Tao Le, author and editor for the First Aid series, will be at AMSA’s 58th Annual Convention March 12-16th in Houston Texas. Tao will be giving a First Aid for the Wards talk on Thursday, the 13th at 8am and a First Aid for the USMLE Step 1 talk at 4pm the same day. Come down to Texas and meet with your fellow medical students!
Dr. Tao Le (series editor for the First Aid for the USMLE Step 1) invites you to a free Webinar Saturday, Jan 26th from 1-2pm EDT!
This high-yield talk will cover the basics of the USMLE Step 1 including an overview of the boards, goal setting, high-yield topics in each subject area, study strategies, review resources, and study schedules. There will be an opportunity for a live Q & A session at the end of the talk.
The way it works:
Register to hold your place now (space is limited).Rationale: Medical students have few validated predictors of USMLE performance. We hypothesized that USMLERx Step 1 Qmax could predict USMLE Step 1 performance.
Methods: In this prospective cohort study, 26
Results: See table below. Participants had higher than average scores for the USMLE Step 1, MCAT, and USMLERx. USMLERx scores strongly correlated with USMLE scores. Kaplan and MCAT scores had moderate correlation. In single linear regression modeling, USMLERx, Kaplan Qbank and MCAT scores were highly significant predictors of USMLE performance with high T-scores. USMLERx scores were able to account almost 80% of the variance in USMLE scores.
|
Test |
Mean score (SD) |
Correlation ( |
T-score |
p-value |
Variance (R2) |
|
USMLERx |
68.9 ±7.7 |
0.89 |
7.95 |
<.001 |
0.79 |
|
Kaplan |
67.6±7.2 |
0.76 |
5.17 |
<.001 |
0.67 |
|
MCAT |
31.7 ±0.5 |
0.73 |
4.80 |
<.001 |
0.59 |
|
USMLE (3-digit) |
234.7 ±19.8 |
– |
– |
– |
- |
Conclusions: USMLERx, Kaplan and MCAT scores appear to be significant predictors of USMLE performance. In this sample, USMLERx was highly correlated with the USMLE Step 1 performance and was able to predict approximately 80% of the variation in USMLE scores.
Case 20 – A 1-month-old girl with failure to thrive
A 1-month-old white girl is sent to the emergency room by her pediatrician for failure to thrive. She was born at full term, weighing 2.72 kg (6 lb), via spontaneous vaginal delivery with no complications. She was discharged to home with her mother and has been feeding well; she takes 3-4 ounces of formula every 2-3 hours. Her parents deny any emesis, fevers, or diarrhea, although her mother notes frequent foul-smelling loose stools. Family history is unremarkable. She lives with her parents and four siblings. She is afebrile with normal vital signs. Her weight is 3.3 kg (7.3 lb) (<5th percentile), length is 50 cm (19.7 in) (<5th percentile), and head circumference is 37 cm (14.6 in) (at 10th percentile). She is cachetic but interactive. The remainder of her examination is unremarkable.
What is the definition of failure to thrive (FTT)?
The term FTT may be attributed to a child who meets any of the following criteria:
What are the two types of FTT?
Organic causes of FTT include:
Most cases of FTT are due to nonorganic causes, typically psychosocial factors.
What organic causes of FTT should be considered in patients <6 months old?
While in the hospital the patient feeds well, but despite adequate caloric intake, she fails to gain weight. What tests should be included in the initial work-up of this patient’s cause of FTT?
Malabsorption must be considered when a patient fails to gain weight despite feeding well. Initial screening studies for malabsorption include:
What is the most likely diagnosis in this patient, and how should it be confirmed?
Since this patient is a white person with a history of FTT, malabsorption, and foul-smelling stools, cystic fibrosis must be considered. The next step in the work-up of this patient should be a sweat chloride test, which is the gold standard for the diagnosis of cystic fibrosis.
How should this patient’s malabsorption be treated?
The mainstay of treatment for pancreatic insufficiency in cystic fibrosis is pancreatic enzyme replacement. In addition, patients should receive supplementation of fat-soluble vitamins (vitamins A, D, E, and K).
By Jessica Kagen Hart, Resident, Department of General Pediatrics, Children’s Hospital of Philadelphia; in association with Le TT, Schabelman E, Shivaram A, and Klein J, eds: First Aid Cases for the USMLE Step 2 CK. New York: McGraw-Hill, 2007.
The Power-point presentation that Tao Le uses during his free Webinars is available as an Adobe Acrobat Reader (pdf) file. Click here to download. This file will always be available under the “Bonus” section of this blog.
Look for an announcement of an upcoming Webinar on January 26th.
Dr. Tao Le (series editor for the First Aid for the USMLE Step 1) invites you to a free Webinar tonight, Tuesday, Jan 15th from 9-10pm EDT!
This high-yield talk will cover the basics of the USMLE Step 1 including an overview of the boards, goal setting, high-yield topics in each subject area, study strategies, review resources, and study schedules. There will be an opportunity for a live Q & A session at the end of the talk.
