)
In HIV-positive patients with recurrent genital herpes, does chronic suppressive therapy with oral valacyclovir decrease frequency and duration of recurrences compared with placebo? (therapy 8.04)
What is the diagnostic utility of a negative induced sputum for Pneumocystis carinii pneumonia in and HIV patient with CD4 below 200 on PCP prophylaxis? (diagnosis 9.04)
Musculoskeletal
In a 50 year old male with LBP of 12 weeks duration what is the benefit of physical therapy versus no physical therapy (allowing for pain relief with NSAIDS and activity as tolerated) on improved functionality (return to work versus scores of physical performance?) and pain? (therapy 9.07)
In a 60 yo woman with T-score of -3.0 but no other risk factors for fracture, what is the benefit of bisphosphonate therapy for prevention of hip fractures? (therapy 2.07)
In a 79 year old female suspected of having osteomyelitis of the toe (on the basis of ) what is the diagnostic utility of MRI? Does measuring CRP play a clinical role in the care of this patient should she prove to have osteomyelitis? (diagnosis 8.05)
In patients with chronic back pain on narcotics, will antidepressant therapy improve pain control? (9.05 therapy)
Neurology
In a 47 year old woman with migraine headaches occurring at least 4 times per month and who was initially placed on venlafaxine for depression, would switching to amitriptyline offer any advantage in decreasing the frequency and severity of migraine headaches?(therapy 3.08)
In a 65 year old male with known CAD undergoing coronary catheterization for evaluation of symptomatic angina, what is the risk of stroke as a complication of the catheterization?(2.07 harm)
In a 45 yo man w/ afib and CHF (35%), HTN, DM, wants to stop coumadin, what is his risk for CVA off anti-coagulation? (prognosis 1.07)
Oncology
In a 65-year-old man with a history of smoking, with a solitary pulmonary nodule, what is the diagnostic accuracy of trained dogs for detecting lung cancer?(diagnosis 1.08)
In a 30 year old male tobacco user with cumulative 15 pack-year history of exposure what is his subsequent risk of dying from lung cancer if he stops smoking now? (prognosis 10.07)
In a 52 yo man with asymptomatic elevation of PSA (4.6), what is the value of free PSA testing for the diagnosis of prostate cancer? (11.06)
How many men with no comorbidities diagnosed with localized prostate cancer (with a certain pathologic finding) after the age of 65 die of their cancer? (prognosis 1.05)
In premenopausal women on OCP, what is the risk of endometrial cancer associated with not having withdrawal bleeds? (harm 4.06)
In a healthy 20 yo female with new diagnosis of breast fibroadenoma, what is her lifetime risk of breast cancer?(prognosis 5.06)
In a 25 yo female with a single pap result of ASCUS (atypical squamous cells of undetermined significance) with unknown HPV status, on thin prep, what is the likelihood that she has cervical cancer? (diagnosis 6.06)
Physical Exam
In an asymptomatic pre-/perimenopausal woman, how good is a bimanual exam for detection of ovarian cancer (or adnexal masses)? (10.06)
In patients with low back pain, what is the diagnostic utility of a straight leg raise test for nerve compression or irritation? (diagnosis 3.05)
PsychiatryIn a 43 yo woman with bulimia nervosa, what is her risk of cardiac arrhythmias? (harm 12.06)
In a 45 yo w/ depression, what is the risk of suicide after starting an SSRI? (harm 10.06)
In a 45 year old woman with first time major depressive episode and wary of taking medication, does combination of medication and psychotherapy reduce the duration of treatment with medication or otherwise improve response to therapy (less depressive symptoms)? (therapy 1.06)
In patients with a history of recurrent depression that stop antidepressant therapy, what is the risk of recurrent depressive episodes? (prognosis 10.05)
In elderly patients (age 65 or greater) with major depression, which class of antidepressants are most effective at relieving symptoms of depression? (therapy 8.04)
Pulmonary
In a 65-year-old man with a history of smoking, with a solitary pulmonary nodule, what is the diagnostic accuracy of trained dogs for detecting lung cancer?(diagnosis 1.08)
In a 78-year-old man with severe COPD (FEV1 < 1), who meets criteria for home O2 but refuses to use it, and who is still smoking, what is his 5-year mortality?(prognosis 12.07)
In patients with known COPD, diagnosed by PFTs, what is the mortality rate for patients after a first hospitalization? (prognosis 2.05)
In a 68 year-old woman with asthma and paroxysmal atrial fibrillation, what is the risk of asthma exacerbation secondary to beta-blocker therapy? (8.05 harm)
In a 49 year-old woman with an FEV1 of 36% predicted and severe COPD, what is her risk of death in 1 year? (prognosis 9.05)
Renal
In a 77 year old man with hypertension and presumed hypertensive nephropathy (creatinine 1.7) does the use of ace inhibitor to control high blood pressure rather than other medications delay further decline in renal function??(therapy 7.05)
Does poorly controlled hypertension increase time to progression to hemodialysis in patients without diabetes? (prognosis 11.04)
Rheumatology
In a 60 you man w/ osteoarthritis, what is the benefit of nabumetone versus other NSAIDs in relief of pain? (therapy 10.06)
In patients with suspected rheumatoid arthritis, what is the sensitivity, specificity, and likelihood ratios of the anti-CCP (anti-cyclic citrullinated peptide) test? (diagnosis 10.04)
In a 60 y.o. patient with chronic low back pain, do topical lidocaine patches such as Lidoderm decrease pain scores and/or improve functional status? (therapy 11.07)