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,p 3 CCS Cases – UW Interactive Case
Summaries | USMLE Preparation 2024 |
What is the genetic inheritance pattern of Hemophilia A?
X-linked recessive: women born to fathers with X linked recessive disorder will be carriers. Males are
50% carriers if born to an affected mother.
What is tx of Lewy body dementia?
Dopamine agonist therapy (PD) & AchE inhibitors (Alzeihmer's) - watch for dopamine agonist therapy
causing complex visual hallucinations.
A patient treated for LTBI and now has positive PPD. Asymptomatic and also has negative CXR.
Asymptomatic patients without radiographic evidence of active TB who have been treated previously for
active TB or LTBI need no further treatment.
Initial tx of lupus?
- steroids + hydroxychloroquine - remember that hydroxychloroquine reduces the risk of arthralgias and
serositis
- you use steroids to bridge until hydroxychloroquine takes affect
- MTX if u have organ damage.
- Rituximab causes PML.
What is the IGRA used for?
Another means of diagnosing LTBI - cannot tell the difference between latent and active TB just like the
TST. They are advantage when you have BCG vaccinated patient.
Isotretinoin in a boy what do you look for?
- hyperglycemia, triglyceridemia, hepatotoxicity, mucocuteanous reaction, blood dyscrasias, and ocular
toxicity.
-tell them to avoid alcohol bc of pancreatitis.
Pt with keratoconjunctivitis sicca (engorgement of eye BV, and stringey discharge), who has caries and
submandibular mass. NBS?
Ro/La antibody for Sjogren's .
50% will be negative.
A patient undergoing UGI and has mechanical valve. No active infection foci. What is the likely abx
prophylaxis for endocarditis?
Valve + ONGOING GI/GU manipulation tract procedure gets SBE prophylaxis prior to procedure - if they
did, you would give them ampicillin.
What do you do to monitor the disease progression in patients with AS?
,Radiographs of hip/chest/and pelvis + ESR markers Q3 months
What is the relationship between alcoholics and pancreatitis?
Alcoholics - decreased Vit D, and alcohol itself damages proximal tubule reabsorption.
- Alcholic compensates by pushing PO4 out of the cell, however once refed/hydrated - PO4 becomes
intracellular and you get HYPOPO4 which can cause rhabdomyolasis and myopathy.
- Especially in the setting of respiratory alkalosis
What are the only requirements to hospice care?
only requirements of hospice are prognosis <6 months and the patient's willingness to forgo life
sustaining treatment.
What is verification bias?
AKA workup bias. It is when a study only SELECTIVELY uses the gold standard test in order to confirm a
positive result of preliminary testing. This can result in overestimates and increase in sensitivity.
How do you overcome this bias?
Use the gold standard in a control population as well.
African man with UTI + blood on dipstick microhematuria and anemia. What is NBS?
The diagnosis of schistomiasis is demonstration of parasite eggs in the stool or urine.
Patient with esophageal variceal bleed x 2 after banding. What is the NBS?
Repeat upper GI endoscopy to do treatment with sclerotherapy or banding. If not, then you should do
shunt or TIPS.
What is chance of adult who gets Hep B of going to chronic HBV?
Adults have <5% chance of chronic Hep B infection - however perinatal transmission is 90%.
After starting HAART what do you expect VL of HIV in 6 months?
<200 copies / mL otherwise resistance or non-compliance.
Preventive management of a cluster headache?
Verapamil is the only preventative measure in RCT.
What epidemiological parameter does not vary with disease prevalence and is based on Sn, and Sp?
Likelihood ratio
For a positive test result: sensitivity / (1-specificity).
For a negative test result: (1-sensitivity) / specificity.
What is the definition of likelihood ratio?
Probability of a given test result occurring in a patient with a disorder compared to the probability of the
same result occurring in a patient without the disorder.
, What is cataplexy treated with?
SNRI (venlafaxine)
SSRI or sodium oxybate.
When a patient has a stroke - dysphagia and aspiration causes in an increased risk of death. What is
NBS?
Make sure to do a quick swallow evaluation (water swallow test or Toronto Bedside Swallowing
Screening test).
What is the insulin administration in DKA?
Continuous insulin.
What is the fluid management in DKA?
Add K to fluids if K is less than <5.2 meQ/L.
How long should IV insulin be continued in DKA?
Until anion gap normalized.
DKA patient with glucose <200 but still elevated anion gap. What do you do?
Half the rate of continuous insulin and add dextrose to the fluids.
What is first step in pheochromocytoma work up?
Get MRI of abdomen - if this is negative, you get MIBG - control BP for 10-14 days with alpha blocker.
What has best long term outcome when behavior modifications fail for enuresis?
Enuresis alarm.
Cocaine ingestion patient with persistent chest pain and new neurologic finding of right sided weakness
in upper arm. What is suspicion and what is NBS?
Suspect acute dissection of aorta, and get CT angiography of the chest.
We have an expert-written solution to this problem!
A patient with hypermobility, h/o velevty hyperextensible skin with easy bruisability and atrophic scars
and has hyperdynamic precordium. What is the suspicion?
Acute mitral regurgitation, with myxomatous degeneration and rupture of chordae.
Later life depression (occuring after age 65) has been found to be a significant risk factor for the
development of what condition?
Alzeihmer's disease.
