iHuman Case Study - Tod G, 57 yrs Old Male CC: Knee
pain (Gout)
YMDD mutation is present. She appears to have compensated liver disease
on the basis
... [Show More] of her albumin, INR,and lack of ascites or encephalopathy. Given
her persistently elevated liver function tests, biopsy results, and high viral
load, she should receive treatment. Treatment with an oral reverse
transcriptase inhibitor is preferred first-line therapy. Interferon and ribavirin
are preferred for chronic HCV infection. Given that the patient has a
lamivudine-resistant organism, as evidenced by the presence of the YMDD
mutation, a drug therapy that treats lamivudine-resistant pathogens, such as
adefovir,is recommended as initial therapy.
10. A new enzyme immunoassay for HCV RNA has a reported sensitivity of
95% and a specificity of 92%. If the
prevalence of HCV in a cohort of 500 patients is 40%, which one of the
following is the positive predictive
value of this new test?
A. 75%.
B. 89%.
C. 92%.
D. 96%. - ANS-10. Answer: B
Positive predictive value tells you the proportion of patients with a disease
when the presence of the disease isindicated by a diagnostic test. It is
affected by disease prevalence; thus, as disease prevalence falls, so will the
positive predictive value of the test. Using the sensitivity,specificity, and
prevalence, a 2 × 2 table can be constructed.The positive predictive value is
calculated by dividing the true positives by the sum of the true and false
positives. In this case, that would be 190/(190 +24) × 100 = 89%.
Result Infection No Infection Total
Positive 190 24 214
Negative 10 276 286
Total 200 300 500
11. A 38-year-old white man is being treated with PEG-IFNα-2b 1.5
mcg/kg/week subcutaneously, as well as with ribavirin 400 mg in the morning
and 600 mg in the evening for chronic HCV (genotype 1). The patient,who
weighs 75 kg, is in the clinic today for his 12-week treatment follow-up.
Pretreatment laboratory values included AST 350 IU/mL, ALT 420 IU/mL, and
HCV RNA 450,000 IU/mL. Today's laboratory values include AST 90 IU/mL,
Patien1. A 75-year-old man with a 3-year history of severe GERD symptoms
and Parkinson disease has been taking ansoprazole 30 mg 2 times/day for 5
months. He has initiated proper nonpharmacologic measures, including
elevating the head of his bed, reducing fat intake and portion size, avoiding
tight-fitting clothes, and losing eight. Because he continues to have daily
heartburn symptoms, he is referred for endoscopy, which reveals ormalappearing mucosa and no structural abnormalities. Which one of the
following is the best course of
action for this patient? . Add metoclopramide 10 mg 4 times/day and
reassess in 3 months.
B. Educate about the proper use of ansoprazole and refer for manometry.C.
Add metoclopramide 10 mg 4 times/day and refer for surgical intervention.
D. Add famotidine 20 mg/day at bedtime and reassess in 4 months. - ANS-1.
Answer: B
Those who assess patients resistant to medical therapy
should try to identify exacerbating drug and disease
factors. Proper use of medications, such as PPIs, is a
key factor in ensuring that medical therapy is maximized.
Patients should be instructed to take PPIs 30
minutes before a meal and to take their evening dose
before their evening meal rather than at bedtime. Endoscopic evaluation is
appropriate for patients older than 45 years; however, many patients will have
normalappearing mucosa. For patients with normal-appearing mucosa and
continuing symptoms despite medical therapy, evaluation with manometry is
useful to exclude potential esophageal motility disorders. Prokinetic agents
facilitate gastric emptying; in the past, they have been cited as having efficacy
similar to H2RAs
Metoclopramide use is not recommended as adjunctive
therapy or monotherapy because of the increased risk of
adverse neurologic events, such as tardive dyskinesia,
compared with the potential benefit, as evidenced by
the grade D attained in the most recent GERD treatment
guidelines. Furthermore, use of dopamine antagonists, [Show Less]