The Verdict Is In! 2021 Q4 edition

"Return if worse"

A score of 75% or higher on the 4-question quiz will earn you 0.25 AMA PRA Category 1 Credits TM, and a score of 100% will enter you in The Mutual's quarterly raffle to win $300 in VISA gift cards. The raffle winner will be drawn and announced on December 30th, 2021. The survey will remain open for CME through December 30th, 2022. Enter your name/email at the end of the survey for credit and your CME cert will be uploaded into Vituity University.

Accreditation Statement
Vituity is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians.
Credit Designation
Vituity designates the internet enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure
No one in a position to control the content of this educational activity have any relevant financial relationships with ineligible entities to disclose.

Question Title

* 1. Overuse of effective antibiotics leaves resistant bacteria, so judgment must be had when determining if your seemingly straight forward kidney stone patient should receive antibiotics. The fact of the matter is secondarily infected stones obstructing the urinary tract can be a life-threatening urologic emergency resulting in pyonephrosis, sepsis, and death. Therefore, you must always look for subtle signs of infection. Which of the following best practice suggestions will you use when seeing and treating kidney stone patients?

Take a cognitive pause before discharging all patients with kidney stones

Order a urine microscopic analysis on all stone patients. Understand pyuria >5 wbc/hpf is significant in the presence of an obstructing stone

Do not discharge patients with persistent tachycardia, borderline hypotension, or fever

Presume the worst if the patient has a leukocytosis and even mild pyuria. Assume this is infection, and not stress demargination and contamination

If you discharge a patient with an obstructing stone, provide ample documentation you considered infection and why you think your patient does not have infection

All the above

Question Title

* 2. If you have any of the above reasons supporting or even suggesting infection:

Consult your on-call Urologist

Perform a urine culture because a culture cannot be performed reliably later should the infection prove resistant to the prescribed antibiotic

Both A and B

Question Title

* 3. Discharge instructions may seem self-explanatory but can be subject to patient perception and interpretation. For example, an instruction to return if worse would depend on the patient’s perception of “if worse” means worse pain or new problems. Be specific. For example, “have your wound rechecked in 36 hours,” “return if fever over 100.4,” “return if vomiting,” “return if increased swelling and new onset numbness or tingling.”
True or false? When discharge instructions are clear and unambiguous, and when questions have been answered, it is reasonable for health care providers to assume that patients have understood the discharge instructions as written.

True

False

Question Title

* 4. We can’t go back in time, but we can learn from the past in hopes of preventing a similar outcome in the future. If you experience a similar case in your practice, what can you do to minimize your risk?

Address repeat abnormal vitals

Document patient/family verbalized comprehension of the diagnosis, risk, and specific return precautions

Timely post discharge call-backs

Have the nurse do your discharge in lieu of you

A, B, and C

Question Title

* 5. Contact information for entry into the raffle

Name

Primary Site

Email Address

Phone Number