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USMLE Step 2 CK Classic Clues Classic clues seen in clinical case scenarios in USMLE Step 2 CK questions.


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  #1  
Old 06-07-2012
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Question PICA + Cough + Eosinophilia

A 4-year-old boy was admitted to the hospital last night with the complaint of “difficulty breathing.” He has no past history of lung infection, no recent travel, and no day-care exposure; he does, however, have an annoying tendency to eat dirt. In the emergency center he was noted to be wheezing and to have hepatomegaly. He is able to talk, relaying his concern about his 6-week-old Chihuahua being left alone at home. Laboratory studies revealed marked eosinophilia (60% eosinophils). Which of the following tests is most likely to produce a specific diagnosis?

a. Tuberculin skin test
b. Histoplasmin test
c. ELISA for Toxocara
d. Silver stain of gastric aspirate
e. Stool examination for ova and parasites
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  #2  
Old 06-07-2012
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Stool for ova & parasite
Pica + respiratory + hepatomegaly --parasitic infection
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  #3  
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Quote:
Originally Posted by tyagee View Post
A 4-year-old boy was admitted to the hospital last night with the
complaint of “difficulty breathing.” He has no past history of lung infection,
no recent travel, and no day-care exposure; he does, however, have an
annoying tendency to eat dirt. In the emergency center he was noted to be
wheezing and to have hepatomegaly. He is able to talk, relaying his concern
about his 6-week-old Chihuahua being left alone at home. Laboratory
studies revealed marked eosinophilia (60% eosinophils). Which of the following
tests is most likely to produce a specific diagnosis?
a. Tuberculin skin test
b. Histoplasmin test
c. ELISA for Toxocara
d. Silver stain of gastric aspirate
e. Stool examination for ova and parasites
c. ELISA for Toxocara

Quote:
The diagnosis of toxocariasis requires a high index of suspicion and depends on serologic testing (eg, ELISA, immunoblot).
Peripheral blood eosinophilia is the most important finding; however, it may be absent in patients with ocular or covert toxocariasis.
Serum total IgE: Patients with toxocariasis often have a marked increase in total IgE levels.
ELISA with Toxocara excretory-secretory antigen (TES-Ag)
An elevated anti–TES-Ag IgE level indicates acute infection or progressive inflammation caused by toxocariasis.
An increase in the immunoglobulin G (IgG) level confirms a past or present infection with minimum inflammation.
In ocular toxocariasis, an IgG or IgE titer is lower because the worm burden is smaller.
ELISA with aqueous fluid is therefore useful when ocular toxocariasis is suspected.
Quote:
Finding Toxocara larvae within a patient is the only definitive diagnosis for toxocariasis, however biopsies to look for second stage larvae in humans are generally not very effective.[10][11] PCR, ELISA, and serological testing are more commonly used to diagnose Toxocara infection.[10][11] Serological tests are dependant on the number of larvae within the patient, and are unfortunately not very specific.[10] ELISAs are much more reliable and currently have a 78% sensitivity and a 90% specificity.[22] A 2007 study announced an ELISA specific to Toxocara canis, which will minimize false positives from cross reactions with similar roundworms and will help distinguish if a patient is infected with T. canis or T. cati.[23] OLM is often diagnosed after a clinical examination.[22] Granulomas can be found throughout the body and can be visualized using ultrasound, MRI, and CT technologies.[
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  #4  
Old 06-07-2012
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Quote:
Originally Posted by bisho View Post
Stool for ova & parasite
Pica + respiratory + hepatomegaly --parasitic infection
-toxocariasis is also parasitic infection=nematodes (roundworms) found in dogs and cats,childern with pica &chlidern with mental retardation are at high risk,stool for ova is confirmatory but usually it came negative .so ellisa is best diagnostic tool.
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  #5  
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ans is ELISA.

are there another worms to think about in such scanario ? [pica+cough+eosinophilia+hepatomegaly] or description is specific for toxocara ?
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Quote:
Originally Posted by tyagee View Post
ans is ELISA.

are there another worms to think about in such scanario ? [pica+cough+eosinophilia+hepatomegaly] or description is specific for toxocara ?
-the same syndrome(specialy vesiseral larva migran)can cause by another worm:
Although Toxocara organisms are the most common causes of VLM, case reports have noted other zoonotic nematodes that cause VLM, including Ascaris suum,[1] Baylisascaris procyonis (raccoon ascarid), and Lagochilascaris minor (opossum
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  #7  
Old 06-08-2012
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Tyagee..are ur questions from Pretest?
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  #8  
Old 06-09-2012
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i am goinig with ascaris so the ans will be
e. Stool examination for ova and parasites
becuz the pica -- iron def anemia
respiratory sym --- migratory larava
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  #9  
Old 06-09-2012
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answer is ELISA for toxocara..
u won't be able to detect it in the stools because it is ingested and then from the intestines enters the lungs kidneys etc and doesn't go back to the intestines so stool culture would be essentially useless.
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  #10  
Old 06-09-2012
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Quote:
Originally Posted by add1 View Post
Tyagee..are ur questions from Pretest?
this q is from pretest. others are not, sources vary.

ascaris not bad option...i am unable to rule it out
...

this is from uptodate

Quote:
DIAGNOSIS The diagnosis of ascariasis is usually made via stool microscopy.

Microscopy Characteristic eggs may be seen on direct examination of feces or following concentration techniques (picture 1). However, eggs do not appear in the stool for at least 40 days after infection; thus, the main drawback of relying upon eggs in feces as the sole diagnostic marker for Ascaris infection is that an early diagnosis cannot be made, including during the phase of respiratory symptoms. In addition, no eggs will be present in stool if the infection is due to male worms only.
but still for ascariasis, we can rely on stool for ova.

regarding serology for ascariasis uptodate says

Quote:
However, serology is generally reserved for epidemiologic studies rather than in the diagnosis in a particular individual
so how can we rule out ascariasis in above q ?
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Quote:
Originally Posted by tyagee View Post
so how can we rule out ascariasis in above q ?
Because of the cute little "Chihuahua"
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  #12  
Old 11-28-2014
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stool examination for ova and parasites only tells you if parasites or eggs are present or not

the stool could be positive for ova and patient could have Hook worm

but question clearly starts DIAGNOSIS

stool and ova don't give you a DIAGNOSIS

ANS IS ELISA
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  #13  
Old 01-27-2015
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Default Pre test

Whats the general consensus on Pre test for CK?
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Infectious-Diseases, Internal-Medicine-, Step-2-Questions

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