,p 3 CCS Cases – UW Interactive Case
Summaries | USMLE Preparation 2024 |
What is the genetic inheritance pattern of Hemophilia A?
X-linked recessive: women born to fathers with X linked recessive disorder will be carriers. Males are
50% carriers if born to an affected mother.
What is tx of Lewy body dementia?
Dopamine agonist therapy (PD) & AchE inhibitors (Alzeihmer's) - watch for dopamine agonist therapy
causing complex visual hallucinations.
A patient treated for LTBI and now has positive PPD. Asymptomatic and also has negative CXR.
Asymptomatic patients without radiographic evidence of active TB who have been treated previously for
active TB or LTBI need no further treatment.
Initial tx of lupus?
- steroids + hydroxychloroquine - remember that hydroxychloroquine reduces the risk of arthralgias and
serositis
- you use steroids to bridge until hydroxychloroquine takes affect
- MTX if u have organ damage.
- Rituximab causes PML.
What is the IGRA used for?
Another means of diagnosing LTBI - cannot tell the difference between latent and active TB just like the
TST. They are advantage when you have BCG vaccinated patient.
Isotretinoin in a boy what do you look for?
- hyperglycemia, triglyceridemia, hepatotoxicity, mucocuteanous reaction, blood dyscrasias, and ocular
toxicity.
-tell them to avoid alcohol bc of pancreatitis.
Pt with keratoconjunctivitis sicca (engorgement of eye BV, and stringey discharge), who has caries and
submandibular mass. NBS?
Ro/La antibody for Sjogren's .
50% will be negative.
A patient undergoing UGI and has mechanical valve. No active infection foci. What is the likely abx
prophylaxis for endocarditis?
Valve + ONGOING GI/GU manipulation tract procedure gets SBE prophylaxis prior to procedure - if they
did, you would give them ampicillin.
What do you do to monitor the disease progression in patients with AS?
,Radiographs of hip/chest/and pelvis + ESR markers Q3 months
What is the relationship between alcoholics and pancreatitis?
Alcoholics - decreased Vit D, and alcohol itself damages proximal tubule reabsorption.
- Alcholic compensates by pushing PO4 out of the cell, however once refed/hydrated - PO4 becomes
intracellular and you get HYPOPO4 which can cause rhabdomyolasis and myopathy.
- Especially in the setting of respiratory alkalosis
What are the only requirements to hospice care?
only requirements of hospice are prognosis <6 months and the patient's willingness to forgo life
sustaining treatment.
What is verification bias?
AKA workup bias. It is when a study only SELECTIVELY uses the gold standard test in order to confirm a
positive result of preliminary testing. This can result in overestimates and increase in sensitivity.
How do you overcome this bias?
Use the gold standard in a control population as well.
African man with UTI + blood on dipstick microhematuria and anemia. What is NBS?
The diagnosis of schistomiasis is demonstration of parasite eggs in the stool or urine.
Patient with esophageal variceal bleed x 2 after banding. What is the NBS?
Repeat upper GI endoscopy to do treatment with sclerotherapy or banding. If not, then you should do
shunt or TIPS.
What is chance of adult who gets Hep B of going to chronic HBV?
Adults have <5% chance of chronic Hep B infection - however perinatal transmission is 90%.
After starting HAART what do you expect VL of HIV in 6 months?
<200 copies / mL otherwise resistance or non-compliance.
Preventive management of a cluster headache?
Verapamil is the only preventative measure in RCT.
What epidemiological parameter does not vary with disease prevalence and is based on Sn, and Sp?
Likelihood ratio
For a positive test result: sensitivity / (1-specificity).
For a negative test result: (1-sensitivity) / specificity.
What is the definition of likelihood ratio?
Probability of a given test result occurring in a patient with a disorder compared to the probability of the
same result occurring in a patient without the disorder.
, What is cataplexy treated with?
SNRI (venlafaxine)
SSRI or sodium oxybate.
When a patient has a stroke - dysphagia and aspiration causes in an increased risk of death. What is
NBS?
Make sure to do a quick swallow evaluation (water swallow test or Toronto Bedside Swallowing
Screening test).
What is the insulin administration in DKA?
Continuous insulin.
What is the fluid management in DKA?
Add K to fluids if K is less than <5.2 meQ/L.
How long should IV insulin be continued in DKA?
Until anion gap normalized.
DKA patient with glucose <200 but still elevated anion gap. What do you do?
Half the rate of continuous insulin and add dextrose to the fluids.
What is first step in pheochromocytoma work up?
Get MRI of abdomen - if this is negative, you get MIBG - control BP for 10-14 days with alpha blocker.
What has best long term outcome when behavior modifications fail for enuresis?
Enuresis alarm.
Cocaine ingestion patient with persistent chest pain and new neurologic finding of right sided weakness
in upper arm. What is suspicion and what is NBS?
Suspect acute dissection of aorta, and get CT angiography of the chest.
We have an expert-written solution to this problem!
A patient with hypermobility, h/o velevty hyperextensible skin with easy bruisability and atrophic scars
and has hyperdynamic precordium. What is the suspicion?
Acute mitral regurgitation, with myxomatous degeneration and rupture of chordae.
Later life depression (occuring after age 65) has been found to be a significant risk factor for the
development of what condition?
Alzeihmer's disease.
