Internal Medicine Correlations and Clinical Scenarios (CCS) USMLE Step 3 (Correlations & Clinical Scenarios for the USMLE Step 3) by Conrad Fischer

Author:Conrad Fischer
Language: eng
Format: mobi
Publisher: McGraw-Hill Education
Published: 2014-04-25T00:00:00+00:00

Features that do not change with disease activity:

• Sclerosing cholangitis

• Pyoderma gangrenosum

Move the clock forward 1 to 3 months at a time. Continue mesalamine chronically.

On CCS, it can be confusing if you think you have done everything, but the case does not end. Remember to do healthy maintenance such as vaccinations and tobacco cessation.

CASE 7: Celiac Disease

Setting: office

CC: “I’ve had diarrhea for months!”

VS: BP: 110/72 mm Hg; P: 76 beats/minute; T: 98° F; R: 14 breaths/minute

HPI: A 28-year-old woman with persistent diarrhea over several months visits you at your office. She has lost 15 lb in the last 6 months. She bruises easily and her menstrual periods are heavy. Her stool has a “greasy” quality and does not flush down the toilet easily because it floats at the top of the water. The entire bathroom is abnormally malodorous after bowel movements.

PMHX:

Iron deficiency ascribed to heavy menstruation

Medications:

Ferrous sulfate

PE:

General: thin and tired

Abdomen: soft, nontender, normal sized organs

Lung, Heart: normal

Skin: several bruises on legs

Initial Orders:

Stool culture, WBCs, ova/parasites

CBC

CHEM-20

Even though an infection is very unlikely to persist for several months, you must first exclude an infectious cause in diarrhea before going to other tests such as endoscopy. It is also very unlikely to have a 15-lb weight loss from an infectious diarrhea.

Report:

Stool Culture, WBCs, Ova/Parasites: negative

CBC: hematocrit 30%; MCV 85 fL; WBCs 3,200/μL (low); platelets 118,000/μL (low)

RDW 25% (markedly elevated)

CHEM-20: albumin 4.5 g/dL; calcium 6.8 mg/dL (low)

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