The way it works:
Register to hold your place now (space is limited).Case 19 – A 27-year-old woman with fever and cough
A 27-year-old woman presents to her physician because of 5 days of fever and cough. She has no significant past medical history but has been “fighting colds” for the past 3 months, which she attributed to the winter season. She began having low-grade fevers as well as a dry cough 5 days ago. She has also become increasingly short of breath over the past 2 days. Her temperature is 38.7°C (102°F), heart rate is 110/min, respiratory rate is 24/min, blood pressure is 110/70 mm Hg, and oxygen saturation is 90% on room air. Physical examination reveals pallor and oral thrush. Lung auscultation is significant for bilateral crackles and rhonchi throughout. The remainder of her examination is unremarkable. She lives with her husband, who is HIV-positive but is currently asymptomatic. She has no pets and no recent travel history. X-ray of the chest reveals diffuse bilateral interstitial infiltrates.
What is the most likely diagnosis?
The patient’s respiratory symptoms, oral thrush, and radiographic findings are most concerning for Pneumocystis carinii pneumonia (PCP) (now called Pneumocystis jiroveci). PCP is an important cause of pneumonia in immunocompromised hosts and is a leading cause of opportunistic infection, morbidity, and mortality in patients with HIV. The fact that this patient’s husband is HIV positive makes her chance of also being HIV positive very likely.
What is the next step in diagnosis?
Specific diagnosis of PCP requires documentation of the organism in respiratory specimens. Conventional stains such as toluidine blue O, methenamine silver, or Giemsa can be used to identify the organism. Immunofluorescent staining is the most common technique currently in use.
What is the most appropriate management for this patient?
Trimethoprim-sulfamethoxazole (TMP-SMX), which acts by inhibiting folic acid synthesis, is considered the drug of choice for all forms of pneumocystosis. Therapy is continued for 14 days in non-HIV-infected patients and for 21 days in persons infected with HIV. In patients with severe PCP, corticosteroids given in conjunction with anti-Pneumocystis therapy, decreases the incidence of mortality and respiratory failure.
What findings would one expect to see on high-resolution computed tomography (HRCT)?
A patchy or nodular ground-glass appearance is the most common finding of PCP on HRCT. HRCT has a high sensitivity for PCP among HIV-positive patients.
What prophylactic therapy should this patient use for her condition?
Indications for prophylaxis of PCP in HIV-positive patients include:
Oral trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred prophylactic regimen. Other options include pentamidine, dapsone, and atovaquone. Oral TMP-SMX is also useful in preventing toxoplasmosis and bacterial infections.
By Jessica Kagen Hart, Resident, Department of General Pediatrics, Children’s Hospital of Philadelphia; in association with Le TT, Schabelman E, Shivaram A, and Klein J, eds: First Aid Cases for the USMLE Step 2 CK. New York: McGraw-Hill, 2007.
On December 31st, the 2008 Edition of First Aid for the USMLE Step 1 became available. You can purchase your copy through Amazon.com, Barnes & Noble, or at your local medical bookstore. We are very proud of this edition and are grateful to all those students that submitted corrections and suggestions to the 2007 Edition. If your correction was accepted, you should have already received your $10 Gift Certificate from Amazon.com. If you have not received yours, please contact Selina at selina dot bush at usmlerx dot com (and make the obvious corrections to the email address.
In the new edition:
Table of Contents
In the past week, there have been two notable items concerning the USMLE Step 1 and Step 3. On January 4th, Usmle.org made the following announcement:
A small number of multiple-choice items with associated audio and/or video clips will be introduced into the USMLE Step 3 Examination beginning in early March 2008. No more than 5 items with associated media clips will appear in a single examination. The 2008 USMLE Orientation Materials include a small number of multiple-choice items that contain exhibits involving audio and/or video clips. Instructions for practicing with items with associated media clips on Step 1, Step 2 CK, and Step 3 are provided in the Tutorials for each Step examination in the orientation materials.
Items with associated media were introduced into Step 2 CK in 2007, and will be introduced into Step 1 later in 2008. An announcement will be posted to the USMLE website approximately 2 months before any items with associated media clips appear on Step 1 examinations. Additional information will be posted to the USMLE website as it becomes available.
On January 9th, the American Physician Scientist Association released a survey asking those in medical education (students, residents and fellows) about proposed changes to the USMLE Step 1 and 2CK. These included:
USMLE Steps 1 and 2 will be combined into a single exam. However, this combination would involve the creation of a new set of questions that test BOTH basic science and clinical science.
A combination exam will necessitate that the exam be administered earlier in training than the current Step 2 in order for its use in residency applications.
Pass/fail could replace the current numerical score. This is separate and may be implemented even if a combined exam is not.
You can fill out their survey (med student) (resident/fellow) or read more about it.
From now until January 31st, we are offering a huge discount on our USMLERx Qmax Step 1 Bank for all medical students with an additional discount for AMSA members. If you’re not already a member of AMSA then join now!
USMLERx was created by the authors of the First Aid and features:
Our special pricing is:
For this special deal, visit www.usmlerx.com/amsa and start preparing today!
Remember, this deal expires on Thursday, January 31st. Please email any questions to info@usmlerx.com.
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